Is duration of residence a proxy for acculturation? The case of health risk behaviors among international immigrants.

AIMS: Among international immigrants, health changes by duration of residence are commonly interpreted as an expression of acculturation to the receiving country context. This study compares changes in immigrants' health risk behaviors by duration of residence to changes by acculturation levels, in order to assess whether duration of residence can be regarded as a proxy for acculturation. METHODS: Using data from a previous systematic review, we identified 17 quantitative studies examining changes in alcohol, tobacco and drug use, physical inactivity, and diet by both duration of residence and acculturation level in the same population. We compared the directionality and consistency of these associations through tabulation and vote counting. RESULTS: The majority of studies reported no or inconsistent changes in health risk behaviors by duration of residence versus by acculturation, including with opposite directionality. Four studies reported significant estimates with consistent directionality, while five reported consistent, non-significant estimates. CONCLUSIONS: Our findings suggest that duration of residence should not be used as a proxy for acculturation when studying health risk behaviors among immigrants. Researchers should consider additional time-dependent factors to explain behavioral changes by duration of residence.

Effects of the COVID-19 pandemic on mental health, working, and life situation of employees in the Swedish hospitality industry.

Introduction: Previous studies reported that the coronavirus disease (COVID-19) pandemic has negatively affected the mental health of employees in the hospitality industry internationally, however, its effect in Sweden has not been studied. Unlike several other countries, Sweden never enforced a lockdown. Restaurants, bars, and hotels could remain open and host a limited number of guests but had to abide by certain restrictions. Methods: A cross-sectional survey was distributed among hospitality industry employees containing questions regarding the perceived effects of the pandemic on the respondents' working and life situations and their physical and psychological health. The sample consisted of 699 individuals, with a response rate of 47.9%. Results: Although several respondents had been laid off or furloughed, the majority of the sample remained at the same employer. However, more than half of the respondents reported that their economic situation had deteriorated. Compared to before the pandemic, 38.1% experienced elevated levels of stress, 48.3% experienced elevated levels of worry, and 31.4% reported worsened mood. A deteriorating personal economy and difficulty in following COVID-19-related restrictions at work were associated with the worsening of these three mental health aspects. While the fear of becoming infected with COVID-19 was related to higher levels of stress, the fear of infecting others was related to higher levels of worry. Conclusion: Although Sweden imposed less strict measures than most other countries, the personal economy and mental health of hospitality workers were negatively affected by the COVID-19 pandemic.

Health Risk Behaviours by Immigrants' Duration of Residence: A Systematic Review and Meta-Analysis.

Objectives: The aim was to systematically review and synthesise international evidence on changes in health risk behaviours by immigrants' duration of residence. Methods: We searched literature databases for peer-reviewed quantitative studies published from 2000 to 2019, examining alcohol, drug and tobacco use; physical inactivity; and dietary habits by duration of residence. Results: Narrative synthesis indicated that immigrants tend to adopt health risk behaviours with longer residence in North America, with larger variation in effect sizes and directionality in other contexts. Random-effects meta-analyses examining the pooled effect across all receiving countries and immigrant groups showed lower odds of smoking (OR 0.54, 0.46-0.63, I 2 = 68.7%) and alcohol use (OR 0.61, 0.47-0.75, I 2 = 93.5%) and higher odds of physical inactivity (OR 1.71, 1.40-2.02, I 2 = 99.1%) among immigrants than natives, but did not provide support for a universal trend by duration of residence. Conclusion: Findings suggest that duration of residence could serve as an effective instrument to monitor immigrants' health changes. However, differences in receiving country contexts and immigrant populations' composition seem to be important to predict the level and direction of behavioural change. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, PROSPERO CRD42018108881.

Social network characteristics and alcohol use by ethnic origin: An ego-based network study on peer similarity, social relationships, and co-existing drinking habits among young Swedes.

