Smoking among immigrants in Norway: a cross-sectional study.

BACKGROUND: Smoking among immigrants varies by country background and is high in some groups. More detailed information about smoking prevalence by country background and sociodemographic factors is needed to target interventions. METHODS: Data from the Survey on Living Conditions among immigrants 2016 were used, including immigrants from 12 countries and with ⩾2 years of residence (N = 3565). Data on smoking (daily and occasional) by country of birth, sex, age group, education, duration of residence, age at immigration, proficiency in the Norwegian language, and social support were reported. RESULTS: The highest proportions of daily smokers were seen among immigrants from Turkey (36%), Poland (34%), and Vietnam (29%) for men, and from Turkey (22%), Bosnia-Herzegovina (18%), and Poland (17%) for women. Differences in smoking by sociodemographic factors varied with country background, but for several groups of men, the lowest proportions of smokers were seen among those with the highest educational level, those who were employed, and those who immigrated during childhood or adolescence. CONCLUSIONS: Policies are warranted that target smoking among immigrant men in general, and particularly among men from Turkey, Poland, and Vietnam, as well as for women from Turkey, Bosnia-Herzegovina, and Poland.

Proficiency in the Norwegian language and self-reported health among 12 immigrant groups in Norway: A cross-sectional study.

BACKGROUND: Migration presents numerous significant changes in a person's life, physically, emotionally and socially. How health develops in the host country depends on a range of factors, including language proficiency. We aimed to investigate associations between language proficiency and health. METHODS: Statistics Norway carried out the Living Conditions Survey for Immigrants (2016), conducting telephone (82%) or face-to-face (18%) interviews with immigrants (two or more years of residence) from 12 countries. The survey collected data on self-reported proficiency in the Norwegian language, health and socio-economic variables, and included 4077 people aged 16-66 years. RESULTS: In logistic regression models adjusted for age, sex and duration of residence, poor or medium self-reported Norwegian proficiency, as compared to good, was associated with poorer health outcomes, including lower odds of self-rated health (odds ratio (OR)=0.46; 95% confidence interval (CI) 0.39-0.54) and higher odds of hypertension (OR=1.74; 95% CI 1.34-2.26), back or neck pain (OR=1.52; 95% CI 1.28-1.80), mental health problems (OR=1.34; 95% CI 1.09-1.65), sleep disturbances (OR=1.51; 95% CI 1.23-1.86) and being overweight (OR=1.20; 95% CI 1.03-1.40). Adjustment for socio-economic status attenuated the associations, but further adjustments for perceived discrimination and lifestyle (smoking and physical activity) did not further alter the estimates. CONCLUSIONS: Host language proficiency has implications for health among immigrants. Equitable access to health services and quality of care requires adjustment to the language level needs of patients. Facilitating language learning for immigrants may be vital in providing access to health services and supporting newcomers in being more active participants in managing their health.

Health risks among long-term immigrants in Norway with poor Norwegian language proficiency.

BACKGROUND: Poor health among immigrants has been associated with longer duration of residence in the host country, poor host language proficiency and low education. However, the interplay among these factors is under-studied. OBJECTIVE: To assess health among immigrants in Norway by combinations of duration of residence, Norwegian language proficiency and education. METHODS: In 2015/2016 Statistics Norway carried out two cross-sectional Living Conditions Surveys in the general adult population (N=5703, response rate 59%) and among immigrants from 12 countries, with ⩾2 years of residence (N=3993, response rate 54%). Health outcomes (poor self-reported health, diabetes, cardiovascular disease, hypertension, obesity, mental health problems, back/neck pain) were assessed with logistic regressions according to combinations of duration of residence, Norwegian language proficiency and education. RESULTS: Negative health conditions were more common among immigrants than in the general population, and varied by duration of residence, proficiency in the Norwegian language and education. In age- and sex-adjusted regressions, immigrants had higher odds of all negative health conditions, except hypertension, regardless of their duration of residence, proficiency of the Norwegian language and educational level. Immigrants with a long duration of residence and poor proficiency in the Norwegian language had the highest odds of negative health conditions. CONCLUSIONS: Special attention is warranted towards health among immigrants who have lived in Norway the longest without acquiring good Norwegian language proficiency.

