Alcohol-related disorders in first- and second-generation immigrants in Sweden: a national cohort study

Gambling and Migration - The Role of Culture and Family

Problem gambling (PG) is a public health concern with severe repercussions for the individual, concerned significant others and the society. Foreign borns generally gamble less but are overrepresented among those with PG. Previous research has suggested that other factors, such as socio-economic status, might explain this, but also that cultural factors might play a role in the relationship to gambling and the development of PG. This qualitative study using content analysis investigates the experiences of and opinions about gambling and PG among 12 males living in Sweden with a migrant background in Afghanistan, the Middle East and North Africa. The results were show that the acculturation process could be a factor in developing PG, as well as a cultural values regarding money and wealth. PG was seen as more stigmatized in the origin country, and the family played a more important role in the rehabilitation of PG compared to the general population. The results of this study could be used to inform preventive and clinical programs to better reach people with a migrant background.

Indications of alcohol or drug use disorders in five different national registers in Sweden: a cross-sectional population-based study

OBJECTIVE

The purpose of this study is to examine the prevalence of indications of alcohol or drug use disorders in five different national Swedish registers and to investigate the correlation between these registers. Furthermore, the intent is to investigate whether combining data from different registers increases the prevalence of these indications in the population due to the identification of different demographic groups in different registers.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Individuals living in Sweden aged 20-64 years in 2006, n=5 453 616.

PRIMARY OUTCOME

National registers included the Registers of Inpatient Care, Outpatient Care, Medications, Social Insurance and Convictions. Demographic variables were sex, age, migrant status, education and civil status. Indications of alcohol or drug use disorders were presented as prevalence in percentage (%), correlation was examined using phi correlation coefficients and differences across demographic factors were studied using logistic regression.

RESULTS

The prevalence of an indication of alcohol or drug use disorder varied between registers, meaning that prevalence increased when all registers were considered together. The prevalence of alcohol use disorder increased by 60% and 66% among men and women, respectively, while the prevalence of drug use disorder increased by 45% and 80% among men and women, respectively, when all registers were combined, compared with only using the register with the highest prevalence. Registers contributed different indications of drug and alcohol use disorders.

CONCLUSIONS

Accurate estimates of alcohol or drug use disorders are critical for healthcare and rehabilitation. This study shows that using a single register alone underestimates the burden of disease unevenly, while combining a range of registers can provide a more accurate picture.

Migrant mortality by duration of residence and co-ethnic density - A register-based study on Finnish migrants in Sweden with matched controls in the origin and the destination

Migrant health depends on factors both at the origin and at the destination. Health-related behaviors established before migration may change at the destination. We compare the mortality rates from alcohol- and smoking-related causes and cardiovascular diseases (CVD) of Finnish migrants in Sweden to matched controls in both Sweden and Finland with similar sociodemographic characteristics. Migrant mortality rates from behavioral risk factors lie in-between the rates of non-migrants in the origin and destination. A longer duration of residence is associated with lower mortality and with mortality patterns more similar to Swedes for men. For women, a longer duration of residence is associated with higher mortality, in particular smoking-related mortality, with no tendency of a gradual convergence. The density of Finnish migrants in the local area is modestly associated with mortality. However, CVD mortality tends to be higher and more similar to the level in Finland for migrants in areas with a higher density of Finnish migrants. The results suggest that behavioral changes can reduce mortality differences between migrants and natives and that this can be either beneficial or detrimental to migrant health.

Grading bias and young adult mental health

We study exposure to grading bias and provide novel evidence of its impact on mental health. Grading bias, which we interpret as over-grading, is constructed as the residual of final upper secondary school grades having controlled for results in a standardized test, itself not subject to grading leniency. Grading bias is further isolated by considering only within-school variation in over-grading and controlling for prior grades and school production. Using Swedish individual-level register data for individuals graduating from upper secondary school in the years 2001-2004, we show that over-grading has substantial significant protective impacts on the mental health of young adults, but only among female students. That grades themselves, independent of knowledge, substantially impact the production of health highlights an important health production mechanism, and implies that any changes to the design of grading systems must consider these wider health implications.

Triangulation of evidence on immigration and rates of alcohol use disorder in Sweden: Evidence of acculturation effects

BACKGROUND

This study aimed to determine the robustness of the impact of immigration on risk for alcohol use disorder (AUD) using different measures, designs, and immigrant regional cohorts.

METHODS

The analytic sample included all individuals born between 1950 and 1990 and registered in Sweden from 1973 to 2017. Using Cox regression models, we examined the risk for AUD from Swedish nationwide registries in immigrants to Sweden from seven geographical regions: Africa, Asia and Oceania, Eastern Europe, Finland, Latin America and the Caribbean, Middle East/North Africa, and Western countries. We assessed greater exposure to Swedish culture, which we interpreted as increasing acculturation, by (i) comparing first-generation immigrants and their children with no and one native Swedish parent and (ii) examining age at immigration. The baseline comparison group was the native Swedish population. We also examined AUD risk in first-generation sibling pairs discordant for their age at immigration.

RESULTS

In nearly all immigrant cohorts in Sweden, increasing degrees of acculturation, as assessed by both our variables, were associated with rates of AUD that approached those of the Swedish population. These findings occurred in both men and women and both regional cohorts whose first-generation immigrants had lower and higher levels of AUD than native-born Swedes. For most cohorts, the rates of change with acculturation were greater in women than in men. In sibling pairs from most regions, the sibling who was younger at immigration had a higher rate of AUD.

CONCLUSIONS

An examination of both sexes and two different proxies for acculturation provides consistent support for socio-cultural influences on AUD risk. Our co-sibling analyses suggest that a meaningful proportion of this effect is likely to be causal in nature.

Family-based prevention in youth's substance misuse in low- and middle-income countries: A review from Turkey and cultural adaptation of family based interventions

Family-based interventions have been recognized and practised more in high-income countries than in low- and middle-income countries. However, the threats posed by substance misuse to the youth do not change for the latter. The development of appropriate preventive programs is an area of interest for addiction prevention in low- and middle-income countries by recognizing the risk factors for substance misuse among young individuals. This study aims to present the risk factors primarily in family-based conditions for substance use among young people in low- and middle-income countries and to provide information on family-based interventions that can be developed in line with these factors. It is aimed to discuss how family-based studies can be adapted to samples such as Turkey in the light of three programs originating in the USA. Fifty-six publications gathered from the literature between 1989-2021 by using keywords were included in the study. Adolescence and young adulthood are the riskiest developmental periods for substance misuse worldwide. Economic, cultural and family-based factors involving the youth are of considerable importance. Families' consciousness of youth's substance use is worthful to prevent youth's addictions in the future. Studies show that family-based preventions are promising interventions in this regard.

Assessing Mental Illness Risk Among North Korean Refugees and Immigrants Resettled in South Korea

IMPORTANCE

The global increase in the numbers of refugees and immigrants has made mental health a major public concern. Although they are divided, North and South Korea share a common ethnic heritage.

OBJECTIVE

To investigate mental illness risk among North Korean immigrants living in South Korea and compare it with that of the general South Korean population.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective, population-based cohort study was based on National Health Insurance claims data from 2007 to 2019, and North Korean immigrants and refugees (NKIRs) and age-matched and sex-matched members of the general population (GP) were included with a 1:3 ratio. Data were analyzed from March 2022 to August 2022.

