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

Health-based homophily in public housing developments

Public housing residents in the United States face disproportionately high risks for disease, presenting an urgent need for interventions. Evidence suggests interventions leveraging social networks can be successful when relationships are homophilous, as this leads to pooling of risk behaviors among interconnected alters. Yet, we know little about networks of public housing residents. To assess the feasibility of network-based interventions, we investigate the incidence of health-based homophily in public housing developments in Boston, Massachusetts. Employing multilevel models (HLM), we find that respondents report their own health characteristics to be similar to their network partners on oral health, weight, and consumption of sugar-sweetened beverages and foods. We discuss the implications of our findings for health-based interventions in low-income communities.

Depressive symptoms homophily among community-dwelling older adults in japan: A social networks analysis

Late-life depression is one of the most common mental illnesses that cause serious consequences, but the majority do not reach out for mental health services and relapses are common. The present study investigated profiled similarity of older adults' social networks in terms of depressive symptoms. In 2017, we distributed questionnaires inquiring about confidants in the community, depressive symptoms based on the 15-item Geriatric Depression Scale (GDS-15), and demographic and functional characteristics to all the community-dwelling older adults under the national insurance system in Wakuya City (Miyagi prefecture, Japan). Applying the Exponential Random Graph Model, we estimated the likelihood of a confidant relational tie by the similarity of overall and specific depressive symptoms within 217,470 potential ties among 660 respondents eligible for analysis. The overall depressive symptom homophily was marginally significant (p < 0.10), indicating that the likelihood of a confidant relational tie between two community-dwelling older adults was decreased by 5%, with one point increase in their difference in the total number of depressive symptoms (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.90-1). Focusing on specific domains of depressive symptoms, we found significant apathy homophily (p < 0.05) but no significant suicidal ideation of homophily. The results indicated that there is a 19% decrease in the likelihood of a confidant relational tie between two community-dwelling older adults by one point increase in their difference in the total number of apathy symptoms (OR, 0.81; 95%CI, 0.67-0.98) but no change by increasing the difference in their total number of suicidal ideation symptoms (OR, 1; 95%CI, 0.87-1.14). These findings suggest depressive symptom homophily, particularly with respect to apathy domains, in confidant social networks of community-dwelling older adults, and the importance of network intervention in preventing late-life depression.

Pilot Social Network Weight Loss Intervention With Two Immigrant Populations During the COVID-19 Pandemic

Purpose

To examine the feasibility and acceptability of a social network weight loss intervention delivered by lay health promoters (HPs) to immigrant populations.

Design

Single-arm, non-randomized, pilot study of a social network weight loss intervention developed by a community-based participatory research partnership and delivered by HPs.

Setting

Community-based setting in Southeastern Minnesota, United States.

Sample

Somali and Hispanic immigrants to the United States: 4 social networks of adults (2 Hispanic and 2 Somali) with 39 network participants.

Intervention

Twelve-week behavioral weight loss intervention delivered by HPs (4 weeks in-person and then 8 weeks virtual).

Measures

Feasibility was assessed by recruitment and retention rates. Acceptability was assessed by surveys and focus groups with HPs and participants. Behavioral measures included servings of fruits and vegetables, drinking soda, and physical activity. Physiologic measures included weight, blood pressure, glucose, cholesterol, and triglycerides.

Analysis

Paired t-tests of pre- to post-intervention changes at the end of 12 weeks of treatment.

Results

Recruitment was feasible and post-intervention was 100%. Participants highly rated the intervention on satisfaction, motivation, and confidence to eat a healthy diet, be physically active, and lose weight. Participants were motivated by group social support and cohesion of their social networks. On average, participants lost weight (91.6 ± 15.9 to 89.7 ± 16.6 kg, P < .0001), lowered their systolic blood pressure (133.9±16.9 to 127.2 ± 15.8 mm Hg; P < .001), lowered their diastolic blood pressure (81 ± 9.5 to 75.8 ± 9.6 mm Hg; P < .0001), had more servings of vegetables per day (1.9 ± 1.2 to 2.6 ± 1.4; P < .001), and increased their physical activity (2690 ± 3231 to 6595 ± 7322 MET-minutes per week; P = .02).

Conclusion

This pilot study of 2 immigrant communities who participated in a peer-led weight loss social network intervention delivered during the COVID-19 pandemic demonstrated high feasibility and acceptability. Participants lost weight, improved their health status, and improved their health behaviors.