The correlation between socioeconomic factors and COVID-19 among immigrants in Norway: a register-based study.

AIM: Immigrants in Norway have higher COVID-19 notification and hospitalisation rates than Norwegian-born individuals. The knowledge about the role of socioeconomic factors to explain these differences is limited. We investigate the relationship between socioeconomic indicators at group level and epidemiological data for all notified cases of COVID-19 and related hospitalisations among the 23 largest immigrant groups in Norway. METHODS: We used data on all notified COVID-19 cases in Norway up to 15 November 2020, and associated hospitalisations, from the Norwegian Surveillance System for Communicable Diseases and the emergency preparedness register at the Norwegian Institute of Public Health. We report notified COVID-19 cases and associated hospitalisation rates per 100,000 and their correlation to income, education, unemployment, crowded housing and years of residency at the group level. RESULTS: Crowded housing and low income at a group level were correlated with rates of both notified cases of COVID-19 (Pearson`s correlation coefficient 0.77 and 0.52) and related hospitalisations (0.72, 0.50). In addition, low educational level and unemployment were correlated with a high number of notified cases. CONCLUSIONS: Immigrant groups living in disadvantaged socioeconomic positions are important to target with preventive measures for COVID-19. This must include targeted interventions for low-income families living in overcrowded households.

SARS-CoV-2 infections and hospitalisations among immigrants in Norway-significance of occupation, household crowding, education, household income and medical risk: a nationwide register study.

BACKGROUND: As in other countries, the COVID-19 pandemic has affected Norway's immigrant population disproportionately, with significantly higher infection rates and hospitalisations. The reasons for this are uncertain. METHODS: Through the national emergency preparedness register, BeredtC19, we have studied laboratory-confirmed infections with SARS-CoV-2 and related hospitalisations in the entire Norwegian population, by birth-country background for the period 15 June 2020 to 31 March 2021, excluding the first wave due to limited test capacity and restrictive test criteria. Straightforward linkage of individual-level data allowed adjustment for demographics, socioeconomic factors (occupation, household crowding, education and household income), and underlying medical risk for severe COVID-19 in regression models. RESULTS: The sample comprised 5.49 million persons, of which 0.91 million were born outside of Norway, there were 82,532 confirmed cases and 3088 hospitalisations. Confirmed infections in this period (per 100,000): foreign-born 3140, Norwegian-born with foreign-born parents 4799 and Norwegian-born with Norwegian-born parent(s) 1011. Hospitalisations (per 100,000): foreign-born 147, Norwegian-born with foreign-born parents 47 and Norwegian-born with Norwegian-born parent(s) 37. The addition of socioeconomic and medical factors to the base model (age, sex, municipality of residence) attenuated excess infection rates by 12.0% and hospitalisations by 3.8% among foreign-born, and 10.9% and 46.2%, respectively, among Norwegian-born with foreign parents, compared to Norwegian-born with Norwegian-born parent(s). CONCLUSIONS: There were large differences in infection rates and hospitalisations by country background, and these do not appear to be fully explained by socioeconomic and medical factors. Our results may have implications for health policy, including the targeting of mitigation strategies.

The Evaluation of a Social Media Campaign to Increase COVID-19 Testing in Migrant Groups: Cluster Randomized Trial.

