Immigration and leisure-time physical inactivity: a population-based study

Self-Reported Physical Activity and Mental Health Among Asylum Seekers in a Refugee Camp

BACKGROUND

Global forced displacement has been rising steeply since 2015 as a result of wars and human rights abuses. Forcibly displaced people are often exposed to physical and mental strain, which can cause traumatic experiences and poor mental health. Physical activity has been linked with better mental health, although such evidence is scarce among those populations. The purpose of the study was to examine the relationships of self-reported physical activity and fitness with mental health indices among people residing in a refugee camp in Greece as asylum seekers.

METHODS

Participants were 151 individuals (76 women, 75 men; mean age 28.90 y) displaced from their homes for an average of 32.03 months. Among them, 67% were from Afghanistan and countries from southwest Asia, and 33% from sub-Saharan African countries. Participants completed self-report measures assessing physical activity, fitness, symptoms of post-traumatic stress disorder, depression, anxiety, and well-being.

RESULTS

High prevalence of mental health disorder symptoms and poor well-being were identified, with women and Asians showing poorer mental health. Symptoms of post-traumatic stress disorder, depression, and anxiety were related to perceived fitness, but not to self-reported physical activity. Regression analysis showed that perceived fitness (β: 0.34; 95% CI, 0.43 to 1.52) and low-intensity physical activity (β: 0.24; 95% CI, 0.001 to 0.009) significantly positively predicted well-being, showing small to medium effect.

CONCLUSIONS

The findings provide useful insights regarding the link between physical activity and well-being; nevertheless, further research examining objectively measured physical activity is warranted to complement these data and further explore the associations between physical activity and mental health.

Race, immigrant status, and inequality in physical activity: An intersectional and life course approach

Physical activity improves health and well-being, but not everyone can be equally active. Previous research has suggested that racial minorities are less active than their white counterparts and immigrants are less active than their native-born counterparts. In this article, we adopt an intersectional and life course approach to consider how race and immigrant status may intersect to affect physical activity across the life span. This new approach also allows us to test the long-standing habitual versus structural debate in physical activity. Analysing data from two recent cycles of the Canadian Community Health Survey (CCHS, 2015-2016 & 2017-2018), we find that physical activity is only lower among immigrants who are also racial minorities and that the gap is most significant during adulthood, but rather insignificant during adolescence and late life. The findings that inequality in physical activity is more apparent among the most disadvantaged racialised immigrants and among working-age adults when structural influences are greater suggest that inequality in physical activity is rooted in structural inequalities, rather than habitual differences. Finally, we demonstrate that the widely observed 'healthy (racialised) immigrant effect' can be underestimated if inequality in physical activity is not considered.

Health and quality of life among women after participation in a CBPR-informed physical activity intervention: with a pandemic perspective

The lack of culturally and contextually oriented interventions promoting physical activity (PA) has led to increased physical inactivity among women living in disadvantaged neighbourhoods in Sweden. In this study one such intervention informed by community-based participatory research (CBPR) has been evaluated among 34 women from a disadvantaged neighbourhood before and during COVID-19. Health-related quality of life (HRQOL), behavioural and biomedical outcomes were assessed directly prior and post-intervention, followed by evaluations at 6-months and 18-months follow-up during COVID-19. The results revealed that HRQOL, particularly psychological, social, and environmental health significantly increased post-intervention compared to prior to intervention but reversed back at 6-months follow-up. Perceived health satisfaction and environmental health increased at 18-months follow-up during COVID-19. Participation in PA improved post-intervention and at 6-months follow-up. Everyday activities and fruit and vegetable intake continued to increase through all timepoints. Systolic blood pressure significantly decreased post-intervention and 6-months follow-up; blood flow rate increased significantly at all timepoints. Overall, the findings underscores the potential effectiveness of CBPR approaches in promoting and sustaining healthy lifestyles, even during acute situations such as the COVID-19. It may even serve as a future model for promoting health and addressing health disparities in similar groups.

Social Inequalities and Health among Older Immigrant Women in the Nordic Countries: An Integrative Review

Introduction

The Nordic countries have a surprisingly strong relative socioeconomic health inequality. Immigrants seem to be disproportionately affected due to their social economic position in the host countries. Healthcare professionals, including nurses, have a professional obligation to adhere to fairness and social equity in healthcare. The aim of this review was to identify and synthesize research on health status and the impact of social inequalities in older immigrant women in the Nordic countries.

Methods

We conducted an integrative review guided by the Whittemore and Knafl integrative review method. We searched multiple research databases using the keywords immigrant, older, women, socioeconomic inequality, health inequality, and Nordic countries. The results were limited to research published between 1990 and 2021. The retrieved articles were screened and assessed by two independent reviewers.

Results

Based on the few studies on older immigrant women in the Nordic countries, the review findings indicate that they fare worse in many health indicators compared to immigrant men and the majority population. These differences are related to various health issues, such as anxiety, depression, diabetes, multimorbidity, sedentary lifestyle, and quality of life. Lower participation in cancer screening programs is also a distinctive feature among immigrant women, which could be related to the immigrant women's help-seeking behavior. Transnational family obligations and responsibilities locally leave little room for prioritizing self-care, but differing views of health conditions might also contribute to avoidance of healthcare services.