EXPOSURE

Emigration from North Korea to South Korea.

MAIN OUTCOMES AND MEASURES

Mental illness incidence and risk through a Cox proportional risk model adjusted for sex, age, disability, region, Charlson Comorbidity Index score, and insurance premium percentile.

RESULTS

A total of 37 209 NKIRs and 111 627 members of the GP were enrolled. The final analysis examined 112 851 individuals (73 238 [64.9%] female, median [IQR] age 34 [19-47] years), with 90 235 (80.0%) in the GP and 22 616 (20.0%) in the NKIR group. The propensity score-matching population numbered 24 532 in total, with 12 266 each in the NKIR and GP groups. NKIR patients had a higher mental illness risk than the GP (hazard ratio [HR], 2.12; 95% CI, 2.04-2.21). The multivariable adjusted HRs (95% CI) for developing mental disorders were 4.91 (3.59-6.71) for posttraumatic stress disorder, 3.10 (2.90-3.30) for major depressive disorder, 2.27 (2.11-2.44) for anxiety and panic disorder, 2.03 (1.58-2.60) for bipolar affective disorder, 1.85 (1.53-2.24) for alcohol use disorder, and 1.89 (1.46-2.45) for schizophrenia.

CONCLUSIONS AND RELEVANCE

In this study, NKIR individuals showed a significantly higher risk of developing most mental disorders. Interventional strategies can prevent psychiatric morbidity and ensure adequate care for this population.

Substance use, affective symptoms, and suicidal ideation among Russian, Somali, and Kurdish migrants in Finland

Comorbidity of substance use with affective symptoms and suicidality has been well documented in the general population. However, population-based migrant studies about this association are scarce. We examined the association of affective symptoms and suicidal ideation with binge drinking, daily smoking, and lifetime cannabis use among Russian, Somali, and Kurdish migrants in comparison with the Finnish general population. Cross-sectional data from the Finnish Migrant Health and Wellbeing Study (Maamu, n = 1307) and comparison group data of the general Finnish population (n = 860) from the Health 2011 Survey were used. Substance use included self-reported current binge drinking, daily smoking, and lifetime cannabis use. Affective symptoms and suicidal ideation were measured using the Hopkins Symptom Checklist-25 (HSCL-25). We performed multivariate logistic regression analyses, including age, gender, and additional socio-demographic and migration-related factors. Suicidal ideation (OR 2.4 95% CI 1.3-4.3) was associated with binge drinking among Kurds and lifetime cannabis use among Russians (OR 5.6, 95% CI 1.9-17.0) and Kurds (OR 5.5, 95% CI 1.9-15.6). Affective symptoms were associated with daily smoking (OR 1.6, 95% CI 1.02-2.6) and lifetime cannabis use (OR 6.1, 95% CI 2.6-14.5) among Kurdish migrants. Our results draw attention to the co-occurrence of suicidal ideation, affective symptoms, and substance use, especially among Kurdish migrants. These results highlight the variation of comorbidity of substance use and affective symptoms between the different populations. This implies that screening for substance use in mental healthcare cannot be neglected based on presumed habits of substance use.

Investigating the salmon bias effect among international immigrants in Sweden: a register-based open cohort study

Background

Studies of migration and health have hypothesized that immigrants may emigrate when they develop poor health (salmon bias effect), which may partially explain the mortality advantage observed among immigrants in high-income countries. We evaluated the salmon bias effect by comparing the health of immigrants in Sweden who emigrated with those who remained, while also exploring potential variation by macro-economic conditions, duration of residence and region of origin.

Methods

A longitudinal, open cohort study design was used to assess risk of emigration between 1992 and 2016 among all adult (18+ years) foreign-born persons who immigrated to Sweden between 1965 and 2012 (n = 1 765 459). The Charlson Comorbidity Index was used to measure health status, using information on hospitalizations from the Swedish National Patient Register. Poisson regression models were used to estimate incidence rate ratios (RRs) with 95% confidence intervals (CIs) for emigrating from Sweden.

Results

Immigrants with low (RR = 0.83; 95% CI: 0.76–0.90) moderate (RR = 0.70; 95% CI: 0.62–0.80) and high (RR = 0.62; 95% CI: 0.48–0.82) levels of comorbidities had decreased risk of emigration relative to those with no comorbidities. There was no evidence of variation by health status in emigration during periods of economic recession or by duration of residence. Individuals with low to moderate levels of comorbidities from some regions of origin had an increased risk of emigration relative to those with no comorbidities.

Conclusions

The study results do not support the existence of a salmon bias effect as a universal phenomenon among international immigrants in Sweden.

Pharmacotherapy for alcohol use disorders - Unequal provision across sociodemographic factors and co-morbid conditions. A cohort study of the total population in Sweden

BACKGROUND

Pharmacotherapy for alcohol use disorders (AUD) is effective. However, knowledge about utilization of, and patient characteristics associated with prescriptions is scarce. The aim is to investigate prescriptions of pharmacotherapy for AUD in Sweden across time, sociodemographics, domicile and comorbid conditions.

METHOD

This is a national cohort study, comprising 132 733 adult patients with AUD diagnosis between 2007 and 2015. The exposure variables were age, sex, income, education, family constellation, domicile, origin, concurrent psychiatric and somatic co-morbid diagnoses. Logistic regression analyses were used to obtain odds ratios (OR) for any filled prescription of AUD pharmacotherapy; Acamprosate, Disulfiram, Naltrexone or Nalmefene during 12 months after AUD diagnosis.

RESULTS

During the study period, the proportion of individuals who received pharmacotherapy ranged between 22.80 and 23.94 % (χ2(64) = 72.00, p = .23). Female sex, age 31-45, higher education and income, living in a big city, co-habiting and born in Sweden, bar Norway, Denmark and Iceland, were associated with higher odds of pharmacotherapy. Concurrent somatic diagnosis was associated with lower odds of pharmacotherapy but psychiatric diagnosis higher (aOR = 0.61 95 % CI 0.59-0.63 and aOR = 1.61 95 % CI 1.57-1.66 respectively).

CONCLUSIONS

Pharmacotherapy for AUD is underutilized. The proportion of individuals with a prescription did not change between 2007 and 2015. Provision of treatment is unequal across different groups in society, where especially older age, lower income and education, and co-morbid somatic diagnosis were associated with lower odds of prescription. There is a need to develop treatment provision, particularly for individuals with co-morbid somatic conditions.

Birth order and alcohol-related mortality by ethnic origin and national context: Within-family comparisons for Finland and Sweden

BACKGROUND

Previous studies have found that birth order is an important predictor of later life health, including hospitalisation for alcohol use. We examine the relationship between birth order and alcohol-related mortality in two national contexts, within native families who differ on ethnic origin.

METHODS

We study the association between birth order and alcohol-related mortality after age 17, using Finnish register data for cohorts born 1953-1999 and Swedish register data for cohorts born 1940-1999. We apply Cox proportional hazard models and use sibling fixed effects that eliminate confounding by factors shared by siblings. We separate full-sibling groups by ethnic origin, which for Finland means mother's and father's Finnish or Swedish ethnolinguistic affiliation. For Sweden, we distinguish native-born according to whether one or both parents were born in Sweden or Finland.