The study explores how social network determinants relate to the prevalence and frequency of alcohol use among peer dyads. It is studied how similar alcohol habits co-exist among persons (egos) and their peers (alters) when socio-demographic similarity (e.g., in ethnic origin), network composition and other socio-cultural aspects were considered. Data was ego-based responses derived from a Swedish national survey with a cohort of 23-year olds. The analytical sample included 7987 ego-alter pairs, which corresponds to 2071 individuals (egos). A so-called dyadic design was applied i.e., all components of the analysis refer to ego-alter pairs (dyads). Multilevel multinomial-models were used to analyse similarity in alcohol habits in relation to ego-alter similarity in ethnic background, religious beliefs, age, sex, risk-taking, educational level, closure in network, duration, and type of relationship, as well as interactions between ethnicity and central network characteristics. Ego-alter similarity in terms of ethnic origin, age and sex was associated with ego-alter similarity in alcohol use. That both ego and alters were non-religious and were members of closed networks also had an impact on similarity in alcohol habits. It was concluded that network similarity might be an explanation for the co-existence of alcohol use among members of peer networks.

Home and away: mortality among Finnish-born migrants in Sweden compared to native Swedes and Finns residing in Finland.

BACKGROUND: Most first-generation migrants have lower mortality compared to the native population. Finnish-born migrants in Sweden instead have higher mortality; possibly because of health behaviours established before migration. To increase our understanding of this excess mortality, we compared the cause-specific mortality of Finnish migrants in Sweden to both the native population of Sweden and the native Finnish population residing in Finland. METHODS: We used Swedish and Finnish register data, applying propensity score matching techniques to account for differences in sociodemographic characteristics between the migrants, Swedes and Finns. The index population were Finnish migrants aged 40-60, residing in Sweden in 1995. We compared patterns of all-cause, alcohol- and smoking-related, and cardiovascular disease mortality across the groups in the period 1996-2007. RESULTS: Finnish migrant men in Sweden had lower all-cause mortality compared to Finnish men but higher mortality compared to the Swedish men. The same patterns were observed for alcohol-related, smoking-related and cardiovascular disease mortality. Among women, all three groups had similar levels of all-cause mortality. However, Finnish migrant women had higher alcohol-related mortality than Swedish women, similar to Finnish women. Conversely, migrant women had similar levels of smoking-related mortality to Swedish women, lower than Finnish women. CONCLUSIONS: Finnish-born migrants residing in Sweden have mortality patterns that are typically in between the mortality patterns of the native populations in their country of origin and destination. Both the country of origin and destination need to be considered in order to better understand migrant health.

Health risk behaviours among migrants by duration of residence: protocol for a systematic review and meta-analysis.

INTRODUCTION: International migrants' health has often been found to deteriorate in new countries, partly due to changes in health risk behaviours such as alcohol consumption, tobacco use, physical inactivity, and poor dietary habits. However, limited efforts have been made to comprehensively evaluate the extent to which migrants adopt unhealthy risk behaviours with longer duration of residence. This systematic review and meta-analysis will summarise evidence on international migrants' behavioural patterns by duration of residence in multiple country contexts. METHODS AND ANALYSIS: PubMed/MEDLINE, Web of Science and ProQuest databases will be searched for quantitative or mixed-method observational studies published in peer-reviewed scientific journals between 1 January 2000 and 31 December 2019. Studies comparing foreign-born individuals by duration of residence will be included. Information on study characteristics, descriptive statistics and measures of effect will be extracted. All included studies will be quality assessed using a modified Newcastle-Ottawa scale. The review will include narrative synthesis and, if sufficient and comparable data are available, random effects meta-analyses. The review will be conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. ETHICS AND DISSEMINATION: Ethical approval is not required since previously published information from peer-reviewed studies will be assessed. The results of this review will be published in peer-reviewed journals and presented at scientific conferences. Other forms of dissemination will include communication to broader audiences using well-established channels, including through university-based press releases. Progress will be regularly updated on the International Prospective Register of Systematic Reviews to ensure full transparency. PROSPERO REGISTRATION NUMBER: CRD42018108881.

