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1.  Attitudes toward female circumcision among Somali immigrants in Oslo: a qualitative study 
Due to its negative impact on public health, female circumcision (FC) has gained increased attention from international communities and the Norwegian public in recent decades. In 1995, the Norwegian government outlawed the practice and simultaneously developed a package of measures aimed at preventing and ultimately eradicating FC in Norway. Like many other Western countries, immigrants of Somali descent constitute the largest immigrant group in Norway from countries with FC traditions. Although this immigrant group is often perceived as a cultural society that supports FC generally as a practice, there appears to be a lack of studies that explore the impact of acculturation and the Western social context on Somali immigrants’ attitudes toward the practice. Against this background, this paper explores the attitudes of Somalis living in Oslo, Norway to the practice of FC. Findings from this qualitative study indicate that Somalis in Oslo have, to a large extent, changed their attitude toward the practice. This was proven by the presence in Oslo of a large number of Somali parents who left their daughters uncut as well as Somali girls, boys, men, and women who attribute being uncircumcised a high status. This study adds to the knowledge of the process of abandonment of FC among immigrants in the Western countries. The study highlights the success that has been achieved in improving attitudes toward the practice of the Somali community in Oslo, Norway, as well as emerging challenges that need to be addressed further.
doi:10.2147/IJWH.S27577
PMCID: PMC3271810  PMID: 22312195
female circumcision; attitude; behavior; immigrants; Somalis
2.  Somali Immigrant Women and the American Health Care System: Discordant Beliefs, Divergent Expectations, and Silent Worries 
Social science & medicine (1982)  2010;71(2):353-361.
The civil war in Somalia resulted in massive resettlement of Somali refugees. The largest diaspora of Somali refugees in the United States currently reside in Minnesota. Partnering with three community organizations in 2007–8, we implemented the Community Connections and Collaboration Project to address health disparities that Somali refugees experienced. Specifically, we examined factors that influenced Somali women’s health experiences. Utilizing a socio-ecological perspective and a social action research design, we conducted six community-based focus groups with 57 Somali women and interviewed 11 key informants including Somali healthcare professionals. Inductively coding, sorting and reducing data into categories, we analyzed each category for specific patterns. The categorical findings on healthcare experiences are reported here. We found that Somali women’s health beliefs related closely to situational factors and contrasted sharply with the biological model that drives Western medicine. These discordant health beliefs resulted in divergent expectations regarding treatment and healthcare interactions. Experiencing unmet expectations, Somali women and their healthcare providers reported multiple frustrations which often diminished perceived quality of health care. Moreover, silent worries about mental health and reproductive decision making surfaced. To provide high quality, transcultural health care, providers must encourage patients to voice their own health explanations, expectations, and worries.
doi:10.1016/j.socscimed.2010.04.010
PMCID: PMC2893335  PMID: 20494500
USA; immigrant health; women’s health; health disparities; cultural competence; health care interactions; community-based social action research; mental health
3.  Migration experiences, employment status and psychological distress among Somali immigrants: a mixed-method international study 
BMC Public Health  2012;12:749.
Background
The discourse about mental health problems among migrants and refugees tends to focus on adverse pre-migration experiences; there is less investigation of the environmental conditions in which refugee migrants live, and the contrasts between these situations in different countries. This cross-national study of two samples of Somali refugees living in London (UK) and Minneapolis, Minnesota, (USA) helps to fill a gap in the literature, and is unusual in being able to compare information collected in the same way in two cities in different countries.
Methods
There were two parts to the study, focus groups to gather in-depth qualitative data and a survey of health status and quantifiable demographic and material factors. Three of the focus groups involved nineteen Somali professionals and five groups included twenty-eight lay Somalis who were living in London and Minneapolis. The quantitative survey was done with 189 Somali respondents, also living in London and Minneapolis. We used the MINI International Neuropsychiatric Interview (MINI) to assess ICD-10 and DSM-IV mental disorders.
Results
The overall qualitative and quantitative results suggested that challenges to masculinity, thwarted aspirations, devalued refugee identity, unemployment, legal uncertainties and longer duration of stay in the host country account for poor psychological well-being and psychiatric disorders among this group.
