Location and Provision of Support from Migrants to Left-behind Parents in Rural Cambodia.

Cambodia is a country where labor migration has been consistently high, particularly out of rural areas. Migration increases the distance between parents and their children, which may lead to a reduction in sources of support. Based on these contemporary realities, it is important to understand the factors that impact provision of support from migrants to their parents. This study examines determinants of support provision, with a focus on migrant location. Based on family solidarity and altruism theories, other factors were considered that indicate migrant's ability to provide, the degree of parental vulnerability and degree of interaction. We hypothesized that the likelihood of migrant support provision to left-behind parents related to their location, ability to provide and needs of the household. Data were sourced from the 2011 Cambodian Rural Urban Migration Project (CRUMP) (N = 3700). In bivariate analysis, 77% of both international and rural to urban internal migrants provide monetary support. Rural to urban internal migrants are most likely, and international migrants least likely, to be providing instrumental support. When examining fully adjusted models, it is rural to urban internal migrants that are the most likely to provide both monetary and instrumental support. Both types of support are more likely to be provided by female migrants and to households headed by females. Results show that left-behind parents are not completely unsupported in rural Cambodia, but support provision may be impacted by other determinants. This study provides baseline information for policy makers to design suitable policies that may optimize the positive impact of migration for migrants and left-behind parents.

Psychosocial resilience among left-behind adolescents in rural Thailand: A qualitative exploration.

When parents migrate, they often leave children behind with relatives. Despite being at higher risk of socio-emotional problems, many left-behind children have good health and social outcomes, suggesting their resilience. We sought to understand how adolescents with internal and international migrant parents build resilience in Thailand. We conducted qualitative interviews with 24 adolescents aged 10-19, and six caregivers, parents and community leaders. Interviews were transcribed, translated and analysed, drawing on techniques from grounded theory. We found that resilience was built in a context where for many families, migration was a financial necessity and the parent-child relationship was mainly phone-based. Adolescents built resilience using three key 'resources': warmth (love and understanding), financial support and guidance. Adolescents with insecure parent or caregiver relationships, or with caring responsibilities for relatives, were less likely to have access to these resources. These adolescents sought emotional and financial independence, prioritised friendships and identified role models to obtain key resources and build resilience. The findings indicate practical and psychosocial barriers to building resilience among left-behind adolescents in Thailand. Further work could explore pathways to mental illness in this population, interventions that build peer networks and caregiver-child relationships and the use of technology to support remote parenting.

Psychiatric symptoms among migrants to Malaysia from the southernmost provinces of Thailand.

AIM: The objective of this paper is to examine the level of psychiatric symptoms and associated factors among Thai migrants from the southernmost Thai provinces of Pattani, Yala, and Narithiwat who are working in Malaysia. Comparisons will be made with the sending population in the southernmost provinces of Thailand. METHODS: Data are drawn from survey and in-depth interviews with Thai migrants who are working in Malaysia. Comparisons are made with a probability sample of working age adults in Thailand. The twenty item Self Reporting Questionnaire (SRQ) was the measure of mental health. RESULTS: The study found that the migrants, on average, have normal levels of psychiatric symptoms. However, although about 24% of migrants reported more eight or more symptoms that may indicate a need for evaluation. There are many stressors in their lives including distance from families, reduced social support, legal matters surrounding immigration, and discrimination/exploitation of migrant groups. CONCLUSION: The study highlights the need for policy makers and non-governmental organizations to give attention to migrants' mental health, well-being and sustainable livelihoods.

Incentive programmes for smoking cessation: cluster randomized trial in workplaces in Thailand.

