The health status of migrants in Australia: a review

Determinants of self-rated health among highly educated Ukrainian women refugees in Czechia: analysis based on cross-sectional study in 2022

BACKGROUND

Russia's military aggression against Ukraine set in motion a large number of refugees. Considerable amount of them came and stayed in Czechia. Refugees represent special vulnerable individuals often affected by war physically and psychologically. Due to the national regulations not allowing most of Ukrainian men aged 18-60 to leave the country, nowadays Ukrainian forced migration is relatively young and strongly gendered. Evidence suggests the higher probability for searching the safe refuge abroad among Ukrainian women with small children as well as those with relatively higher economic and cultural capital. The aim of this study is to identify the structural features of systemic risks associated with war migration by examining determinants of self-rated health among forcibly displaced highly educated Ukrainian women of productive age residing in Czechia.

METHODS

Data from one wave of the panel survey among Ukrainian refugees in Czechia conducted in September 2022 was used. Determinants of self-rated health including self-reported diseases and healthcare factors, lifestyle, human and social capital, economic factors, and migration characteristics were analysed using binary logistic regression.

RESULTS

About 45% highly educated Ukrainian women refugees in Czechia assessed their health as poor. The poor self-rated health was mostly associated with the number of diseases and depressive symptoms, and by social capital and economic factors. Having four and more diseases (OR = 13.26; 95%-CI: 5.61-31.35), showing some severe depressive symptoms (OR = 7.20; 95%-CI: 3.95-13.13), experiencing difficulties to seek help from others (OR = 2.25; 95%-CI: 1.20-4.23), living alone in a household (OR = 2.67; 95%-CI: 1.37-5.27), having severe material deprivation (OR = 2.70; 95%-CI: 1.35-5.41) and coming originally from the eastern part of Ukraine (OR = 2.96; 95%-CI: 1.34-6.55) increased the chance of these refugees to assess their health as poor.

CONCLUSION

Social and economic determinants such as lack of social contacts for seeking help and material deprivation were found to be crucial for self-rated health and should be tackled via migration policies. Further, qualitative research is needed to better understand the mechanisms behind the factors affecting subjectively assessed health.

Examination of Physical Activity, Organized Sport, and Sitting Time Among Women and Mothers From Culturally and Linguistically Diverse Backgrounds

BACKGROUND

Little evidence is available from culturally and linguistically diverse (CALD) communities on the association between motherhood and physical activity (PA). This study aimed to examine independent and joint associations of cultural background and motherhood with meeting PA guidelines, participation in organized sports, and high sitting time (>8 h/d).

METHODS

We used self-reported cross-sectional data from survey 8 of the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health. PA was measured using the Active Australia Survey while organized sport and sitting time were measured using single items. CALD was defined as being born in a non-English speaking country or primarily speaking a non-English language at home. Multivariable-adjusted logistic regression analyses were used to examine independent and joint associations.

RESULTS

Data from 5967 women (mean age 42.4 [SD 1.5] y, 6.9% CALD, 81.2% mothers) were analyzed. Women of CALD background had lower odds of meeting PA guidelines (odds ratio; 95% confidence interval: 0.80; 0.64-0.98) and participation in organized sports (0.68; 0.54-0.86), but no statistically significant association with sitting time (0.90; 0.72-1.14). Mothers had lower odds of meeting PA guidelines (0.75; 0.64-0.87) and high sitting time (0.42; 0.36-0.49). Compared with non-CALD women without children, mothers (irrespective of cultural background) were less likely to meet PA guidelines and have high sitting time. The association of "cultural background and motherhood" with organized sports participation was only significant for CALD mothers.

CONCLUSIONS

Increased efforts and investments are needed to ensure that sports and other PA promotion interventions are culturally sensitive and engaging for CALD women and those with children.

Cross-cultural food practices and nutrition seeking behaviors among pregnant and postpartum Indian women living in Australia

No research has explored the experiences of Indian women who become pregnant after they migrate to Australia, and how their existing traditions mix with their new environment and subsequently impact eating patterns. Semi-structured interviews were conducted with eleven women of Indian heritage who were living in Australia, and data were thematically analyzed. The researchers identified two main themes were identified (a) foods to eat and which to avoid, and (b) support networks and sources of health information during pregnancy. Women get advice and information from a range of sources and have diverse attitudes and beliefs about cultural food practices. that are both rigid and flexible, as well as traditional and contemporary.

Resources used and trusted regarding child health information by culturally and linguistically diverse communities in Australia: An online cross-sectional survey

BACKGROUND

Parents' play a proactive role in seeking health information to ensure optimal growth and development for their children. To date, very little is known about the differences between information seeking behaviour for child health and engagement with resources between culturally and linguistically diverse (CALD) and non-CALD parents.

OBJECTIVE

To investigate the differences in resources used and trusted for information related to child health behaviours and engagement with online features among CALD and non-CALD respondents in Australia.

METHODS

An analysis of a theory informed online cross-sectional survey was conducted using data from 122 CALD and 399 non-CALD parents who had a child younger than 24 months or were currently pregnant in Australia. Descriptive statistics and chi-squared were used to compare the differences, and logistic regression models were used to identify factors associated with using health resources.

RESULTS

The most trusted sources for information reported by respondents were health professionals (76.2 %), websites run by health professionals (59.5 %), and government websites (53.2 %). Social media was significantly more trusted as a source of information for child health behaviours among CALD respondents than non-CALD respondents (odds ratio (OR) 1.92, P = 0.01). In contrast, booklets/ pamphlets and friends were significantly more trusted by non-CALD parents than for CALD parents (OR 0.54, P = 0.02). General search engines were used very frequently among CALD respondents for child health information (39.3 % vs 24.1 %, p = 0.013). Overall, the most common features respondents enjoyed on websites were images (81 %), videos (40.1 %), and discussion forums (39.9 %). CALD respondents significantly favoured videos (p = 0.003) while non-CALD respondents preferred obtaining information through attachments (p < 0.001).

CONCLUSIONS

Despite parents' reporting health professionals, websites run by health professionals, and government websites as trustworthy, general search engines and social media were still the most frequently used information source for parents with young children. Credible resources parents deem as trustworthy should take into account effective and engaging means of disseminating information that are accessible to both CALD and non-CALD communities.

Nativity in the healthy migrant effect: Evidence from Australia

Migrant health constitutes an important public health issue; however, variations in the 'healthy migrant effect' among migrants of different nativity are not adequately understood. To fill this gap, this study examines the life expectancy (LE) and healthy life expectancy (HLE) of the Australian-born population and eight major migrant groups in Australia for 2006, 2011 and 2016. The results show that compared with the Australian-born population, the foreign-born population overall had a higher LE and HLE but a lower HLE/LE ratio. Considerable variations in migrant health status according to nativity were also observed. Specifically, migrants from South Africa, Britain and Germany exhibited a similar or higher LE, HLE and HLE/LE ratio, while those from China, India, Italy and Greece had a higher LE but a significantly lower HLE/LE ratio compared with the Australian-born population. Lebanese migrants were the only group who experienced an unchanging LE and a declining HLE from 2006 to 2016. These notable differences in migrants' health outcomes with respect to nativity may be explained by the sociocultural differences between the origin and host countries and the different extents of migration selectivity of different migrant groups. Targeted countermeasures such as improving the quality of life of migrants from culturally diverse backgrounds or with negative migration experiences are suggested.

The relationship between fall incidents and place of birth in residential aged care facilities: a retrospective longitudinal cohort study

BACKGROUND

Older populations in residential aged care facilities (RACFs) in many immigrant-receiving countries are now being increasingly culturally and linguistically diverse (CALD). CALD populations require tailored social and health services to support their needs and improve health outcomes. Falls among the elderly are common and can have significant health and psychosocial consequences. There is some evidence to suggest that country of birth may influence risk of falls among older people, but such evidence has been scarce. This study aimed to determine the association between place of birth and the incidence of falls in RACFs.

METHODS

Routinely collected incident data relating to 5,628 residents aged ≥ 65 years in 25 RACFs in Sydney, New South Wales, Australia were used. RACF residents were classified into two groups, Australia-born (N = 4,086) and overseas-born (N = 1,542). Overseas-born RACF residents were further categorised into two subgroups: overseas-English-speaking-country (N = 743) and overseas-non-English-speaking-country (N = 799). Outcomes measures were rate of all falls, injurious falls and falls requiring hospitalisation. Multilevel binary negative regression was used to examine the relationship between fall risk and place of birth.