Conclusion
The use of a mixed-methods approach in this international study was essential since the quantitative and qualitative data provide different layers and depth of meaning and complement each other to provide a fuller picture of complex and multi-faceted life situations of refugees and asylum seekers. The comparison between the UK and US suggests that greater flexibility of access to labour markets for this refugee group might help to promote opportunities for better integration and mental well-being.
doi:10.1186/1471-2458-12-749
PMCID: PMC3489604  PMID: 22954304
4.  Forced migration and child health and mortality in Angola 
This study investigates the effects of forced migration on child survival and health in Angola. Using survey data collected in Luanda, Angola, in 2004, just two years after the end of that country's prolonged civil war, we compare three groups: migrants who moved primarily due to war, migrants whose moves were not directly related to war, and non-migrants. First, we examine the differences among the three groups in under-five mortality. Using an event-history approach, we find that hazards of child death in any given year were higher in families that experienced war-related migration in the same year or in the previous year, net of other factors. To assess longer-term effects of forced migration, we examine hazards of death of children who were born in Luanda, i.e., after migrants had reached their destinations. We again observe a disadvantage of forced migrants, but this disadvantage is explained by other characteristics. When looking at the place of delivery, number of antenatal consultations, and age-adequate immunization of children born in Luanda, we again detect a disadvantage of forced migrants relative to non-migrants, but now this disadvantage also extends to migrants who came to Luanda for reasons other than war. Finally, no differences across the three groups in child morbidity and related healthcare seeking behavior in the two weeks preceding the survey are found. We interpret these results within the context of the literature on short- and long-term effects of forced migration on child health.
doi:10.1016/j.socscimed.2009.09.057
PMCID: PMC3340544  PMID: 19879027
childhood mortality; child health; war; forced migration; sub-Saharan Africa, Angola
5.  Risk of Mycobacterium tuberculosis Transmission in a Low-Incidence Country Due to Immigration from High-Incidence Areas 
Journal of Clinical Microbiology  2001;39(3):855-861.
Does immigration from a high-prevalence area contribute to an increased risk of tuberculosis in a low-incidence country? The tuberculosis incidence in Somalia is among the highest ever registered. Due to civil war and starvation, nearly half of all Somalis have been forced from their homes, causing significant migration to low-incidence countries. In Denmark, two-thirds of all tuberculosis patients are immigrants, half from Somalia. To determine the magnitude of Mycobacterium tuberculosis transmission between Somalis and Danes, we analyzed DNA fingerprint patterns of isolates collected in Denmark from 1992 to 1999, comprising >97% of all culture-positive patients (n = 3,320). Of these, 763 were Somalian immigrants, 55.2% of whom shared identical DNA fingerprint patterns; 74.9% of these were most likely infected before their arrival in Denmark, 23.3% were most likely infected in Denmark by other Somalis, and 1.8% were most likely infected by Danes. In the same period, only 0.9% of all Danish tuberculosis patients were most likely infected by Somalis. The Somalian immigrants in Denmark could be distributed into 35 different clusters with possible active transmission, of which 18 were retrieved among Somalis in the Netherlands. This indicated the existence of some internationally predominant Somalian strains causing clustering less likely to represent recent transmission. In conclusion, M. tuberculosis transmission among Somalis in Denmark is limited, and transmission between Somalis and Danes is nearly nonexistent. The higher transmission rates between nationalities found in the Netherlands do not apply to the situation in Denmark and not necessarily elsewhere, since many different factors may influence the magnitude of active transmission.
doi:10.1128/JCM.39.3.855-861.2001
PMCID: PMC87841  PMID: 11230395
6.  Health and health care utilisation among asylum seekers and refugees in the Netherlands: design of a study 
BMC Public Health  2004;4:7.
Background
This article discusses the design of a study on the prevalence of health problems (both physical and mental) and the utilisation of health care services among asylum seekers and refugees in the Netherlands, including factors that may be related to their health and their utilisation of these services.
Methods/Design
The study will include random samples of adult asylum seekers and refugees from Afghanistan, Iran and Somali (total planned sample of 600), as these are among the largest groups within the reception centres and municipalities in the Netherlands.
