Migration-related changes in smoking among non-Western immigrants in France.

BACKGROUND: Migrants make up a growing share of European populations, and very little is known about the impact of migration on their smoking patterns. We develop a longitudinal analysis of smoking prevalence among native-born and immigrants in France based on retrospective data collected in the 2010 national Baromètre santé health survey. METHODS: Analyses concerned 19 578 individuals aged 18-70 years and born in metropolitan France, in the Maghreb or in sub-Saharan Africa. Person-years with and without smoking were reconstructed using migration and smoking histories and analyzed with discrete-time regression models. RESULTS: Prior to migration, immigrants from both the Maghreb and sub-Saharan Africa had lower smoking prevalence than the native-born of similar birth cohort, age and education. After migration, the prevalence increased over time among Maghrebin men up to levels beyond those of the native-born (odds ratio: 1.54 [1.09-2.17] for 10 years of residence or more), while it remained much lower throughout among men from sub-Saharan Africa (odds ratio: 0.36 [0.19-0.68] for 10 years of residence or more). Starting at extremely low levels, the prevalence in both groups of women rose considerably after migration. Women from sub-Saharan Africa nearly caught up to the native-born (odds ratio: 0.70 [0.37-1.32] for 10 years of residence or more), but this was not the case for those from the Maghreb (odds ratio: 0.52 [0.33-0.81] for 10 years of residence or more). CONCLUSION: The findings uncover the low pre-migration prevalence and the diversity of post-migration trajectories. Tobacco control programs targeting recently arrived migrants would contribute to prevent unhealthy assimilation.

Mortality gradient across the labour market core-periphery structure: a 13-year mortality follow-up study in north-eastern France.

PURPOSE: This study explores mortality related to temporary employment, about which very little is known to date. METHODS: In 1996, a health survey was carried out in the French region of Lorraine, and all members of 8,000 randomly chosen households were followed up for mortality over a 13-year period. Mortality of subjects in relation to their employment situation at baseline was analysed using a Cox survival regression. RESULTS: In comparison with permanent workers, for unemployed men, we found age and occupation-adjusted hazard ratios (HR) of 4.1 for all-causes of death and 3.9 for non-violent causes, and for male temporary workers a HR of 2.2 for both all-causes and non-violent causes of death. Bad health, tobacco smoking and alcohol misuse explained 17 % of the excess risk for the unemployed and 41 % of that for temporary workers. CONCLUSION: The observation of large mortality inequalities across the labour market core-periphery structure has important policy implications, particularly in terms of prevention focused on unhealthy behaviours among male unemployed and temporary workers.

Strong association of physical job demands with functional limitations among active people: a population-based study in North-eastern France.

PURPOSE: To assess the association between physical job demands (PJD) and physical/cognitive functional limitations, and the role of adverse health behaviours, obesity, and socio-demographic factors as confounders of those associations. METHODS: The sample included 3,368 active subjects aged 18-64 years, randomly selected from North-eastern France. Subjects completed a post-mailed questionnaire. PJD score was defined as the product of years of employment with the cumulative number of a wide range of high job demands. Data were analysed through the logistic regression models. RESULTS: The physical and cognitive functional limitations affected 16.9 and 28.6% of subjects, respectively. A strong relationship was found between PJD and physical functional limitation: significant odds ratios (OR) adjusted for all the factors studied 1.41 for PJD1-29, 1.72 for PJD30-99, and 2.57 for PJD >or=100 versus PJD0; and between PJD and cognitive functional limitation: OR 1.28 for PJD1-29, 1.60 for PJD30-99, and 2.00 for PJD >or=100 versus PJD0. Adverse health behaviours, obesity and job category were modest confounders of those associations. CONCLUSIONS: This study identified a wide range of job demands and individual characteristics related to physical/cognitive functional limitations. Prevention should aim at improving working conditions and adverse health behaviours.

[Pregnancy-related deaths. Genesis of the concept and methodological aspects]. / Les décès liés à la grossesse. Genèse du concept et aspects méthodologiques.