RESULTS

Incidence rates of all falls, injurious falls and falls requiring hospitalisation were 8.62, 3.72 and 1.07 incidents per 1,000 resident days, respectively, among the Australia-born RACF residents, but were higher at 11.02, 4.13 and 1.65, respectively, among the overseas-born RACF residents. Within those born overseas, fall rates were higher among the overseas-non-English-speaking-country-born residents (11.32, 4.29 and 2.22, respectively) than those overseas-English-speaking-country-born (10.70, 3.96 and 1.05, respectively). After controlling for confounders, the overseas-born RACF residents overall experienced a higher risk of all three types of falls (incidence rate ratios: [IRR] = 1.278, 95% confidence interval [CI] = 1.131, 1.443; injurious falls: IRR = 1.164 [95% CI = 1.013, 1.338]; falls requiring hospitalisation: IRR = 1.460 [95% CI = 1.199, 1.777]) than the Australia-born RACF residents. Among the overseas-born RACF residents, males, respite residents and those overseas-non-English-speaking-country-born experienced higher rates of falls.

CONCLUSIONS

Fall incidence in RACFs varies significantly by place of birth. With increasingly diverse RACF populations, fall intervention and prevention programs should consider cultural and linguistical backgrounds of RACF residents. Greater attention to understand the mechanisms for the differences by place of birth in risk profiles is warranted.

Multicultural emergency medicine epidemiology: A health economic analysis of patient visits

OBJECTIVE

There is growing evidence to suggest that culturally and linguistically diverse (CALD) patients cost the health system more than non-CALD patients because of a higher burden of disease and increased resource consumption. The present study aimed to compare the ED resource utilisation of CALD and non-CALD patients at a tertiary hospital in Sydney, Australia.

METHODS

The total ED resource utilisation was calculated by separating each visit into diagnostic test cost and time spent in ED components. The time component was calculated using the product of the total length of stay and a resource cost per unit time measure. Diagnostic tests were costed using the Australian Medicare Benefit Schedule. A generalised additive model was developed to estimate the isolated effect of CALD status on the resource utilisation during an ED visit.

RESULTS

CALD patients had a higher median resource utilisation than non-CALD patients ($736.93 vs $701.36, P < 0.0001); however, the generalised additive model demonstrated that CALD status was not independently associated with increased resource utilisation.

CONCLUSION

CALD status is not an independent influence on ED resource utilisation but other explanatory variables such as increased age and altered case-mix appear to have a much greater influence. There may, however, be other reasons to consider CALD loading such as equity in healthcare and to address poorer overall health outcomes for CALD patients.

Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges

Background

About half of first- or second-generation Australians are born overseas, and one-in-five speak English as their second language at home which often are referred to as Culturally and Linguistically Diverse (CALD) populations. These people have varied health needs and face several barriers in accessing health services. Nevertheless, there are limited studies that synthesised these challenges. This study aimed to explore issues and challenges in accessing health services among CALD populations in Australia.

Methods

We conducted a scoping review of the literature published from 1^st January 1970 to 30^th October 2021 in four databases: PubMed, Scopus, Embase, and the Web of Science. The search strategy was developed around CALD populations and the health services within the Australian context. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for selection and Arksey and O’Malley framework for analysis of relevant articles. A narrative synthesis of data was conducted using inductive thematic analysis approach. Identified issues and challenges were described using an adapted socioecological model.

Results

A total of 64 studies were included in the final review. Several challenges at various levels were identified to influence access to health services utilisation. Individual and family level challenges were related to interacting social and health conditions, poor health literacy, multimorbidity, diminishing healthy migrants’ effect. Community and organisational level challenges were acculturation leading to unhealthy food behaviours and lifestyles, language and communication problems, inadequate interpretation services, and poor cultural competency of providers. Finally, challenges at systems and policy levels included multiple structural disadvantages and vulnerabilities, inadequate health systems and services to address the needs of CALD populations.

Conclusions

People from CALD backgrounds have multiple interacting social factors and diseases, low access to health services, and face challenges in the multilevel health and social systems. Health systems and services need to focus on treating multimorbidity through culturally appropriate health interventions that can effectively prevent and control diseases. Existing health services can be strengthened by ensuring multilingual health resources and onsite interpreters. Addressing structural challenges needs a holistic policy intervention such as improving social determinants of health (e.g., improving living and working conditions and reducing socioeconomic disparities) of CALD populations, which requires a high level political commitment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13256-z.

Exploring the Effect of Health on Migrants' Social Integration in China

There are 376 million migrants, which account for more than 25% of the population in China according to the newest national demographic census, most of whom are from undeveloped areas to developed urban regions. Migrants’ social integration was one of the most important issues when the country aimed to build an inclusive society. As a form of human capital, the effect of migrants’ health status on social integration has rarely been explored until now, especially empirically. Previous studies have usually ignored health indicators when discussing the determinants of migrants’ social integration, and understanding the role of migrants’ physical health and mental health on their social integration is significant for efforts to ensure inclusive urbanization. For filling this research gap, the China Migrants Dynamic Survey dataset was used to uncover the role of migrants’ health status, including physical health and mental health, in their degree of social integration, and a further comparison of impact was conducted among rural–urban and urban–urban migrants. Through the empirical analysis, our results indicated the following. First, both better physical and mental health lead to higher social integration levels, and a one-point increase in physical and mental health improves the odds of good social integration by 33.27% and 5.98% for belonging and 66.05% and 6.35% for harmony, respectively. Second, health status is equally important for rural–urban and urban–urban migrants’ social integration, and the significant positive effect was consistent across groups, although some other impact factors may exhibit differences. Third, the effect of health status on social integration was moderated by social participation, which was more obvious for mental health than physical health. According to our findings, we discuss the measures to promote migrants’ health status and additional countermeasures to improve their social integration level.

Suicide among hospitality workers in Australia, 2006-2017

PURPOSE

Suicide among hospitality workers has recently attracted attention in the media. To date, little is known about suicide among hospitality workers in Australia.

METHODS

Suicide data were obtained from the National Coronial Information System (NCIS). Occupational suicide rates were calculated using the Australian Bureau of Statistics population-level data from the 2011 census. Negative binomial regression, univariate logistic regression, and multivariate logistic regression were used to estimate the association between suicide and employment as a hospitality worker over the period 2006-2017, compared to all other occupations.

RESULTS

Suicide rates for chefs was significantly higher than for persons in non-hospitality occupations [incidence rate ratio (IRR), 3.93; 95% CI 2.53-5.79; P < 0.001]. The interaction between occupation and sex was examined with follow-up testing. Suicide rates for female chefs were significantly higher than for females in non-hospitality occupations (IRR, 3.93; 95% CI 2.60-5.94). Suicide rates for male chefs were also significantly higher than males in non-hospitality occupations (IRR, 1.38; 95% CI 1.14-1.67). Compared with non-hospitality occupations, hospitality workers who died by suicide had significantly greater odds of being female (OR 0.63, 95% CI 0.50-0.79), residing in residential Socio-Economic Indexes for Areas (SEIFA) classified as most disadvantaged (OR 1.62, 95% CI 1.19-2.20), and being born outside of Australia (OR 1.74, 95% CI 1.34-2.25).

CONCLUSION

Results indicate the need for targeted prevention of suicide by Australian hospitality workers. Overall, results suggest that specific hospitality occupations present a higher risk of suicidal behaviour than other non-hospitality occupations.

The prevalence of drug use and illicit trafficking: A descriptive cross sectional study of irregular migrant returnees in Nigeria

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Drug use prevalence in irregular migration among study participants is 61.3%.

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Alcohol and marijuana is mostly the drug use among irregular migrants.

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Migration frustration and trauma are the major reason for drug use.

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Marijuana is most trafficked drug by irregular migrants.

