'Imported risk' or 'health transition'? Smoking prevalence among ethnic German immigrants from the Former Soviet Union by duration of stay in Germany - analysis of microcensus data

<p>Abstract</p> <p>Background</p> <p>It can be assumed that <it>resettlers </it>(ethnic German immigrants from the Former Soviet Union) show similar smoking patterns as persons in their countries of origin at the time of migration. We analysed how the smoking prevalence among <it>resettlers </it>differs from that among the general population of Germany and whether the prevalence differs between groups with increasing duration of stay.</p> <p>Methods</p> <p>To estimate the smoking prevalence we used the scientific-use-file (n = 477,239) of the German 2005 microcensus, an annual census representing 1% of all German households. Participation in the microcensus is obligatory (unit-nonresponse <7%). We stratified the prevalence of smoking among <it>resettlers </it>and the comparison group (population of Germany without <it>resettlers</it>) by age, sex, educational level and duration of stay. In total, 14,373 (3% of the total) persons were identified as <it>resettlers</it>.</p> <p>Results</p> <p>Female <it>resettlers </it>with short duration of stay had a significantly lower smoking prevalence than women in the comparison group. With increasing duration of stay their smoking prevalence appears to converge to that of the comparison group (e.g.: high educational level, age group 25-44 years: short duration of stay 15%, long duration of stay 24%, comparison group 28%). In contrast, the smoking prevalence among male <it>resettlers </it>with short duration of stay was significantly higher than that among men in the comparison group, but also with a trend towards converging (e.g.: high educational level, age group 25-44 years: short duration of stay 44%, long duration of stay 35%, comparison group 36%). Except for female <it>resettlers </it>with short duration of stay, the participants with low educational level had on average a higher smoking prevalence than those with a high educational level.</p> <p>Conclusions</p> <p>This is the first study estimating the smoking prevalence among <it>resettlers </it>by duration of stay. The results support the hypothesis that <it>resettlers </it>brought different smoking habits from their countries of origin shortly after migration. The observed convergence of the smoking habits with increasing duration of stay is in line with the hypothesis of migration as 'health transition'. However, due to the cross-sectional design of the study, further research is needed to confirm these findings.</p

Die Entwicklung des Rauchverhaltens im Kontext der Migration nach Deutschland : eine Synthese von Theorie und Empirie

Reiss K. Die Entwicklung des Rauchverhaltens im Kontext der Migration nach Deutschland : eine Synthese von Theorie und Empirie. Bielefeld: Universität Bielefeld; 2016

Unconscious bias in organizations: Discriminatory forces at work

This special issue revolves around the topic of unconscious bias in organizations. The six articles included draw on diverse disciplinary, theoretical, and methodological approaches to show how unconscious bias play out in organizational settings and how they lead to various forms of discrimination. The articles contribute to the current bias literature by (1) elevating the idea of bias from individualist perspectives toward more contextual considerations, (2) drawing on multiple perspectives from different research fi elds and thereby creating a more interdisciplinary understanding, (3) considering unconscious and discriminatory gender bias in intersection with other markers of social inequality, and (4) by reframing current understandings of bias in organizations toward a more actionable and change-oriented perspective. To conclude, the special issue illustrates novel approaches to and discussions on the matter of investigating bias at the root of discrimination in organizations.This special issue revolves around the topic of unconscious bias in organizations. The six articles included draw on diverse disciplinary, theoretical, and methodological approaches to show how unconscious bias play out in organizational settings and how they lead to various forms of discrimination. The articles contribute to the current bias literature by (1) elevating the idea of bias from individualist perspectives toward more contextual considerations, (2) drawing on multiple perspectives from different research fi elds and thereby creating a more interdisciplinary understanding, (3) considering unconscious and discriminatory gender bias in intersection with other markers of social inequality, and (4) by reframing current understandings of bias in organizations toward a more actionable and change-oriented perspective. To conclude, the special issue illustrates novel approaches to and discussions on the matter of investigating bias at the root of discrimination in organizations

Effect of Length of Stay on Smoking among Turkish and Eastern European Immigrants in Germany—Interpretation in The Light of the Smoking Epidemic Model and the Acculturation Theory