Social Capital and Sustainable Social Development—How Are Changes in Neighbourhood Social Capital Associated with Neighbourhood Sociodemographic and Socioeconomic Characteristics?

The development of social capital is acknowledged as key for sustainable social development. Little is known about how social capital changes over time and how it correlates with sociodemographic and socioeconomic factors. This study was conducted in 46 neighbourhoods in Umeå Municipality, northern Sweden. The aim was to examine neighbourhood-level characteristics associated with changes in neighbourhood social capital and to discuss implications for local policies for sustainable social development. We designed an ecological study linking survey data to registry data in 2006 and 2020. Over 14 years, social capital increased in 9 and decreased in 15 neighbourhoods. Higher levels of social capital were associated with specific sociodemographic factors, but these differed in urban and rural areas. Urban neighbourhoods with a higher proportion of older pensioners (OR = 1.49, CI: 1.16–1.92), children under 12 (OR= 2.13, CI: 1.31–3.47), or a lower proportion of foreign-born members (OR= 0.32, CI: 0.19–0.55) had higher odds for higher social capital levels. In rural neighbourhoods, a higher proportion of single-parent households was associated with higher levels of social capital (OR = 1.44, 95% CI = 1.04–1.98). Neighbourhood socioeconomic factors such as income or educational level did not influence neighbourhood social capital. Using repeated measures of social capital, this study gives insights into how social capital changes over time in local areas and the factors influencing its development. Local policies to promote social capital for sustainable social development should strive to integrate diverse demographic groups within neighbourhoods and should increase opportunities for inter-ethnic interactions.

Psychological Distress, Suicidal Ideation, and Suicide Attempt Among Lesbian, Gay, and Bisexual Immigrants: Population-Based Findings from the Stockholm Public Health Cohort

In a large, population-based sample in Sweden, we sought to examine mental health disparities between lesbian, gay and bisexual (LGB) and heterosexual individuals with different immigration statuses. We conducted a population-based study including 1799 LGB and 69,324 heterosexual individuals, recruited in 2010 and 2014 as part of the Stockholm Public Health Cohort. Data were obtained from self-administered surveys that were linked to nationwide registers. We examined associations between mental health outcomes (i.e., psychological distress, suicidal ideation, and suicide attempt) and sexual orientation (LGB versus heterosexual), immigration status (immigrant versus Nordic-born), and their interaction. Sex-stratified weighted multivariable logistic regression analyses were used to calculate adjusted odds ratios with 95% confidence intervals. LGB individuals demonstrated substantially elevated odds of all mental health outcomes compared to heterosexuals; immigrants reported moderately elevated odds of psychological distress and suicide attempt, but not suicidal ideation, compared to Nordic-born individuals. Interaction terms between sexual orientation and immigration status were significant at p < 0.05 for psychological distress for both sexes and for suicidal ideation and attempt among women. Unexpectedly, models probing interactions generally demonstrated that Nordic-born LGB individuals demonstrated greater risk of psychological distress, suicidal ideation, and suicide attempt than did immigrant LGB individuals, especially among women. Supplemental analyses showed that Nordic-born bisexual women demonstrated the highest risk of all studied outcomes. Being LGB in Sweden is generally a stronger risk factor for poor mental health among Nordic-born than immigrant populations. These findings call for future intersectionality-focused research to delineate the unique cultural, social, and psychological factors associated with mental health and resilience among LGB immigrants.

Social Cost and Health: The Downside of Social Relationships and Social Networks

The research tradition on social relationships, social networks, and health dates back to the beginning of sociology. As exemplified in the classic work of Durkheim, Simmel, and Tönnies, social relationships and social networks play a double-edged-protective and detrimental-role for health. However, this double-edged role has been given unbalanced attention. In comparison to the salubrious role, the deleterious role has received less scrutiny and needs a focused review and conceptual integration. This article selectively reviews the post-2000 studies that demonstrate the harmful physical and mental health consequences of social relationships (intimate relationships and parenthood) and social networks. It uses a parsimonious three-category typology-structural forms, structural composition, and contents-to categorize relationship and network properties and proposes the social cost model, in contrast to the social resource model, to synthesize and integrate the adverse aspects of these properties. It concludes with future research directions.

Social Networks and Cognitive Function: An Evaluation of Social Bridging and Bonding Mechanisms

BACKGROUND AND OBJECTIVES

Social connectedness has been linked prospectively to cognitive aging, but there is little agreement about the social mechanisms driving this relationship. This study evaluated nine measures of social connectedness, focusing on two forms of social enrichment - access to an expansive and diverse set of loosely connected individuals (i.e., social bridging) and integration in a supportive network of close ties (i.e., social bonding).