The study assessed the prevalence of drug use and drug trafficking among Nigerian returned migrants from Libyan detention centers in the transit or destination along the Mediterranean irregular migration route. This is a descriptive cross sectional study. The study population was restricted to migrants who returned from May 2017 and April 2018. A total of 382 (238 male and 144 female) were contacted and provided information for this study. These participants were recruited using judgemental and snowballing techniques. Both quantitative and qualitative methods of data collection were used. Results showed that 61.3% of the respondents used drugs during their migration. Drug use was predominant among those in the younger age group (26–30) accounting for 24.9%. The study revealed reasons for respondents’ drug use which were as a result of migration frustration and trauma, or compulsion. The findings on drug trafficking revealed that 15.7% of the respondents engaged in drug trafficking during their migration, and 28% of the respondents that trafficked drugs had previous experience of arrest or detention by law enforcement agent (in Libya). Findings from this study showed high prevalence of drug use among irregular migrants. Experience of migration frustration and trauma were among the factors that contribute to drug use among the migrant population. The study also discovered that some of the migrants who got into illicit drug trafficking were to raise money for survival while some were compelled into the business. The high prevalence of drug use among irregular migrants from findings draw attention to the important implications for public health and social security, while drug trafficking in existence among migrants calls for need of social reintegration.

A Longitudinal Assessment of Risk Factors and Chronic Diseases among Immigrant and Non-Immigrant Adults in Australia

This study aimed to investigate the prevalence and trajectories of chronic diseases and risk behaviors in immigrants from high-income countries (HIC), low–middle-income countries (LMIC), to Australian-born people. Data were used from five waves of the HABITAT (2007–2016) study—11,035 adults living in Brisbane, Australia. Chronic diseases included cancer, diabetes mellitus, coronary heart disease, and chronic obstructive pulmonary disease (COPD). Risk factors assessed were body mass index (BMI), insufficient physical activity, and cigarette smoking. Diabetes mellitus increased in all groups, with the highest increase of 33% in LMIC immigrants. The prevalence of cancers increased 19.6% in the Australian-born, 16.6% in HIC immigrants, and 5.1% in LMIC immigrants. The prevalence of asthma increased in HIC immigrants while decreased in the other two groups. Poisson regression showed that LMIC immigrants had 1.12 times higher rates of insufficient physical activity, 0.75 times lower rates of smoking, and 0.77 times lower rates of being overweight than the Australian-born population. HIC immigrants had 0.96 times lower rates of insufficient physical activity and 0.93 times lower rates of overweight than Australian-born. The findings of this study can inform better strategies to reduce health disparities by targeting high-risk cohorts.

Cervical Cancer Screening Among Immigrant Women Residing in Australia: A Systematic Review

Since the introduction of systematic population-based cervical cancer screening in Australia in 1991, age-standardized incidence of cervical cancer has halved. Given recent advances in human papillomavirus (HPV) vaccination and screening, cervical cancer may be eliminated nationally within 20 years. However, immigrant women are not equitably reached by screening efforts. This study systematically reviewed evidence on cervical cancer screening practices among immigrant women in Australia. A systematic search of MEDLINE, Embase, PubMed, CINAHL, and PsycINFO and gray literature for English language studies published till March 1, 2019, was conducted. Observational and qualitative studies evaluating cervical cancer screening awareness and participation of immigrant women were screened. Of 125 potentially relevant studies, 25 were eligible: 16 quantitative (4 cohort, 12 cross-sectional), 6 qualitative, and 3 mixed-methods studies. Quantitative studies indicated 1% to 16% lower screening rates among migrant women compared with Australian-born women, with participation of South Asian women being significantly lower (odds ratio = 0.54, 95% confidence interval = 0.48-0.61). Qualitative studies illustrated factors affecting women's willingness to participate in screening, including insufficient knowledge, low-risk perception, and unavailability of a female health professionals being key barriers. Future studies should focus on South Asian women, due to recent increase in their immigration.

The Relationship Between Mental Health and Psychosocial Stress of Reservoir Migrants in the Middle Route of China's South-to-North Water Diversion Project (SNWDP): The Mediating Role of Social Support

BACKGROUND

South-North Water Diversion Project (SNWDP) migrants were vulnerable to developing mental health problems due to post-migration stresses and lack of social support. However, the evidence on the mental health, psychosocial stress and social support of SNWDP migrants and their interrelationships are limited and inconclusive. We aimed to explore the mechanism of influence of social support on the relationship between mental health and social psychosocial stress of SNWDP migrants.

METHODS

We performed a cross-sectional analysis of the data of 983 SNWDP migrants. The mental health status, psychosocial stress and social support of the participants were evaluated by Symptom Checklist-90-Revised (SCL-90-R), Psychosocial Stress Survey for Groups (PSSG) and Social Support Rating Scale (SSRS). Multiple stepwise regression model was used to analyze the data.

RESULTS

Among the 983 individuals, the average SCL-90-R score was 1.47, the PSSG score was 30.50, and the SSRS score was 40.30. The SCL-90-R was positively correlated with PSSG (r=0.483, P<0.001) and negatively correlated with SSRS (r=-0.257, P<0.001), PSSG was negatively correlated with SSRS (r=-0.516, P<0.001). Multiple regression analysis showed that PSSG and SSRS had significant effects on SCL-90-R prediction and that SSRS played a partial intermediary role in SCL-90-R and PSSG (46.87%).

CONCLUSION

The SNWDP migrants performed a strong correlation between social support, mental health and psychosocial stress. Social support plays a part role in mediating mental health and psychosocial stress.

Projections of Older European Migrant Populations in Australia, 2016-56

Many of the European migrant populations which settled in Australia in the three decades after World War Two are now much older, and their aged care and health care needs are changing. While there is a considerable literature on individual aspects of ageing in many migrant groups (particularly as it pertains to culturally appropriate aged care), little research attention has been given to population aspects of ageing and its implications. The aim of this paper is to address this lacuna by presenting projections of Australia's Europe-born older migrant population from 2016 to 2056. The population projections were created by a cohort-component model modified to accommodate multiple birthplace populations. Findings show the older Europe-born population is projected to experience a slight increase over the next few years, reach a peak of just under one million in the early 2030s, and then undergo a gradual decline thereafter. The Europe-born share of Australia's 65+ population will fall, from 25.5% in 2016 to 10% by 2056. Populations born in Western and Southern Europe are likely to decline throughout the projection horizon while, the Northern Europe-born and Ireland-born older populations are projected to grow continually. The populations born in the UK and South Eastern Europe initially grow before decline sets in. To a large extent the future population size of these older migrant groups will be the result of cohort flow. We discuss the implications of the coming demographic changes for government policy and culturally appropriate service provision.

An examination of chronic ill-health and lifestyle factors among inmates: searching for the healthy immigrant effect in New South Wales Prisons

PURPOSE

The purpose of this paper is to compare the rates of chronic health conditions and lifestyle factors between Australian-born and overseas-born inmates and to uncover predictive relationships between lifestyle factors and health outcomes for both groups.

DESIGN/METHODOLOGY/APPROACH

Data are presented from a cross-sectional study based on a sample of inmates from correctional sites in New South Wales (NSW). The inclusion of results here was guided by the literature relating to the healthy immigrant effect.

FINDINGS

Results indicate that a higher proportion of Australian-born inmates consumed alcohol at higher levels and were more likely to smoke on a daily or almost daily basis than overseas-born inmates. Australian-born inmates were also more likely than overseas-born inmates to have been diagnosed with cancer, epilepsy or hepatitis C. Physical activity predicted the number of diagnoses for Australian-born inmates while physical activity and smoking frequency predicted the number of diagnoses for overseas-born inmates.

PRACTICAL IMPLICATIONS

Overseas-born inmates make up a considerable portion of the prison population in NSW. A better understanding of those health and lifestyle factors that distinguish them from Australian-born inmates provides important insight regarding health promotion and the planning of service provision for those providing health care in this space.

ORIGINALITY/VALUE

Comparison of the health of immigrant and native-born prison inmates has not been undertaken before and promises to provide important information regarding those factors that distinguish a sizeable minority in the prison population.

The perceptions, barriers and enablers to physical activity and minimising sedentary behaviour among Arab-Australian adults aged 35-64 years

ISSUES ADDRESSED

The objective of this study was to explore the perceptions, barriers and enablers to physical activity (PA) and minimising sedentary behaviour among Arab-Australians, a group who have lower levels of PA and higher rates of certain chronic diseases when compared with the general Australian population.

METHODS

A total of 28 Arab-Australians aged 35-64 years participated in one of five focus groups conducted in Western Sydney during 2017-2018, a culturally diverse region in New South Wales, Australia. Focus group duration ranged from 35-90 minutes with 4-7 participants in each group. Focus group data were recorded and transcribed verbatim and analysed using inductive thematic analysis.