RESULTS

We find a positive correlation between birth order and alcohol-related mortality, but only for ethnic Finns in Finland and primarily men. Within these sibling groups, second-borns have an alcohol-related mortality risk that is 9% higher than that of first-borns, third-borns 19 % higher, fourth-borns 22 % higher, and fifth- or higher-borns 47 % higher. No such birth order associations can be found for any of the other ethnic groups analysed in Finland or Sweden.

CONCLUSIONS

Our findings suggest that cultural-related behaviours typical for ethnic groups, and the national context in which they are studied, are relevant for whether any association between birth order and alcohol-related mortality can be observed. Differences in the social interplay within the family may be an important factor.

Drinking cultures and socioeconomic risk factors for alcohol and drug use disorders among first- and second-generation immigrants: A longitudinal analysis of Swedish population data

BACKGROUND

Few longitudinal studies investigate predictors of substance use incidence among immigrants. The current study describes substance use disorders in immigrants to Sweden, focusing on drinking culture in the country of origin and socioeconomic status (SES), and how these intersect with generational status to influence risk.

METHODS

Using pseudonymized Swedish population registry data, we track onset of alcohol use disorder and drug use disorder in a longitudinal study of 815,778 first-generation immigrants and 674,757 second-generation immigrants from 64 countries over a 6-year period. Cox regression analysis estimated risks of alcohol and drug use disorders in second-generation immigrants compared to first-generation, and moderation analyses assessed interactions of generational status with country-of-origin per capita alcohol consumption and SES.

RESULTS

Immigrants and second-generation immigrants originating from countries with high levels of alcohol consumption had higher risks for alcohol and drug use disorders. Immigrants with high SES had lower risks for alcohol and drug use disorders. The interaction between generational status and country-of-origin alcohol consumption was significant for drug use disorder (not for alcohol use disorder), with drug use disorder risk for second-generation immigrants being highest for those from countries with the lowest level of country-of-origin per capita alcohol consumption. The interaction between generational status and SES was significant for alcohol use disorder, with low-SES second-generation immigrants showing markedly higher risk than first-generation immigrants with comparable SES.

CONCLUSIONS

Among immigrants in Sweden, second-generation immigrants are at increased risk of developing alcohol and drug use disorders, particularly if they have lower SES. Policy and community attention to these high-risk subgroups in immigrant communities is warranted.

Social network characteristics and alcohol use by ethnic origin: An ego-based network study on peer similarity, social relationships, and co-existing drinking habits among young Swedes

The study explores how social network determinants relate to the prevalence and frequency of alcohol use among peer dyads. It is studied how similar alcohol habits co-exist among persons (egos) and their peers (alters) when socio-demographic similarity (e.g., in ethnic origin), network composition and other socio-cultural aspects were considered. Data was ego-based responses derived from a Swedish national survey with a cohort of 23-year olds. The analytical sample included 7987 ego-alter pairs, which corresponds to 2071 individuals (egos). A so-called dyadic design was applied i.e., all components of the analysis refer to ego-alter pairs (dyads). Multilevel multinomial-models were used to analyse similarity in alcohol habits in relation to ego-alter similarity in ethnic background, religious beliefs, age, sex, risk-taking, educational level, closure in network, duration, and type of relationship, as well as interactions between ethnicity and central network characteristics. Ego-alter similarity in terms of ethnic origin, age and sex was associated with ego-alter similarity in alcohol use. That both ego and alters were non-religious and were members of closed networks also had an impact on similarity in alcohol habits. It was concluded that network similarity might be an explanation for the co-existence of alcohol use among members of peer networks.

Mental disorders among young adults of immigrant background: a nationwide register study in Norway

PURPOSE

Previous research indicates increased risk of various mental disorders in immigrant populations, particularly for schizophrenia and PTSD. However, findings are inconclusive due to variations in contextual factors, characteristics of immigrant groups and study design. Our study aims to investigate prevalence differences of receiving an ICD-10 psychiatric diagnosis between 2008 and 2016 among four first-generation immigrant groups and one second-generation immigrant group compared to ethnic Norwegians.

METHODS

Linked register data from the Norwegian Patient Registry and Statistics Norway were utilised. The sample (age 18-35) comprises 758,774 ethnic Norwegians, 61,124 immigrants originating from Poland, Somalia, Iran and Pakistan and 4630 s-generation Pakistani immigrants. Age- and gender-adjusted binary logistic regression models were applied.

RESULTS

The odds of schizophrenia were significantly elevated for all groups except for Poles. The highest odds were observed for second-generation Pakistani immigrants (adjusted OR 2.72, 95% CI 2.21-3.35). For PTSD, the odds were significantly increased for Somalis (aOR 1.31, 95% CI 1.11-1.54), second-generation Pakistani immigrants (aOR 1.37, 95% CI 1.11-1.70), and in particular for Iranians (aOR 3.99, 95% CI 3.51-4.54). While Iranians showed similar or higher odds of receiving the vast majority of psychiatric diagnoses, the remaining groups showed lower or similar odds compared to ethnic Norwegians.

CONCLUSION

Our findings suggest considerable prevalence differences in receiving a psychiatric diagnosis according to country of origin and generational status compared to ethnic Norwegian controls. The general pattern was lower prevalence of most ICD-10 mental disorders for the majority of immigrant groups compared to ethnic Norwegians, except for schizophrenia and PTSD.

Alcohol-related mortality by ethnic origin of natives: a prospective cohort study based on multigenerational population register data from Finland and Sweden

OBJECTIVES

The aim was to assess alcohol-related mortality of persons with mixed and uniform ethnic origins in two national contexts.

SETTING

Data were from the multigenerational population registers of the total population of Finland and Sweden observed from 1971 to 2017. Study persons were men and women of ethnic Finnish and Swedish background, born in their country of residence.

PARTICIPANTS

Persons were born between 1953 and 1999. In Finland, ethnic origin was assessed through own, mother's and father's Finnish or Swedish ethnolinguistic affiliation. Data on Sweden included persons born in Sweden, with mother and father born in Sweden or Finland. A total of 2 997 867 and 4 148 794 persons were included in the Finnish and Swedish data, respectively. The total number of alcohol-related deaths by main cause was 13 204 and 3336. Cox regressions were used to examine associations.

OUTCOME MEASURES

For the period 1971-2017, we studied alcohol as the main cause of death. For the period 1996-2017, we observed if alcohol was the main or contributing cause of death. Parallel analyses were performed for all-cause mortality.

RESULTS

For men in Finland, the hazard rate of alcohol-related mortality of Swedish speakers with uniform Swedish background was 0.44 (95% CI: 0.38 to 0.52) that of Finnish speakers with uniform Finnish background. The corresponding hazard rate for women was 0.40 (95% CI: 0.28 to 0.55). In Sweden, the hazard rate of men with both parents born in Sweden was 0.40 (95% CI: 0.32 to 0.49) that of men with both parents born in Finland. The corresponding hazard rate for women was 0.50 (95% CI: 0.31 to 0.79). In both countries, persons with mixed background had an alcohol-related mortality rate between that of persons with uniform Finnish and Swedish background.

CONCLUSION

The consistent pattern across countries necessitates increased policy attention towards offspring disadvantaged via parental ethnicity to minimise harmful consequences of alcohol consumption across and within ethnic groups.

Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study

BACKGROUND AND AIMS

The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds.

DESIGN

Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language.

SETTING

Population-based data were collected from six cities in Finland during 2010-12.

PARTICIPANTS

The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%).

MEASUREMENTS

The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for.

FINDINGS

Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18).

CONCLUSIONS

In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.