The questionnaire that will be used will include questions on physical health (chronic and acute diseases and somatization), mental health (Hopkins Symptoms Checklist-25 and Harvard Trauma Questionnaire), utilisation of health care services, pre- and post-migratory traumatic experiences, life-style, acculturation, social support and socio-demographic background. The questionnaire has gone through a translation process (translation and back-translation, several checks and a pilot-study) and cross-cultural adaptation. Respondents will be interviewed by bilingual and bicultural interviewers who will be specifically trained for this purpose.
This article discusses the selection of the study population, the chosen outcome measures, the translation and cross-cultural adaptation of the measurement instrument, the training of the interviewers and the practical execution of the study. The information provided may be useful for other researchers in this relatively new field of epidemiological research among various groups of asylum seekers and refugees.
doi:10.1186/1471-2458-4-7
PMCID: PMC385239  PMID: 15070416
7.  Childhood residential mobility and health in late adolescence and adulthood: findings from the West of Scotland Twenty-07 Study 
Background
The relationship between childhood residential mobility and health in the UK is not well established; however, research elsewhere suggests that frequent childhood moves may be associated with poorer health outcomes and behaviours. The aim of this paper was to compare people in the West of Scotland who were residentially stable in childhood with those who had moved in terms of a range of health measures.
Methods
A total of 850 respondents, followed-up for a period of 20 years, were included in this analysis. Childhood residential mobility was derived from the number of addresses lived at between birth and age 18. Multilevel regression was used to investigate the relationship between childhood residential mobility and health in late adolescence (age 18) and adulthood (age 36), accounting for socio-demographic characteristics and frequency of school moves. The authors examined physical health measures, overall health, psychological distress and health behaviours.
Results
Twenty per cent of respondents remained stable during childhood, 59% moved one to two times and 21% moved at least three times. For most health measures (except physical health), there was an increased risk of poor health that remained elevated for frequent movers after adjustment for socio-demographic characteristics and school moves (but was only significant for illegal drug use).
Conclusions
Risk of poor health was elevated in adolescence and adulthood with increased residential mobility in childhood, after adjusting for socio-demographic characteristics and school moves. This was true for overall health, psychological distress and health behaviours, but physical health measures were not associated with childhood mobility.
doi:10.1136/jech-2011-200316
PMCID: PMC3433221  PMID: 22315239
Residential mobility; health; Scotland; UK; child health; deprivation; health behaviour; health status; migration
8.  HIV-related travel restrictions: trends and country characteristics 
Global Health Action  2013;6:10.3402/gha.v6i0.20472.
Introduction
Increasingly, HIV-seropositive individuals cross international borders. HIV-related restrictions on entry, stay, and residence imposed by countries have important consequences for this mobile population. Our aim was to describe the geographical distribution of countries with travel restrictions and to examine the trends and characteristics of countries with such restrictions.
Methods
In 2011, data presented to UNAIDS were used to establish a list of countries with and without HIV restrictions on entry, stay, and residence and to describe their geographical distribution. The following indicators were investigated to describe the country characteristics: population at mid-year, international migrants as a percentage of the population, Human Development Index, estimated HIV prevalence (age: 15–49), presence of a policy prohibiting HIV screening for general employment purposes, government and civil society responses to having non-discrimination laws/regulations which specify migrants/mobile populations, government and civil society responses to having laws/regulations/policies that present obstacles to effective HIV prevention, treatment, care, and support for migrants/mobile populations, Corruption Perception Index, and gross national income per capita.
Results
HIV-related restrictions exist in 45 out of 193 WHO countries (23%) in all regions of the world. We found that the Eastern Mediterranean and Western Pacific Regions have the highest proportions of countries with these restrictions. Our analyses showed that countries that have opted for restrictions have the following characteristics: smaller populations, higher proportions of migrants in the population, lower HIV prevalence rates, and lack of legislation protecting people living with HIV from screening for employment purposes, compared with countries without restrictions.