Reiss K, Schunck R, Razum O. Effect of Length of Stay on Smoking among Turkish and Eastern European Immigrants in Germany—Interpretation in The Light of the Smoking Epidemic Model and the Acculturation Theory. International Journal of Environmental Research and Public Health. 2015;12(12):15925-15936.Background: We analyzed changes in smoking by length of stay among immigrants in Germany and related them to the “smoking epidemic” model and the acculturation theory. Methods: We used data from a longitudinal survey (German Socio-economic Panel). Immigrants were identified by country of birth (Turkey: respondents n = 828, observations n = 3871; Eastern Europe: respondents n = 2009, observations n = 7202; non-immigrants: respondents n = 34,011, observations n = 140,701). Smoking status data was available for nine years between 1998 and 2012. Length of stay (LOS, in years) was used as proxy for acculturation. We calculated smoking prevalences, prevalence ratios and a random intercept multilevel logistic regression model. Results: With each year spent in Germany, smoking prevalence increases among Turkish women (OR = 1.14 (95%CI = 1.06–1.21)) and slightly decreases among men. Recently immigrated Turkish women smoke less than non-immigrant women (0–5 years: SPR = 0.25 (95%CI = 0.10–0.57)); prevalences converge with increasing LOS (31+ years: SPR = 1.25 (95%CI = 1.06–1.48)). Among Eastern European immigrants no significant changes were apparent. Conclusions: Immigrants from Turkey “import” their smoking prevalence from a country which is in the earlier stages of the “smoking epidemic”. With increasing LOS (thus, advancing acculturation), they “move” to the later stages. Anti-smoking interventions should consider different smoking attitudes in Turkey/Germany and need to discourage women from initiating smoking. Future research should also identify reasons for the possible differences between immigrant groups

Factors associated with smoking in immigrants from non-western to western countries – what role does acculturation play? A systematic review

Reiss K, Lehnhardt J, Razum O. Factors associated with smoking in immigrants from non-western to western countries – what role does acculturation play? A systematic review. Tobacco Induced Diseases. 2015;13(1): 11.Introduction We aimed to identify factors associated with smoking among immigrants. In particular, we investigated the relationship between acculturation and smoking, taking into consideration the stage of the ‘smoking epidemic’ in the countries of origin and host countries of the immigrants. Methods We searched PubMed for peer-reviewed quantitative studies. Studies were included if they focused on smoking among adult immigrants (foreign-born) from non-western countries now residing in the USA, Canada, Ireland, Germany, the Netherlands, Norway, the UK, and Australia. Studies were excluded if, among others, a distinction between immigrants and their (native-born) offspring was not made. Results We retrieved 27 studies published between 1998 and 2013. 21 of the 27 studies focused on acculturation (using bidimensional multi-item scales particularly designed for the immigrant group under study and/or proxy measures such as language proficiency or length of stay in host country) and 16 of those found clear differences between men and women: whereas more acculturated women were more likely to smoke than less acculturated women, the contrary was observed among men. Conclusion Immigrants’ countries of origin and host countries have reached different stages of the ‘smoking epidemic’ where, in addition, smoking among women lags behind that in men. Immigrants might ‘move’ between the stages as (I) the (non-western) countries of origin tend to be in the early phase, (II) the (western) host countries more in the advanced phase of the epidemic and (III) the arrival in the host countries initiates the acculturation process. This could explain the ‘imported’ high (men)/low (women) prevalence among less acculturated immigrants. The low (men)/high (women) prevalence among more acculturated immigrants indicates an adaptation towards the social norms of the host countries with ongoing acculturation