Conclusion

This integrative review shows that there is a paucity of studies on the impact of social inequalities on the health status of older immigrant women in the Nordic countries. There is a need for not only research focused on the experiences of health status and inequality but also larger studies mapping the connection between older immigrant women's economic and health status and access to healthcare services.

Towards Understanding Post-Socialist Migrants’ Access to Physical Activity in the Nordic Region: A Critical Realist Integrative Review

Experiences of, and access and barriers to, physical activity (PA) differ between individuals. This becomes perpetuated in a migration context. Although there is super-diversity between migrant groups, health research rarely accounts for this cultural diversity. More concerningly, the matter of context is rarely scrutinized or juxtaposed with the specifics of certain ethnic groups. This integrative review assessed the evidence on post-socialist migrants’ PA levels, constraints, and enablers for PA in the Nordic region. The results show that post-socialist female migrants have an especially high risk of being physically inactive. The qualitative work elucidates socio-cultural factors that impose specific constraints on females when attempting to engage in PA. Furthermore, in scrutinizing the context, Nordic nature (Friluftsliv) is a viable way for migrants to access PA with additional health benefits (e.g., mental). However, the Nordic environment also poses specific PA challenges, such as harsh winters. This can be understood by considering post-socialist migrants’ prior use of, and attitude to, nature. The review highlights the importance of understanding specifics about both migrant groups and contexts through a critical-realist lens in the pursuit of providing PA opportunities. Future PA programs need to understand the contextual, sociohistorical, and cultural settings in which they and migrants are embedded.

Physical activity participation among Arab immigrants and refugees in Western societies: A scoping review

Insufficient physical activity (PA) is the fourth prime risk factor for numerous non-communicable diseases. Arab immigrants and refugees (AIR) are at elevated risk for low or no participation in PA due to socio-cultural and ecological factors. This scoping review examined PA prevalence, knowledge, attitudes as well as barriers vs. facilitators to PA engagement across life domains among AIR in Western countries. A systematic search strategy was implemented across five automated databases (PubMed, Embase, Medline, Sociology Database and Transportation Research Board) to locate pertinent English language papers. Seventy-five articles were included in this study, and stakeholder consultation was conducted to validate the findings. The US and Europe are substantially ahead of Canada, Australia, and New Zealand in AIR-PA research. Despite showing positive attitudes and sound knowledge of PA recommendations, AIR exhibited a low PA engagement prevalence, revealing a knowledge-compliance gap. The prevalence of sufficient PA was lowest in the US (11-22%), whereas Europe showed the highest figures (26-45%). Personal barriers to PA participation involved mainstream language illiteracy and limited exercise skills, whereas improved PA literacy was a significant facilitator. Family responsibility and cultural restrictions were common psychosocial/cultural barriers, whereas social support and culturally-sensitive resources were powerful facilitators. Poorly maintained pedestrian/cyclist infrastructure was a leading environmental barrier amongst AIR in North America, but not Europe. Longitudinal and community-engaged AIR-PA research is needed, and intersectoral collaboration is required to inform tailored interventions and inclusive policies, fostering AIR and other vulnerable populations' exercise participation and improving their health and well-being.

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.

Risk of Incident Cardiovascular Disease and Cardiovascular Risk Factors in First and Second-Generation Indians: The Singapore Indian Eye Study

Population-based data investigating generational differences in the risk of incident cardiovascular disease (CVD) and its risk determinants are rare. We examined the 6-year incidence of CVD and its risk factors in first- and second-generation ethnic Indians living in Singapore. 1749 participants (mean age [SD]: 55.5 [8.8] years; 47.5% male) from a population-based, longitudinal study of Indian adults were included for incident CVD outcome. Incident CVD was defined as self-reported myocardial infarction, angina pectoris or stroke which developed between baseline and follow-up. CVD-related risk factors included incident diabetes, hypertension, hyperlipidemia, obesity and chronic kidney disease (CKD). For incident CVD outcome, of the 1749 participants, 406 (23.2%) and 1343 (76.8%) were first and second-generation Indians, respectively. Of these, 73 (4.1%) reported incident CVD. In multivariable models, second-generation individuals had increased risk of developing CVD (RR = 2.04; 95% CI 1.04, 3.99; p = 0.038), hyperlipidemia (RR = 1.27; 95% CI 1.06, 1.53; p = 0.011), and CKD (RR = 1.92; 95% CI 1.22, 3.04; p = 0.005), compared to first-generation Indians. Second-generation Indians have increased risk of developing CVD and its associated risk factors such as hyperlipidemia and CKD compared to first-generation immigrants, independent of traditional CVD risk factors. More stratified and tailored CVD prevention strategies on second and subsequent generations of Indian immigrants in Singapore are warranted.