OBJECTIVE: To compare several monetary incentive programmes for promoting smoking abstinence among employees who smoke at workplaces in a middle income country. DESIGN: Parallel group, open label, assessor blinded, cluster randomized controlled trial. SETTING: Large industrial workplaces in metropolitan Bangkok, Thailand. PARTICIPANTS: Employees who smoked cigarettes and planned to quit within six months recruited from 101 worksite clusters (84 different companies). INTERVENTIONS: Worksites were digitally cluster randomized by an independent investigator to usual care or usual care plus one of eight types of incentive programmes. Usual care consisted of one time group counseling and cessation support through a 28 day text messaging programme. The incentive programmes depended on abstinence at three months and varied on three intervention components: refundable deposits, assignment to a teammate, and bonus size ($20 (£15; €17) or $40). MAIN OUTCOME MEASURES: The primary outcome was biochemically verified seven day point prevalence smoking abstinence at 12 months. Secondary outcomes were programme acceptance at enrollment and smoking abstinence at three months (end of intervention) and at six months. All randomized participants who had complete baseline information were included in intention-to-treat analyses; participants with missing outcomes were coded as continuing smokers. RESULTS: Between April 2015 and August 2016, the trial enrolled 4190 participants. Eighteen were omitted because of missing baseline covariates and death before the primary endpoint, therefore 4172 participants were included in the intention-to-treat analyses. Programme acceptance was relatively high across all groups: 58.7% (2451/4172) overall and 61.3% (271/442) in the usual care group. Abstinence rates at 12 months did not differ among deposit programmes (336/2253, 14.9%) and non-deposit programmes (280/1919, 14.6%; adjusted difference 0.8 points, 95% confidence interval -2.7 to 4.3, P=0.65), but were somewhat lower for team based programmes (176/1348, 13.1%) than individual based programmes (440/2824, 15.6%; -3.2 points, -6.6 to -0.2, P=0.07), and higher for $40 bonus programmes (322/1954, 16.5%) than programmes with no bonus (148/1198, 12.4%; 5.9 points, 2.1 to 9.7, P=0.002). The $40 individual bonus was the most efficacious randomization group at all endpoints. Intervention components did not strongly interact with each other. CONCLUSIONS: Acceptance of monetary incentive programmes for promoting smoking abstinence was high across all groups. The $40 individual bonus programmes increased long term smoking abstinence compared with usual care, although several other incentive designs did not, such as team based programmes and deposit programmes. Incentive design in workplace wellness programmes might influence their effectiveness at reducing smoking rates in low resource settings. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02421224).

Migration and Unrest in the Deep South Thailand: A Multilevel Analysis of a Longitudinal Study.

Although migration of Muslims from the southernmost provinces of Thailand to Malaysia has a long history, research suggests that the intensity of this migration has increased in the past 10 years along with increased unrest in the provinces. This study examines how migration in the three southernmost provinces is affected by the ongoing unrest. Data are drawn from household probability surveys conducted in 2014 and 2016. An individual sample of 3,467 persons who were household residents at the 2014 survey was followed to see who remained in the household of origin or moved out two years later (2016 survey). Data on violent events from the Deep South Watch, an independent organization, were used to measure exposure to violence. Results from a multilevel analysis show that net of other characteristics at the individual, household, and village levels, individuals who live in a village in which a violent event occurred in the previous year are more likely to move out than those who live in a village with no violent event in the previous year. Findings suggest that in addition to the economic reasons that have long motivated migration from this area, violent events accelerate this migration.

Psychological factors associated with protected sex among indirect female sex workers in Denpasar, Bali, Indonesia.

A cross-sectional study was conducted among indirect FSWs (a type of FSWs who provide sex services under the cover of entertainment or recreational enterprises) in Denpasar, Bali from August to October 2017 to investigate factors associated with protected sex with clients using the Health Belief Model (HBM) framework. The protected sex as a dependent variable was identified through self-reported consistency in using condoms with clients in the last month. Independent variables consisted of six HBM constructs and three main groups of modifying factors (personal, sex work, and interventional factors). Binary logistic regression was employed to identify the determinants. The prevalence of protected sex with clients in last month was 50.17% (95%CI = 41.50-80.83). Indirect FSWs were more likely to use condoms consistently if they completed senior high school or higher. Meanwhile, those working in a karaoke lounge, bar, or café were less likely to have protected sex than those in a massage parlour, spa, or beauty salon. Based on HBM, an increase of one-score of these following constructs increased likelihood of protected sex: perceived susceptibility, self-efficacy, and cues to action. Low protected sex among indirect FSWs indicates the need for public health interventions at individual, interpersonal, and institutional level.

Long-term civil conflict, migration, and the mental health of adults left behind in Thailand: a longitudinal study.