RESEARCH DESIGN AND METHODS

This study used egocentric network and cognitive data from 311 older adults in the Social Networks in Alzheimer Disease (SNAD) study. Linear regressions were used to estimate the association between social connectedness and global cognitive function, episodic memory, and executive function.

RESULTS

Measures indicative of social bridging (larger network size, lower density, presence of weak ties, and proportion non-kin) were consistently associated with better cognitive outcomes, while measures of social bonding (close ties, multiplex support, higher frequency of contact, better relationship quality, and being married) largely produced null effects.

DISCUSSION AND IMPLICATIONS

These findings suggest that the protective benefits of social connectedness for cognitive function and memory may operate primarily through a cognitive reserve mechanism that is driven by irregular contact with a larger and more diverse group of peripheral others.

Social networks, group exercise, and anxiety among college students

This study aimed to evaluate the relationship between group exercise membership, social network characteristics, and general state anxiety in a sample of college students. Participants: 490 undergraduates from a private university in the southern US participated in the study. Methods: An egocentric network analysis was conducted to test whether demographic variables, leisure-time physical activity, group exercise membership, flourishing scores, and network variables were related to anxiety. Results: Regression analyses (R² = .174, F = 7.650, p < .0001) suggest group exercise membership (β = -.105, p = .034) and flourishing scores (β = -.342, p < .0001) were related to lower anxiety scores, while being a racial/ethnic minority (β = .094, p = .036), and having personal networks composed of more people who exercise often (β = .100, p = .025), were related to higher anxiety scores in this sample. Conclusions: Findings suggest a connection between group exercise membership, activity habits of peers, and anxiety. Encouraging group exercise participation could be an effective way of combating anxiety for college students.

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.

Weight Status and BMI-Related Traits in Adolescent Friendship Groups and Role of Sociodemographic Factors: The European IDEFICS/I.Family Cohort

BACKGROUND

During adolescence, health behaviors and weight status are increasingly influenced by friendship and peer networks. This paper examines resemblances in weight-related characteristics and how they differ by sociodemographic factors.

METHODS

Over 3,000 friendships were reported by 1,603 adolescents, aged 11-16 years, who participated in the school-based I.Family study in 6 European countries. Each "source child" named 1-10 friends for whom standardized weight-related traits were available in the same survey. The mean value of the friends' traits weighted by time spent together was calculated, and related to the source child's trait. Country, age and sex of the source child, parental education, and immigrant background were considered for confounding and moderation.

RESULTS

Source children's z-scores of body fat percent and BMI were positively associated with their friends' characteristics, in particular if they had highly educated parents. Positive associations were also found regarding the frequency of fast-food consumption, impulsivity, screen time, preference for sugar-sweetened foods, and hours spent in sports clubs, in increasing order of effect size. Additionally, correlations were observed between friends' cognitive and school functioning and being bullied. No associations were seen for a preference for high-fat foods, weight concerns, and health-related quality of life. Finally, parental education and immigrant background were associated between friends in all countries except Sweden, where no associations were observed.

CONCLUSION

Adolescent friends shared a number of weight-related characteristics. For weight measures per se, positive associations with friends' characteristics were only observed in adolescents with high parental education. Associations regarding energy-balance behaviors and indicators of school-related well-being did not differ by parental education. Parental education and immigrant background correlated positively in friends in most countries showing that social aggregation is already occurring in adolescence. The wide spectrum of friendship associations in weight-related traits and behaviors suggests that health promotion initiatives in adolescents should be directed towards peer groups in both school-related and leisure-time environments. ISRCTN Registry: Pan-European IDEFICS/I.Family children cohort (ID ISRCTN62310987; https://doi.org/10.1186/ISRCTN62310987).

Young people's labour market patterns and later mental health: A sequence analysis exploring the role of region of origin for young people's labour market trajectories and mental health

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Experiencing early employment disadvantage could lead to long-term labour market instability and labour market exclusion.

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Migrants showed more turbulent transitions between labour market states than natives.

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Belonging to a turbulent labour market trajectory is association with poor mental ill health in mid-life.