Economic stress and low leisure-time physical activity: Two life course hypotheses

The aim was to investigate associations between economic stress in childhood and adulthood, and low leisure-time physical activity (LTPA) in adulthood from two life course perspectives. The public health survey in Scania in the southernmost part of Sweden in 2012 is a cross-sectional study based on a stratified random sample with 28,029 respondents aged 18-80 (51.7% response rate). Associations between childhood and adult economic stress, and low LTPA were analyzed with logistic regressions. A 14.8% prevalence of men and 13.5% of women had low LTPA (sedentary lifestyle). Low LTPA was associated with higher age, being born abroad, low socioeconomic status, low trust, smoking, poor self-rated health, and economic stress in childhood and adulthood. The odds ratios of low LTPA increased with more accumulated economic stress across the life course in a dose-response relationship. There was no specific critical period (childhood or adulthood), because economic stress in childhood and adulthood were both associated with low LTPA but the associations were attenuated after the introduction of smoking and self-rated health. The accumulation hypothesis was supported because the odds ratios of low LTPA indicated a graded response to life course economic stress. The critical period hypothesis was thus not supported. Economic stress across the life course seems to be associated with low LTPA in adulthood.

Patients requests and needs for culturally and individually adapted supportive care in type 2 diabetes patients: A comparative study between Nordic and non-Nordic patients in a social economical vulnerable area of Linköping, Sweden

AIMS

This study sought to determine and compare the metabolic control of type 2 diabetes mellitus (T2DM) in non-Nordic immigrants and native Nordics. The aim was also to describe and compare the request of supportive care between these two groups.

METHODS

One hundred and eighty-four patients (n=184) coming to a routine check-up in a primary healthcare setting (PHC), were consecutively enrolled to the study during a period of one year. Data on therapeutic interventions, clinical measurements, healthcare consumption, and adherence to standard diabetes healthcare program were extracted from the patientś medical record. Structured interviews on supportive care were conducted by diabetes trained nurses. If needed, a qualified interpreter was used. Comparisons were made between Nordic patients (n=151) and non-Nordic patients (n=33).

RESULTS

Among T2DM patients in a setting of PHC, there was a difference in meeting the metabolic target HbA1c, between native Nordics and non-Nordic immigrants. There was also a difference in request on supportive care. The non-Nordic group significantly requested more and different supportive care. They also attended the standard diabetes program to a lesser degree.

CONCLUSIONS

Culturally/individually adapted prevention is not only medically warranted but also requested by the patients themselves.

Changes in Sports Participation across Transition to Retirement: Modification by Migration Background and Acculturation Status

While total physical activity decreases over the life course, sports and leisure-time physical activity (LTPA) have shown to increase after transition to retirement. This paper aimed to investigate whether this change in sports participation differs (1) between non-migrant persons (NMP) versus persons with a migrant background (PMB), and (2) by acculturation status. Data was drawn from 16 waves of the German Socio-Economic Panel Study (SOEP) including 2664 NMP and 569 PMB. PMB were grouped according to acculturation status (integrated, assimilated, marginalised, separated), assessed regarding three dimensions (language, social interaction and identification). We applied multilevel logistic regression models, adjusting for sex, retirement age, socioeconomic status, health status and body mass index. Our results show that (1) transition to retirement led to an increase in the sports participation of NMP during the first 5 years and the subsequent 5 years after retirement. Changes in sports participation were modified by migration status: In PMB sports participation increased to a lesser extent than in NMP. (2) While sports participation of integrated PMB was not significantly different from NMP in the preretirement phase, sports participation among integrated PMB increased less after retirement compared with NMP. Marginalized and assimilated PMB did not show consistent sports participation patterns before retirement, but seemingly increased their sports participation less than NMP over the retirement transition. Separated PMB had particularly low levels of sports participation. Considering that LTPA is a key factor for healthy ageing, the increasing gap in levels of sports participation after transition to retirement indicates the need for interventions targeting physical activity of the older migrant population.

Systematic mapping review of the factors influencing physical activity and sedentary behaviour in ethnic minority groups in Europe: a DEDIPAC study

Background

Physical activity and sedentary behaviour are associated with health and wellbeing. Studies indicate that ethnic minority groups are both less active and more sedentary than the majority population and that factors influencing these behaviours may differ. Mapping the factors influencing physical activity and sedentary behaviour among ethnic minority groups living in Europe can help to identify determinants of physical activity and sedentary behaviour, research gaps and guide future research.

Methods

A systematic mapping review was conducted to map the factors associated with physical activity and sedentary behaviour among ethnic minority groups living in Europe (protocol PROSPERO ID = CRD42014014575). Six databases were searched for quantitative and qualitative research published between 1999 and 2014. In synthesizing the findings, all factors were sorted and structured into clusters following a data driven approach and concept mapping.

Results

Sixty-three articles were identified out of 7794 returned by the systematic search. These included 41 quantitative and 22 qualitative studies. Of these 58 focused on physical activity, 5 on both physical activity and sedentary behaviour and none focused on sedentary behaviour. The factors associated with physical activity and sedentary behaviour were grouped into eight clusters. Social & cultural environment (n = 55) and Psychosocial (39) were the clusters containing most factors, followed by Physical environment & accessibility (33), Migration context (15), Institutional environment (14), Social & material resources (12), Health and health communication (12), Political environment (3). An important finding was that cultural and religious issues, in particular those related to gender issues, were recurring factors across the clusters.

Conclusion

Physical activity and sedentary behaviour among ethnic minority groups living in Europe are influenced by a wide variety of factors, especially informed by qualitative studies. More comparative studies are needed as well as inclusion of a wider spectrum of the diverse ethnic minority groups resettled in different European countries. Few studies have investigated factors influencing sedentary behaviour. It is important in the future to address specific factors influencing physical activity and sedentary behaviour among different ethnic minority groups in order to plan and implement effective interventions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0554-3) contains supplementary material, which is available to authorized users.

