Epidemiology of substance abuse among migrants compared to native born population in primary care

Cross-Cultural Validation of the Barcelona Immigration Stress Scale

The concept of acculturative stress has been the subject of debate, resulting in contradictory arguments regarding its measurement. Many of the existing acculturative stress instruments have been developed for use with specific migrant groups. The objective of the current study is to revisit the psychometric properties of the Barcelona Immigration Stress Scale, an instrument aimed at measuring stress levels associated with the migration trajectory in any migrant group. Using a sample of 915 migrants who consulted in primary care, we carried out principal component and confirmatory factor analyses as well as item response theory analyses applied both to the entire sample and to different migratory groups separately. The new reduced version of the scale has very good psychometric properties both in general and applied to the Latino migratory group, the largest in the area where the study was carried out. Results were acceptable among sub-Saharan, North African, and Asian groups but not among Eastern Europeans. These results are discussed through the specificities of each migratory group and the limitations of psychometrics to capture the complexity of immigration-related and acculturative stress.

Prevalence and factors associated with substance use among Chinese immigrants in Spain: A mixed-design study

OBJECTIVE

To explore the use of tobacco, alcohol, and illicit drugs and its associated factors among Chinese immigrants living in Spain.

DESIGN AND MEASURES

A mixed-method design, using surveys and semi-structured interviews.

SAMPLE

A total of 133 Chinese immigrants and stakeholders were assessed in the quantitative study and 7 stakeholders were interviewed in the qualitative study.

RESULTS

The use of tobacco and alcohol was higher than the use of illicit drugs in Chinese immigrants. The prevalence of daily smokers was greater in men than in women (37.3% vs. 2.5%, p < .001). Men consumed more alcohol (76% vs. 50.6%, p = .004) and more frequently (21.6% daily vs. 2.4%, p = .024) than women. The use of illicit drugs was low and Cannabis was the most illicit drug consumed (4%). Qualitative data revealed that due to a great workload, the workers tended to avoid behaviors of illicit drug consumption, but not of alcohol and tobacco, in which the consumption is associated with business meetings and leisure.

CONCLUSION

This study found that Chinese immigrants in Spain consume more alcohol and tobacco than illicit drugs and that men have a high consumption compared to women. These findings reveal important cultural differences that should be addressed by public health managers in order to develop strategies that consider the characteristics of this population.

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

BACKGROUND

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

METHODS AND FINDINGS

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

CONCLUSIONS

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

Comparison between a morocco and a native-born population, in a sample of first episode psychosis

INTRODUCTION

Ethnic differences have been studied previously in schizophrenia and first episodes of psychosis (FEP). Previous studies in Netherlands have reported a higher incidence of psychosis in male Moroccan immigrants and more clinical severity. However there is lack of studies in Spain with morocco population and FEP.

OBJECTIVES

This study aims to determine the clinical differences in a sample of FEP between Morocco and Spanish population, recruited in a hospitalisation unit.

MATERIAL AND METHODS

Descriptive and cross-sectional study of 83 inpatients (FEP). Functionality and symptomatology were evaluated at entry and discharge, the pattern of use of cannabis was evaluated at entry, the dose of antipsychotic and the pattern of side-effects at discharge. Comparisons between native-born population and Morocco population was made with univariate analysis and logistic regression was made for evaluating the independence of the associations.

RESULTS

The 28.9% of the sample was Morocco group. No significance differences were found in clinical characteristics between groups at entry or at discharge. Compared with native-born, the Morocco group were more male, with less years of education, worse functionality, reported less use of cannabis, a better pattern of side effects and a tendency of more prescription of LAis. After the multivariate analysis, just remains a lower functionality (OR 0.93; IC 95%: 0.88-0.99, P=0.02) and lower years of education (OR 0.75; IC 95%: 0.56-1.01, P=0.05), remain significative with being related with Morocco origin.

CONCLUSIONS

Our study provides evidence for ethnic differences in Morocco population with FEP. Patients with Morocco ethnicity have more probability of being males, less years of educations. Have lower functionality and a better profile of side effects.

Emotion regulation and alcohol abuse in second-generation immigrant adolescents: The protective role of cognitive reappraisal

The individual predictors of drinking behaviors among second-generation immigrant adolescents are still understudied. This study investigated emotion regulation strategies and alcohol abuse in 472 adolescents (86 second-generation immigrants and 386 Italian natives; age range: 17–18). The Emotion Regulation Questionnaire and the Alcohol Use Disorder Identification Test were used to assess cognitive reappraisal, emotional suppression, and alcohol abuse, respectively. Immigrants reported lower alcohol abuse than natives. A negative relationship between cognitive reappraisal and alcohol abuse was found for immigrants, but not for natives. Specifically, cognitive reappraisal was a protective factor against alcohol abuse only for immigrant adolescents. Clinical and research implications are discussed.

The Use of E-Cigarettes Among U.S. Immigrants: The 2014 National Health Interview Survey

OBJECTIVE

Although e-cigarette popularity has increased substantially in recent years in the United States, it is unclear whether e-cigarette use has extended to immigrants in the United States. We characterized differences in ever and current use of e-cigarettes among non-U.S. citizens, naturalized U.S. citizens, and U.S. natives.

METHODS

We used cross-sectional data from the 2014 National Health Interview Survey to measure the prevalence of e-cigarette ever and current use by immigration status, characterized as U.S. native, naturalized U.S. citizen, and non-U.S. citizen. We used multivariate logistic regression to examine the association between e-cigarette use and immigration status adjusting for demographic characteristics, socioeconomic status, and history of tobacco use. We also stratified the use of e-cigarettes by cigarette smoking status and analyzed the impact of length of residency and country of origin on e-cigarette use among immigrants.

RESULTS

Naturalized U.S. citizens and non-U.S. citizens had a similar prevalence of e-cigarette use, which was significantly lower than the prevalence among U.S. natives. After adjusting for covariates, naturalized U.S. citizens had 38% lower odds and non-U.S. citizens had 54% lower odds of ever using e-cigarettes than U.S. natives. Non-U.S. citizens were less likely than U.S. natives to currently use e-cigarettes. Among both current smokers and nonsmokers of tobacco cigarettes, non-U.S. citizens were less likely than U.S. natives to indicate current e-cigarette use. U.S. immigrants with >5 years residency were more likely than U.S. immigrants with <5 years residency to try e-cigarettes.

CONCLUSION

Although non-U.S. citizens are less likely than U.S. natives to currently use e-cigarettes, e-cigarette use may increase with length of residency in the United States.