Within the past 10 years, the outlook on the causes underlying maternal deaths has evolved, with the advent in the last "International classification of diseases" of the concepts of late maternal mortality and pregnancy-related mortality. Those concepts have led to an enlargement of the field, in terms of the range of causes as well as of the length of the time period at risk. Causes of death traditionally considered as "fortuitous" are now included in the count, given that the notion of pregnancy-related mortality covers all deaths occurring during pregnancy or at the latest one year after pregnancy termination, whatever the cause. Given this background, we critically review the definitions and classification systems of deaths of pregnant or post-partum women, and discuss the philosophy underlying these conceptual changes, and their consequences in terms of data collection and measurement issues.

Ethnicity and cancer risk in São Paulo, Brazil.

Data from the São Paulo Cancer Registry (Brazil) for the period 1969-1974 are used to investigate ethnic differentials in cancer risk. Risks for specific cancers were estimated for mulattos and blacks relative to whites, using a case-control approach with other cancers as controls. For both sexes, blacks and mulattos are at higher risk than whites for cancer of the esophagus, stomach, and liver and for myeloma; for prostate cancer in males; and for gall bladder, pancreas, and cervix uteri cancers in females. Blacks and mulattos are at lower risk than whites for cancer of the colon, lung, larynx (males only), bladder, bone, testis, breast, and corpus uteri and for melanoma and leukemia. Except for lung and colon cancers, for which life-style habits are the main risk factors, these ethnic differences are similar to those observed in the United States.

Studies of cancer in migrants: rationale and methodology.

Migrant populations comprise substantial numbers of individuals who have undergone a change in their environment, sociocultural and physical. The corresponding changes in risk for different cancers have, therefore, been widely used to infer the relative importance of environmental factors versus inherited predisposition in cancer aetiology. The uncontrolled experiment of migration also provides an indication of the possible effects of certain preventive interventions at the population level--especially with respect to diet. In the past, there has been a surprising lack of attention to analytical methods for migrant data, and we review the epidemiological methods available to best bring out the relevant differences in risk. The major sources of bias which confuse interpretation are also described. Migrant studies are classified into four groups, in a hierarchy corresponding to the amount of information which they can provide, and examples of each type are provided.

Cancer risks among European migrants in São Paulo, Brazil.

Using both mortality and incidence data, cancer risk in Italian, Spanish and Portuguese migrants to São Paulo were compared with those in the Brazil-born population, and with those in their countries of origin. Italian and Spanish migrants show changes in cancer risks which are rather similar to those observed in migrants of the same origin in other parts of South America: they increase their rates of oropharyngeal, oesophageal, cervical and breast cancers and they decrease their rates of lung cancers. However, for cancer of the oesophagus, the changes are greater in São Paulo, where migrants acquire rates similar to those of the natives. For colon cancer, rates in Italian migrants decrease in the low risk area of São Paulo and increase in the high risk area of Argentina. Changes in Portuguese migrants are less evident: their rates of colorectal cancer remain high, and, as found for Japanese migrants in São Paulo, they also retain their higher risks of stomach cancer.

Education and mortality from cancer in São Paulo, Brazil.

This study investigated social class differentials in cancer mortality in São Paulo county, Brazil, for the period 1978 to 1982. A measure of socioeconomic status based on education was used, and cancer risk by level of education was estimated by a case-control approach in which other cancers were considered as controls. For most cancers, the socioeconomic differences in risk were similar to those found in western Europe and North America. For lung cancer, however, the highest risk was observed in men and women with the most education. Other cancers related to tobacco--cancer of the larynx, pharynx, and esophagus--showed a negative association with education. The differences between social classes in consumption habits of alcohol and maté and the use of black tobacco are probably responsible for these contrasting patterns. For breast and cervix uteri cancer the social class patterns were similar to those found in developed countries--a positive relationship for breast and a negative one for cervix uteri cancer. The magnitude of the differences observed between social classes for these cancers was frequently greater in South America than in the United States or western Europe.

Perception of consanguineous marriages and their genetic effects among a sample of couples from Beirut.