RESULTS

Participants had a general understanding of PA and the associated health benefits. Fewer participants were aware of the independent health effects associated with prolonged sitting. A lack of time and motivation due to work, familial duties, domestic roles and lack of effort reportedly influenced PA participation. Health was perceived to be both a barrier and an enabler to PA. Barriers related to health included pain and existing conditions and enablers included preventive and reactive measures. Social support and accessibility, such as a lack of support networks, the availability of services and costs were also discussed. Cultural and religious influences, such as traditional gender roles and the importance of gender-exclusive settings, were also important factors influencing the PA behaviours of participants.

CONCLUSIONS

This study highlighted the factors that influence the PA levels and sedentary behaviour of Arab-Australian adults aged 35-64 years. SO WHAT?: The findings of this study could help inform the design and development of culturally tailored PA interventions for Arab-Australian adults.

Revealing the air pollution burden associated with internal Migration in Peru

This study aims to quantify changes in outdoor (ambient) air pollution exposure from different migration patterns within Peru and quantify its effect on premature mortality. Data on ambient fine particulate matter (PM2.5) was obtained from the National Aeronautics and Space Administration (NASA). Census data was used to calculate rates of within-country migration at the district level. We calculated differences in PM2.5 exposure between "current" (2016-2017) and "origin" (2012) districts for each migration patterns. Using an exposure-response relationship for PM2.5 extracted from a meta-analysis, and mortality rates from the Peruvian Ministry of Health, we quantified premature mortality attributable to each migration pattern. Changes in outdoor PM2.5 exposure were observed between 2012 and 2016 with highest levels of PM2.5 in the Department of Lima. A strong spatial autocorrelation of outdoor PM2.5 values (Moran's I = 0.847, p-value=0.001) was observed. In Greater Lima, rural-to-urban and urban-to-urban migrants experienced 10-fold increases in outdoor PM2.5 exposure in comparison with non-migrants. Changes in outdoor PM2.5 exposure due to migration drove 137.1 (95%CI: 93.2, 179.4) premature deaths related to air pollution, with rural-urban producing the highest risk of mortality from exposure to higher levels of ambient air pollution. Our results demonstrate that the rural-urban and urban-urban migrant groups have higher rates of air pollution-related deaths.

Prevalence of eating disorder is lower in migrants than in the Australian-born population

OBJECTIVES

There are limited data on the epidemiology of eating disorders (ED) in migrants. Recent Scandinavian research suggests that migrants are at lower risk of eating disorders, however, to our knowledge there have not been comparable studies exploring eating disorders in Australian adult populations. We sought to explore the prevalence of EDs in first-generation migrants to Australia in comparison with the Australian-born population. A secondary aim was to explore ED prevalence across first-generation migrants from different regions of birth (Europe, Asia, Africa, and Other).

METHODS

We conducted sequential cross-sectional population surveys in South Australian individuals aged over 15 years in 2015 and 2016 (n = 6052). Demographic data were collected and migration status was inferred based on a country of birth outside Australia. Questions asked regarding disordered eating were based on the Eating Disorders Examination.

FINDINGS

The 3-month prevalence of any ED was found to be significantly lower in first-generation migrants born outside Australia (4.5%, 95% CI 3.6-5.6) in comparison to the Australian-born population (6.4%, 95% CI 5.7-7.2). People born in countries in Africa (11.0% 95% CI 6.1-19.1) had a significantly higher prevalence of EDs than those born in Asia (4.0% 95% CI 2.7-5.8).

CONCLUSIONS

First-generation migrants to Australia may be at lower risk of eating disorders compared to their Australia-born peers, suggesting support for a 'healthy immigrant effect'.

A comparison of the characteristics and treatment outcomes of migrant and Australian-born users of a national digital mental health service

BACKGROUND

To explore the characteristics and compare clinical outcomes of non-Australian born (migrant) and Australian-born users of an Australian national digital mental health service.

METHODS

The characteristics and treatment outcomes of patients who completed online treatment at the MindSpot Clinic between January 2014 and December 2016 and reported a country of birth other than Australia were compared to Australian-born users. Data about the main language spoken at home were used to create distinct groups. Changes in symptoms of depression and anxiety were measured using the Patient Health Questionnaire-9 Item (PHQ-9), and Generalized Anxiety Disorder Scale - 7 Item (GAD-7), respectively.

RESULTS

Of 52,020 people who started assessment at MindSpot between 1st January 2014 and 22nd December 2016, 45,082 reported a country of birth, of whom 78.6% (n = 35,240) were Australian-born, and 21.4% (n = 9842) were born overseas. Of 6782 people who completed the online treatment and reported country of birth and main language spoken at home, 1631 (24%) were migrants, 960 (59%) were from English-speaking countries, and 671 (41%) were from non-English speaking countries. Treatment-seeking migrant users reported higher rates of tertiary education than Australian-born users. The baseline symptom severity, and rates of symptom reduction and remission following online treatment were similar across groups.

CONCLUSIONS

Online treatment was associated with significant reductions in anxiety and depression in migrants of both English speaking and non-English speaking backgrounds, with outcomes similar to those obtained by Australian-born patients. DMHS have considerable potential to help reduce barriers to mental health care for migrants.

Effect of language and country of birth on the consent process and medical suitability of potential organ donors; a linked-data cohort study 2010-2015

PURPOSE

Australia has unmet need for transplantation. We sought to assess the impact of cultural and linguistic diversity (CALD) on family consent and medical suitability for organ donation.

METHOD

Cohort study of New South Wales donor referrals, 2010-2015. Logistic regression estimated effects of primary language other than English and birthplace outside Australia (odds ratios OR, with 95% confidence intervals, 95%CI). Outcomes were whether families were asked for consent to donation, provided consent for donation, and whether the referral was medically suitable for donation.

RESULTS

Of 2977 organ donor referrals, a similar proportion of families had consent for donation was sought between non-English speakers and English speakers (p = .07), and between overseas-born compared to Australian-born referrals (p = .3). However, consent was less likely to be given for both non-English speakers than English speakers (OR 0.44, 95%CI:0.29-0.67), and those overseas-born than Australian-born (OR 0.54, 95%CI:0.41-0.72). For referrals both overseas-born and non-English speaking, families were both less likely to be asked for consent (OR 0.67; 95%CI:0.49-0.91) or give consent (OR 0.24; 95%CI0.16-0.37). There was no difference in medical suitability between English speakers and non-English speakers (p = .6), or between Australian-born and overseas-born referrals (p = .6).

CONCLUSION

Intervention to improve consent rates from CALD families may increase donation.

Country of birth differences in lifestyle-related chronic disease among middle-aged and older adults of Lebanese ethnicity

OBJECTIVE

To examine country of birth differences in the odds of reporting chronic diseases among those of Lebanese ethnicity in comparison to those of Australian ethnicity.

METHODS

Participants were 41,940 Australians aged 45 years and older, sampled from the 45 and Up Study baseline dataset. Participants included those of Lebanese ethnicity born in Lebanon (n=401), Australia (n=331) and other countries (n=73); and those of Australian ethnicity (n=41,135). Logistic regression models were conducted to examine differences in the odds of reporting chronic disease between those of Lebanese ethnicity and those of Australian ethnicity.

RESULTS

Those of Lebanese ethnicity had higher odds of reporting diabetes (OR 1.62; 95%CI 1.32-2.00) and lower odds of reporting hypertension (OR 0.82; 95%CI 0.70-0.96) when compared with those of Australian ethnicity. After country of birth stratification, only those born in Lebanon had higher odds of reporting diabetes (OR 2.21; 95%CI 1.71-2.85) and also had lower odds of reporting cancer (OR 0.66; 95%CI 0.46-0.97), when compared with those of Australian ethnicity.

CONCLUSIONS

Country of birth differences in health exist among those of Lebanese ethnicity. Implications for public health: Country of birth is an important factor that could assist in explaining differences in health among ethnic groups of the same origin.