Conclusion
Countries with a high proportion of international migrants tend to have travel restrictions – a finding that is relevant to migrant populations and travel medicine providers alike. Despite international pressure to remove travel restrictions, many countries continue to implement these restrictions for HIV-positive individuals on entry and stay. Since 2010, the United States and China have engaged in high profile removals. This may be indicative of an increasing trend, facilitated by various factors, including international advocacy and the setting of a UNAIDS goal to halve the number of countries with restrictions by 2015.
doi:10.3402/gha.v6i0.20472
PMCID: PMC3672469  PMID: 23735755
HIV/AIDS; travel restrictions; restrictions on entry; stay and residence; migrants; mobility
9.  Medical and social factors influencing admission to residential care. 
The increasing number of people aged over 75 in Britain makes heavy demands on health and social services. To obtain accurate information for rational allocation of resources to domiciliary and residential services a group of 98 housebound women over 75 were compared with a group of 99 women of the same age in residential care. They had a similar range of physical disorders with the exception that deafness was more common among women in residential care. A much higher proportion in residential care were demented. Though in many respects women in residential care had less physical incapacity, a higher proportion needed help at times of crisis. Important social factors were that women at home were more likely to be living with others, and that the principal helper was more likely to be a husband or relative than a neighbour. Both groups received the same amount of support from home helps and community nurses. Any reduction in the number of residential care places for elderly women whose relatives are not available or are unable to cope would require the establishment of an effective community psychogeriatric service and a system for providing appropriate subjects with 24 hour care and supervision.
Images
PMCID: PMC1444399  PMID: 6230134
10.  Associations of homelessness and residential mobility with length of stay after acute psychiatric admission 
BMC Psychiatry  2012;12:121.
Background
A small number of patient-level variables have replicated associations with the length of stay (LOS) of psychiatric inpatients. Although need for housing has often been identified as a cause of delayed discharge, there has been little research into the associations between LOS and homelessness and residential mobility (moving to a new home), or the magnitude of these associations compared to other exposures.
Methods
Cross-sectional study of 4885 acute psychiatric admissions to a mental health NHS Trust serving four South London boroughs. Data were taken from a comprehensive repository of anonymised electronic patient records. Analysis was performed using log-linear regression.
Results
Residential mobility was associated with a 99% increase in LOS and homelessness with a 45% increase. Schizophrenia, other psychosis, the longest recent admission, residential mobility, and some items on the Health of the Nation Outcome Scales (HoNOS), especially ADL impairment, were also associated with increased LOS. Informal admission, drug and alcohol or other non-psychotic diagnosis and a high HoNOS self-harm score reduced LOS. Including residential mobility in the regression model produced the same increase in the variance explained as including diagnosis; only legal status was a stronger predictor.
Conclusions
Homelessness and, especially, residential mobility account for a significant part of variation in LOS despite affecting a minority of psychiatric inpatients; for these people, the effect on LOS is marked. Appropriate policy responses may include attempts to avert the loss of housing in association with admission, efforts to increase housing supply and the speed at which it is made available, and reforms of payment systems to encourage this.
doi:10.1186/1471-244X-12-121
PMCID: PMC3505156  PMID: 22905674
Length of stay; Hospitals psychiatric; Mental disorders; Residential mobility; Homeless persons
11.  Metropolitan Heterogeneity and Minority Neighborhood Attainment: Spatial Assimilation or Place Stratification? 
Social problems  2012;59(2):258-281.
Using geo-referenced data from the Panel Study of Income Dynamics, in conjunction with decennial census data, this research examines metropolitan-area variation in the ability of residentially mobile blacks, Hispanics, and whites to convert their income into two types of neighborhood outcomes—neighborhood racial composition and neighborhood socioeconomic status. For destination tract racial composition, we find strong and near-universal support for the “weak version” of place stratification theory; relative to whites, the effect of individual income on the percent of the destination tract population that is non-Hispanic white is stronger for blacks and Hispanics, but even the highest earning minority group members move to tracts that are “less white” than the tracts that the highest-earning whites move to. In contrast, for moves into neighborhoods characterized by higher levels of average family income, we find substantial heterogeneity across metropolitan areas in minorities’ capacity to convert income into neighborhood quality. A slight majority of metropolitan areas evince support for the “strong version” of place stratification theory, in which blacks and Hispanics are less able than whites to convert income into neighborhood socioeconomic status. However, a nontrivial number of metropolitan areas also evince support for spatial assimilation theory, where the highest-earning minorities achieve neighborhood parity with the highest-earning whites. Several metropolitan-area characteristics, including residential segregation, racial and ethnic composition, immigrant population size, poverty rates, and municipal fragmentation, emerge as significant predictors of minority-white differences in neighborhood attainment.