Intergenerational transmission of alcohol misuse: mediation and interaction by school performance in a Swedish birth cohort.

BACKGROUND: Children whose parents misuse alcohol have increased risks of own alcohol misuse in adulthood. Though most attain lower school marks, some still perform well in school, which could be an indicator of resilience with protective potential against negative health outcomes. Accordingly, the aim of this study was to examine the processes of mediation and interaction by school performance regarding the intergenerational transmission of alcohol misuse. METHODS: Data were drawn from a prospective Swedish cohort study of children born in 1953 (n=14 608). Associations between parental alcohol misuse (ages 0-19) and participants' own alcohol misuse in adulthood (ages 20-63) were examined by means of Cox regression analysis. Four-way decomposition was used to explore mediation and interaction by school performance in grade 6 (age 13), grade 9 (age 16) and grade 12 (age 19). RESULTS: Mediation and/or interaction by school performance accounted for a substantial proportion of the association between parental alcohol misuse and own alcohol misuse in adulthood (58% for performance in grade 6, 27% for grade 9 and 30% for grade 12). Moreover, interaction effects appeared to be more important for the outcome than mediation. CONCLUSION: Above-average school performance among children whose parents misused alcohol seems to reflect processes of resilience with the potential to break the intergenerational transmission of alcohol misuse. Four-way decomposition offers a viable approach to disentangle processes of interaction from mediation, representing a promising avenue for future longitudinal research.

Changes in alcohol-related harm in Sweden after increasing alcohol import quotas and a Danish tax decrease--an interrupted time-series analysis for 2000-2007.

BACKGROUND: Denmark decreased its tax on spirits by 45% on 1 October 2003. Shortly thereafter, on 1 January 2004, Sweden increased its import quotas of privately imported alcohol, allowing travellers to bring in much larger amounts of alcohol from other European Union countries. Although these changes were assumed to increase alcohol-related harm in Sweden, particularly among people living close to Denmark, analyses based on survey data collected before and after these changes have not supported this assumption. The present article tests whether alcohol-related harm in southern Sweden was affected by these changes by analysing other indicators of alcohol-related harm, e.g. harm recorded in different kinds of registers. METHODS: Interrupted time-series analysis was performed with monthly data on cases of hospitalization due to acute alcohol poisoning, number of reported violent assaults and drunk driving for the years 2000-07 in southern Sweden using the northern parts of Sweden as a control and additionally controlling for two earlier major changes in quotas. RESULTS: The findings were not consistent with respect to whether alcohol-related harm increased in southern Sweden after the decrease in Danish spirits tax and the increase in Swedish alcohol import quotas. On the one hand, an increase in acute alcohol poisonings was found, particularly in the 50-69 years age group, on the other hand, no increase was found in violent assaults and drunk driving. CONCLUSIONS: The present results raise important questions about the association between changes in availability and alcohol-related harms. More research using other methodological approaches and data is needed to obtain a comprehensive picture of what actually happened in southern Sweden.

Changes in alcohol availability, price and alcohol-related problems and the collectivity of drinking cultures: what happened in southern and northern Sweden?

AIMS: The aims of this study were to study whether alcohol-related self-reported problems follow the same pattern of changes in alcohol consumption in southern Sweden, assumed to be affected by a decrease in Danish spirits tax and by an increase in Swedish travellers' import quotas, and to study whether the results obtained for southern and northern Sweden follow the predictions of Skog's theory of collectivity of drinking cultures. METHODS: Analysis was carried out on a sample from the Swedish general population from southern and northern Sweden separately. Two indices such as impaired self-control/dependent behaviour and extrinsic problems for alcohol-related problems were computed and analysed in terms of sex, age, income and alcohol consumption level. RESULTS: Although there were no huge changes in the number of persons reporting alcohol-related problems, the general trend in data for various subpopulations was a decrease in the southern site and an increase in the northern site. In the northern site, the increase in alcohol consumption among men also showed an increase in alcohol-related problems. However, various population subgroups changed in different directions and did not move in concert over the population distribution. CONCLUSIONS: Analysis confirmed that alcohol-related problems, according to the two indices used, followed a similar pattern to alcohol consumption, but less divergent. A version of Skog's theory applied on alcohol-related problems could not confirm that alcohol-related problems did not change collectively within the population.