Epilepsy in immigrants and Swedish-born: A cohort study of all adults 18 years of age and older in Sweden

PURPOSE

We aimed to study the association between country of birth and incident epilepsy in several immigrant groups using Swedish-born individuals as referents.

METHOD

The study population included all adults aged 18 years and older in Sweden, living and deceased, 6,690,598 in the first-generation and 6,683,125 in the second-generation sub-study. Epilepsy was defined as having at least one registered diagnosis of epilepsy in the National Patient Register. The incidence of epilepsy in different immigrant groups, using Swedish-born as referents, was assessed by Cox regression, expressed as hazard ratios (HRs) and 95 % confidence intervals (CI). The models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, and neighbourhood socioeconomic status.

RESULTS

In the first-generation sub-study, totally 76,541 individuals had at least one registered diagnosis of epilepsy (1.14 % in total; men 1.22 % and women 1.07 %), and in the second-generation study 72,545 (1.09 %; men 1.18 % and women 0.99 %). After adjusting for confounders, in first-generation immigrants compared to their Swedish-born counterparts the incidence was somewhat lower among both men (HR 0.92, 0.90-0.96) and women (HR 0.93, 0.90-0.96), and in the second-generation immigrants among women (HR 0.95, 0.92-0.99) but not men (HR 0.99; 0.96-1.02). Among immigrant groups, a higher incidence of epilepsy was observed among first-generation women from Africa and Iraq, and second-generation men and women from Bosnia, and women from Finland.

CONCLUSIONS

Risk of epilepsy was lower in immigrants in general compared to the Swedish-born population; but with higher incidence in some specific groups.

IMMIGRATION AND MENTAL DISORDERS

Introduction: Immigration is the movement of people into a country where they will remain as its permanent residents or future citizens without having citizenship. Purpose: The purpose of this review study is to highlight the impact of immigration on the mental health of immigrants and to identify the mental disorders from which immigrants are at risk of getting ill. Methodology: The study material consisted of articles on the topic, found in Greek and international databases such as: Google Scholar, Mednet, Pubmed, Medline and the Hellenic Academic Libraries Association (HEAL-Link), using the appropriate keywords: mental illness, immigrants, treatment. Results: It is estimated that two-thirds of refugees - migrants experience anxiety and depression. Studies show that these are populations with severe social problems, unmet needs, and a range of mental health problems such as depression, panic attacks, social phobia, generalized anxiety disorder, suicidal ideation, and post-traumatic stress disorder (PTSD). Conclusions: Addressing the mental health problems of immigrants and refugees can only be holistic. It requires much more psychosocial interventions and practical solutions, always combined with culturally appropriate psychological support methods.

Substance use disorders in refugee and migrant groups in Sweden: A nationwide cohort study of 1.2 million people

BACKGROUND

Refugees are at higher risk of some psychiatric disorders, including post-traumatic stress disorder (PTSD) and psychosis, compared with other non-refugee migrants and the majority population. However, it is unclear whether this also applies to substance use disorders, which we investigated in a national register cohort study in Sweden. We also investigated whether risk varied by region of origin, age at migration, time in Sweden, and diagnosis of PTSD.

METHODS AND FINDINGS

Using linked Swedish register data, we followed a cohort born between 1984 and 1997 from their 14th birthday or arrival in Sweden, if later, until an International Classification of Diseases, 10th revision (ICD-10), diagnosis of substance use disorder (codes F10.X-19.X), emigration, death, or end of follow-up (31 December 2016). Refugee and non-refugee migrants were restricted to those from regions with at least 1,000 refugees in the Swedish registers. We used Cox proportional hazards regression to estimate unadjusted and adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) in refugee and non-refugee migrants, compared with Swedish-born individuals, for all substance use disorders (F10.X-19.X), alcohol use disorders (F10.X), cannabis use disorders (F12.X), and polydrug use disorders (F19.X). In adjusted analyses, we controlled for age, sex, birth year, family income, family employment status, population density, and PTSD diagnosis. Our sample of 1,241,901 participants included 17,783 (1.4%) refugee and 104,250 (8.4%) non-refugee migrants. Refugees' regions of origin were represented in proportions ranging from 6.0% (Eastern Europe and Russia) to 41.4% (Middle East and North Africa); proportions of non-refugee migrants' regions of origin ranged from 11.8% (sub-Saharan Africa) to 33.7% (Middle East and North Africa). These groups were more economically disadvantaged at cohort entry (p < 0.001) than the Swedish-born population. Refugee (aHR: 0.52; 95% CI 0.46-0.60) and non-refugee (aHR: 0.46; 95% CI 0.43-0.49) migrants had similarly lower rates of all substance use disorders compared with Swedish-born individuals (crude incidence: 290.2 cases per 100,000 person-years; 95% CI 287.3-293.1). Rates of substance use disorders in migrants converged to the Swedish-born rate over time, indicated by both earlier age at migration and longer time in Sweden. We observed similar patterns for alcohol and polydrug use disorders, separately, although differences in cannabis use were less marked; findings did not differ substantially by migrants' region of origin. Finally, while a PTSD diagnosis was over 5 times more common in refugees than the Swedish-born population, it was more strongly associated with increased rates of substance use disorders in the Swedish-born population (aHR: 7.36; 95% CI 6.79-7.96) than non-refugee migrants (HR: 4.88; 95% CI 3.71-6.41; likelihood ratio test [LRT]: p = 0.01). The main limitations of our study were possible non-differential or differential under-ascertainment (by migrant status) of those only seen via primary care and that our findings may not generalize to undocumented migrants, who were not part of this study.

CONCLUSIONS

Our findings suggest that lower rates of substance use disorders in migrants and refugees may reflect prevalent behaviors with respect to substance use in migrants' countries of origin, although this effect appeared to diminish over time in Sweden, with rates converging towards the substantial burden of substance use morbidity we observed in the Swedish-born population.

Acculturation or unequal assimilation? Smoking during pregnancy and duration of residence among migrants in Sweden

A growing corpus of evidence reveals that smoking patterns of migrant women tend to converge with that of the host population over time ('acculturation paradox'). In this paper we aim to adopt a health equity perspective by studying the extent to which this pattern reflects a convergence with the group of natives who are more socioeconomically disadvantaged. Using population-based registers, we study 1,194,296 women who gave birth in Sweden between 1991 and 2012. Using logistic regression, we estimated odds ratios to assess the effect of duration of residence on the association between smoking during pregnancy and women's origin (classified according to inequality-adjusted Human Development Index (iHDI) of the country of birth). Sibling information and multilevel models were used to assess the extent to which our results might be affected by the cross-sectional nature of the data. Smoking during pregnancy increases with duration of residence among migrants from all levels of iHDI to such an extent that they tend to converge or increase in relation to the levels of the Swedish population with low education and low income, leaving behind the native population with high education and income. The results are robust to possible selection bias related to the cross-sectional nature of the data. Our findings indicate the need of a health equity perspective and suggest the use of 'unequal assimilation' rather than 'acculturation paradox' as a more suitable framework to interpret these findings.

Dementia in immigrant groups: A cohort study of all adults 45 years of age and older in Sweden

OBJECTIVE

To study the association between country of birth and incident dementia in several immigrant groups in Sweden.