Psychological distress by age at migration and duration of residence in Sweden

Migrants suffer from worse psychological health than natives in many countries, yet the extent to which this varies by age at migration and duration of residence in the receiving context remains unexplored in Sweden. Drawing on a life course approach, we investigate differences in psychological distress by age at migration and duration of residence in working-age migrants to Sweden, and examine the role of various social determinants of health in explaining these differences relative to Swedish-born. Using pooled cross-sectional data from the 2011/2015 Health on Equal Terms survey in Västra Götaland Region, Sweden (n = 58,428), we applied logistic regression analysis to calculate predicted probabilities and average marginal effects (AME) of migrant status, by age at migration and duration of residence, on psychological distress. Analyses were stratified by sex and region of origin and controlled for indicators of socioeconomic status (SES), social cohesion, and discrimination to assess their potential contribution to differences in migrants' and natives' psychological distress. All migrants except men from OECD-predominant regions had a greater probability of psychological distress than Swedish-born (ranging from AME 0.031 [95% Confidence Interval or CI 0.000-0.062] for OECD women to AME 0.115 [95% CI 0.074-0.156] for non-OECD men). Marginal effects of migration status on psychological distress probabilities generally increased with age at migration and duration of residence. Differences between migrants and natives were largely attenuated after controlling for social determinants, the greatest contribution coming from inequalities in social cohesion, followed by inequalities in discrimination and SES. Our results suggest a relative health advantage of early-life compared to later-life migration, albeit with worse outcomes with longer residence in Sweden. The predominance of integration opportunities in childhood strengthens calls for supportive policies to assist older migrants' integration directly upon arrival, which may ultimately improve their psychological wellbeing.

Social networks and obesity among Somali immigrants and refugees

BACKGROUND

Somali immigrants and refugees to the United States are at high risk for obesity and related cardiovascular risk. Social network factors influence health behaviors and are important contributors to the obesity epidemic. The objective of this study was to describe social networks and obesity-related characteristics among adult Somali immigrants in a Minnesota city in order to inform a community-based, participatory, research-derived, social network intervention to decrease obesity rates.

METHODS

Survey data (demographics, general health measures, and sociobehavioral and network measures) and height and weight measures (for calculating body mass index) were collected from adult Somali immigrants by bilingual study team members at community locations. Descriptive statistics were used to report the survey and biometric data. Logistic regression models were used to describe the basic associations of participants and network factors. Network data were analyzed to identify nodes and ties, to visualize the network, and to identify potential interventionists for a future social network intervention.

RESULTS

Of the 646 participants, 50% were overweight or affected by obesity. The network had 1703 nodes with 3583 ties between nodes, and modularity was high (0.75). Compared with respondents of normal weight, participants who were overweight or affected by obesity had more network members who were also overweight or obese (odds ratio [OR], 2.90; 95% CI, 1.11-7.56; P = .03); this was most notable for men (OR, 4.58; 95% CI, 1.22-17.22; P = .02) and suggestive for those 50 years or older (OR, 24.23; 95% CI, 1.55-377.83; P = .03). Weight loss intention among participants who were overweight or affected by obesity was associated with number of family members and friends trying to lose weight, enabling functional network factors (social norms for weight loss, social support for healthy eating, and social cohesion), and less favorable obesogenic social norms.

CONCLUSIONS

In this community sample of Somali immigrants, distinct social networks are clustered by weight status, and social contacts and functional network characteristics are related to individuals' weight loss intentions. These factors should be considered in weight loss interventions and programs. A social network intervention targeting weight loss, within a community-based participatory research framework, is feasible in this vulnerable population.

Social integration and mental health - a decomposition approach to mental health inequalities between the foreign-born and native-born in Sweden

Background

The increasing mental health inequalities between native- and foreign-born persons in Sweden is an important public health issue. Improving social integration has been stressed as a key strategy to combat this development. While a vast amount of studies have confirmed the importance of social integration for good mental health, less is known about the role of different types of social integration, and how they relate to mental health inequalities. This study aimed to examine the extent to which indicators of social integration explained mental health inequalities between the native- and foreign-born.

Methods

Based on the Health on Equal Terms survey from 2011/2015 in Västra Götaland, Sweden (n = 71,643), a non-linear Oaxaca–Blinder decomposition analysis was performed comparing native- and foreign-born individuals from Nordic-, European- and non-European countries. The General Health Questionnaire was used to assess psychological distress, while 11 items assessed employment conditions and economic disparities, social relations, and experiences of discrimination to measure different aspects of social integration.