doi:10.1525/sp.2012.59.2.258
PMCID: PMC3359053  PMID: 22639470
residential attainment; neighborhood inequality; segregation; racial stratification; ethnic stratification
12.  Long-term psychiatric care in Ontario: the Homes for Special Care Program. 
During the last decade in Ontario large numbers of patients with chronic psychiatric disorders have been discharged from the mental hospitals and are now scattered throughout other psychiatric facilities. The Homes for Special Care Program offers privately run but government-funded accommodation for severely disabled patients with relatively stable and socially acceptable behaviour, who require residential or nursing care but are thought unlikely to benefit from further hospital treatment. Salient features of the program include the formal discharge of patients from hospital and their legal reinstatement as "persons", the cessation of active psychiatric treatment, and the provision of ongoing care and supervision by largely untrained personnel. Medical care is provided by general practitioners and the program looks to volunteer agencies to provide recreational and other activities for residents.
PMCID: PMC1956945  PMID: 829750
13.  Rural-urban Migration and Health: Evidence from Longitudinal Data in Indonesia 
Social science & medicine (1982)  2009;70(3):412-419.
Previous studies on the impact of migration on health often face the difficulties of choosing the proper comparison group and addressing potential selection of migration. Using longitudinal data from Indonesia, this paper examines the effect of rural-urban migration on physical and psychological health, (1) by comparing the health of migrants with that of the appropriate group of comparison, people who remained in rural origins, and (2) studying health both prior to and after migration to adjust for possible selection bias. This research further explores various socioeconomic, psychosocial, and behavioral pathways mediating the migration effect. Results show that rural-urban labor migration increased the risk of psychological disorder as measured by depressive symptoms. This was largely a result of reduced social support due to family disruption, because the deleterious effect was particularly strong for migrants who moved alone and was negligible for migrants moving with family members. In contrast, migration had little impact on physical health in the medium term. This was largely attributed to the multiple offsetting influences of migration: migration improved economic status and living standards but led to increased work-related stressors and barriers to health utilization. In addition, despite earning higher income, migrants tend to underconsume and remit a large amount of earnings to original families, which hindered potential health gains from improved economic well-being.
doi:10.1016/j.socscimed.2009.10.028
PMCID: PMC3724752  PMID: 19897297
14.  MOTIVES FOR RESIDENTIAL MOBILITY IN LATER LIFE 
This qualitative study delineates motives for residential mobility, describes dynamics between the elder and family members during the move decision process, and locates the move decision within ecological layers of the aging context. Interviews were conducted with 30 individuals and couples (ages 60-87) who experienced a community-based move within the past year, and with 14 extended family members. Reasons for moving (from perspectives of both elders who moved and their family members) were grouped into four themes and eleven issues that influenced the move decision. These themes parallel the ecological context of individual health and functioning, beliefs and attitudes, physical environment, and social pressures. Late-life mobility is a significant life transition that is the outcome of an ongoing appraisal and reappraisal of housing fit with individual functioning, needs, and aspirations. Family members are an integral part of these decision and residential mobility processes.
Well, she moved because my sister and I decided she was going to move. But she wanted to move. It wouldn’t have happened if we hadn’t decided that she was gonna move. It was a little complicated . . . - Linda Brierton’s daughter, Karen
PMCID: PMC2386962  PMID: 18453180
15.  The effects of house moves during early childhood on child mental health at age 9 years 
BMC Public Health  2012;12:583.
Background
Residential mobility is common in families with young children; however, its impact on the social development of children is unclear. We examined associations between the number, timing and type of house moves in childhood and child behaviour problems using data from an ongoing longitudinal study.
Methods
Complete data on residential mobility and child behaviour was available for 403 families. Three aspects of mobility were considered: (a) number of house moves from birth to <2 years, 2 to <5 years and 5 to 9 years; (b) lifetime number of house moves; and (c) moves associated with different housing trajectories characterized by changes in housing tenure. The primary outcomes were internalizing and externalizing behaviour problems at 9 years derived from Achenbach’s Child Behaviour Checklist. Linear regression analyses were used to investigate the effect of the housing variables on internalizing and externalizing behaviour problem scores with adjustment for a range of sociodemographic and household covariates.