METHODS

The study population included all adults (n = 3,286,624) aged 45 years and older in Sweden. Dementia was defined as having at least one registered diagnosis of dementia in the National Patient Register. The incidence of dementia in different immigrant groups, using Swedish-born as referents, was assessed by Cox regression, expressed in hazard ratios (HRs) and 95% confidence intervals (CI). All models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, and neighbourhood socioeconomic status.

RESULTS

A total of 136,713 individuals had a registered dementia event, i.e. 4.2%; 3.6% among men and 4.9% among women. After adjusting for confounders, in general, there was a lower incidence of dementia among both male immigrants (HR 0.85, 0.83-0.88) and female immigrants (HR 0.93, 0.91-0.95) compared to their Swedish-born counterparts. Among immigrant groups, a higher incidence (HR, 95%CI) of dementia was observed among men from Finland (1.14, 1.08-1.20), Bosnia (1.61, 1.18-2.20), Estonia (1.25, 1.10-1.43) and Russia (1.37, 1.12-1.69), and women from Finland (1.20 1.15-1.24) and Norway (1.14, 1.07-1.22).

CONCLUSIONS

Risk of dementia was lower in immigrants in general compared to the Swedish-born population; however there were substantial differences among immigrant groups in risk of dementia. Developing dementia in a new country with a different language could cause problems for both patients and the health care staff.

Immigrants’ Health in Europe: A Cross-Classified Multilevel Approach to Examine Origin Country, Destination Country, and Community Effects

In this study, we examined origin, destination, and community effects on first- and second-generation immigrants’ health in Europe. We used information from the European Social Surveys (2002–2008) on 19,210 immigrants from 123 countries of origin, living in 31 European countries. Cross-classified multilevel regression analyses reveal that political suppression in the origin country and living in countries with large numbers of immigrant peers have a detrimental influence on immigrants’ health. Originating from predominantly Islamic countries and good average health among natives in the destination country appear to be beneficial. Additionally, the results point toward health selection mechanisms into migration.

Factors Associated with Unplanned Early Discharges from a Dual Diagnosis Inpatient Detoxification Unit in Israel

OBJECTIVES

Currently, Israel has a single governmental inpatient dual diagnosis detoxification unit. We provide a cross-section of patient profiles in this study as well as explore possible associations between clinical/demographic factors and the unplanned early discharge of patients from the unit, aiming at improving rehabilitation success rates.

METHODS

In this retrospective study, medical records of all patients admitted to the unit between January 1, 2012, and July 1, 2013, were examined (N = 323). ICD-10 was used for diagnosis. Statistical analysis was carried out using Pearson's chi-squared test and binary logistic regression.

RESULTS

Patients admitted to our unit were affected by schizophrenia (31.8%), personality disorder (25%), and depression (18.3%). Substances in use included alcohol (67.5%), cannabis (8.35%), and benzodiazepines (9%). Almost half of the patients were polysubstance users (48.9%). The unit had high rates of immigrants, mainly ex-USSR- and Ethiopian-born. It had low rates of individuals who had served in the army (52.8%), despite the service being mandatory in Israel. Sixty-eight percent of patients completed the program as planned, and 32% were discharged early: 8.6% discharged due to drug use in detoxification settings, violence, or hospitalization for clinical reasons and 23.2% discharged against medical advice. Immigrants had increased rates of completing the program as scheduled. Of the 46.7% of patients with severe mental illness, 44.3% were discharged early. Higher education and a diagnosis of depression were associated with program completion as planned. Using logistic regression, we found that patients with disability pensions (odds ratio [OR] = 0.36; 95% confidence interval [CI] [0.14-0.91]; p = .03) and polysubstance use (OR = 0.39; 95% [CI] [0.23, 0.66], p < .001) had a higher risk of early discharge. Upon completion of individual programs, 52% were referred to an ambulatory addiction center and 13% to a nationally sponsored dual diagnosis therapeutic community.

CONCLUSIONS

Israel's single official dual diagnosis detox inpatient unit has satisfactory annual program completion rates when compared to similar institutions. A suboptimal treatment regimen may contribute to the early discharge of patients with polysubstance use and diagnosed personality disorders. An association between early discharges and a disability pension warrant further investigation, as there is no apparent connection between the two.

The prevalence of substance use among Russian, Somali and Kurdish migrants in Finland: a population-based study

Background

Substance use is a well-known public health problem, but population-based research on migrants’ substance use in Europe is limited. Factors related to the cultural background and current life situation might influence substance use among migrants. Here, the prevalence of substance use in Russian, Somali and Kurdish migrants in Finland is reported in comparison with the general population, and the associations between substance use and socio-economic and migration-related background factors among migrants are analysed.

Methods

Cross-sectional data from the Finnish Migrant Health and Wellbeing Study (Maamu) and comparison group data of the general Finnish population (n = 1165) from the Health 2011 Survey were used. The survey participants were of Russian (n = 702), Somali (n = 512), and Kurdish (n = 632) origin. Substance use included self-reported alcohol use within previous 12 months (AUDIT-C questionnaire), current and lifetime daily smoking and lifetime use of cannabis and intravenous drugs.

Results

Binge drinking was less prevalent among all migrant groups than in the general Finnish population (Russian men 65%, p < 0.01; Russian women 30%, p < 0.01, Somali men 2%, p < 0.01, Kurdish men 27%, p < 0.01, Kurdish women 6%, p < 0.01, general population men 87% and women 72%). Current daily smoking was more prevalent among Russian (28%, p = 0.04) and Kurdish (29%, p < 0.01) migrant men compared with the reference group (20%). Younger age and employment were associated with binge drinking among migrants. Socio-economic disadvantage increased the odds for daily smoking in Russian, Somali and Kurdish migrant men. Several migration-related factors, such as age at migration and language proficiency, were associated with substance use.

Conclusions

Binge drinking is less common among migrants than in the Finnish general population. However, current daily smoking was more prevalent among Russian and Kurdish migrant men compared with the general population. Younger age, level of education, employment, duration of residence in Finland and language proficiency were associated with binge drinking and daily smoking with varying patterns of association depending on the migrant group and gender. These findings draw attention to the variation in substance use habits among migrant populations.

Religion, Alcohol Use and Risk Drinking Among Canadian Adults Living in Ontario

This research examines (1) the association between risk drinking and religious affiliation and (2) differences between religions for risk drinking among adults living in Ontario, Canada, for Christians, Buddhists, Sikhs, Muslims, Hindus, Jews, other religious groups and the non-religious. Data are based on telephone interviews with 16,596 respondents and are derived from multiple cycles (2005-2011) of the Centre for Addiction and Mental Health's (CAMH) Monitor survey, an ongoing cross-sectional survey of adults in Ontario, Canada, aged 18 years and older. Data were analysed using bivariate cross-tabulations, Mann-Whitney U nonparametric test and logistic regression. Alcohol use and risk drinking occur among members of all religious groups; however, the rate of drinking ranges widely. Risk drinking is significantly associated with religion. When compared to the No religion/Atheist group, several religious groups (Baptist, Christian, Hindu, Jehovah's Witness, Jewish, Muslim/Islam, Non-denominational, Pentecostal, Sikh and Other religion) in our sample have significantly lower odds of risk drinking. Risk drinkers also attended significantly fewer services among several religions. Results suggest that there are differences in the risk drinking rates among Canadian adults, living in Ontario, by religion. It appears that religious traditions of prohibition and abstention do hold sway among Canadian adults for some religious groups.