OBJECTIVES: A long-term civil conflict has been occurring in the southernmost provinces of Thailand, and migration to Malaysia has been accelerated by this conflict. The objective of this work was to examine the influence of perceived effects of the unrest, migration of a household member, and children left behind on the reporting of psychiatric symptoms of working age adults. METHODS: A first round of data collection was conducted in 2014 including interviews with a probability sample of 1102 households and individual interviews with 2058 males and females aged 18-59. In 2016, a second round of data collection was conducted. A fixed effects model was used in the analysis. RESULTS: The perceived effect of the unrest on the household was associated with an increased reporting of psychiatric symptoms. Furthermore, the migration of a household member for work and the presence of children left behind were related to an increased reporting of psychiatric symptoms among adults, especially among females. CONCLUSIONS: The unrest and its associated migration was related to an increased reporting of psychiatric symptoms among working age adults in the study population.

Coming of age in a conflict area: Mental health, education, employment, migration and family formation in the southernmost provinces of Thailand.

OBJECTIVES: Three southern provinces of Thailand - Pattani, Yala and Narathiwat - have been involved in a long period of unrest. Young people in these provinces have lived with this violence for many years. The objectives of this article are to assess the prevalence of psychiatric symptoms of young adults aged 18-24 years and to examine the perceived effects of the conflict on education, employment, social and religious life. METHODS: Data were drawn from a probability sample of 2,053 Muslim adults aged 18-59 years conducted in 2014. Mental health was assessed using World Health Organization's (WHO) Self Reporting Questionnaire (SRQ) of 20 questions, the Thai Mental Health questionnaire and a Happiness scale. In-depth interviews with 30 respondents were also used to assess the perceived effects of the conflict on daily life, education, employment and settlement. RESULTS: Most respondents reported low levels of psychiatric symptoms, though a small proportion reported a large high enough number to be of concern. Most of them also reported high levels of happiness. Respondents who wished to migrate to work in another area reported more psychiatric symptoms and lower levels of happiness. Many respondents reported concerns about the violence in their daily lives, although some may have become habituated to its effects. There were many obstacles reported toward obtaining education including the threat of violence, financial cost and drug use. Male respondents had concerns about consequences of being suspected to be involved in the violence and drug use. The limited employment and the threat of violence were related to the plan to migrate or to settle in the three provinces. CONCLUSION: In summary, most young people in the area move forward with their lives and many display some habituation to the violence. However, the economic depression due to the violence and the threat of violence often affected their daily lives.

Religiosity, the Practices of Religions, and the Perception of Older People Among Muslims and Buddhists in Thailand.

We examined the effects of religiosity and the practices of religions among the Buddhists and Muslims aged 20 to 79 in Thailand on maintaining positive attitudes toward older people. Factor and multiple regression analyses are applied, using data from the 2011 National Survey on Conditions of Society and Culture. The measures of perception of older people are Social Value and Personal Value. Religiosity is measured by the self-assessment of religious strictness and one's own practices according to the religious principles. Among Buddhists, the practices are measured by the frequency of praying, Takbat, Pancha Sila, and meditation. For Muslims, the practices are measured by the frequency of doing Salat, observing Saum, and giving Zakat. We found that religiosity and some practices of religions have positive effects on the perception of the value of older people. In addition, social policy for a smooth transition to an aging society should be considered alongside this religious mechanism.

Mental health in a conflict area: Migration, economic stress and religiosity in the three southernmost provinces of Thailand.

AIM: Three southern provinces of Thailand, Pattani, Yala and Narathiwat, have been involved in a long period of unrest due to differences between the population in the provinces and the Thai government with regard to language, culture and governance. The objectives of this article are to examine the effects of everyday stressors due to the conflict, including economic stress and migration, as well as the effect of religiosity on the reporting of psychiatric symptoms among adults in the three provinces. METHODS: Data were drawn from a survey conducted in 2014. The survey included a probability sample of 2,053 Muslim adults aged 18-59 years.Mental health was assessed using World Health Organization's (WHO) Self-Reporting Questionnaire (SRQ) of 20 questions. Multilevel models were estimated to examine the influence of economic stress due to the conflict, as well as community and individual aspects of migration and religion on mental health. RESULTS: The data showed that migration from the household and the community and the economic effects of the unrest were associated with reporting of more psychiatric symptoms among adults in the southern provinces. Religion was related to reporting of fewer psychiatric symptoms at the individual and the community levels. CONCLUSION: The study documented increased reporting of psychiatric symptoms among persons reporting perceived household economic stress due to the conflict and the migration of family members.

Climate Shocks and Migration: An Agent-Based Modeling Approach.