Results
Moving house ≥2 times before 2 years of age was associated with an increased internalizing behaviour score at age 9 years. This association remained after adjustment for sociodemographic and household factors. There was no association between increased residential mobility in other time periods and internalizing behaviour, or mobility in any period and externalizing behaviour. There was no effect of lifetime number of moves, or of an upwardly or downwardly mobile housing trajectory. However, a housing trajectory characterized by continuous rental occupancy was associated with an increased externalizing behaviour score.
Conclusions
These findings may suggest that there is a sensitive period, in the first few years of life, in which exposure to increased residential mobility has a detrimental effect on mental health in later childhood.
doi:10.1186/1471-2458-12-583
PMCID: PMC3490785  PMID: 22853693
Residential mobility; Child behaviour; Child development; Housing; Longitudinal studies
16.  PLACE OF ORIGIN AND LABOR MARKET OUTCOMES AMONG MIGRANT WORKERS IN URBAN CHINA 
Urban studies (Edinburgh, Scotland)  2013;50(14):10.1177/0042098013482499.
The localistic enclave is a special kind of enclave in urban China, which is characterized by high concentration of rural migrants from the same place of origin. Prior research has documented that rural migrants work in these localistic enclaves, but the significance of participation in them for labor market outcomes among migrant workers has yet to be determined. In this article, we argue that localistic economic enclaves may improve the labor force outcomes of rural-to-urban migrants. We report results from a study of the social determinants and consequences of working in localistic enclaves, based on data from a 2010 survey of migrant workers in the Pearl River and the Yangzi River Deltas. The results provide limited support for our hypothesis: Localistic enclaves enable migrant workers to earn higher earnings overall, but the earnings returns to human capital in an enclave are limited.
doi:10.1177/0042098013482499
PMCID: PMC3819234  PMID: 24223441
17.  Multidisciplinary assessment of applicants for residential accommodation 
The Ulster Medical Journal  1988;57(1):28-33.
Fifty of 62 applicants for residential accommodation underwent assessment at a geriatric day hospital. Twenty-five were suitable, 11 were suitable following rehabilitation and 14 were unsuitable for placement in residential accommodation. Around 35% of all applicants were not assessed. Seventy-nine per cent of assessed applicants, without dementia, either were unsure of how their application had been initiated or did not understand the implications of a move to residential accommodation. Twenty-two per cent of all applicants assessed were taking four or more drugs. To maximise the use of residential accommodation, all applicants should be assessed to reduce inappropriate referrals.
PMCID: PMC2448476  PMID: 3420721
18.  The basic principles of migration health: Population mobility and gaps in disease prevalence 
Currently, migrants and other mobile individuals, such as migrant workers and asylum seekers, are an expanding global population of growing social, demographic and political importance. Disparities often exist between a migrant population's place of origin and its destination, particularly with relation to health determinants. The effects of those disparities can be observed at both individual and population levels. Migration across health and disease disparities influences the epidemiology of certain diseases globally and in nations receiving migrants. While specific disease-based outcomes may vary between migrant group and location, general epidemiological principles may be applied to any situation where numbers of individuals move between differences in disease prevalence. Traditionally, migration health activities have been designed for national application and lack an integrated international perspective. Present and future health challenges related to migration may be more effectively addressed through collaborative global undertakings. This paper reviews the epidemiological relationships resulting from health disparities bridged by migration and describes the growing role of migration and population mobility in global disease epidemiology. The implications for national and international health policy and program planning are presented.
doi:10.1186/1742-7622-3-3
PMCID: PMC1513225  PMID: 16674820
19.  The contribution of a gender perspective to the understanding of migrants' health 
Journal of Epidemiology and Community Health  2007;61(Suppl 2):ii4-ii10.
In 2005 women represented approximately half of all 190 million international migrants worldwide. This paper addresses the need to integrate a gender perspective into epidemiological studies on migration and health, outlines conceptual gaps and discusses some methodological problems. We mainly consider the international voluntary migrant. Women may emigrate as wives or as workers in a labour market in which they face double segregation, both as migrants and as women. We highlight migrant women's heightened vulnerability to situations of violence, as well as important gaps in our knowledge of the possible differential health effects of factors such as poverty, unemployment, social networks and support, discrimination, health behaviours and use of services. We provide an overview of the problems of characterising migrant populations in the health information systems, and of possible biases in the health effects caused by failure to take the triple dimension of gender, social class and ethnicity into account.
doi:10.1136/jech.2007.061770
PMCID: PMC2465778  PMID: 18000117
gender perspective; migrants' health; women
20.  Role of social support and self-efficacy in treatment outcomes among clients with co-occurring disorders✩ 
Drug and alcohol dependence  2007;89(2-3):267-274.