Hospital admissions due to alcohol related disorders among young adult refugees who arrived in Sweden as teenagers - a national cohort study

Background

Psychological distress and lack of family support may explain the mental health problems that are consistently found in young unaccompanied refugees in Western countries. Given the strong relationship between poor mental health and alcohol misuse, this study investigated hospital admissions due to alcohol related disorders among accompanied and unaccompanied young refugees who settled in Sweden as teenagers.

Methods

The dataset used in this study was derived from a combination of different registers. Cox regression models were used to estimate the risks of hospital care due to alcohol related disorders in 15,834 accompanied and 4376 unaccompanied young refugees (2005–2012), aged 13 to 19 years old when settling in Sweden and 19 to 32 years old in December 2004. These young refugees were divided into regions with largely similar attitudes toward alcohol: the former Yugoslavian republics, Somalia, and the Middle East. The findings were compared with one million peers in the native Swedish population.

Results

Compared to native Swedes, hospital admissions due to alcohol related disorders were less common in young refugees, with a hazard ratio (HR) of 0.65 and 95% confidence interval (CI) between 0.56 and 0.77. These risks were particularly lower among young female refugees. However, there were some differences across the refugee population. For example, the risks were higher in unaccompanied (male) refugees than accompanied ones (HR = 1.49, 95% CI = 1.00–2.19), also when adjusted for age, domicile and income. While the risks were lower in young refugees from Former Yugoslavia and the Middle East relative to native Swedes, independent of their length of residence in Sweden, refugees from Somalia who had lived in Sweden for more than ten years showed increased risks (HR = 2.54, 95% CI = 1.71–3.76), after adjustments of age and domicile. These risks decreased considerably when income was adjusted for.

Conclusion

Young refugees have lower risks of alcohol disorders compared with native Swedes. The risks were higher in unaccompanied young (male) refugees compared to the accompanied ones. Moreover, Somalian refugees who had lived in Sweden for more than ten years seems to be particularly vulnerable to alcohol related disorders.

Mortality by country of birth in the Nordic countries - a systematic review of the literature

Background

Immigration to the Nordic countries has increased in the last decades and foreign-born inhabitants now constitute a considerable part of the region’s population. Several studies suggest poorer self-reported health among foreign-born compared to natives, while results on mortality and life expectancy are inconclusive. To date, few studies have summarized knowledge on mortality differentials by country of birth. This article aims to systematically review previous results on all-cause and cause-specific mortality by country of birth in the Nordic countries.

Methods

The methodology was conducted and documented systematically and transparently using a narrative approach. We identified 43 relevant studies out of 6059 potentially relevant studies in August 2016, 35 of which used Swedish data, 8 Danish and 1 Norwegian.

Results

Our findings from fully-adjusted models on Swedish data support claims of excess mortality risks in specific categories of foreign-born. Most notably, immigrants from other Nordic countries, especially Finland, experience increased risk of mortality from all causes, and specifically by suicide, breast and gynaecological cancers, and circulatory diseases. Increased risks in people from Central and Eastern Europe can also be found. On the contrary, decreased risks for people with Southern European and Middle Eastern origins are found for all-cause, suicide, and breast and gynaecological cancer mortality. The few Danish studies are more difficult to compare, with conflicting results arising in the analysis. Finally, results from the one Norwegian study suggest significantly decreased mortality risks among foreign-born, to be explored in further research.

Conclusions

With new studies being published on mortality differentials between native and foreign-born populations in the Nordic countries, specific risk patterns have begun to arise. Regardless, data from most Nordic countries remains limited, as does the information on specific causes of death. The literature should be expanded in upcoming years to capture associations between country of birth and mortality more clearly.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4447-9) contains supplementary material, which is available to authorized users.

Trends in Alcohol Consumption and Alcohol-Related Harms in Norway around the Turn of the Millennium

Aims

This study aims to examine whether the significant increase in alcohol consumption in Norway since 1993 is reflected in various alcohol-related harms over the same period.

Data

The study draws on various register statistics and population sample surveys that provide mostly annual time series data on alcohol-related mortality morbidity crimes and other social harms.

Results and Discussion

When examining a wide range of alcohol-related harms some—but not all—harm trends were found to follow the same increasing trend as alcohol consumption. The results are discussed with respect to data accuracy as well as more substantive possible explanations for a mismatch in trends in consumption and harms.

Age at immigration and crime in Stockholm using sibling comparisons

Past Swedish research has shown that immigrants arriving in the receiving country at an older age are less likely to commit crime than immigrants arriving at a younger age. Segmented assimilation theory argues that the family and neighborhood may be important factors affecting how age at immigration and crime are related to one another. This study used population-based register data on foreign-background males from Stockholm to test the effect of age at immigration on crime. Potential confounding from the family and neighborhood was addressed using variables and modeling strategies. Initial results, using variables to control for confounding, showed that people who immigrated around age 4 were the most likely to be suspected of a crime. When controlling for unmeasured family characteristics, it seemed that a later age at immigration was tied to a lower likelihood of crime, which does not corroborate past research findings. The effect of age at immigration, however, was not statistically significant. The results imply that future research on entire families may be a worthwhile endeavor.

Effect of immigration background and country-of-origin contextual factors on adolescent substance use in Spain

PURPOSE

The effects of adolescent- and parental-birthplace and country-of-origin contextual factors on substance use among adolescents with recent immigrant background (ARIBs) are poorly understood. We aimed to assess these effects and identify the main mediating factors in Spain.

METHODS

Participants were 12,432 ARIBs (≥1 foreign-born parent) and 75,511 autochthonous adolescents from pooled 2006-2010 school surveys. Outcomes were prevalence of use of alcohol, tobacco, cannabis, stimulants and sedative-hypnotics. ARIBs were classified by adolescent birthplace (Spain/abroad), whether they had mixed-parents (one Spanish-born and one foreign-born), and country-of-origin characteristics. Adjusted prevalence ratios (aPRs) and percent change expressing disparities in risk were estimated using Poisson regression with robust variance.

RESULTS

Compared to autochthonous adolescents, foreign-born ARIBs without mixed-parents showed significant aPRs <1 for all substances, which generally approached 1 in Spanish-born ARIBs with mixed-parents. The main factors mediating ARIBs' lower risk were less frequent socialization in leisure environments and less association with peers who use such substances. ARIBs' lower risk depended more on country-of-origin characteristics and not having mixed-parents than being foreign-born. Tobacco, cannabis and stimulant use in ARIBs increased with increasing population use of these substances in the country-of-origin. ARIBs from the non-Muslim-regions had a lower risk of using alcohol and higher risk of using sedative-hypnotics than those from the Muslim-region.

CONCLUSIONS

Among ARIBs in Spain, parental transmission of norms and values could influence substance use as much as or more than exposure to the Spanish context. Future research should better assess effects of adolescent- and parental-birthplace and country-of-origin contextual factors on substance use.

What Role Do Changes in the Demographic Composition Play in the Declining Trends in Alcohol Consumption and the Increase of Non-drinkers Among Swedish Youth? A Time-series Analysis of Trends in Non-drinking and Region of Origin 1971-2012

Aim

Non-drinkers among youth in Sweden have increased markedly during the last 15 years. The aim of this study is to investigate the temporal association between region of origin among Swedish youth and rates of non-drinking.