Health Selectivity and Rural-Urban Migration in China: A Nationwide Multiple Cross-Sectional Study in 2012, 2014, 2016

Background: China is undergoing an unprecedented rural-urban migration, which may deeply influence the health of internal migrants. Previous studies suggested that migrants are a selectively healthier population. This paper examines the evidence for and the changes of health selectivity among Chinese internal migrants. Methods: We use data from the China Labor-force Dynamics Survey (CLDS), a nationally representative survey conducted in 2012, 2014, and 2016, respectively. The health statuses of four groups of research subjects (out-migrants, returned migrants, rural residents, and urban residents) are measured by general health, physical health, and emotional health. Results: By comparing the health status of migrants with that of rural residents, we find supportive evidence for the Healthy Migrant Hypothesis that migrants exhibit better health than rural residents in their hometown. We also add strength to the Salmon Bias Hypothesis that migrants returning to their hometowns are less healthy than those still being outside. However, migrants present worse emotional health in both comparisons. The general and physical health gaps between migrants, rural residents, and returnees widened in all three rounds of the survey, which implies a possibly increasing trend of health selectivity. This study also suggests that bringing family to the destination requires better general and physical health, but not emotional health. Conclusions: Migrants are positively selected on general and physical health. The health selectivity in 2012–2016 is highly likely to increase, which means that there are increasing number of obstacles for migrants to overcome. Family migration’s high requirement for health might also contribute to it. It is urgent to establish and improve primary health care service systems in rural areas in current circumstances.

Suicide by persons with foreign background in Japan

Purpose

This study examined trends in the suicide rates of persons with foreign background in Japan.

Methods

Using the nationwide death records in the Vital Statistics of Japan, we first reported the age-adjusted suicide rates of 8 foreign nationals (Brazil, China, Korea, Peru, the Philippines, Thailand, the United Kingdom, and the United States) in Japan by sex from 1980 to the mid-2010s. We also computed rate ratios to compare the suicide rate of each group with those of the Japanese population. Second, we focused on Koreans, who had the highest suicide rate in Japan. We compared the suicide rates of Koreans in Japan with Koreans in South Korea to examine whether their suicide rates were more closely related to those of their country of origin or those of their host country.

Results

We found that the suicide rates of Koreans and Chinese in Japan were similar to or higher than those of Japanese, while other groups tended to show lower suicide rates. Most notably, Koreans displayed consistently high suicide rates from 1980 to the mid-2010s, which were nearly twice as high as those of the Japanese population. Korean males and females in Japan had higher suicide rates than those in South Korea.

Conclusions

Immigrants in Japan were not necessarily influenced by the suicide rates of the host country. The high suicide rates among Korean residents in Japan might be explained by various disadvantages and adversities that they face in Japan.

Assessment of the health status and health service perceptions of international migrants coming to Guangzhou, China, from high-, middle- and low-income countries

BACKGROUND

China, which used to be an export country for migrants, has become a new destination for international migrants due to its rapid economic growth. However, little empirical data is available on the health status of and health service access barriers faced by these international migrants.

METHODS

Foreigners who visited the Guangzhou Municipal Exit-Entry Administration Office to extend their visas were invited to participate in the study. Quantitative data were collected using electronic questionnaire in 13 languages. The participants were characterised by the income level of their country of origin (high-, middle- and low-income countries (HICs, MICs and LICs, respectively)), and the key factors associated with their health status, medical insurance coverage and perceptions of health services in China were examined.

RESULTS

Overall, 1146 participants from 119 countries participated in the study, 57.1, 25.1 and 17.8% of whom were from MICs, HICs and LICs, respectively. Over one fifth of the participants experienced health problems while staying in China, and about half had no health insurance. Although the participants from HICs were more likely than those from MICs and LICs to have medical insurance, they were also more likely to have health problems. Furthermore, 43.0, 45.0 and 12.0% of the participants thought that the health services in China were good, fair and poor, respectively. Among the participants, those from HICs were less likely to have positive feedback.

CONCLUSIONS

Our study is the first to report a quantitative survey of the health status, health insurance coverage, and health service perceptions of a diverse and surging population of international migrants in China. The findings call for more in-depth studies on the challenges presented by the increasing global migration to the health system.

Health and Well-Being of International University Students, and Comparison with Domestic Students, in Tasmania, Australia

International students comprise an increasingly larger proportion of higher education students globally. Empirical evidence about the health and well-being of these students is, however, limited. We sought to examine the health and well-being of international students, primarily from Asian countries, attending the University of Tasmania, Australia, using domestic students as a comparison group. Ethics approval was given to invite (via email) all currently enrolled students to participate in the study by completing a pilot-tested, online survey. The survey was completed by 382 international students (response rate = 8.9%) and 1013 domestic students (9.2%). Independent samples t-tests, analysis of variance (ANOVA) and chi-square tests were used for bivariate comparisons between international and domestic students, and between subgroups of international students. Regression models were used to examine the associations between student status (international vs. domestic) and health outcomes, controlling for demographic and enrolment variables. International students, particularly male students, were found to be at increased risk of several adverse health outcomes while also being less likely to seek help for mental health and related problems. The findings indicate the need for accessible, targeted, culturally-sensitive health promotion and early intervention programs.

Psychological distress and unmet mental health needs among urban taxi drivers: A cross-sectional survey

OBJECTIVES

The taxi industry relies on a male-dominated, predominately immigrant workforce who face multiple risk factors for poor mental health including shift work, low pay and threats of violence. Despite these risk factors, no previous study has documented the prevalence of psychological distress in the taxi industry. We investigated psychological distress among urban taxi drivers and explored the factors associated with high levels of distress.

METHOD

A total of 380 taxi drivers were surveyed at the Melbourne Airport holding yard between September 2016 and March 2017. Psychological distress was measured using the K10. Logistic regression models were used to estimate the association between high levels of psychological distress and migration, work patterns, potentially traumatic events, health care use and social connectedness.

RESULTS

A third (33%) of drivers had very high (K10 ⩾ 30) levels of distress and 28% had high (K10 = 22-29) levels of distress. Trauma was significantly associated with high levels of psychological distress, and rates of trauma were much higher among drivers than among the Australian population. Despite high levels of distress, drivers were no more likely than other Australian men to visit a health professional.

CONCLUSION

Urban taxi drivers are at very high risk for mental health problems, yet the mental health needs of this largely immigrant workforce has gone largely unnoticed. Interventions tailored to the unique characteristics of the job and the demographic composition of the workforce are urgently needed.

Non-prescribed antibiotic use and general practitioner service utilisation among Chinese migrants in Australia

Non-prescribed antibiotic use occurs worldwide and is an important contributor to antibiotic resistance. Social and health system factors were related to the practice of self-medication with antibiotics. This study aims to investigate the practice of non-prescribed antibiotic use, and to assess the impact of primary health service access and use on this practice among Australian Chinese migrants. Four-hundred and twenty-six participants, who self-identified as Chinese and who had been residing in Australia for at least 12 months, were recruited through several Australian Chinese social websites to participate in an online health survey about antibiotic use and health services use from July to October 2013. Logistic regression analyses were conducted to assess the associations between health services utilisation factors and the use of non-prescribed antibiotics. In total, 20.2% (86/426) participants reported having used antibiotics without medical consultation in the last 12 months. Of 170 antibiotic users, 50.6% (86/170) used antibiotics without medical consultation. Chinese migrants who self-evaluated as 'satisfied' with the experiences of GP services were less likely to self-medicate with antibiotics. In addition, Chinese migrants without any perceived barriers to using primary health services in Australia were less likely to use non-prescribed antibiotics. Among Australian Chinese migrants, over half of antibiotic users admitted that they had used antibiotics without medical consultation. Participants with positive experience and perception of primary health services, primarily GP services, had a lower risk of using non-prescribed antibiotics.