Individuals with co-occurring substance use and psychiatric disorders have a more severe clinical course and poorer outcomes than do individuals with one disorder. In an attempt to find intervening variables that may contribute to improvement in treatment outcomes among individuals with co-occurring disorders, we investigated the roles of social support and self-efficacy in a sample of 351 clients with co-occurring disorders in residential drug abuse treatment programs (53% male; 35% African American, 13% Hispanic). Given their demographic variability, we also explored how ethnicity and age influence self-efficacy and access to social support, as well as their relationships to the outcomes. Structural equation modeling was used to examine the impact of the demographics and baseline psychological status, substance use, social support, and self-efficacy on mental health and substance use outcomes 6 months after treatment entry. Time in treatment was included as a control. Greater social support at baseline predicted better mental health status and less heroin and cocaine use; greater self-efficacy predicted less alcohol and cocaine use. Older clients reported less social support. African-American ethnicity was associated with more cocaine use at baseline and follow-up; however, African Americans reported more self-efficacy, which moderated their cocaine use. The current study highlights the potential therapeutic importance of clients' personal resources, even among a sample of severely impaired individuals.
doi:10.1016/j.drugalcdep.2007.01.009
PMCID: PMC2753536  PMID: 17329040
Co-occurring disorders; Self-efficacy; Social support; Treatment outcomes
21.  Communal Living Settings for Adults Recovering from Substance Abuse 
Research on treatment outcome for addictive disorders indicates that a variety of interventions are effective. However, the progress clients make in treatment frequently is undermined by the lack of an alcohol and drug free living environment supporting sustained recovery. This introduction to a special edition on Oxford Houses suggests that treatment providers have not paid sufficient attention to the social environments where clients live after residential treatment or while attending outpatient programs. The paper begins with a description of the need for alcohol and drug free living environments. The history of communal living for recovering addicts and alcoholics is then reviewed and the Oxford House model emphasized as a recent and widespread communal living option for recovering persons. The structure and philosophy of Oxford Houses are presented along with recent outcome studies providing support for their effectiveness. Three different perspectives are presented as ways of conceptualizing how residents in Oxford Houses benefit: social context theory, self governance/self care, and peer affiliation/identification.
doi:10.1080/15560350802712355
PMCID: PMC2677754  PMID: 19424443
Oxford House; Sober Living House; Recovery Homes; Peer Helping
22.  Factors Associated with Residential Mobility in Children with Leukemia: Implications for Assigning Exposures 
Annals of epidemiology  2009;19(11):834-840.
Purpose
In epidemiologic studies, neighborhood characteristics are often assigned to individuals based on a single residence despite the fact that people frequently move and, for most cancer outcomes, the relevant time-window of exposure is not known. The authors evaluated residential mobility patterns for a population-based series of childhood leukemia cases enrolled in the Northern California Childhood Leukemia Study.
Methods
Complete residential history from one year prior to birth to date of diagnosis was obtained for 380 cases diagnosed between 1995 and 2002. All residences were assigned U.S. Census block group designations using a geographic information system.
Results
Overall, two-thirds (65.8%) of children had moved between birth and diagnosis, and a third (34.5%) moved during the first year of life. Approximately 25% of the mothers had moved during the year before the child's birth. Multivariable analysis indicated greater residential mobility to be associated with older age of the child at diagnosis, younger age of the mother at child's birth, and lower household income. Among those who had moved, residential urban/rural status for birth and diagnosis residences changed for about 20% of subjects, and neighborhood SES for 35%.
Conclusions
These results suggest that neighborhood attribute estimates in health studies should account for patterns of residential mobility. Estimates based on a single residential location at a single point in time may lead to different inferences.
doi:10.1016/j.annepidem.2009.03.001
PMCID: PMC2761989  PMID: 19364662
Childhood leukemia; Epidemiology; Exposure classification; Residential mobility; Socioeconomic status
23.  When female circumcision comes to the West: Attitudes toward the practice among Somali Immigrants in Oslo 
BMC Public Health  2012;12:697.