Physical Activity Disparities Between US-born and Immigrant Children by Maternal Region of Origin

We examined and compared patterns in physical activity participation for children of US-born and immigrant mothers from seven world geographic regions, and tested whether the physical activity differences were attenuated by socioeconomic status or maternal language proficiency. Using the Early Childhood Longitudinal Study-Kindergarten data (N = 18,850) we utilized logistic regression to predict adequate vigorous physical activity and participation in group and individual sports for kindergarten children. US-born children of US-born parents have significantly higher rates of physical activity compared to immigrant children. Children of Mexican, Southeast Asian, and Caribbean immigrants were especially unlikely to participate in sports. These disparities were not significantly attenuated by socioeconomic status, but accounting for language proficiency reduced some differences between the US-born and immigrant children, particularly for group sports participation. Researchers interested in improving the physical activity patterns of second-generation children should consider the relevance of language barriers in promoting healthy living.

Health-Related Quality of Life, Subjective Health Complaints, Psychological Distress and Coping in Pakistani Immigrant Women With and Without the Metabolic Syndrome : The InnvaDiab-DEPLAN Study on Pakistani Immigrant Women Living in Oslo, Norway

The increasingly high number of immigrants from South-East Asia with The Metabolic Syndrome (MetS) is an important challenge for the public health sector. Impaired glucose is essential in MetS. The blood glucose concentration is not only governed by diet and physical activity, but also by psychological distress which could contribute to the development of MetS. The aim of this study is to describe health-related quality of life, subjective health complaints (SHC), psychological distress, and coping in Pakistani immigrant women, with and without MetS. As a part of an randomized controlled intervention study in Oslo, Norway, female Pakistani immigrants (n = 198) answered questionnaires regarding health related quality of life, SHC, psychological distress, and coping. Blood variables were determined and a standardized oral glucose tolerance test was performed. The participants had a high score on SHC and psychological distress. About 40% of the participants had MetS, and this group showed significantly lower general health, lower physical function, and more bodily pain, than those without MetS. Those with MetS also had more SHC, depressive symptoms, higher levels of somatisation, and scored significantly lower on the coping strategy of active problem solving. Pakistani immigrant women seem to have a high prevalence of SHC and psychological distress, especially those with MetS.

Social capital and lack of belief in the possibility to influence one's own health: A population-based study

Objectives: To study the impact of social capital (social participation and trust) on lack of belief in possibility to influence health. Methods: The Scania 2000 public-health survey is a cross-sectional, postal questionnaire study including 13,604 persons aged 18—80 years which was conducted in 2000 by the regional healthcare authorities in Region Skåne, southern Sweden, to investigate health-related risk factors in the population. A logistic regression model was used to investigate the association between social capital and lack of belief in possibility to influence health. The multivariate analyses analysed the importance of confounders on the differences in lack of belief in possibility to influence health according to the social capital variables. Results: In total, 31.0% of all men and 33.5% of all women lack belief in the possibility to influence their own health. Lack of belief in possibility to influence health was positively associated with both low social participation and low trust, although stronger for social participation than for trust. Conclusions: Low levels of social capital, particularly low social participation, is positively associated with lack of belief in the possibility to influence one's own health.

The impact of migration on body weight: a review

Immigrants may be more vulnerable to obesity as a result of the immigration process. The aim of this article is to summarize current knowledge about the impact of immigration on body mass index (BMI). A systematic review was performed in accordance with PRISMA guidelines through a database search of scientific articles (last updated in August 2014). Thirty-nine articles were included and assessed. Results varied according to ethnic background, country of origin and host country. A consistent positive association between BMI and time since immigration was found among Hispanic, European and African immigrants. Less than half of the studies observed a positive association among Asian immigrants. The quality of the majority of the studies assessed was poor, reflecting a need to improve methodology and concept definition. Immigration appears to have a deteriorative effect on BMI. Underlying causes may include changes in nutrition and physical activity, psychological and social factors, and genetic susceptibility and these aspects should be included as moderator variables in future studies.

Distal and proximal factors of health behaviors and their associations with health in children and adolescents

OBJECTIVE

The aim of the present paper was to analyze factors affecting distal and proximal health behavior within a biopsychosocial model for examining their interactions and associations with respect to health.

METHODS

Path analysis was based on the nationwide, cross-sectional German Health Interview and Examination Survey for Children and Adolescents (2003 to 2006). The data was collected from 4,529 participants with an average age of 9.45 years (SD = 4.01). Socio-demographic data, psychosocial factors and health behavior were assessed via questionnaire. Participants also underwent physical fitness tests and a medical examination.

RESULTS

Over the five levels of the model analyzed with socioeconomic status, immigration background, and rural-urban differences on the first level; physical activity of relatives and peers, intrinsic motivation, and quality of life on the second level; eating patterns, sedentary behavior, and physical activity on the third level; physical fitness and objective health on the fourth level; and health complaints and subjective health on the fifth level; direct, moderation, and mediation effects could be shown.

CONCLUSIONS

Several distal and proximal factors are needed to take account of the multivariate complexity of health: e.g., immigration background affected health behaviors only indirectly and the effect of physical activity on objective health was mediated by physical fitness.