Neighbourhood disadvantage, geographic remoteness and body mass index among immigrants to Australia: A national cohort study 2006-2014

Obesity is socioeconomically, geographically and ethnically patterned. Understanding these elements of disadvantage is vital in understanding population obesity trends and the development of effective and equitable interventions. This study examined the relationship between neighbourhood socioeconomic disadvantage and geographic remoteness with prospective trends in mean body mass index (BMI) among immigrants to Australia. Longitudinal data (2006–2014) from a national panel survey of Australian adults was divided into an immigrant-only sample (n = 4,293, 52.6% women and 19,404 person-year observations). The data were analysed using multi-level random effects linear regression modelling that controlled for individual socioeconomic and demographic factors. Male immigrants living in the most disadvantaged neighbourhoods had significantly higher mean BMI compared with those living in the least disadvantaged. Over time, mean BMI increased for all groups except for men living in the least disadvantaged neighbourhoods, for whom mean BMI remained almost static (0.1 kg/m² increase from 2006 to 2014), effectively widening neighbourhood inequalities. Among women, mean BMI was also significantly higher in the most compared with the least, disadvantaged neighbourhoods (β = 2.08 kg/m²; 95%CI: 1.48, 2.68). Neighbourhood inequalities were maintained over time as mean BMI increased for all groups at a similar rate. Male and female immigrants residing in outer regional areas had significantly higher mean BMI compared with those living in major cities; however, differences were attenuated and no longer significant following adjustment for ethnicity, individual socioeconomic position and neighbourhood disadvantage. Over time, mean BMI increased in all male and female groups with no differences based on geographic remoteness. Obesity prevention policy targeted at immigrant cohorts needs to include area-level interventions that address inequalities in BMI arising from neighbourhood disadvantage, and be inclusive of immigrants living outside Australia’s major cities.

Comparison of Health and Risk Factors of Older, Working-age Australians, Italians and Italian-born Migrants to Australia, with Data from an Italian (PASSI), and an Australian (SAMSS) Risk Factor Surveillance System

Italian-born migrants (post-WWII) are the largest non-English-speaking background migrant group in South Australia. A cross-sectional, inter-country comparison using independent samples (40–69 years of age) from two (one in Australia, one in Italy) similar risk factor and chronic disease surveillance systems. None of the three groups (Italians, Australian-born and Italian-born Australians) had definitively worse health although the Italians had high rates for four of the seven risk factors reported (current high blood pressure, current high cholesterol, current smoking, eating less than five fruit and/or vegetables per day) than Australian-born and Italian-born Australians. Italian-born Australians had higher rates for insufficient physical activity, overweight/obese, poor self-reported health and diabetes. Australian respondents were more likely to report having two or more drinks of alcohol per day. Issues facing an ageing population require appropriate health care needs and an assessment of structural or cultural barriers to health services.

Cancer survival disparities worsening by socio-economic disadvantage over the last 3 decades in new South Wales, Australia

BACKGROUND

Public concerns are commonly expressed about widening health gaps. This cohort study examines variations and trends in cancer survival by socio-economic disadvantage, geographical remoteness and country of birth in an Australian population over a 30-year period.

METHODS

Data for cases diagnosed in New South Wales (NSW) in 1980-2008 (n = 651,245) were extracted from the population-based NSW Cancer Registry. Competing risk regression models, using the Fine & Gray method, were used for comparative analyses to estimate sub-hazard ratios (SHR) with 95% confidence intervals (CI) among people diagnosed with cancer.

RESULTS

Increased risk of cancer death was associated with living in the most socio-economically disadvantaged areas compared with the least disadvantaged areas (SHR 1.15, 95% CI 1.13-1.17), and in outer regional/remote areas compared with major cities (SHR 1.05, 95% CI 1.03-1.06). People born outside Australia had a similar or lower risk of cancer death than Australian-born (SHR 0.99, 95% CI 0.98-1.01 and SHR 0.91, 95% CI 0.90-0.92 for people born in other English and non-English speaking countries, respectively). An increasing comparative risk of cancer death was observed over time when comparing the most with the least socio-economically disadvantaged areas (SHR 1.07, 95% CI 1.04-1.10 for 1980-1989; SHR 1.14, 95% CI 1.12-1.17 for 1990-1999; and SHR 1.24, 95% CI 1.21-1.27 for 2000-2008; p < 0.001 for interaction between disadvantage quintile and year of diagnosis).

CONCLUSIONS

There is a widening gap in comparative risk of cancer death by level of socio-economic disadvantage that warrants a policy response and further examination of reasons behind these disparities.

U-Shaped Relationship between Years of Residence and Negative Mental Health Outcomes among Rural-to-Urban Children in Migrant Schools in Beijing, China: The Moderating Effects of Socioeconomic Factors

AIM

This study aimed to test the relationship between length of residence and mental health in a school-based sample of migrant children who studied in migrant schools.

METHODS

A total of 7,296 rural-to-urban migrant children were recruited from 58 schools in Beijing and assessed by the State-Trait Anxiety Inventory and Children's Depression Inventory.

RESULTS

A quadratic relationship was found between mental health and length of residence. The results suggested that the scores for anxiety and depression were high during the initial resettlement after migrating and then decreased. However, after approximately 8 years, the scores increased. Our findings also showed a significant moderating effect of family socioeconomic status on the relation between mental health and length of residence.

CONCLUSION

This study provided empirical evidence for a better understanding of psychosocial factors on the mental health of migrant children during the process of urbanization in China.

Lifestyle behaviours of Lebanese-Australians: Cross-sectional findings from The 45 and Up Study

Little is known regarding the health and lifestyle behaviours of Australians of Lebanese ethnicity. The available evidence suggests that Australians of Lebanese ethnicity who were born in Lebanon reportedly have higher rates of cardiovascular disease-related and type 2 diabetes-related complications when compared with the wider Australian population. The aim of this study is to compare lifestyle behaviours of middle-aged to older adults of Lebanese ethnicity born in Lebanon, Australia, and elsewhere to those of Australian ethnicity. Participants were 37,419 Australians aged ≥45 years, from the baseline dataset of The 45 and Up Study which included 4 groups of interest: those of Australian ethnicity (n = 36,707) [Reference]; those of Lebanese ethnicity born in Lebanon (n = 346); 302 those of Lebanese ethnicity born in Australia (n = 302); and those of Lebanese ethnicity born elsewhere (n = 64). Multilevel logistic regression was used to examine the odds of those of Lebanese ethnicity reporting suboptimal lifestyle behaviours (insufficient physical activity, prolonged sitting, smoking, sleep duration, and various diet-related behaviours) relative to those of Australian ethnicity. Multilevel linear regression was used to examine the clustering of suboptimal lifestyle behaviours through a ‘lifestyle index’ score ranging from 0–9 (sum of all lifestyle behaviours for each subject). The lifestyle index score was lower among Lebanese-born (-0.36, 95% CI -0.51, -0.22, p<0.001) and Australian-born (-0.17, 95% CI -0.32, -0.02, p = 0.031) people of Lebanese ethnicity in comparison to those of Australian ethnicity. Those of Lebanese ethnicity born in Lebanon had higher odds of reporting suboptimal lifestyle behaviours for physical activity, smoking, and sleep duration, and lower odds of reporting optimal lifestyle behaviours for sitting time, fruit, processed meat, and alcohol consumption, when compared with those of Australian ethnicity. Differences in the individual lifestyle behaviours for those of Lebanese ethnicity born in Australia and elsewhere compared with those of Australian ethnicity were fewer. Lifestyle behaviours of those of Lebanese ethnicity vary by country of birth and a lower level of suboptimal lifestyle behaviour clustering was apparent among Lebanese-born and Australian-born middle-aged to older adults of Lebanese ethnicity.

Pre-pregnancy BMI-specific optimal gestational weight gain for women in Japan

Background

The Institute of Medicine (IOM) guidelines are the most widely used guidelines on gestational weight gain; however, accumulation of evidence that body composition in Asians differs from other races has brought concern regarding whether their direct application is appropriate. We aimed to study to what extent optimal gestational weight gain among women in Japan differs by pre-pregnancy body mass index (BMI) and to compare estimated optimal gestational weight gain to current Japanese and Institute of Medicine (IOM) recommendations.

Methods

We retrospectively studied 104,070 singleton pregnancies among nulliparous women in 2005–2011 using the Japanese national perinatal network database. In five pre-pregnancy BMI sub-groups (17.0–18.4, 18.5–19.9, 20–22.9, 23–24.9, and 25–27.4 kg/m²), we estimated the association of the rate of gestational weight gain with pregnancy outcomes (fetal growth, preterm delivery, and delivery complications) using multivariate regression.

Results

Weight gain rate associated with the lowest risk of adverse outcomes decreased with increasing BMI (12.2 kg, 10.9 kg, 9.9 kg, 7.7 kg, and 4.3 kg/40 weeks) for the five BMI categories as described above, respectively. Current Japanese guidelines were lower than optimal gains, with the lowest risk of adverse outcomes for women with BMI below 18.5 kg/m², and current IOM recommendations were higher than optimal gains for women with BMI over 23 kg/m².