BACKGROUND: A low test positivity rate is key to keeping the COVID-19 pandemic under control. Throughout the pandemic, several migrant groups in Norway have seen higher rates of confirmed COVID-19 and related hospitalizations, while test positivity has remained high in the same groups. The Norwegian government has used several platforms for communication, and targeted social media advertisements have in particular been an important part of the communication strategy to reach these groups. OBJECTIVE: In this study, we aimed to investigate whether such a targeted Facebook campaign increased the rate of COVID-19 tests performed in certain migrant groups. METHODS: We randomly assigned 386 Norwegian municipalities and city districts to intervention or control groups. Individuals born in Eritrea, Iraq, Pakistan, Poland, Russia, Somalia, Syria, and Turkey residing in intervention areas were targeted with a social media campaign aiming at increasing the COVID-19 test rate. The campaign message was in a simple language and conveyed in the users' main language or in English. RESULTS: During the 2-week follow-up period, the predicted probability of having a COVID-19 test taken was 4.82% (95% CI 4.47%-5.18%) in the control group, and 5.58% (95% CI 5.20%-5.99%) in the intervention group (P=.004). CONCLUSIONS: Our targeted social media intervention led to a modest increase in test rates among certain migrant groups in Norway. TRIAL REGISTRATION: ClinicalTrials.gov NCT04866589; https://clinicaltrials.gov/ct2/show/NCT04866589.

Coronavirus immunisation abroad among foreign-born persons in Norway. / Koronavaksinering i utlandet blant utenlandsfødte.

BACKGROUND: The Norwegian Institute of Public Health's statistics on immunisation against SARS-CoV-2 show that vaccination coverage for foreign-born persons living in Norway is lower than for persons born in Norway. As of January 2022, the difference was 18 percentage points (76 % versus 94 %). This difference is likely to be due to several factors, one of which may be that many of those who were immunised abroad have not had this registered in the Norwegian Immunisation Registry. MATERIAL AND METHOD: In November 2021, the Norwegian Institute of Public Health conducted a public health survey in the county of Viken. Respondents were asked if they had been vaccinated against the coronavirus, if they were vaccinated in Norway or abroad, and if immunisation abroad had been reported to the Norwegian health service. They were also asked to specify their country of birth. The sample was drawn from the National Population Register. The survey was conducted online and the response rate was 41 % (n = 108 738). RESULTS: A total of 105 010 (97 %) of the respondents had had at least one dose of the coronavirus vaccine. Of these, 724 (<1 %) had only been vaccinated abroad. This applied to 392 (3 %) of the 13 286 foreign-born persons, 203 (52 %) of whom had reported their immunisation to the Norwegian health service. INTERPRETATION: In this dataset, unregistered immunisation abroad explains only a small proportion of the difference in vaccination coverage between Norwegian-born and foreign-born persons.

COVID-19 vaccination among immigrants from Europe and in their countries of birth. / Covid-19-vaksinasjon blant innvandrarar frå Europa og i fødelanda deira.

BACKGROUND: Vaccination coverage for COVID-19 varies among immigrant groups in Norway and between different countries. Most likely, childhood/adolescence and consistent contact with the country of birth help form the attitudes to and the desire for vaccination. We therefore compared the vaccination rate among European-born immigrants in Norway and the vaccination coverage in their countries of birth. MATERIAL AND METHOD: Vaccination coverage, the percentage of the adult population that had received at least one vaccination dose, for 22 European countries with universal access to vaccines by 31 August 2021 was retrieved from the European Centre for Disease Prevention and from the Norwegian emergency preparedness register for COVID-19 for the equivalent immigrant groups in Norway on 30 September 2021. Scatter plots with least-squares regression lines showed the association between the vaccination coverage in the country of birth and the rate in the equivalent immigration group in Norway, in total and by time of residence in Norway (< 6 years and ≥ 6 years). RESULT: The model estimated an increase in the vaccination rate in immigrant groups in Norway of 0.64 percentage points for each percentage point increase in the vaccination coverage in their European countries of birth, and explained 63 % of the variation in the vaccination rate in the immigrant groups. There was no statistically significant difference in the co-variation with the country of birth when comparing immigrants with short versus long time of residence. INTERPRETATION: There is a correlation between the vaccination rate for COVID-19 among European-born immigrants in Norway and the coverage in their countries of birth. Attitudes to and desire for vaccination varies between countries and can explain part of the observed differences between immigrant groups in Norway.