We interviewed 100 women who had married a relative and 100 other women of the same age, religious affiliation, and socioeconomic status, but who were not related to their husbands. Both women were selected from a hospital setting in Beirut, and were questioned about their outlook on consanguineous marriages, their awareness of the genetic consequences of consanguinity, and their relationships with in-laws. In general, the women in consanguineous marriages were more favorably inclined than the matched women to marriages between relatives; however, about half of each group would advise their son/daughter to marry his/her cousin. Awareness of the genetic consequences of consanguinity was wide-spread among the respondents, although the women who had married a relative were reluctant to express it. These women also reported better relationships with in-laws, which may be considered as a social benefit derived from consanguineous marriages. Based on the above findings, recommendations are made regarding the content of a public health educational program.

Child survival in Beirut during wartime: time trends and socio-religious differentials.

BACKGROUND: Child mortality estimates in Beirut are presented for the late 1970s and the mid 1980s, and changes in socio-religious differentials of mortality across time are investigated. METHODS: Baseline information was obtained from maternity registries in Beirut in 1984 and 1991. Age of mother, number of children ever born and number of children alive, hospitalization class (1, 2 or 3 within each hospital, depending on the room rate, the services and the doctor's fees), and religion of newborn was recorded. Brass and Macrae's technique was used to convert the proportion dead among children ever born to mothers in age group 30-34 into 5q0 estimates for the reference periods 1978 (1984 data) and 1985 (1991 data). Using hospitalization class as a proxy for social class, religious differentials in child mortality were explored by logistic regression analysis within each period. RESULTS: Overall, 5q0 is estimated at 46 per 1000 in the late 1970s, and at 36 per 1000 in the mid 1980s. The religious differentials in 5q0 mortality estimates were quite large in the former period, with a risk for Muslims relative to Christians of 1.53, which declined to 1.35 in the latter period. The regression analysis of the proportion dead among children ever born; (1) confirmed the magnitude of the religious differentials in child mortality, and their reduction over time; (2) demonstrated the existence of an interaction between religion and social class, as the religious differentials in child mortality were found to be highly prevalent in the lower social classes, and almost insignificant in the middle and upper ones; (3) highlighted the decisive role of differential fertility in generating differential child mortality, with higher fertility and higher child mortality in Muslims, and with the disappearance of religious differentials in child mortality after adjustment for fertility. CONCLUSION: The findings confirm the hypothesis of a reduction over time of religious-based child mortality differences in the capital city of Lebanon, in agreement with the pattern found for religious-based fertility differences. Comparisons with other countries in the region indicate that the war in Lebanon has slowed down the decline in child mortality, causing the country to loose its priviledged position among Arab countries.

PIP: The authors investigated changes in socioreligious differentials of mortality over time using baseline information from maternity registries in Beirut in 1984 and 1991. Mother's age, number of children ever born, number of children alive, hospitalization class, and religion of newborn were recorded. Brass and Macrae's technique was used to convert the proportion dead among children ever born to mothers in age group 30-34 years into mortality estimates for 1978 and 1985. Using hospitalization class as a proxy for social class, religious differentials in child mortality were explored by logistic regression analysis within each period. A reduction over time of religious-based child mortality differences was observed in Beirut, in agreement with the pattern found for religious-based fertility differences. Relative to other countries in the region, the war in Lebanon has slowed down the decline in child mortality.

Cancer mortality among north African migrants in France.

BACKGROUND: Data on cancer mortality in North African migrants to France (the largest foreign-born community in the country) are presented, providing useful insights both into cancer patterns in North Africa and their changes following migration. METHODS: The cancer mortality in migrants from North Africa (Algeria, Morocco, Tunisia and Egypt) resident in France relative to that of the local-born population, is estimated from mortality data for the period 1979-1985, and population data from the 1982 French census. Risks of death from different cancers were adjusted for important confounding factors such as social status and area of residence. RESULTS: The risks are quite similar for Algerian, Tunisian and Moroccan migrants. Compared to the local-born, those Maghrebian migrants of one or both sexes have higher risks of death from cancer of the nasopharynx, gallbladder and bladder (in Algerians only). Conversely, Maghrebian migrants have lower risks of death from cancer of the oral cavity, other pharynx, oesophagus, stomach, colon, rectum, lung, larynx, melanoma (in Algerians only), kidney and nervous system (except in Tunisians), breast, ovary, and cervix uteri (except in Moroccans). For Egyptian migrants, because of small numbers, few of the estimates are statistically significant. They are at lower risk of death from lung cancer and at higher risk for lymphoma and leukaemia. CONCLUSION: The findings provide confirmatory evidence of the unusual cancer patterns among North African populations, who have low risks for most cancer sites, and high risks for certain cancers, such as of the nasopharynx and bladder.