Results

Differences in social integration explained large proportions of observed mental health differences between the native- and foreign-born. Important indicators included low levels of social activity (20%), trust in others (17%) and social support (16%), but also labour market disadvantages, such as being outside the labour market (15%), unemployment (10%) and experiencing financial strain (16%). In analyses stratified by region of origin, low trust in others and discrimination contributed to the mental health gap between the native-born and European-born (17 and 9%, respectively), and the native-born and non-European-born (19 and 10%, respectively). Precarious labour market position was a particularly important factor in the mental health gap between the native-born and Nordic-origin (22%), and non-European origin (36%) populations.

Conclusion

Social integration factors play a central role in explaining the mental health inequality between natives and migrants in Sweden. Our findings suggest that public health actions targeting mental health gaps could benefit from focusing on inequalities in social and economic recourses between natives and migrants in Sweden. Areas of priority include improving migrants’ financial strain, as well as increasing trust in others and social support and opportunities for civic engagement.

The narrow treatment road to survival: Everyday life perspectives of women with breast cancer from Iraq and the former Yugoslavia undergoing radiation therapy in Sweden

This study aimed at exploring how women from Iraq and the former Yugoslavia, diagnosed with breast cancer and living in Sweden, experience their everyday life during radiation therapy. A qualitative research design was used comprising interviews with ten women, five originating from Iraq and five from the former Yugoslavia. Striving to survive, the women experienced their everyday life during radiation therapy as extremely challenging. This experience can be placed into three categories: strategies for survival, keeping up appearances and staying in control. Because of these specific challenges, immigrant women may need additional information and guidance in conjunction with the diagnosis, which may enable them to identify possible sources of support from those closest to them. Also, greater attention should focus on acknowledging the woman behind the diagnosis, regardless of her origin, to develop an individualised support programme to help her cope with everyday life during radiation therapy.

Access to occupational networks and ethnic variation of depressive symptoms in young adults in Sweden

Social capital research has recognized the relevance of occupational network contacts for individuals' life chances and status attainment, and found distinct associations dependent on ethnic background. A still fairly unexplored area is the health implications of occupational networks. The current approach thus seeks to study the relationship between access to occupational social capital and depressive symptoms in early adulthood, and to examine whether the associations differ between persons with native Swedish parents and those with parents born in Iran and the former Yugoslavia. The two-wave panel comprised 19- and 23-year-old Swedish citizens whose parents were born in either Sweden, Iran or the former Yugoslavia. The composition of respondents' occupational networks contacts was measured with a so-called position generator. Depressive symptoms were assessed with a two-item depression screener. A population-averaged model was used to estimate the associations between depressive symptoms and access to occupational contact networks. Similar levels of depressive symptoms in respondents with parents born in Sweden and Yugoslavia were contrasted by a notably higher prevalence of these conditions in those with an Iranian background. After socioeconomic conditions were adjusted for, regression analysis showed that the propensity for depressive symptoms in women with an Iranian background increased with a higher number of manual class contacts, and decreased for men and women with Iranian parents with a higher number of prestigious occupational connections. The respective associations in persons with native Swedish parents and parents from the former Yugoslavia are partly reversed. Access to occupational contact networks, but also perceived ethnic identity, explained a large portion of the ethnic variation in depression. Mainly the group with an Iranian background seems to benefit from prestigious occupational contacts. Among those with an Iranian background, social status concerns and expected marginalization in manual class occupations may have contributed to their propensity for depressive symptoms.

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.

Social Networks Across Common Cancer Types: The Evidence, Gaps, and Areas of Potential Impact

Although the association between social context and health has been demonstrated previously, much less is known about network interactions by gender, race/ethnicity, and sociodemographic characteristics. Given the variability in cancer outcomes among groups, research on these relationships may have important implications for addressing cancer health disparities. We examined the literature on social networks and cancer across the cancer continuum among adults. Relevant studies (N=16) were identified using two common databases: PubMed and Google Scholar. Most studies used a prospective cohort study design (n=9), included women only (n=11), and were located in the United States (n=14). Seventy-five percent of the studies reviewed used a validated scale or validated items to measure social networks (n=12). Only one study examined social network differences by race, 57.1% (n=8) focused on breast cancer alone, 14.3% (n=2) explored colorectal cancer or multiple cancers simultaneously, and 7.1% (n=1) only prostate cancer. More than half of the studies included multiple ethnicities in the sample, while one study included only low-income subjects. Despite findings of associations between social networks and cancer survival, risk, and screening, none of the studies utilized social networks as a mechanism for reducing health disparities; however, such an approach has been utilized for infectious disease control. Social networks and the support provided within these networks have important implications for health behaviors and ultimately cancer disparities. This review serves as the first step toward dialog on social networks as a missing component in the social determinants of cancer disparities literature that could move the needle upstream to target adverse cancer outcomes among vulnerable populations.