Is acculturation associated with physical activity among female immigrants in Sweden?

BACKGROUND

Immigrant women in Sweden have lower levels of leisure time physical activity (LTPA) than Swedish-born women. The reasons are unclear, although acculturation has been suggested to play a role.

METHODS

We used a cross-sectional study design to investigate the association between LTPA and two indicators of acculturation: (i) language proficiency (ability to understand news reports on the radio and television) and (ii) age at the time of migration, and if there existed a modifying effect on these hypothesized associations. The study sample consisted of 1651 women, aged 18-65, living in Sweden and born in Finland, Chile or Iraq. A postal questionnaire (translated into the women's native language) was used to collect the variables. The International Physical Activity Questionnaire was used to assess LTPA. Data were collected in 2002-05 and analyzed in 2009-10. A partial-proportional odds model was used for the analysis.

RESULTS

Increased language proficiency was associated with increased LTPA [odds ratio (OR) = 2.31, 95% confidence interval (CI) = 1.57-3.41]. Country of birth modified the association. Furthermore, younger age at migration was associated with increased LTPA (OR = 1.44, 95% CI = 1.01-2.03).

CONCLUSIONS

Increased language proficiency has the potential to be an important health-promoting factor among immigrant women.

The InnvaDiab-DE-PLAN study: a randomised controlled trial with a culturally adapted education programme improved the risk profile for type 2 diabetes in Pakistani immigrant women

The objective of the present study was to explore whether a culturally adapted lifestyle education programme would improve the risk factor profile for type 2 diabetes (T2D) and the metabolic syndrome (MetS) among Pakistani immigrant women in Oslo, Norway. The randomised controlled trial (the InnvaDiab study), lasting 7 ± 1 months, comprised six educational sessions about blood glucose, physical activity and diet. Participants (age 25-62 years) were randomised into either a control (n 97) or an intervention (n 101) group. Primary outcome variables were fasting and 2 h blood glucose, and secondary outcome variables were fasting levels of insulin, C-peptide, lipids, glycated Hb, BMI, waist circumference and blood pressure, measured 1-3 weeks before and after the intervention. During the intervention period, the mean fasting blood glucose decreased by 0·16 (95 % CI -0·27, -0·05) mmol/l in the intervention group, and remained unchanged in the control group (difference between the groups, P=0·022). Glucose concentration 2 h after the oral glucose tolerance test decreased by 0·53 (95 % CI -0·84, -0·21) mmol/l in the intervention group, but not significantly more than in the control group. A larger reduction in fasting insulin was observed in the intervention group than in the control group (between-group difference, P= 0·036). Among the individuals who attended four or more of the educational sessions (n 59), we found a more pronounced decrease in serum TAG (-0·1 (95 % CI -0·24, 0·07) mmol/l) and BMI (-0·48 (95 % CI -0·78, -0·18) kg/m²) compared with the control group. During the intervention period, there was a significant increase in participants having the MetS in the control group (from 41 to 57 %), which was not seen in the intervention group (from 44 to 42 %). Participation in a culturally adapted education programme may improve risk factors for T2D and prevent the development of the MetS in Pakistani immigrant women.

Arab American college students' physical activity and body composition: reconciling Middle East-West differences using the socioecological model

In this study, I conducted focus group interviews with 21 Arab American college students (9 men, 12 women; 9 Muslims, 12 non-Muslims), who were selected for extreme manifestation of religiosity or acculturation, to explore their beliefs and attitudes toward socioecological (SE) factors that facilitated and hindered their individual physical activity (PA) and body composition (I also considered body image and food and eating behavior). To analyze responses, I used a combination of deductive coding, which used levels of the SE model and demographic variable groupings, and inductive coding, to search for common themes among participants within and between research questions. Results revealed that (a) the context of physical activity participation differed by gender; (b) ideal body image was conflicted and varied by gender; and (c) consumption of cultural foods diminished along with Arab social customs related to eating. Interpersonal and cultural/community levels of the SE model were identified as primary influences, with parents regulating and instilling values backed by cultural norms to preserve Arab identity, especially in women. Finally, I identified an indeterminate adjustment period, during which immigrants transitioned between physical activity purpose/form in the Middle East and the United States.

Effect of a primary health-care-based controlled trial for cardiorespiratory fitness in refugee women

BACKGROUND

Refugee women have a high risk of coronary heart disease with low physical activity as one possible mediator. Furthermore, cultural and environmental barriers to increasing physical activity have been demonstrated. The aim of the study was to evaluate the combined effect of an approximate 6-month primary health care- and community-based exercise intervention versus an individual written prescription for exercise on objectively assessed cardiorespiratory fitness in low-active refugee women.

METHODS

A controlled clinical trial, named "Support for Increased Physical Activity", was executed among 243 refugee women recruited between November 2006 and April 2008 from two deprived geographic areas in southern Stockholm, Sweden. One geographic area provided the intervention group and the other area the control group. The control group was on a higher activity level at both baseline and follow-up, which was taken into consideration in the analysis by applying statistical models that accounted for this. Relative aerobic capacity and fitness level were assessed as the two main outcome measures.