Log-linear models for cancer risk among migrants.

Epidemiological studies of migrants have played an important role in separating the environmental and genetic components of cancer aetiology. The statistical analyses of these studies have typically involved calculating age- and sex-adjusted rates by country of birth. We describe methods which permit the effect of duration of residence in the host country to be estimated after adjusting for other temporal effects such as age, and period or cohort. The methods, which are based on log-linear modelling, can also be applied in a case-control manner if appropriate denominator populations are unavailable. Examples are given in which the more traditional methods of analysis may have yielded misleading results.

Evidence for a 'healthy pregnant woman effect' in Niakhar, Senegal?

BACKGROUND: Although it is generally believed that pregnancy exposes women to a wide variety of excess health risks that go beyond the direct obstetric complications of pregnancy, the epidemiological evidence in support of such excess indirect risks is inconclusive. In this article we attempt to document the contribution of indirect causes of death to maternal mortality in rural Senegal by using an epidemiological approach whereby the time spent during pregnancy and postpartum is considered a transient period of exposure to the health hazards of childbearing. METHODS: We use data from an ongoing demographic surveillance system in Niakhar, Senegal and calculate rate ratios comparing death rates in pregnant or recently pregnant women (exposed) with death rates in other women (unexposed), including and excluding direct obstetric deaths. RESULTS: Between ages 20 and 44, pregnancy does not confer additional risks to women. After excluding direct obstetric deaths, exposed women aged 20--39 have surprisingly lower risks of death than unexposed women of the same age. For the very young (15-19) and the very old (45-49), on the other hand, the excess risks associated with pregnancy are considerable and, among women age 45 or older, persist even after excluding direct obstetric deaths. CONCLUSION: The apparent protective effect of pregnancy on women's health that is observed in this study illustrates the paradoxical nature of the concept of indirect causes of maternal mortality, and the difficulties in measuring the risks of death attributable to the pregnancy. Further studies aimed at separating risks attributable to the pregnancy from those that are incidental to the pregnancy are required.

Epidemiology of primary health problems in Beirut.

As a result of 12 years of civil war in Lebanon, it has been impossible to collect regular morbidity information at the primary level. This report is based on a case-control analysis of various health problems as identified from a population based health survey in Beirut in 1983-1984. Cases of headache, backpain and peptic ulcer, as identified from this survey of 2752 households, were matched for age, sex, and neighbourhood with controls from the same sample. Cases and controls were compared for the presence of various characteristics as collected in the household interview. Headaches were more prevalent in females and in the higher educational categories, and the odds ratio was 1.3 (95 per cent confidence interval 1.01-1.68) for the married compared to the non-married. In comparisons of backpain, the odds ratio for alcohol consumption was 2.40 (1.14-5.08), and for belonging to skilled and unskilled labour categories of occupation it was 2.33 (1.05-5.15) when the analysis was limited to the employed group only. Although the peptic ulcer cases were of lower educational background compared to their controls, no other findings were identified in this third case-control comparison. The methodological shortcomings of such studies and the various interpretations of the findings are presented in the discussion.

Determinants of perceived mental health status and help-seeking behavior: preliminary testing of a conceptual model.

This paper presents a preliminary test of the conceptual model of cognitive determinants of the perception of mental health status. Path analysis was used to examine the causal relationships between education, awareness of higher level needs, one's definition of mental health, and self-rating of mental health status. Discriminant analyses was used to evaluate these variables and others as predictors of help-seeking behavior. Results indicate the importance of cognitive factors in the perception of mental health status and support a direct causal interpretation of model variables. Symptom checklist scores and path variables were found to be the best predictors of help-seeking behavior.

