Ethno-epidemiology of alcohol use among Zimbabwean migrants living in the UK

Title: Ethno-epidemiology of alcohol use among Zimbabwean migrants living in the United Kingdom Background: Despite the UK having a relatively long history of migration, very little is known about the relationship between alcohol use and migrants. With more than half of the increase in the UK population over the last decade a result of migration, understanding alcohol use in migrant communities provides an important platform for the formulation of health policies and interventions that suit the cultural diversity that is now prevalent in the UK. Purpose: This study explored attitudes, perceptions and beliefs related to alcohol use, based on the experiential and lived realities of Zimbabwean migrants who settled in UK from the 1990s because of the political and economic decline in Zimbabwe. This study also investigated the factors associated with increased alcohol intake in Zimbabwean migrants living in the UK. Method: The study utilized a mixed methods approach by applying a multi-sited focused ethnography, comprising 44 in-depth interviews and participant observations at three sites in the Yorkshire region of the UK. It explored themes emerging from narrated accounts of attitudes, motivations and beliefs shaping alcohol’s meaning in UK based Zimbabwean migrants’ lives. Findings from the focused ethnography were used as inputs to enhance a questionnaire that collected information on a broad cross section of Zimbabweans across the UK (n=331). The questionnaire measured alcohol intake using the Alcohol Use Disorders Identification Tool (AUDIT) along with questions on demographic, psychosocial and socio-economic attributes. Results: The findings describe the role of social identity and culture in shaping drinking patterns. The findings also describe the role of Zimbabwean public spaces and alcohol in protecting Zimbabweans from homesickness, isolation and alienation in an environment most perceived as hostile and unwelcoming. The risk of harmful drinking among Zimbabwean migrants was found to be high, particularly in males. High social capital and religious activity were found to be protective against the risk of harmful drinking, whilst being male and experiencing stress exposed Zimbabwean migrants to increased risk of harmful alcohol use. Conclusion: The findings represent an important contribution to our knowledge of the Zimbabwean diaspora in particular, and to the wider field of alcohol research in migrant populations. The thesis is distinctive in its use of focused ethnography, and demonstrates how mixed methods can be applied in alcohol research to develop culturally sensitive screening and brief interventions on emerging migrant populations. The findings may therefore contribute towards policy formulation and efforts to reduce the harmful use of alcohol by utilizing culturally specific intervention programmes that aim to address 'problematic' drinking patterns in the less understood and hard to reach migrant populations in the UK

A Comparative Evaluation of the Cost Effectiveness of Treating the Metabolic Syndrome in African Americans and the General Population

The Metabolic Syndrome poses an important public health threat to the U.S. health care delivery system. Disparate access to quality health care makes African Americans (blacks) especially susceptible to the adverse effects of MS. Although direct evidence suggests that early treatment of MS risk factors saves lives, no study to date has compared the cost effectiveness of such measures in blacks and the general population. Interventions that promote early treatment of MS risk factors may improve public health but could also lead to excess costs that are ultimately borne by society. The objective of this study was to assess the value of early treatment of MS risk factors in blacks and the general population. A cost effectiveness analysis was carried out using a Markov decision model to compare early treatment and late treatment of MS risk factors in blacks and the general population. The main outcome measure was the incremental cost per Quality Adjusted Life Year (QALY). With the exception of early treatment of hyperlipidemia in blacks ($187,462/QALY), early treatment of individual MS risk factors at age 30 was found to be cost effective (\u3c$27,000/QALY) for both blacks and the general population. With the exception of treatment of hyperlipidemia, early treatment strategies targeted at blacks were found to be more cost effective than those targeted towards the general population. Sensitivity analyses indicated that age and cost of treatment were the most influential factors in the model. The cost effectiveness of early treatment of MS risk factors in blacks and the general population compares favorably with similar health care interventions. The results support a growing body of literature that indicates the cost effectiveness of providing preventative services to apparently healthy individuals