The Influence of Social Network Characteristics on Peer Clustering in Smoking: A Two-Wave Panel Study of 19- and 23-Year-Old Swedes

OBJECTIVES

The present study examines how the composition of social networks and perceived relationship content influence peer clustering in smoking, and how the association changes during the transition from late adolescence to early adulthood.

METHODS

The analysis was based on a Swedish two-wave survey sample comprising ego-centric network data. Respondents were 19 years old in the initial wave, and 23 when the follow-up sample was conducted. 17,227 ego-alter dyads were included in the analyses, which corresponds to an average response rate of 48.7 percent. Random effects logistic regression models were performed to calculate gender-specific average marginal effects of social network characteristics on smoking.

RESULTS

The association of egos' and alters' smoking behavior was confirmed and found to be stronger when correlated in the female sample. For females, the associations decreased between age 19 and 23. Interactions between network characteristics and peer clustering in smoking showed that intense social interactions with smokers increase egos' smoking probability. The influence of network structures on peer clustering in smoking decreased during the transition from late adolescence to early adulthood.

CONCLUSIONS

The study confirmed peer clustering in smoking and revealed that females' smoking behavior in particular is determined by social interactions. Female smokers' propensity to interact with other smokers was found to be associated with the quality of peer relationships, frequent social interactions, and network density. The influence of social networks on peer clustering in smoking decreased during the transition from late adolescence to early adulthood.

Knowledge and utilization of sexual and reproductive healthcare services among Thai immigrant women in Sweden

Background

Migration from Thailand to Sweden has increased threefold over the last 10 years. Today Thailand is one of the most common countries of origin among immigrants in Sweden. Since the year 2000, new HIV cases are also more prevalent among Thai immigrants compared to other immigrant nationalities in Sweden. The purpose of this study was to investigate the association between knowledge and utilization of sexual and reproductive healthcare services, contraceptive knowledge and socio-demographic characteristics and social capital among Thai immigrant women in Sweden.

Methods

This is a cross-sectional study using a postal questionnaire to all Thai women (18–64) in two Swedish regions, who immigrated to the country between 2006 and 2011. The questionnaire was answered by 804 women (response rate 62.3 %). Bivariate and multivariate logistic regression analyses were used.

Results

The majority (52.1 %) of Thai women had poor knowledge of where they should turn when they need sexual and reproductive healthcare services. After controlling for potential confounders, living without a partner (OR = 2.02, CI: 1.16–3.54), having low trust in others (OR = 1.61, CI: 1.10–2.35), having predominantly bonding social capital (OR = 1.50, CI: 1.02–2.23) and belonging to the oldest age group (OR = 2.65, CI: 1.32–5.29) were identified as risk factors for having poor knowledge. The majority (56.7 %) had never been in contact with healthcare services to get advice on contraception, and about 75 % had never been HIV/STI tested in Sweden. Low utilization of healthcare was associated with poor knowledge about healthcare services (OR = 6.07, CI: 3.94–9.34) and living without a partner (OR = 2.53, CI: 1.30–4.90). Most Thai women had knowledge of how to prevent an unwanted pregnancy (91.6 %) and infection with HIV/STI (91.1 %).

Conclusions

The findings indicate that social capital factors such as high trust in others and predominantly bridging social capital promote access to knowledge about healthcare services.

However, only one-fourth of the women had been HIV/STI tested, and due to the HIV prevalence among Thai immigrants in Sweden, policy makers and health professionals need to include Thai immigrants in planning health promotion efforts and healthcare interventions.

Does social capital protect mental health among migrants in Sweden?