RESULTS

The intervention group increased their relative aerobic capacity and the percentage with an acceptable fitness level (relative aerobic capacity > 23 O2 mlxkgxmin-1) to a greater extent than the control group between baseline and the 6-month follow-up, after adjusting for possible confounders (P = 0.020).

CONCLUSIONS

A combined primary health-care and community-based exercise programme (involving non-profit organizations) can be an effective strategy to increase cardiorespiratory fitness among low-active refugee women.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT00747942.

Health behaviour among non-Western immigrants with Danish citizenship

Aims: To compare belief in own effort to stay healthy, health behaviour and body mass index (BMI) among non-Western immigrants with Danish citizenship and citizens with Danish background. Methods: Based on the National Health Interview Survey 2005, logistic regression analyses were used to examine differences in belief in own effort to stay healthy, in health behaviour and in BMI between 136 non-Western immigrants with Danish citizenship and 9,901 citizens with Danish background in the age group 25—64 years. Results: Non-Western immigrants had lower odds for reporting that own effort is very important to maintain good health (odds ratio (OR) 0.45; 95% confidence interval (CI) 0.32—0.62) and for reporting consuming more alcohol on a weekly basis than recommended by the Danish National Board of Health (OR 0.21, 95% CI 0.09—0.51). The odds were higher for non-Western immigrants for than citizens with Danish background for reporting sedentary spare-time activities (OR 2.96, 95% CI 1.96—4.17), daily consumption of boiled vegetables (OR 2.50, 95% CI 1.77—3.53), and daily consumption of salad/raw vegetables (OR 2.84, 95% CI 2.02—3.99). We found no differences in daily smoking, daily fruit consumption, BMI≥25 or BMI≥30. Conclusions: The non-Western immigrants are healthier in terms of alcohol and vegetable consumption and unhealthier with regard to leisure-time physical activity. The non-Western immigrants are less likely to report that their own effort is important in maintaining good health.

Strategies for recruiting Middle Eastern-American young adults for physical activity research: a case of snowballs and Salaam

Recruitment of minorities into health studies is a process that has been the subject of recent research effort. The prevalence of hypokinetic disease in the fast growing Middle Eastern-American community is higher than whites and some minority groups and descriptive research is needed to further quantify morbidity status and antecedent behavior. To date, we know of no study that reports recruitment methods of Middle Eastern-American young adults, a demographic group that is transitioning into an at-risk stratum for ethnically associated morbidity. We report and analyze a multi-method approach used in recruiting 240 young adults of this ethnic group into a 1-week study of physical activity utilizing activity logs and pedometers. Participants were primarily recruited through snowball sampling (48.3%), flyers (15.8%), presentations to university campus organizations (15.4%), and graduate research assistants (10.8%). Access was facilitated by assistants who were community insiders; active recruitment was more successful than passive recruitment; and different techniques appealed to different group segments based on gender and religion.

Social capital, anticipated ethnic discrimination and self-reported psychological health: a population-based study

This study investigates the association between anticipated ethnic discrimination and self-reported psychological health, taking generalized trust in other people into consideration. The 2004 Public Health Survey in Skåne, Sweden, is a cross-sectional postal questionnaire study including a total of 27,757 respondents aged 18-80 with a 59% response rate. Multivariate analyses of anticipated discrimination and self-reported psychological health were performed using logistic regressions in order to investigate the importance of possible confounders (age, country of origin, education and horizontal trust). Poor psychological health was reported by 13.0% of men and 18.9% of women, and 44.8% and 44.7%, respectively, reported that 50% or more of employers would discriminate according to race, colour of skin, religion, or cultural background. Respondents in younger age groups, born abroad, with high education, low trust and high levels of self-reported anticipated discrimination, had significantly higher levels of poor self-reported psychological health. There was a significant association between anticipated discrimination and low horizontal trust. After multiple adjustments for age, country of origin and education, the addition of trust in the model reduced the odds ratio of poor self-reported psychological health in the "most employers" category from 1.8 (1.4-2.1) to 1.5 (1.3-1.9) among men and from 2.2 (1.8-2.6) to 1.8 (1.5-2.2) among women. Generalized trust in other people may be a confounder of the association between anticipated discrimination and poor psychological health. Anticipated discrimination may have effects on the mental health of not only the affected minorities, but also on the mental health of the general population.

Self-care requirements for activity and rest: an Orem nursing focus

According to Orem's self-care deficit nursing theory, helping people to maintain a balance between activity and rest (a universal self-care requisite) is a legitimate concern of nursing. The meaning of activity and rest, the requirements and potential measures for meeting this self-care requisite, and factors that might influence the process are explored. Criteria for determining a need for nursing, guides for a nursing clinical assessment, and guides for nursing action are suggested as potential ways to assist persons to meet the action demands associated with this self-care requisite.

The effectiveness of a health promotion programme for women in southern Taiwan

The purpose of this study was to assess the effectiveness of an 8 week aerobic exercise class for women on changes in their physical activity behaviour. This was a descriptive, retrospective and comparison study. Because the data were collected after an 8 week aerobic exercise class, there were two groups of subjects. Subjects in the exercise group had attended exercise classes, but subjects in the control group had not. Results showed statistically significant differences between the two groups in the frequency/week of moderately intense exercise-related activities, caloric expenditure/week in all exercise-related activities and caloric expenditure/week in moderately intense exercise-related activities. However, there was no statistically significant difference in the frequency/week of all exercise-related activities. The result that women in the exercise group practised physical activities more than women in the control group might be related to their high exercise self-efficacy expectations.