Data and method

Data on non-drinkers were obtained from The Swedish Council on Information and Other drugs (CAN) yearly school surveys among Swedish ninth-grade students over the period 1971–2013. Annual data of region of origin for 1968–2012 has been compiled from Statistics Sweden (SCB) and consists of all 15-year-olds in Sweden and their region of birth; Sweden, The Nordic Countries, Europe, The Middle East and the rest of the world. Autoregressive Integrated Moving Average (ARIMA) modelling was applied in order to estimate these associations.

Results

Descriptive results revealed a change in the demography of Swedish 15- to 16-year-olds. In the early 1990s 1% of Swedish 15- to 16–year-olds were born in a Middle East country, this proportion increased to 6% in 2012. Furthermore, those born in the rest of the world (non-European or non-Nordic countries) increased from 1% to almost 4%. Similarly, the trend of non-drinkers increased from about 20% to more than 40% among Swedish 15- to 16-year-olds during the same period. However, a more thorough analysis using ARIMA modelling revealed no significant association between rates of region of origin and non-drinking.

Conclusion

The marked increase in non-drinkers during the last 15 years is not associated to changes in the demographic composition, in terms of region of origin, among Swedish youth.

School performance and alcohol-related disorders in early adulthood: a Swedish national cohort study

Background Alcohol misuse is an important global health determinant and a major contributor to health inequalities. We aimed to investigate the association between school performance and alcohol-related disorders in early adulthood in a longitudinal register-based national cohort study.

Methods We followed a register-based national cohort of Swedish citizens born 1973–1984 (N = 948 440) from compulsory school graduation at age 15–16 to 2009. We divided the population into five groups: high school marks (> mean + 1 SD); high average (between mean and mean + 1 SD); low average (between mean and mean − 1 SD); low (< mean – 1SD); and missing. Cox proportional hazard models were used to investigate the relation between school marks at time of graduation and hospital care for alcohol-related disorders in early adulthood.

Results There was a steep gradient in the risk of alcohol-related disorders related to school performance. In comparison with peers in the top category of school marks, students with low marks had adjusted hazard ratios of 8.02 [95% confidence interval (CI) 7.20 to 8.91], low average 3.02 (2.72 to 3.35) and high average 1.55 (1.39 to 1.73). The risk associated with low school marks was stronger in the male population and in the group from high socioeconomic background.

Conclusions The study demonstrated a strong graded relation between low school performance and alcohol-related disorders in young adulthood. School performance should be taken into account when developing prevention programmes/policies targeting alcohol misuse among teenagers and young adults, especially if the aim is to reach high-risk groups.

Mortality in adult offspring of immigrants: a Swedish national cohort study

BACKGROUND

Higher risks of psychiatric disorders and lower-than-average subjective health in adulthood have been demonstrated in offspring of immigrants in Sweden compared with offspring of native Swedes, and linked to relative socioeconomic disadvantage. The present study investigated mortality rates in relation to this inequity from a gender perspective.

METHODS

We used data from national registers covering the entire Swedish population aged 18-65 years. Offspring of foreign-born parents who were either Swedish born or had received residency in Sweden before school age (<7 years) were defined as "offspring of immigrants." We used Cox regression models to examine the association between parental country of birth and mortality between 1990 and 2008, with adjustment for education, income, age and family type.

RESULTS

Male offspring of immigrants from the Middle East (HR:2.00, CI:1.66-2.26), other non-European countries (HR:1.80, CI:1.36-2.36) and Finland (HR:1.56, CI:1.48-1.65) showed an age-adjusted excess mortality risk from all causes of death when compared to offspring with Swedish-born parents. Income, but not education, greatly attenuated these increased mortality risks. No excess mortality rates were found among female offspring of immigrants, with the exception of external cause of death among offspring of Finnish immigrants.

CONCLUSION

The study demonstrates high mortality rates in male offspring of immigrants from Finland and non-European countries that are associated with economic, but not educational, disadvantage. No increased mortality rates were found among female offspring of immigrants. Future studies are needed to explain this gender differential and why income, but not education, predicts mortality in male offspring of immigrants.

Mortality differentials by immigrant groups in Sweden: the contribution of socioeconomic position

OBJECTIVES

We studied mortality differentials between specific groups of foreign-born immigrants in Sweden and whether socioeconomic position (SEP) could account for such differences.

METHODS

We conducted a follow-up study of 1 997 666 men and 1 964 965 women ages 30 to 65 years based on data from national Swedish total population registers. We examined mortality risks in the 12 largest immigrant groups in Sweden between 1998 and 2006 using Cox regression. We also investigated deaths from all causes, circulatory disease, neoplasms, and external causes.

RESULTS

We found higher all-cause mortality among many immigrant categories, although some groups had lower mortality. When studying cause-specific mortality, we found the largest differentials in deaths from circulatory disease, whereas disparities in mortality from neoplasms were smaller. SEP, especially income and occupational class, accounted for most of the mortality differentials by country of birth.

CONCLUSIONS

Our findings stressed that different aspects of SEP were not interchangeable in relation to immigrant health. Although policies aimed at improving immigrants' socioeconomic conditions might be beneficial for health and longevity, our findings indicated that such policies might have varying effects depending on the specific country of origin and cause of death.

EPA Guidance Mental Health Care of Migrants

Migration is an increasingly commonplace phenomenon for a number of reasons. People migrate from rural to urban areas or across borders for reasons including economic, educational or political. There is increasing recent research evidence from many countries in Europe that indicates that migrants are more prone to certain psychiatric disorders. Because of their experiences of migration and settling down in the new countries, they may also have special needs such as lack of linguistic abilities which must be taken into account using a number of strategies at individual, local and national policy levels. In this guidance document, we briefly present the evidence and propose that specific measures must be taken to improve and manage psychiatric disorders experienced by migrants and their descendants. This improvement requires involvement at the highest level in governments. This is a guidance document and not a systematic review.

The effect of childhood socioeconomic position on alcohol-related disorders later in life: a Swedish national cohort study

BACKGROUND

Alcohol use is the third most important global-health risk factor and a main contributor to health inequalities. Previous research on social determinants of alcohol-related disorders has delivered inconsistent results. We aimed to investigate whether socioeconomic position (SEP) in childhood predicts alcohol-related disorders in young adulthood in a Swedish national cohort.

METHODS

We studied a register-based national cohort of Swedish citizens born during 1973-1984 (N=948 518) and followed them up to 2009 from age 15. Childhood SEP was defined by a six-category socioeconomic index from the Censuses of 1985 and 1990. HRs of alcohol-related disorders, as indicated by register entries on alcohol-related death and alcohol-related medical care, were analysed in Cox regression models with adjustment for sociodemographic variables and indicators of parental morbidity and criminality.

RESULTS

Low childhood SEP was associated with alcohol-related disorders later in life among both men and women in a stepwise manner. Growing up in a household with the lowest SEP was associated with risk for alcohol-related disorders of HR: 2.24 (95% CI 2.08 to 2.42) after adjustment for sociodemographic variables, compared with the highest SEP group. Adjusting the analysis for parental psychosocial problems attenuated the association to HR 1.87 (95% CI 1.73 to 2.01).

CONCLUSIONS

The study demonstrates that low SEP in childhood predicts alcohol-related disorders in young adulthood. Alcohol abuse needs to be addressed in policies to bridge the gap of health inequalities.