Conclusion

Optimal weight gain during pregnancy varies largely by pre-pregnancy BMI, and defining those with BMI over 23 kg/m² as overweight, as proposed by the World Health Organization, may be useful when applying current IOM recommendations to Japanese guidelines.

•

We estimated gestational weight gain that optimizes pregnancy outcomes in Japanese.

•

Optimal gain was 12.2 kg/40 weeks for pre-pregnancy BMI 17.0–18.4 kg/m².

•

Optimal gain was 4.3 kg/40 weeks for pre-pregnancy BMI 25.0–27.4 kg/m².

•

Current national guidelines are too low for women with pre-pregnancy BMI < 18.5 kg/m².

•

BMI > 23 kg/m² should be defined as overweight if applying IOM recommendations.

Ethnic status and engagement with health services: Attitudes toward help-seeking and intercultural willingness to interact among South East Asian students in Australia

Previous research has demonstrated the importance of intercultural willingness to interact; however, these investigations have yet to be applied to a health context or to compare an ethnic minority with a majority sample. Consequently, the current study sought to better understand engagement with health services by investigating both attitudes towards seeking psychological help and intercultural willingness to interact within an ethnic minority South East Asian population, relative to an Anglo Australian sample. As predicted, negative attitudes towards seeking psychological help were higher in the South East Asian sample, with this relationship persisting across generations, despite significant differences in acculturation. In contrast, intercultural willingness to interact was not associated with ethnicity status but was associated with higher anxiety, uncertainty, ethnocentrism and help-seeking, consistent with current empirical and theoretical literature. The current study also sought to examine factors associated with help-seeking attitudes and found that ethnocentrism was a significant predictor, when accounting for previous health experience.

Ethnic differences in overweight and obesity and the influence of acculturation on immigrant bodyweight: evidence from a national sample of Australian adults

Background

Despite growing international migration and documented ethnic differences in overweight and obesity in developed countries, no research has described the epidemiology of immigrant overweight and obesity at a national level in Australia, a country where immigrants comprise 28.1 % of the population. The aim of this study was to examine ethnic differences in body mass index (BMI) and overweight/obesity in Australia and the influence of acculturation on bodyweight among Australian immigrants.

Methods

Data from the national Household Income and Labour Dynamics in Australia (HILDA) survey were used to examine mean BMI and odds of overweight/obesity comparing immigrants (n = 2 997) with Australian born (n = 13 047). Among immigrants, acculturation differences were examined by length of residence in Australia and age at migration. Data were modelled in a staged approach using multilevel linear and logistic regression, controlling for demographic and socioeconomic variables.

Results

Relative to Australian born, men from North Africa/Middle East and Oceania regions had significantly higher BMIs, and men from North West Europe, North East Asia and Southern and Central Asia had significantly lower BMIs. Among women, the majority of foreign born groups had significantly lower BMIs compared with Australian born. Male and female immigrants living in Australia for 15 years or more had significantly higher BMIs and increased odds of being overweight/obese respectively, compared with immigrants living in Australia for less than 5 years. Male immigrants arriving as adolescents were twice more likely to be overweight/obese and had significantly higher BMIs than immigrants who arrived as adults. Male and female immigrants who arrived as children (≤11 years) had significantly higher odds of adult overweight/obesity and BMIs.

Conclusions

This study provides evidence of ethnic differences in overweight and obesity in Australia with male immigrants from North Africa/Middle East and Oceania regions being particularly vulnerable. In addition, this study suggests that greater acculturation may negatively impact immigrant bodyweight and recently arrived immigrants as well as those who arrive as children or adolescents may benefit from obesity prevention intervention. Public health policy targeted at and tailored to these immigrant cohorts will assist in the multi-pronged approach required to address the obesity epidemic.

The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews

BACKGROUND

First generation migrants are reportedly at higher risk of mental ill-health compared to the settled population. This paper systematically reviews and synthesizes all reviews on the mental health of first generation migrants in order to appraise the risk factors for, and explain differences in, the mental health of this population.

METHODS

Scientific databases were searched for systematic reviews (inception-November 2015) which provided quantitative data on the mental ill-health of first generation migrants and associated risk factors. Two reviewers screened titles, abstracts and full text papers for their suitability against pre-specified criteria, methodological quality was assessed.

RESULTS

One thousand eight hundred twenty articles were identified, eight met inclusion criteria, which were all moderate or low quality. Depression was mostly higher in first generation migrants in general, and in refugees/asylum seekers when analysed separately. However, for both groups there was wide variation in prevalence rates, from 5 to 44 % compared with prevalence rates of 8-12 % in the general population. Post-Traumatic Stress Disorder prevalence was higher for both first generation migrants in general and for refugees/asylum seekers compared with the settled majority. Post-Traumatic Stress Disorder prevalence in first generation migrants in general and refugees/ asylum seekers ranged from 9 to 36 % compared with reported prevalence rates of 1-2 % in the general population. Few studies presented anxiety prevalence rates in first generation migrants and there was wide variation in those that did. Prevalence ranged from 4 to 40 % compared with reported prevalence of 5 % in the general population. Two reviews assessed the psychotic disorder risk, reporting this was two to three times more likely in adult first generation migrants. However, one review on the risk of schizophrenia in refugees reported similar prevalence rates (2 %) to estimates of prevalence among the settled majority (3 %). Risk factors for mental ill-health included low Gross National Product in the host country, downward social mobility, country of origin, and host country.

CONCLUSION

First generation migrants may be at increased risk of mental illness and public health policy must account for this and influencing factors. High quality research in the area is urgently needed as is the use of culturally specific validated measurement tools for assessing migrant mental health.

Epidemiology of Substance Use among Forced Migrants: A Global Systematic Review

INTRODUCTION

Forced migration is occurring at unprecedented levels. Forced migrants may be at risk for substance use for reasons including coping with traumatic experiences, co-morbid mental health disorders, acculturation challenges and social and economic inequality. This paper aimed to systematically review the literature examining substance use among forced migrants, and identify priority areas for intervention and future research.

METHODS

Seven medical, allied health and social science databases were searched from inception to September 2015 in accordance with PRISMA guidelines to identify original peer-reviewed articles describing any findings relating to alcohol and/or illicit drug use among refugees, internally displaced people (IDPs), asylum seekers, people displaced by disasters and deportees. A descriptive synthesis of evidence from quantitative studies was conducted, focusing primarily on studies which used validated measures of substance use. Synthesis of evidence from qualitative studies focused on identifying prominent themes relating to the contexts and consequences of substance use. Critical Appraisal Skills Programme (CASP) checklists were used to assess methodological quality of included studies.

RESULTS

Forty-four quantitative (82% cross-sectional), 16 qualitative and three mixed-methods studies were included. Ten studies were rated as high methodological quality (16%), 39 as moderate quality (62%) and 14 as low quality (22%). The majority of research was conducted among refugees, IDPs and asylum seekers (n = 55, 87%), predominantly in high-income settings. The highest-quality prevalence estimates of hazardous/harmful alcohol use ranged from 17%-36% in camp settings and 4%-7% in community settings. Few studies collected validated measures of illicit drug use. Seven studies compared substance use among forced migrants to other migrant or native-born samples. Among eight studies which conducted multivariable analysis, male sex, trauma exposure and symptoms of mental illness were commonly identified correlates of substance use.

CONCLUSION

Our understanding of substance use among forced migrants remains limited, particularly regarding persons displaced due to disasters, development and deportation. Despite a growing body of work among refugee-background populations, few studies include refugees in low and middle-income countries, where over 80% of the global refugee population resides. Findings suggest a need to integrate substance use prevention and treatment into services offered to forced migrants, particularly in camp settings. Efforts to develop and evaluate interventions to reduce substance use and related harms are needed.

Factors associated with psychological distress or common mental disorders in migrant populations across the world

We systematically review factors associated with the presence of psychological distress or common mental disorders in migrant populations. Articles published between January 2000 and December 2014 were reviewed and 85 applying multivariate statistical analysis were selected. Common mental disorders were significantly associated with socio-demographic and psychological characteristics, as observed in large epidemiological studies on general populations. The probability of common mental disorders occurrence differs significantly among migrant groups according to their region of origin. Moreover, traumatic events prior to migration, forced, unplanned, poorly planned or illegal migration, low level of acculturation, living alone or separated from family in the host country, lack of social support, perceived discrimination, and the length of migrants' residence in the host country all increase the likelihood of CMD. In contrast, language proficiency, family reunification, and perceived social support reduce such probability. Factors related with the risk of psychiatric morbidity among migrants should be taken into account to design preventive strategies.