COVID-19 vaccination coverage by immigrant background. / Vaksinasjonsdekning mot covid-19 etter innvandrerbakgrunn.

BACKGROUND: High vaccination coverage against COVID-19 limits COVID-19-related infections, hospitalisations and deaths. Studies have shown varying vaccine willingness and vaccine coverage in different minority groups. This study investigates the vaccination coverage among persons with various immigration and country backgrounds in Norway. MATERIAL AND METHOD: The study includes all persons over 18 years of age resident in Norway with a Norwegian national identity number. We used data from Beredt C19, the Norwegian emergency preparedness register for COVID-19, and investigated the association between vaccine status and immigrant and country background using logistic regression models, adjusted for income, education, sex, age, medical risk group and place of residence. RESULTS: Foreign- and Norwegian-born persons with foreign-born parents had a lower COVID-19 vaccine coverage than those who were Norwegian-born with Norwegian-born parents. Vaccination coverage for different country backgrounds varied from around 45 % for persons from Latvia, Bulgaria, Poland, Romania and Lithuania to 92 % for persons from Vietnam, Thailand and Sri Lanka. Those in the former group had from 15 to 18 times (unadjusted) and from 8 to 11 times (adjusted) higher odds of not having been vaccinated as persons with a country background from Norway. INTERPRETATION: There is considerable variation in COVID-19 vaccine coverage between different immigrant groups in Norway. The differences can be explained to some extent by income and education, but this does not explain the bulk of the observed differences. We cannot rule out the possibility that some differences are attributable to weaknesses in the registers.

COVID-19 among immigrants in Norway, notified infections, related hospitalizations and associated mortality: A register-based study.

Aim: Research concerning COVID-19 among immigrants is limited. We present epidemiological data for all notified cases of COVID-19 among the 17 largest immigrant groups in Norway, and related hospitalizations and mortality. Methods: We used data on all notified COVID-19 cases in Norway up to 18 October 2020, and associated hospitalizations and mortality, from the emergency preparedness register (including Norwegian Surveillance System for Communicable Diseases) set up by The Norwegian Institute of Public Health to handle the pandemic. We report numbers and rates per 100,000 people for notified COVID-19 cases, and related hospitalizations and mortality in the 17 largest immigrant groups in Norway, crude and with age adjustment. Results: The notification, hospitalization and mortality rates per 100,000 were 251, 21 and five, respectively, for non-immigrants; 567, 62 and four among immigrants; 408, 27 and two, respectively, for immigrants from Europe, North-America and Oceania; and 773, 106 and six, respectively for immigrants from Africa, Asia and South America. The notification rate was highest among immigrants from Somalia (2057), Pakistan (1868) and Iraq (1616). Differences between immigrants and non-immigrants increased when adjusting for age, especially for mortality. Immigrants had a high number of hospitalizations relative to notified cases compared to non-immigrants. Although the overall COVID-19 notification rate was higher in Oslo than outside of Oslo, the notification rate among immigrants compared to non-immigrants was not higher in Oslo than outside. Conclusions: We observed a higher COVID-19 notification rate in immigrants compared to non-immigrants and much higher hospitalization rate, with major differences between different immigrant groups. Somali-, Pakistani- and Iraqi-born immigrants had especially high rates.

Patient experiences with general practice in Norway: a comparison of immigrant groups and the majority population following a national survey.