cross-sectional study

Objective: Research on health services for immigrants has mostly been concerned with access barriers but rarely with appropriateness and responsiveness of care. We assessed whether appropriateness and responsiveness of care depend on migration status, using provision of neuraxial anaesthesia (NA) during labour as indicator. In relation to their migration status, we analysed whether (1) women undergoing elective or secondary/urgent secondary caesarean sections (ESCS) appropriately receive NA (instead of general anaesthesia), (2) women delivering vaginally appropriately receive NA and (3) women objecting to NA, for example, for religious reasons, may deliver vaginally without receiving NA (provider responsiveness). Design: Cross- sectional study. Setting: Three obstetric hospitals in Berlin, Germany. Methods: Questionnaire survey covering 6391 women with migration history (first and second generations) and non-immigrant women giving birth; data linkage with routine obstetric data. We assessed the effects of migrant status, German language proficiency, religion and education on the provision of NA (primary outcome) after adjusting for other maternal and obstetric parameters. Results: The chance of receiving NA for elective/ESCS was independent of migrant status after controlling for confounding variables (adjusted OR (aOR) 0.93, 95% CI 0.65 to 1.33). In vaginal deliveries, first (but not second) generation women (aOR 0.79, 95% CI 0.65 to 0.95), women with low German language skills (aOR 0.77, 95% CI 0.58 to 0.99) and women with low educational attainment (aOR 0.62, 95% CI 0.47 to 0.82) had lower chances of receiving NA; there was no evidence of overprovision among women with strong affinity to Islam (aOR 0.77, 95% CI 0.63 to 0.94). Conclusions: We found evidence for underprovision of care among first-generation immigrants, among women with low German language proficiency and particularly among all women with low educational attainment, irrespective of migration status. There was no evidence for overprovision of care to immigrant women, either inappropriately (general anaesthesia for ESCS) or because of low provider responsiveness (no opt-out for NA in vaginal delivery)

Sobre la presència de Teucrium pumilum i Teucrium libanitis (Lamiaceae) a la província de València.

12p. fotog.color.[EN] About the presence of Teucrium pumilum and Teucrium libanitis (Lamiaceae) in the Valencian province, Spain.- Teucrium pumilum and T. libanitis have been cited from Valencia province (Spain) since the middle of the XXth Century from the gypsic soils in the Valle de Ayora-Cofrentes shire. The analysis of specimens and labels is not conclusive; no specimen would certify the presence of any of these taxa. The field identification and their inclusion in a phyotosociological table (relevé) by Rivas Goday are the only basis of their presence in the territory in a particular moment of the recent Spanish botanical history. Additionally, the unique herbarium specimen from Valencia, impossible to assign a concrete geographic locality, which was traditionally assigned to T. pumilum by some authors, is actually its congeneric T. carolipaui.[ES] Sobre la presencia de Teucrium pumilum y Teucrium libanitis (Lamiaceae) en la provincia de Valencia.- Teucrium pumilum y T. libanitis son dos especies que han sido citadas como presentes en la provincia de Valencia desde mediados del siglo XX, para los yesos que afloran en la comarca del Valle de Ayora-Cofrentes. El análisis de las etiquetas de los pliegos de los herbarios no es concluyente; ningún pliego testigo certificaría la presencia de estas especies. La determinación de visu por parte de Rivas Goday, y su inclusión en una tabla de inventarios fitosociológica, son el único fundamento de su existencia en la zona en algún momento determinado de la reciente historia botánica española. Además, para T. pumilum, el pliego de herbario que tradicionalmente se ha asignado a la cita valenciana se trata de una confusión en la determinación por parte de algunos autores con su congénere T. carolipaui, siendo imposible al mismo tiempo asignar una localidad geográfica concreta a este material.[CAT] Sobre la presència de Teucrium pumilum i Teucrium libanitis (Lamiaceae) a la província de València.- Teucrium pumilum i T. libanitis són dues espècies que han estat citades com a presents a la província de València des de mitjans del segle XX, sobre els guixos que afloren a la comarca de la Vall d’Aiora-Cofrents. L’anàlisi de les etiquetes dels plecs dels herbaris no és concloent; cap plec testimoni certificaria la presència d’aquestes espècies. La determinació de visu per part de Rivas Goday, i la seva inclusió en una taula d’inventaris fitosociològica, són l’únic fonament de la seva existència a la zona en un moment determinat de la recent història botànica espanyola. A més, per a T. pumilum, el plec d’herbari que tradicionalment s’ ha assignat a la cita valenciana es tracta d’una confusió en la determinació per part d’alguns autors amb el seu congènere.Peer reviewe

How immigrants adapt their smoking behaviour: comparative analysis among Turkish immigrants in Germany and the Netherlands