Can oral vitamin D prevent the cardiovascular diseases among migrants in Australia? Provider perspective using Markov modelling

The study was designed to model the effectiveness and cost effectiveness of oral Vitamin D supplementation as a primary prevention strategy for cardiovascular disease among a migrant population in Australia. It was carried out in the Community Health Service, Kensington, Melbourne. Best-case scenario analysis using a Markov model was employed to look at the health care providers' perspective. Adult migrants who were vitamin D deficient and free from cardiovascular disease visiting the medical centre at least once during the period from 1 January 2010 to 31 December 2012 were included in the study. The blood pressure-lowering effect of vitamin D was taken from a published meta-analysis and applied in the Framingham 10 year cardiovascular risk algorithm (with and without oral vitamin D supplements) to generate the probabilities of cardiovascular events. A Markov decision model was used to estimate the provider costs associated with the events and treatments. Uncertainties were derived by Monte Carlo simulation. Vitamin D oral supplementation (1000 IU/day) for 10 years could potentially prevent 31 (interquartile range (IQR) 26 to 37) non-fatal and 11 (IQR 10 to 15) fatal cardiovascular events in a migrant population of 10,000 assuming 100% compliance. The provider perspective incremental cost effectiveness per year of life saved was AU$3,992 (IQR 583 to 8558). This study suggests subsidised supplementation of oral vitamin D may be a cost effective intervention to reduce non-fatal and fatal cardiovascular outcomes in high-risk migrant populations.

Improving the identification of priority populations to increase hepatitis B testing rates, 2012

Background

It is estimated that over 40 % of the 218,000 people with chronic hepatitis B (CHB) in Australia in 2011 are undiagnosed. A disproportionate number of those with undiagnosed infection were born in the Asia-Pacific region. Undiagnosed CHB can lead to ongoing transmission and late diagnosis limits opportunities to prevent progression to hepatocellular carcinoma (HCC) and cirrhosis.

Strategies are needed to increase testing for hepatitis B virus (HBV) (including culturally and linguistically diverse communities, Aboriginal and/or Torres Strait Islander (Indigenous) people and people who inject drugs). General practitioners (GPs) have a vital role in increasing HBV testing and the timely diagnosis CHB. This paper describes the impact of a GP-based screening intervention to improve CHB diagnosis among priority populations in Melbourne, Australia.

Methods

A non-randomised, pre-post intervention study was conducted between 2012 and 2013 with three general practices in Melbourne, Australia. Using clinic electronic health records three priority populations known to be at increased CHB risk in Australia (1: Asian-born patients or patients of Asian ethnicity living in Australia; 2: Indigenous people; or 3): people with a history of injecting drugs were identified and their HBV status recorded. A random sample were then invited to attend their GP for HBV testing and/or vaccination. Baseline and follow-up electronic data collection identified patients that subsequently had a consultation and HBV screening test and/or vaccination.

Results

From a total of 33,297 active patients, 2674 (8 %) were identified as a priority population at baseline; 2275 (85.1 %) of these patients had unknown HBV status from which 338 (14.0 %) were randomly sampled. One-fifth (n = 73, 21.6 %) of sampled patients subsequently had a GP consultation during the study period; only four people (5.5 %) were subsequently tested for HBV (CHB detected in n = 1) and none were vaccinated against HBV.

Conclusion

CHB infection is an important long-term health issue in Australia and strategies to increase appropriate and timely testing are required. The study was effective at identifying whether Asian-born patients and patients of Asian had been tested or vaccinated for HBV; however the intervention was not effective at increasing HBV testing.

Lifestyle Behaviors Predict Negative and Positive Changes in Self-reported Health

Studies of changes in health following immigration are inconsistent, and few are based on longitudinal designs to test associations based on change. This study identified factors that predicted changes in self-reported health (SRH) among California residents of Korean descent. A sample of California residents of Korean descent were interviewed and followed-up 2 or 3 times by telephone during 2001-2009. The questionnaires dealt with SRH, lifestyle behaviors (smoking, physical activity, and fast food consumption), and socioeconomic measures. Statistical analysis included random-intercepts longitudinal regression models predicting change in SRH. A similar percentage of respondents reported improved and deteriorating SRH (30.3% and 29.1%, respectively). Smoking, consumption of fast foods, age, percentage of life spent in the United States, and being female were predictors of deteriorating SRH, whereas physical activity, education, and living with a partner were predictive of improvement in SRH. The effect of immigration on SRH is influenced by socioeconomic factors and lifestyle practices. Results support promotion of healthy lifestyle practices among immigrants.

EFFECT OF NATIVITY AND DURATION OF RESIDENCE ON CHRONIC HEALTH CONDITIONS AMONG ASIAN IMMIGRANTS IN AUSTRALIA: A LONGITUDINAL INVESTIGATION

This study examined the effect of Asian nativity and duration of residence in Australia on the odds of reporting a chronic health condition (cancer, respiratory problems, cardiovascular disease (CVD) and diabetes mellitus). Data were from waves 3, 7 and 9 of the Household Income and Labour Dynamics in Australia (HILDA) longitudinal survey, and multi-level group-mean-centred logistic regression models were used for the analysis. After covariate adjustment, Asian immigrants were less likely to report cancer and respiratory problem compared with native-born Australians. While there was no significant difference in reporting CVD, they were more likely to report diabetes than native-born people. Asian immigrants maintained their health advantage with respect to cancer regardless of duration of residence. However, after 20 years of stay, Asian immigrants lost their earlier advantage and were not significantly different from native-born people in terms of reporting a respiratory problem. In contrast, Asian immigrants were not measurably different from native-born Australians in reporting diabetes if their length of stay in Australia was less than 20 years, but became disadvantaged after staying for 20 years or longer. There was no measurable difference in the odds of reporting CVD between Asian immigrants and native-born Australians for any duration of residence. On the whole this study found that health advantage, existence of healthy immigrant effect and subsequent erosion of it with increasing duration of residence among Asian immigrants depends upon the chronic health condition.

Are immigrants responsible for the recent decline in Australian suicide rates?

AIMS

This study aims to examine Queensland suicide trends in the Australian-born population and in the overseas-born populations over the past 2 decades.

METHODS

All suicide cases for the period 1991-2009 were identified in the Queensland Suicide Register. Age-standardised suicide rates were calculated. Joinpoint regression and Poisson regression were applied.

RESULTS

A significant decline in suicide rates of young (15-44 years) overseas-born males was reported over the past 2 decades. Australian-born young males showed significant increase until 1996, followed by a significant decline; furthermore, their suicide rates were significantly higher when compared to overseas-born (RR = 1.36, 95%CI: 1.15; 1.62). Contrary older Australian-born males (45+ years) had significantly lower suicide rates than overseas-born males (RR = 0.90, 95%CI: 0.83; 0.98). Despite the convergence of the suicide trends for older males, changes were not significant. While Australian-born females had a significant increase in suicides, overseas-born females had a decline in 1991-2009.

CONCLUSION

Significantly declining suicide rates of migrants have contributed to the declining in suicide trends in Queensland. Potential reasons for significantly lower suicide rates among young migrants might include the change in the nature of migration from involuntary to voluntary.

What are the health needs, familial and social problems of Thai migrants in a local community in Australia? A focus group study

This study explored the health needs, familial and social problems of Thai migrants in a local community in Brisbane, Australia. Five focus groups with Thai migrants were conducted. The qualitative data were examined using thematic content analysis that is specifically designed for focus group analysis. Four themes were identified: (1) positive experiences in Australia, (2) physical health problems, (3) mental health problems, and (4) familial and social health problems. This study revealed key health needs related to chronic disease and mental health, major barriers to health service use, such as language skills, and facilitating factors, such as the Thai Temple. We concluded that because the health needs, familial and social problems of Thai migrants were complex and culture bound, the development of health and community services for Thai migrants needs to take account of the ways in which Thai culture both negatively impacts health and offer positive solutions to problems.