Women's health in relation with their family and work roles: France in the early 1990s.

In this paper, the health of women aged 30 to 49 years is analyzed according to the family and work roles which they exercise, based on the 1991-1992 French national health survey. Households are classified based on the amount of their material resources, and a variety of measures of health and of health-related behaviors are considered. Looking at each role separately, the 'healthy married', 'healthy mother' and 'healthy worker' effects are very obvious for almost all health measures, and higher household income per unit of consumption is clearly associated with better health of women. The role patterns of women are not evenly distributed across income levels: housewives and lone mothers are more common at the bottom and middle of the income scale than at the top, while working women without children, married or not, are much more common at the top. In health terms, more heterogeneity is attached to role patterns in the middle of the income scale than at either extreme. In the middle stratum, two groups of women stand out as being clearly disadvantaged in comparison with that of married women with children and a job: (1) lone mothers, particularly in terms of mental health conditions, malaise symptoms and health-related behaviour, and (2) housewives, particularly in terms of physical health conditions. At the bottom of the income scale, no significant disadvantage is found for housewives compared to married working mothers, yet their overall health pattern is somewhat negative. At the top of the income scale, married working women without children, as well as single women do feel more often than married working mothers that they suffer from handicap or discomfort. The findings are discussed in terms of role enhancement and role strain, health selection, the nature of the health disadvantage associated with specific role patterns, and the importance of the structural context in the role framework.

[Health of the unemployed in France: literature review]. / La santé des chômeurs en France: revue de la littérature.

BACKGROUND: This paper reviews and analyses the main publications concerning health and mortality of the unemployed in France, in order to formulate research orientations for future studies or secondary data analysis. METHODS: The conceptual framework was first set up by assembling the different hypotheses concerning the link between health and unemployment (causality versus selection). A review of the different studies was organized by type: health studies based on data from either cross-sectional health surveys at a national or regional scale, or longitudinal surveys, and mortality studies based on data from follow-up of census samples. RESULTS: Those studies confirm the health disadvantage of the unemployed relative to the employed, in terms of self-perceived health, morbidity, health services utilization and mortality. They provide arguments in favor of both the causality and selection hypotheses. CONCLUSION: The exact nature of the health conditions and causes of death associated with unemployment needs further clarification, as well as the causal pathways.

[Life style and health behavior of southern European and North African immigrants in France]. / Habitudes de vie et comportements en matière de santé des immigrés de l'Europe du sud et du Maghreb en France.

Using data from a French national survey, preventive and dietary habits, alcohol and smoking consumption of three groups of migrants (Italy, Spain and Portugal, Maghreb) were compared to those of French nationals. Odds ratios were estimated using a logistic regression, after adjustment by age, socio-professional group and place of residence. Differences in attitude were observed, in particular: lower primary and secondary practice of prevention; lower consumption of meat and dairy products and higher consumption of starchy food and dried vegetables; lower consumption of alcohol and higher tobacco intake among Maghrebian migrants. The observed differences were interpreted in the light of other available data in France. They confirm notably imported dietary habits and a weaker perception of preventive messages, as shown in other studies.

[Cancer mortality in immigrants from the Near East in Australia]. / Mortalité par cancer des immigrés du Proche-Orient en Australie.

A differential mortality study shows that in Australia, between 1969 and 1983, Near Eastern migrants had a lower cancer mortality than the local-born, and that their cancer profile resembled that of the other mediterranean migrants in Australia. Compared to local-born, Near Eastern migrants were characterized by: (1) a lower mortality from oesophagus and colon cancers, and from melanoma, in both sexes, from prostate cancer in men borne in males, from ovary and bladder cancers in females; (2) a higher mortality from liver and thyroïd cancers in males, and from stomach and gallbladder cancers in females. The analysis by country of birth indicates a higher mortality from lung and bladder cancers in men born in Turkey, a lower mortality from lung cancer in men born in Syria or Lebanon, and a lower mortality from breast cancer in women born in Syria or Lebanon. These differences are interpreted in the light of the available information on dietary habits and reproductive behaviour of Near Eastern migrants in Australia.