Reiss K, Sauzet O, Breckenkamp J, Spallek J, Razum O. How immigrants adapt their smoking behaviour: comparative analysis among Turkish immigrants in Germany and the Netherlands. BMC Public Health. 2014;14(1): 844.Background Smoking behaviour among immigrants is assumed to converge to that of the host country’s majority population with increasing duration of stay. We compared smoking prevalence among Turkish immigrants residing in two different countries (Germany (DE)/the Netherlands (NL)) between and within countries by time spent in Turkey and DE/NL. Methods The German 2009 micro-census and the Dutch POLS database (national survey, 1997–2004) were analysed. An interaction variable with dichotomised length of stay (LOS) in Turkey (age: 0–17; 18+) and categorised LOS in the host country (immigration year: 1979 and earlier, 1980–1999, 2000–2009; the latter only for Germany) was generated. Age standardised smoking prevalences and sex-specific logistic regression models were calculated. Results 6,517 Turkish participants were identified in Germany, 2,106 in the Netherlands. Age-standardised smoking prevalences were higher among Turkish immigrants in the Netherlands compared to those in Germany: 62.3% vs. 53.1% (men/lower education); 30.6% vs. 23.0% (women/lower education). A similar trend was observed for the majority population of both countries. The chance of being a smoker was lower among Turkish men with short LOS in Turkey and middle LOS in Germany/the Netherlands compared to those with short LOS in Turkey and long LOS in Germany/the Netherlands (NL: OR = 0.57[95% CI = 0.36-0.89]; DE: OR = 0.73[95% CI = 0.56-0.95]). Contrary to that, the chance of being a smoker was higher among Turkish men with long LOS in Turkey and middle LOS in Germany/the Netherlands compared to those with long LOS in Turkey and long LOS in Germany/the Netherlands (NL: OR = 1.35[95% CI = 0.79-2.33]; DE: OR = 1.44[95% CI = 1.03-2.02]). The effects for Turkish women were similar, but smaller and often non-significant. Conclusion Turkish immigrants adapt their smoking behaviour towards that of the Dutch/German majority population with increasing duration of stay. This was particularly obvious among those who left Turkey before the age of 18 years – a group that needs tailored interventions to prevent further increases in smoking. Those who left Turkey as adults and spent a short time in the host countries show ‘imported’ smoking patterns. A limitation of this study is the use of cross-sectional data: a cohort effect cannot be ruled out. Our findings have to be confirmed with longitudinal data

Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study

Razum O, Reiss K, Breckenkamp J, et al. Comparing provision and appropriateness of health care between immigrants and non-immigrants in Germany using the example of neuraxial anaesthesia during labour: cross-sectional study. BMJ Open. 2017;7(8): e015913.Objective Research on health services for immigrants has mostly been concerned with access barriers but rarely with appropriateness and responsiveness of care. We assessed whether appropriateness and responsiveness of care depend on migration status, using provision of neuraxial anaesthesia (NA) during labour as indicator. In relation to their migration status, we analysed whether (1) women undergoing elective or secondary/urgent secondary caesarean sections (ESCS) appropriately receive NA (instead of general anaesthesia), (2) women delivering vaginally appropriately receive NA and (3) women objecting to NA, for example, for religious reasons, may deliver vaginally without receiving NA (provider responsiveness). Design Cross-sectional study. Setting Three obstetric hospitals in Berlin, Germany. Methods Questionnaire survey covering 6391 women with migration history (first and second generations) and non-immigrant women giving birth; data linkage with routine obstetric data. We assessed the effects of migrant status, German language proficiency, religion and education on the provision of NA (primary outcome) after adjusting for other maternal and obstetric parameters. Results The chance of receiving NA for elective/ESCS was independent of migrant status after controlling for confounding variables (adjusted OR (aOR) 0.93, 95% CI 0.65 to 1.33). In vaginal deliveries, first (but not second) generation women (aOR 0.79, 95% CI 0.65 to 0.95), women with low German language skills (aOR 0.77, 95% CI 0.58 to 0.99) and women with low educational attainment (aOR 0.62, 95% CI 0.47 to 0.82) had lower chances of receiving NA; there was no evidence of overprovision among women with strong affinity to Islam (aOR 0.77, 95% CI 0.63 to 0.94). Conclusions We found evidence for underprovision of care among first-generation immigrants, among women with low German language proficiency and particularly among all women with low educational attainment, irrespective of migration status. There was no evidence for overprovision of care to immigrant women, either inappropriately (general anaesthesia for ESCS) or because of low provider responsiveness (no opt-out for NA in vaginal delivery)