Background
Female circumcision (FC) has lifelong adverse social and health consequences for women, and its abolition will not only enhance the health of children and women, but also promote gender equality. Like many other Western countries, Norway hosts a large proportion of immigrants from FC-practicing countries, though primarily from Somalia, which is the country with the highest prevalence of FC in the world. A behavioral change by the practicing communities has the best chance to successfully and sustainably eliminate this practice. However, FC prevention programs require a behavioral surveillance that monitors the process of change, with this being the first quantitative study since the major migration of the Somali community to Norway began in 1991 to investigate whether or not Somali immigrants’ attitudes toward the practice has improved in favor of its abandonment.
Methods
A cross-sectional study using a respondent-driven sampling (RDS) was conducted in Oslo from April to June of 2011. A sample of 214 persons was interviewed, using structured questionnaires.
Results
The results show that 70% of Somalis in Oslo support the discontinuation of all forms of FC compared to 30% who support its continuation, with the latter group more likely to be people who lived in Norway ≤ 4 years. Of the 10 girls who came to Norway at the age of ≤ 7 years, only one was circumcised, though whether the circumcision occurred before or after the girl’s arrival in Norway remains unclear. The perception that FC is required by religion was the sole factor to be significantly associated with an ongoing support of FC.
Conclusion
The study reveals that Somalis in Oslo demonstrate a trend to abandon this practice over time. Nevertheless, the 30% of the people who still support its continuation, and who are primarily newly arrived immigrants, require a targeted intervention that is implemented in the early phase of the immigrants’ arrival.
doi:10.1186/1471-2458-12-697
PMCID: PMC3519553  PMID: 22925310
24.  Sex Differences in Risk Factors for Cardiovascular Disease: The PERU MIGRANT Study 
PLoS ONE  2012;7(4):e35127.
Introduction
Although men and women have similar risk factors for cardiovascular disease, many social behaviors in developing countries differ by sex. Rural-to-urban migrants have different cardiovascular risk profiles than rural or urban dwellers. The objective of this study was to evaluate the sex differences with specific cardiovascular risk factors in rural-to-urban migrants.
Methods and Results
We used the rural-to-urban migrant group of the PERU MIGRANT cross-sectional study to investigate the sex differences in specific cardiovascular risk factors: obesity, hypertension, metabolic syndrome, as well as exposures of socioeconomic status, acculturation surrogates and behavioral characteristics. Logistic regression analysis was used to characterize strength of association between sex and our outcomes adjusting for potential confounders. The sample of migrants was 589 (mean age 46.5 years) and 52.4% were female. In the adjusted models, women were more likely to be obese (OR=5.97; 95%CI: 3.21–11) and have metabolic syndrome (OR=2.22; 95%CI: 1.39–3.55) than men, explaining the greatest variability for obesity and metabolic syndrome but not for hypertension.
Conclusions
Our results suggest that interventions for CVD in Peru should be sex-specific and address the unique health needs of migrant populations living in urban shantytowns since the risk factors for obesity and metabolic syndrome differ between males and females.
doi:10.1371/journal.pone.0035127
PMCID: PMC3320626  PMID: 22496899
25.  Anticipation of Migration and Psychological Stress and the Three Gorges dam project, China 
Social science & medicine (1982)  2007;65(5):1012-1024.
Findings from a prospective study of project-induced migration in China's Three Gorges Dam project are reported. The study tests the hypotheses that anticipation of involuntary migration is stressful and that the harmful effects are partially mediated and moderated by the resources migrants possess. Using data collected from a sample of designated migrants (n = 975) who will be forced to relocate because they live in an area which will be flooded once the Three Gorges project is completed, and non-migrants (n = 555) in the same region, our analysis indicates that anticipation of involuntary migration is a robust predictor of mental distress. Anticipation of forced migration elevates depression (CES-D) not only directly, but also indirectly by weakening the social and the psychological resources (i.e., social support and mastery) which safeguard the mental well-being of migrants. However, our results show much less support for the hypothesis that resources moderate harmful effects of forced migration.
doi:10.1016/j.socscimed.2007.05.003
PMCID: PMC2829888  PMID: 17548141
China; Three Gorges; Development; Involuntary migration; Stress

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