Prevalence of alcohol, tobacco and street drugs consumption in adult Latin American immigrants

To estimate the prevalence of alcohol, tobacco and illicit drug consumption (through the self-report) in adult Latin-American immigrants of Seville, a cross-sectional descriptive study was carried out in a representative sample of 190 immigrants. The results showed that 61.4% of the participants had consumed alcohol in previous month before data collection, although 13.2% of them were at risk of alcoholism. Moreover, 30.0% were smokers. In addition, 5.3% of the interviewed people had consumed illicit psychoactive substances in the previous six months (Marihuana: 3.7%, hashish: 1.1% and cocaine: 0.5%). For all substances under analysis, the consumption prevalence was much higher in men from 25 to 39 years of age. In conclusion, prevalence levels of this consumption were high among the studied immigrants. Nurses could train the population in the prevention of these risk behaviors through preventive practices.

Comparison of stroke mortality in Finnish-born migrants living in Sweden 1970-1999 and in Swedish-born individuals

A limited number of studies have been found on stroke mortality in migrants showing higher mortality for some groups. Influence of time of residence has been studied by one research group. An earlier study showed a significantly higher number of deaths in Diseases of the circulatory system in Finnish migrants compared with native Swedes. To test the hypothesis of a higher mortality in and a decrease in mortality over time in stroke among Finnish migrants in Sweden. The study was based on National Population data, the study population included 321,407 Swedish and 307,174 foreign born persons living in Sweden 1987-1999. Mean age was lower at time for death for Finnish migrants than native Swedes, men 5.1 years difference and women 2.3 years. The difference decreased over time. The risk of death by stroke was higher for migrants with short time of residence than with long time (≤10 years, OR 1.61-1.36 vs ≥11 year, OR 1.18). Migrants with short time of residence died 9.8-5.3 years earlier than native Swedes. The hypothesis was confirmed and an indication of adjustment to life in the new country was found. International studies show similar results for other migrant groups but further studies are needed to verify if the same pattern can be found in other migrants groups in Sweden and to generalise the findings.

Thizzin'-Ecstasy use contexts and emergent social meanings

The drug "Ecstasy" has been most commonly associated with raves, or electronic music dance events, and attributed with sexual disinhibition. In an ethnographic investigation of drug use among second-generation Southeast Asian youth in Northern California (2003), respondents described little use of or interest in using Ecstasy; yet in a second study, Ecstasy was the fourth most commonly-used substance. This paper investigates the social contexts for this change in use patterns. Respondents were second-generation Southeast Asian youths and young adults between the ages of 15 and 26 who were currently or recently drug-involved. We compared qualitative data from the two studies and found emerging patterns of meaning and context related to the observed change in use patterns. Ecstasy use among co-resident African American youth within the context of the local "hyphy" hip-hop music subculture had influenced Southeast Asian youths' uptake of the drug, known as "thizz." Respondents referred to the effects of the drug as "thizzin'," described as energizing, disinhibiting, numbing, and emotion enhancing. Reported consequences of "thizzin'" included violence and aggression as well as fun, while sexual disinhibition was rarely mentioned. The meanings assigned to drugs, including the effects ascribed to them, may be relative to the social contexts within which users are exposed to and consume drugs. The findings indicate the susceptibility of youths to local trends in drug use, particularly associated with popular cultural movements and music. Second-generation youths may be particularly susceptible relative to the conditions of their immigration and processes of identity formation unique to them.

Perception and consumption of alcohol among the immigrant population from Latin America in Valencia region (Spain)

This study examines patterns of alcohol consumption among the Hispanic immigrant population in Valencia (Spain), and also whether the length of immigrants' residence in our country and perceived degree of discrimination have any influence on such patterns. A total of 610 Spanish-speaking immigrants (314 women, 296 men) over 15 years of age, from six Hispano-American countries were interviewed in 2006; 76.8% had consumed alcohol in the previous 12 months; 37.6% drink more alcohol in Spain than in their country of origin. This study shows the need to develop specific programs for the immigrant population, with special consideration for the young, males, and smokers. The study's limitations are noted.

Mortality for alcohol-related harm by country of birth in Scotland, 2000-2004: potential lessons for prevention

AIMS

Deaths caused by alcohol have increased in the UK, and Scotland in particular, but the change in the rates of alcohol-related deaths for migrants are uncertain, and could yield insights for the general population.

METHODS

Alcohol-related mortality in immigrants among Scotland's residents was assessed using 2001 census data and mortality data from 2000 to 2004.

RESULTS

Mortality from direct alcohol-related causes accounted for nearly 1500 deaths per year in Scotland. Age-standardized mortality ratios were comparatively low for people born in Pakistan, other parts of the UK (largely England and Wales) and those from elsewhere in the world.

CONCLUSIONS

Scotland's propensity to alcohol-related deaths is not shared by all its residents. Studying such variations in more depth could yield lessons for prevention.

Drug-Intake Methods and Social Identity: The Use of Marijuana in Blunts Among Southeast Asian Adolescents and Emerging Adults

This article examines why Southeast Asian American adolescents and emerging adults in two urban settings prefer to use "blunts," or hollowed-out cigars filled with marijuana, over other methods of drug intake. Rationales for preferring blunts were both instrumental and social. Blunts allowed users to more easily share marijuana, the preferred drug among their peers, and protected against potential adverse effects associated with the "high." Blunts also allowed users to identify with the dominant style of drug use and differentiate themselves from users of stigmatized drugs such as crack cocaine and methamphetamine. This article highlights the importance of drug-intake methods in the formation and performance of drug-using behaviors among adolescents, emerging adults, and members of ethnic minority subgroups.

Birds of a feather flock together--and fall ill? Migrant homophily and health in Sweden

Although studies show that health inequities between ethnic groups exist, few have expressed interest in the origins of these disparities. As homophily (the phenomenon that people principally form relationships with those who are similar to them) influences people's norms and interactions, it might be an important property of migrants' networks, and have implications on their health. The aim of this study is to examine health inequities between natives and immigrants in Sweden and the health consequences arising from participation in homogenous migrant networks. Using total population registers and representative survey data initial analyses show that migrants experience poorer health than native Swedes. The findings further suggest that homophily is a prominent feature of migrant social networks and that migrants in networks with a high proportion of other migrants experience poorer health than those who include a high proportion of natives in their networks. However, unhealthy behaviour and disadvantaged social conditions may account for a considerable share of their excess risk. Hence, network closure may reinforce and maintain norms leading to negative behaviour and social conditions in such networks.

Adolescent alcohol and illicit drug use among first- and second-generation immigrants in Sweden

Aim: This article compares adolescent alcohol and illicit drug use among first- and second-generation immigrants from Nordic, non-Nordic European and non-European countries with that of the native Swedish majority population. Methods: Using data from a 2005 survey, multilevel logistic regression analysis was performed on a sample of 13,070 adolescents. The survey was conducted in three Swedish regions containing 24 municipalities. Results: Second-generation immigrants from Nordic countries were more likely to use alcohol and to binge drink, while first generation immigrants from non-European countries were less likely to; this difference is mainly explained by the relatively low use by girls from non-European countries. All immigrant groups were more likely to use illicit drugs than were the majority population. The highest drug use was found among first-generation Nordic immigrants and non-European immigrants. Consumption patterns among second-generation immigrants were more similar to those of the Swedish majority population, implying more alcohol use and less illicit drug use. Conclusions: Preventive policy for alcohol use should target Nordic immigrants in Sweden (second generation), while preventive policy for drug use, which is a more general immigrant phenomena, should mostly target both Nordic and non-European immigrants.