Psychosocial work conditions, unemployment, and leisure-time physical activity: a population-based study

OBJECTIVE

To investigate the association between psychosocial work conditions and unemployment, and low leisure-time physical activity.

DESIGN/SETTING/PARTICIPANTS/MEASUREMENTS

The 2000 public health survey in Scania is a cross-sectional postal questionnaire study with a 59% participation rate. A total of 5,180 persons aged 18-64 years who belonged to the workforce and the unemployed were included in this study. Logistic regression models were used to investigate the associations between psychosocial factors at work and unemployment, and low leisure-time physical activity. Psychosocial conditions at work were defined according to the Karasek-Theorell demand-control/decision latitudes into relaxed, active, passive, and job strain categories. The multivariate analyses included age, country of birth, education, economic stress, and social participation.

RESULTS

In total, 16.1% of men and 14.8% of women had low leisure-time physical activity. The job strain (high demands/low control) and unemployed categories had significantly higher odds ratios of low leisure-time physical activity among both men and women compared with the relaxed (low demands/high control) reference category. However, the significant differences between the job strain, the unemployed, and the relaxed categories disappeared in the multivariate models.

CONCLUSIONS

Respondents with job strain or unemployment have significantly higher odds ratios of low leisure-time physical activity than the relaxed category. However, after adjustments for education in particular the differences disappear. Nevertheless, the results suggest that the association between psychosocial work conditions, which are often dependent on education, and leisure-time physical activity may be interesting to study in more detail.

The influence of ethnicity and length of time since immigration on physical activity

OBJECTIVE

This study investigates whether ethnicity and length of time since immigration influence levels of leisure-time physical activity in Sweden.

DESIGN/SETTING/PARTICIPANTS

This cross-sectional study analyses data from the Swedish Survey of Living Conditions from the years 1996, 1997 and 1999, which is conducted annually and is a simple, random sample drawn from the register of the total population in Sweden. The total sample was 14,485 men and women aged 20-74 years, who were categorised according to country of origin: born in Sweden, Western Europe, Finland, Southern Europe, Eastern Europe or all other countries. The multivariate analysis was performed using a logistic regression model in order to investigate the effects of possible confounding factors on physical activity.

MAIN RESULTS

The risk of reporting low levels of physical activity was significantly higher for men born in Finland, Southern Europe and in the category 'all other countries', and also for women born in Southern Europe, Eastern Europe and 'all other countries', compared with men and women born in Sweden. After the inclusion of the variables education, smoking, body mass index and longstanding illness or disability into the model, the relationship between ethnicity and low levels of physical activity decreased to non-significance for men born in Finland and Southern Europe, but remained significant for men born in the category 'all other countries'. The differences in risk for women observed in the crude model remained significant even after inclusion of all other variables in the multivariate model. A positive gradient was observed between the length of time since immigration to Sweden and low levels of physical activity in women but no relationship was observed in men.

CONCLUSIONS

There are significant differences in levels of leisure-time physical activity between different ethnic groups living in Sweden, which could not all be explained by the confounding factors age, education, smoking, body mass index or long-term illness or disability. In women, but not in men, levels of leisure-time physical activity increased with increasing time since immigration to Sweden.

The impact of country of birth and time in Sweden on overweight and obesity: a population-based study

AIMS

A study was undertaken to investigate the relationship between country of birth, time in Sweden, and overweight and obesity.

METHODS

Approximately 4,000 people aged 20-80 participated in a cross-sectional survey in 1994. The ethnic differences in overweight and obesity were analysed in a multivariate logistic regression analysis adjusting for age and education. The effect of number of years spent in Sweden on overweight and obesity was assessed for some of the ethnic groups compared with the Swedish-born group.

RESULTS

Men from Yugoslavia and Arabic-speaking countries were overweight/obese (BMI 25.0-) and obese (BMI 30.0-) to a significantly higher extent than men born in Sweden. Women born in Poland, Arabic-speaking countries, and all other countries were overweight/obese and obese to a significantly higher extent than women born in Sweden. Both Arabic men and women who had immigrated to Sweden in 1989 or earlier had an increased risk of overweight/obesity and obesity compared with the participants born in Sweden, while no increased risk was observed for the Arabic group that immigrated after 1989.

CONCLUSIONS

There were significant differences in overweight and obesity between the country of birth groups. The findings follow the patterns of low leisure time physical activity among certain ethnic groups reported in a previous study, which has implications for public health measures directed to decrease differences in overweight and obesity by country of birth.

Obesity, dietary pattern and physical activity among children in a suburb with a high proportion of immigrants

BACKGROUND

Obesity among children is a growing problem. Interventions should be planned to meet needs in different cultural settings. The objective of this study was to explore dietary patterns, physical activity and perceptions of relationships between life-style and health among children in a suburb with low socio-economic status and a high proportion of immigrants and refugees.