Ernährungskommunikation in Schwangerschaft und früher Kindheit: Erkenntnisse aus zwei Literaturreviews

Hintergrund: In der Schwangerschaft sowie im Säuglings- und Kleinkindalter werden entscheidende Weichen für die spätere Gesundheit gestellt. Das trifft in besonderem Maße auf die Ernährung zu. Unbestritten ist, dass Kommunikation eine wesentliche Rolle dabei spielt, ob ernährungsbezogene Präventionsprogramme erfolgreich sind bzw. sein können. Ziel der Arbeit: Ziel dieser Arbeit war es, den internationalen Forschungsstand zu kommunikationsbasierten ernährungsbezogenen Interventionen bei Schwangeren, jungen Familien und Kindern im Alter bis 36 Monate aus einem kommunikationswissenschaftlichen Blickwinkel zu analysieren. Erhoben wurde, welche Kommunikationsstrategien im Kontext der Ernährungskommunikation erfolgreich waren und welche nicht. Material und Methoden: Zwei Reviews des internationalen Forschungsstands zu kommunikativen Interventionen im Kontext der Ernährung in Schwangerschaft und früher Kindheit wurden durchgeführt: Ein Scoping Review von 187 Übersichtsarbeiten sowie ein systematisches Review von 65 Einzelstudien mit einem mittleren oder hohen Evidenzgrad. Ergebnisse: Obwohl sich keine Übersichtsarbeit fand, in der verschiedene kommunikative Zugänge im Detail diskutiert wurden, ergab das Scoping Review viele Hinweise auf Erfolgsfaktoren und Barrieren ernährungsbezogener Interventionen. Das systematische Review der Einzelstudien illustrierte u. a. die wichtige Rolle interpersoneller Ansprachen (z. B. durch Kinder- und Jugendärztinnen und -ärzte, Frauenärztinnen und -ärzte, Hebammen), sowohl einzeln als auch ergänzend zu massenmedialen, digitalen (z. B. Apps) oder Social-Media-Interventionszugängen. Schlussfolgerung: Verschiedene kommunikative Zugänge der Ernährungskommunikation werden bislang unzureichend in der nötigen Differenziertheit diskutiert und sind überwiegend schlecht in der Literatur dokumentiert. Ein gesicherteres und umfangreicheres Wissen über evidenzbasierte Kommunikationsstrategien im Kontext von Schwangerschaft und früher Kindheit ist nötig, wenn ernährungsbezogene Präventionsprogramme erfolgreich sein sollen.Background: A healthy diet during pregnancy and early childhood is crucial for a family’s long-term health and well-being. It is undisputed that communication plays an essential role in whether nutrition-related prevention programs are successful or not. These interventions are also rarely based on communication science or theoretically grounded in evidence-based communication theories. Objectives: The aim of this project was to examine the international state of research regarding communication-based nutrition-related interventions for expectant and young families from a communication science perspective. The aim was to determine which communication strategies were successful in the context of strategic nutrition communication for promoting a healthy lifestyle during pregnancy and early childhood, and which were not. Materials and methods: Two reviews of the international state of research on communicative interventions in the context of nutrition during pregnancy and early childhood were conducted: First, a scoping review of 187 existing reviews and meta-analyses, and second a systematic review of 65 intervention studies with a high or at least medium level of evidence (i.e., randomized controlled trials, quasi-experimental studies, cross-sectional studies). Results: No single review or meta-analysis was found in which several communicative approaches (e.g., framing techniques, narrative approaches, social or moral appeals, types of presented evidence) were discussed in detail. Nonetheless, the scoping review revealed many indicators for success factors and barriers of nutrition-related communicative interventions. The systematic review of original studies illustrated, among others, the important role of interpersonal communication channels (e.g., doctors, nurses, midwives), either individually or in addition to mass media and social media approaches or digital interventions (e.g., smartphone apps). Conclusions: So far, the many existing communicative approaches towards nutrition communication have been largely neglected in the literature and have not been discussed in sufficient detail. Moreover, communicative approaches used for nutrition-related interventions during pregnancy and early childhood are poorly documented in published studies. More comprehensive knowledge of evidence-based communication strategies is deemed necessary from both a practical and scientific point of view in order to better motivate pregnant women and young families to rethink and adjust their nutrition habits