Poor mental health is common among migrants. This has been explained by migration-related and socio-economic factors. Weak social capital has also been related to poor mental health. Few studies have explored factors that protect mental health of migrants in the post-migration phase. Such knowledge could be useful for health promotion purposes. Therefore, this study aimed to analyse associations between financial difficulties, housing problems and experience of discrimination and poor mental health; and to detect possible effect modification by social capital, among recently settled Iraqi migrants in Sweden. A postal questionnaire in Arabic was sent to recently settled Iraqi citizens. The response rate was 51% (n = 617). Mental health was measured by the GHQ-12 instrument and social capital was defined as social participation and trust in others. Data were analysed by means of logistic regression. Poor mental health was associated with experience of discrimination (OR 2.88, 95% CI 1.73-4.79), housing problems (OR 2.79, 95% CI 1.84-4.22), and financial difficulties (OR 2.14, 95% CI 1.44-3.19), after adjustments. Trust in others seemed to have a protective effect for mental health when exposed to these factors. Social participation had a protective effect when exposed to experience of discrimination. Social determinants and social capital in the host country play important roles in the mental health of migrants. Social capital modifies the effect of risk factors and might be a fruitful way to promote resilience to factors harmful to mental health among migrants, but must be combined with policy efforts to reduce social inequities.

Study protocol: SWING--social capital and well-being in neighborhoods in Ghent

Background

Investing in social capital has been put forth as a potential lever for policy action to tackle health inequity. Notwithstanding, empirical evidence that supports social capital’s role in the existence of health inequity is limited and inconclusive. Furthermore, social capital literature experiences important challenges with regard to (1) the level on which social capital is measured and analyzed; (2) the measurement of the concept in line with its multidimensional nature; and (3) the cross-cultural validity of social capital measurements.

The Social capital and Well-being In Neighborhoods in Ghent (SWING) study is designed to meet these challenges. The collected data can be used to investigate the distribution of health problems and the association between social capital, health and well-being, both at the individual and at the neighborhood level. The main goals of the SWING study are (1) to develop a coherent multilevel dataset of indicators on individual and neighborhood social capital and well-being that contains independent indicators of neighborhood social capital at a low level of aggregation and (2) to measure social capital as a multidimensional concept. The current article describes the background and design of the SWING study.

Methods/Design

The SWING study started in 2011 and data were collected in three cross-sectional waves: the first in 2011, the second in 2012, and the third in 2013. Data collection took place in 142 neighborhoods (census tract level) in the city of Ghent (Flanders, Belgium). Multiple methods of data collection were used within each wave, including: (1) a standardized questionnaire, largely administered face-to-face interviews for neighborhood inhabitants (N = 2,730); (2) face-to-face interviews with key informants using a standardized questionnaire (N = 2,531); and (3) an observation checklist completed by the interviewers (N = 2,730 in total). The gathered data are complemented by data available within administrative data services.

Discussion

The opportunities and ambitions of the SWING study are discussed, together with the limitations of the database.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-015-0163-1) contains supplementary material, which is available to authorized users.

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.

Social network characteristics and daily smoking among young adults in Sweden

A large number of studies have shown that friends' smoking behavior is strongly associated with an individual's own risk for smoking. However, few studies have examined whether other features of social networks, independently or conjointly with friends' smoking behavior, may influence the risk for smoking. Because it is characterized by the growing importance of friendship networks, the transition from adolescence to young adulthood may constitute a particularly relevant period on which to focus our investigation of network influences on smoking behavior. The aim of this study was therefore to examine the consequences of peer smoking as well as other network characteristics (friends' other health behaviors, relationship content, and structural aspects of the network) on the risk for smoking among young adults. The data was based on a cross-sectional survey of Swedish 19-year-olds carried out in 2009 (n = 5,695) with a response rate of 51.6%. Logistic regression was the primary method of analysis. The results show that having a large percentage of smokers in one's network was by far the most important risk factor for daily smoking. The risk of daily smoking was 21.20 (CI 14.24. 31.54) if 76%-100% of the network members smoked. Having a high percentage of physically active friends was inversely associated with daily smoking. The risk of smoking was 0.65 (CI 0.42. 1.00) if 76%-100% of the network members were physically active. No main associations between the other network characteristics (relationship content and structural aspects of the network) and smoking were found. However, there was an interaction between the percentage of smokers in the network and relationship content (i.e., trust, relationship quality and propensity to discuss problems): positive relationship content in combination with peer smoking may increase the risk of smoking. Women with a high percentage of smokers in their networks were also at higher risk of daily smoking than were men with many smoking friends. Hence, it is important to consider the interplay between peer smoking and other network characteristics on the risk of smoking, where features of networks which traditionally are seen as constructive may occasionally provide the impetus to smoke. Future studies should use longitudinal data to study whether these findings reflect peer selection or peer influence.

Health inequalities among workers with a foreign background in Sweden: do working conditions matter?