METHODS

All children (n = 114) in Grades 5 and 6, aged 11 to 12 years, at a local Swedish school were invited, 112 participated. Food and exercise habits and perceptions on health and body image were assessed by a validated questionnaire and an interview. Height and weight were measured and risk for passing BMI 25 and 30 kg/m(2), respectively at the age of 18 was calculated.

RESULTS

Thirty-one percent of the children were obese or overweight. Thirty-four percent spent more than 3 h daily watching TV or using computer, a behaviour, which clustered with excess intake of sweet drinks and habitually skipping breakfast. Only about half of the children believed that their life-style could affect their health. The results show that low socio-economic status and migration are proxies for overweight and obesity.

CONCLUSIONS

Obesity, unhealthy living and a low awareness of relations between life-style and health call for action, for culturally sensitive prevention and treatment approaches.

Ethnic differences in social participation and social capital in Malmö, Sweden: a population-based study

The aim of this study was to investigate ethnic differences in different aspects of social participation in Malmö, Sweden. The public health survey in Malmö 1994 is a cross-sectional study. A total of 5600 randomly chosen individuals aged 20-80 years were asked to complete a postal questionnaire. The participation rate was 71%. The population was divided into categories born in Sweden, Denmark/Norway, other Western countries, former Yugoslavia, Poland, Arabic speaking countries and all other countries. The age-adjusted and multivariate analyses were performed using a logistic regression model in order to investigate the importance of possible confounders (age, education, economic stress and unemployment) on the differences by country of origin in different aspects of social participation. Men and women born in Arabic speaking countries and other countries (Iran, Turkey, Vietnam, Chile and subsaharan Africa) participate to a significantly lower extent in a variety of civic and social activities when compared to the reference population born in Sweden. The differences in participation in these groups compared to the group born in Sweden are observed both for social participation items at the core of the definition of social capital and cultural and other activities unrelated to social capital. This pattern is particularly pronounced for women born in Arabic speaking countries. These women even sharply differ from the participation rates of men born in Arabic speaking countries. The ethnic differences in most cases do not seem to be explained satisfactorily by education, economic stress or possibly unemployment.

Acculturation and physical activity among North Carolina Latina immigrants

The objective of this study was to examine the association between acculturation and physical activity among first generation Latina (Hispanic women) immigrants living in North Carolina. As part of the multi-site Women's Cardiovascular Health Network, 671 first generation Latina immigrants 20-50 years of age completed in-person interviews on physical activity, acculturation (measured by a language scale, length of residence in the US, and age at arrival in the US) and other potential individual and contextual correlates of physical activity. All statistical models were adjusted for age, general health, number of children in the home, marital status, and education, with self-reported physical activity as the dependent variable. Among participants, 37.4% met recommendations for physical activity, 41.9% reported insufficient activity, and 20.7% reported no moderate or vigorous activity. Latinas with higher English language acculturation were more likely to be physically active than women with lower English language acculturation. Likewise, women who arrived to the US when they were younger than 25 years were more likely to be physically active than women who arrived when they were 25 years or older. Length of residence in the US was not associated with physical activity. These relationships persisted when restricting the sample to Mexican born women. We conclude that among first generation immigrants living in North Carolina, those with higher English language acculturation or who arrived to the US at younger ages were more likely to report being physically active. These findings suggest that future epidemiologic studies and physical activity interventions should measure and tailor programs based on English-language use and age of arrival to the US among Latina immigrants.

Individual self-reported health, social participation and neighbourhood: a multilevel analysis in Malmö, Sweden

BACKGROUND

The influence of neighbourhood and individual factors on self-reported health was investigated.

METHODS

The public health survey in Malmö 1994 is a cross-sectional study. A total of 3,602 individuals aged 20-80 living in 75 neighbourhoods answered a postal questionnaire. The participation rate was 71%. A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second, was performed. We analysed the effect (intra-area correlation, cross-level modification and odds ratios) of neighbourhood on self-reported health after adjustment for individual factors.

RESULTS

The neighbourhoods accounted for 2.8% of the crude total variance in self-reported health status. This effect was significantly reduced when individual factors such as country of origin, education and social participation were included in the model. In fact, no significant variance in self-reported health remained after the introduction of the individual factors in the model.

CONCLUSIONS

In Malmö, the neighbourhood variance in self-reported health is mainly affected by individual factors, especially country of origin, socioeconomic status measured as level of education and individual social participation.

Social capital and leisure time physical activity: a population based multilevel analysis in Malmö, Sweden

OBJECTIVE

To investigate the influence of social capital and individual factors on the level of leisure time physical inactivity in the neighbourhoods.

METHODS

The public health survey in Malmö 1994 is a cross sectional study. A total of 5600 people aged 20-80 years were invited to answer a postal questionnaire. The participation rate was 71%. A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second, was performed. The effect (intra-area correlation, cross level modification, and odds ratios) was analysed of individual and neighbourhood (the 1993 migration out of an area as a proxy for social capital) factors on leisure time physical inactivity after adjustment for individual factors.

RESULTS

Neighbourhood factors accounted for 5.0% of the crude total variance in physical inactivity. This effect was significantly reduced when the individual factors, especially country of origin, education, and social participation, were included in the model. In contrast, it was not reduced by the introduction of the contextual social capital variable.

CONCLUSION

This study suggests that in the neighbourhoods of Malmö leisure time physical inactivity is mainly affected by individual factors.