This is a study of migration responses to climate shocks. We construct an agent-based model that incorporates dynamic linkages between demographic behaviors, such as migration, marriage, and births, and agriculture and land use, which depend on rainfall patterns. The rules and parameterization of our model are empirically derived from qualitative and quantitative analyses of a well-studied demographic field site, Nang Rong district, Northeast Thailand. With this model, we simulate patterns of migration under four weather regimes in a rice economy: 1) a reference, 'normal' scenario; 2) seven years of unusually wet weather; 3) seven years of unusually dry weather; and 4) seven years of extremely variable weather. Results show relatively small impacts on migration. Experiments with the model show that existing high migration rates and strong selection factors, which are unaffected by climate change, are likely responsible for the weak migration response.

Predictors of Successful Quitting among Thai Adult Smokers: Evidence from ITC-SEA (Thailand) Survey.

This study uses longitudinal data from the International Tobacco Control Southeast Asia (ITC-SEA Thailand) survey to explore patterns and predictors of successful quitting among Thai adult smokers as a function of time quit. A cohort of a representative sample of 2000 smokers was surveyed four times from 2005 to 2009. A sample of 1533 individuals provided data for at least one of the reported analyses. Over the four years of follow-up, 97% made attempts to quit. Outcomes were successful quitting/relapse: (a) quit attempts of at least one month (short-term relapse, 43%) (57% remaining quit); (b) surviving at least six months (medium-term) (31%); (c) relapse between one and six months (45%); (d) having continuously quit between Waves 3 and 4 (sustained abstinence) (14%); and (e) relapse from six months on (44%) compared to those who continuously quit between Waves 3 and 4 (56%). Predictors for early relapse (<1 month) differ from longer-term relapse. Age was associated with reduced relapse over all three periods, and was much stronger for longer periods of abstinence. Cigarette consumption predicted relapse for short and medium terms. Self-assessed addiction was predictive of early relapse, but reversed to predict abstinence beyond six months. Previous quit history of more than one week was predictive of early abstinence, but became unrelated subsequently. Self-efficacy was strongly predictive of abstinence in the first month but was associated with relapse thereafter. Some determinants of relapse change with time quit, but this may be in somewhat different to patterns found in the West.

The impact of parental migration on the mental health of children left behind.

This study aims to examine the impact of parental international migration on the mental health of children left behind. Data for this paper were taken from the "Child Health and Migrant Parents in South-East Asia, Thailand, 2008" project. A total of 1,030 children (519 from emigrant parents and 511 from non-migrant parents) were covered. Data were collected from the caregivers of children using the Strength and Difficulties Questionnaire. Multivariate analyses were performed to determine the association between parental migration and the mental health status of children left behind. Several factors were significantly associated with children's mental health. Our study did not find any association between current parental migration status and mental health status of the children left behind. The study found, however, that mother's earlier migration history had a significant, independent association with mental health problems of the children left behind. Therefore, effective strategies to prevent such mental health problems among children are warranted.

The Subjective Well-Being of Children in Transnational and Non-Migrant Households: Evidence from Thailand.

To date, research that includes children's views on parental migration has been insufficient. Based on the children's assessment of well-being, we use a case study of Thailand to ask whether children of overseas migrant parents are less or more resilient compared to children of non-migrant parents. We make use of data from the Child Health and Migrant Parents in South-East Asia (CHAMPSEA) Project, one of the few studies that provide space for children, both of migrant and non-migrant parents, to voice their views. Our sample includes 496 children aged 9 to 11 years old. The outcome variable captures children's subjective well-being as an indicator of whether they are a resilient child. Our multivariate analysis controls for other potential contributing factors, including the children's individual attributes, carer's mental health, parents' education, family functioning as reported by the children, and household economic status in order to investigate the effects of parental migration. Qualitative information from in-depth interviews with selected carers and group interviews with community leaders are also used to explain the results. Our findings highlight the importance of taking into account children's own perceptions. Compared to children of non-migrant parents, those of migrant parents are more likely to give a positive assessment of their own well-being. The other contributing factors include whether the child sees their family as functioning well. In Thailand, international migration is predominantly undertaken by fathers while childcare remains the responsibility of mothers, and public attitudes towards overseas migration, especially paternal migration, is generally favorable. This may help explain the positive perception of children of migrants towards themselves.

Impact of children's migration on health and health care-seeking behavior of elderly left behind.