Employment and working conditions are key social determinants of health, yet current information is lacking regarding relationships between foreign background status, working conditions and health among workers in Sweden. This study utilized cross-sectional data from the 2010 Swedish Level of Living Survey (LNU) and the Level of Living Survey for Foreign Born Persons and their Children (LNU-UFB) to assess whether or not health inequalities exist between native Swedish and foreign background workers and if exposure to adverse psychosocial and physical working conditions contributes to the risk for poor health among foreign background workers. A sub-sample of 4,021 employed individuals aged 18-65 was analyzed using logistic regression. Eastern European, Latin American and Other Non-Western workers had an increased risk of both poor self-rated health and mental distress compared to native Swedish workers. Exposure to adverse working conditions only minimally influenced the risk of poor health. Further research should examine workers who are less integrated or who have less secure labor market attachments and also investigate how additional working conditions may influence associations between health and foreign background status.

Racial Healthcare Disparities: A Social Psychological Analysis

Around the world, members of racial/ethnic minority groups typically experience poorer health than members of racial/ethnic majority groups. The core premise of this article is that thoughts, feelings, and behaviors related to race and ethnicity play a critical role in healthcare disparities. Social psychological theories of the origins and consequences of these thoughts, feelings, and behaviors offer critical insights into the processes responsible for these disparities and suggest interventions to address them. We present a multilevel model that explains how societal, intrapersonal, and interpersonal factors can influence ethnic/racial health disparities. We focus our literature review, including our own research, and conceptual analysis at the intrapersonal (the race-related thoughts and feelings of minority patients and non-minority physicians) and interpersonal levels (intergroup processes that affect medical interactions between minority patients and non-minority physicians). At both levels of analysis, we use theories of social categorization, social identity, contemporary forms of racial bias, stereotype activation, stigma, and other social psychological processes to identify and understand potential causes and processes of health and healthcare disparities. In the final section, we identify theory-based interventions that might reduce ethnic/racial disparities in health and healthcare.

Life-Threatening Disparities: The Treatment of Black and White Cancer Patients

Cancer mortality and survival rates are much poorer for Black patients than for White patients. We argue that Black-White treatment disparities are a major reason for these disparities. We examine three specific kinds of Black-White treatment disparities: disparities in information exchange in oncology interactions, disparities in the treatment of breast cancer, and disparities in the treatment of clinically localized prostate cancer. In the final section, we discuss possible causes of these disparities, with a primary focus on communication within medical interactions and the role that race-related attitudes and beliefs may play in the quality of communication in these interactions.

An experimental study of homophily in the adoption of health behavior

How does the composition of a population affect the adoption of health behaviors and innovations? Homophily--similarity of social contacts--can increase dyadic-level influence, but it can also force less healthy individuals to interact primarily with one another, thereby excluding them from interactions with healthier, more influential, early adopters. As a result, an important network-level effect of homophily is that the people who are most in need of a health innovation may be among the least likely to adopt it. Despite the importance of this thesis, confounding factors in observational data have made it difficult to test empirically. We report results from a controlled experimental study on the spread of a health innovation through fixed social networks in which the level of homophily was independently varied. We found that homophily significantly increased overall adoption of a new health behavior, especially among those most in need of it.

Young Diaspora Immigrants’ Attitude and Behavior Toward the Host Culture

Positive attitudes toward contact with members of the host culture, host-culture language usage, and social relations with natives are frequently used criteria for assessing immigrants’ host-culture participation. Precursors of these criteria are, however, rarely studied, especially from a longitudinal perspective. We expected that a strong identification with the host culture or the culture of origin would be associated with higher or lower host-culture participation, respectively, and were able to test these assumptions longitudinally. Study 1 utilized a sample of 376 ethnic German adolescents who had repatriated from Russia to Germany. Over four annual waves, the adolescents reported their identification with being “German” and “Russian,” their attitude toward host-culture contact, frequency of host-culture language usage, and the share of natives in their peer network. Growth curve modeling revealed that level and change of identification with being “German” related positively to level and change of host-culture participation, whereas level and change of “Russian” identification related negatively. Study 2 utilized a sample of 549 Russian-Jewish immigrants to Israel, who reported identification at Wave 1 and host-culture participation in three annual assessments. Results basically resembled those of Study 1. Findings from both studies underscore the importance of cultural identification for immigrants’ successful acculturation into the host culture. However, results also revealed between-country differences with regard to level of cultural identification and the relation between identification with the host culture and culture of origin.