BACKGROUND: Patient experience is an important indicator of quality of health care. In Norway, little is known about the quality of health care for immigrants. The aim of this study was to compare patient-reported experiences with general practice between the Norwegian-born population and immigrant groups. METHODS: We performed secondary analyses of data from a national survey on patient experiences with general practice, including assessments of general practitioners (GPs) and their GP offices. The survey was carried out in Norway in 2018-19. The total number of respondents was 2029, with a response rate of 42.6%. Region of birth was available for 1981 participants, and these were included in the analyses ("Norway" (N = 1756), "Asia, Africa or South America" (N = 95), "Eastern Europe" (N = 70) and "Western Europe, North America or Oceania" (N = 60)). Five indicators of patient experiences were used as dependent variables in bivariate and multivariate analyses, with region of birth as the main exposure variable and other background variables about the patient as adjustment variables: "the GP" (measures related to communication and competency), "auxiliary staff" (politeness, competency, organization), "accessibility" (waiting times), "coordination" (with other services) and `enablement` (GP facilitates coping with/understanding illness). RESULTS: Immigrants as a whole reported poorer experiences with general practice than the majority population, with significantly poorer scores on four of five patient experience indicators. Patients from Asia/Africa/South America reported poorer experiences than those from Norway on the indicators "GP", "auxiliary staff", "accessibility" and "coordination": on a scale from 0 to 100 where 100 is the best, the difference ranged from 7.8 (GP) to 20.3 (accessibility). Patients from Eastern Europe reported lower scores on "GP" and patients from Western Europe/North America/Oceania reported lower scores on "auxiliary staff". These associations were still significant after adjustment for sex, age, self-rated physical and mental health, number of contacts with the GP and education. CONCLUSIONS: For countries with a substantial proportion of foreign-born patients in the health system, immigrant background is an important parameter in quality improvement work. Immigrant background is also an important parameter in health service research.

Lowering COVID-19 vaccine hesitancy among immigrants in Norway: Opinions and suggestions by immigrants.

Even though COVID-19 vaccine has been proved effective, vaccine uptake and coverage has been and still is a great concern across different immigrant groups. Vaccine hesitancy remains a barrier to accept the vaccine among immigrants across the globe-including Norway-despite higher rates of hospitalizations and deaths. This study aimed to explore the opinions and suggestions of immigrants on how to lower the COVID-19 vaccine hesitancy among immigrants in Norway. Qualitative interviews were conducted with 88 persons with different immigrant background. Data was analyzed using framework analysis, utilizing "3Cs model of vaccine hesitancy" as a theoretical framework. The analysis yielded five main themes related to factors that may lower the vaccine hesitancy among immigrants in Norway: (1) Effective cultural communication, (2) Vaccine advocacy through community engagement, (3) Motivating factors, (4) Collaborative efforts via government and healthcare, and (5) Incentives for vaccination. This study enhanced our understanding of factors that according to immigrants themselves may lower the vaccine hesitancy. The insights obtained in this study can contribute to a better understanding of the current status of vaccine uptake among immigrants and can further give directions on how to improve vaccine uptake in these groups in Norway.

A microanalysis of the clarity of information in physicians' and patients' discussions of treatment plans with and without language barriers.

OBJECTIVE: Physicians and patients discuss treatment plans. If tasks within plans are not described adequately, patients cannot adhere. We evaluated task descriptions, testing whether patient engagement and language barriers affected task clarity. METHOD: We sampled 12 videotaped hospital interactions from a corpus of 497: two encounters each from six hospital physicians, interacting with one native-speaking and one non-native-speaking patient. We used microanalysis of face-to-face dialogue to assess whether the physicians and patients achieved a complete, clear description of each task's three core information elements (who should do what and when). RESULTS: We conducted detailed analysis on 78 of the 90 tasks. Core information elements were complete in 62 (0.79) and clear in 37 (0.47). Language barriers had no effect on task clarity. When native-speaking patients were engaged, tasks were clearer (p<0.05). Although non-native-speaking patients were significantly more engaged (p<0.01), their engagement had no effect. CONCLUSION: Physicians may be pursuing patients' agreement, motivation, and commitment at the expense of working with the patient to be clear about what needs to be done. PRACTICE IMPLICATIONS: Physicians need to improve how clearly they present basic task information. Previous research demonstrated that even a short course can significantly improve the clarity of instructions.