BACKGROUND: Many countries are facing the burden of accelerated population aging and a lack of institutional support to meet the needs of older individuals. In developing countries, adult children are primarily responsible for the care of their elderly parents. However, out-migration of adult children is common in these countries. This study aims to explore the impact of migration on the health of the elderly left behind and their health care-seeking behavior. METHODS: This paper uses data from a national survey of older persons in Thailand conducted in 2007. The analysis is confined to those who were aged 60 years or above and who had at least one child (biological or step/adopted) (n = 28,677). Logistic regression was used to assess the net effect of migration of adult children on the health of the elderly left behind and their health care-seeking behavior, after controlling for other socio-demographic and economic variables. RESULTS: More than two-thirds of the elderly (67%) had at least one migrant child. About three-fifths (58%) reported that they had at least one symptom of poor mental health. Almost three in five elderly (56%) rated their health as poor, and 44% had experienced at least one chronic disease. About two-thirds of the elderly (65%) got sick during the 5 years preceding the survey. An overwhelming majority of elderly (88%) who got sick during the five years preceding the survey had sought treatment for their last illness.After controlling for socio-demographic and economic variables, our study found that those elderly who had a migrant child were more likely (OR = 1.10; 95% CI 1.05-1.17) to have symptoms of poor mental health than those whose children had not migrated. However, no significant association was observed among physical health, such as experience of chronic disease, perceived poor health, and illness of the elderly left behind. Interestingly, however, out-migration of adult children was independently associated with higher utilization of health services. The elderly who had migrant children were more likely (odds ratio = 1.22, CI 1.11-1.33) than those whose children had not migrated to seek treatment for their most recent illness, after controlling for socio-demographic and economic variables. CONCLUSION: Our study provides novel evidence on an issue of special importance to countries affected by heavy out-migration of adult children, an issue that has received little attention. Out-migration of adult children was highly associated with poor mental health but it was not associated with the physical health of the elderly left behind. Out-migration of children was also highly associated with higher utilization of health facilities by the elderly. Thus, in order to decrease morbidity among the elderly as well as to maintain and enhance the well-being of families, programs should focus on alleviating the symptoms of poor mental health among the elderly left behind and aim to reduce the differences in utilization of health care-seeking behavior among elderly with children present in the community and elderly left behind.

Risk factors of tobacco use among Thai adolescents: finding from International Tobacco Control Policy Survey Southeast Asia (ICT-SEA).

OBJECTIVE: To determine the risk factors of tobacco use among Thai adolescents. MATERIAL AND METHOD: A cross-sectional study was conducted among 706 adolescents sampled from 5 regions of Thailand using stratified multistage sampling. Participants were asked to complete self-administered questionnaires about tobacco use and psychosocial factors. A logistic regression model of risk factors for tobacco use was estimated using backward stepping. RESULTS: The prevalence of smoking in Thai adolescent was 15 percent (27.8% in males, 2.3% in females). Older age (OR = 1.25, 95% CI = 1.02-1.51), number of close friend smoking (OR = 1.61, 95% CI = 1.35-1.93), number of older sibling smoking (OR = 1.44, 95% CI = 1.01-2.04), heavy alcoholic consumption (OR = 3.99, 95% CI = 1.87-8.49), low self-worth (OR = 3.16, 95% CI = 1.71-5.84) were risk factors of smoking in Thai adolescents. Females (OR = 0.10, 95% CI = 0.04-0.24), currently studying in school (OR = 0.33, 95% CI = 0.18-0.59) and religious beliefs guide actions (OR = 0.41, 95% CI = 0.22-0.77) were protective factors against smoking. CONCLUSION: Male adolescents are target group for tobacco control in Thailand. The strong correlation between smoking and alcoholic consumption indicate that anti-smoking campaign should be done in parallel with anti-alcohol campaign.

How does leaving home affect marital timing? An event-history analysis of migration and marriage in Nang Rong, Thailand.

This study examines the effects of migration on marital timing in Thailand between 1984 and 2000 using prospective and retrospective survey data from Nang Rong. In contrast to previous results in the literature, event-history analysis of the longitudinal data reveals a positive, not a negative, effect of lagged migration experience on the likelihood of marriage. The findings also indicate gender differences. Migration's positive impact is independent of other life events for women but is completely "explained" by employment for men.