Alcohol consumption in southern Sweden after major decreases in Danish spirits taxes and increases in Swedish travellers' quotas.

BACKGROUND: In 2003, Denmark lowered its tax on spirits, and in 2004, Sweden increased its traveller import quotas. AIM: The aim of the study was to determine whether these two changes increased self-reported alcohol consumption in southern Sweden, which is located near Denmark. METHOD: Data were collected through telephone interviews with the general population between 2003 and 2006. Individuals aged 16-80 years were interviewed. Some lived in southern Sweden, others in the northern region, which was assumed to be unaffected by the policy changes and was thus used as a control site. Analyses were performed for the total population as well as by sex, age, socio-economic group and consumption pattern. RESULTS: The expected results were not found: alcohol consumption in southern Sweden had not changed. The few statistically significant changes found in southern Sweden indicated decreases. In the north, however, consumption seemed to have increased. CONCLUSION: In addition to the two policy changes mentioned above, other changes seem to have affected alcohol consumption in Sweden. It is possible, however, that the policy changes have affected population groups not reached by the survey, and thus other types of data need to be analysed before drawing any far-reaching conclusions.

Changes in alcohol-related problems after alcohol policy changes in Denmark, Finland, and Sweden.

OBJECTIVE: European Union travelers' allowances for alcohol import to Denmark, Sweden, and Finland were abolished in 2004. In addition, excise taxes on alcohol were lowered in 2003 and 2005 in Denmark, and in 2004 in Finland. Using northern Sweden as a control site, this study examines whether levels of reported alcohol problems have changed in Denmark, Finland, and southern Sweden as a consequence of these policy changes. METHOD: Annual cross-sectional surveys were conducted in Denmark, Finland, and Sweden from 2003 to 2006. Five dependency items and seven extrinsic alcohol-related problems were examined. Changes were analyzed within each country/region with logistic regressions and tested for short- and long-term changes. Differential change was also tested between each country and the control site, northern Sweden. RESULTS: Prevalence of alcohol problems decreased over the study period. Only in selected subgroups did problems increase. This mainly occurred in the samples for northern Sweden and Finland, and mostly among older age groups and men. In relation to the control site, however, no increases in problem prevalence were found. CONCLUSIONS: Our findings on a decline in reported alcohol problems largely agree with published reports on alcohol consumption over the same period in the study countries. They do not agree, however, with findings on changes in health and social statistics in Finland and Denmark, where some significant increases in alcohol-related harm have been found.

Changes in alcohol consumption in Denmark after the tax reduction on spirits.

AIMS: This paper examines changes in alcohol consumption in Denmark between 2003 and 2006 after the excise tax on spirits in Denmark was lowered by 45% on October 1, 2003 and travelers' allowances for the import of alcohol were increased on January 1, 2004. METHODS: Cross-sectional and panel data from Denmark from 2003 to 2006 were analyzed. Samples were collected by telephone interviews using random digit dialing. RESULTS: Panel data for Denmark revealed that alcohol consumption remained relatively stable. Similar results were found in the Danish cross-sectional data. It appears that 'substitution' rather than increased importation occurred. CONCLUSION: We found no evidence to support earlier research stating that decreased prices and increased availability is related to higher alcohol consumption. This could be partly because (1) Denmark has reached a 'saturation' level of consumption over the past 30 years and (2) the survey mode of data collection did not capture specific subpopulations who might have increased their consumption. It may be necessary to examine other indicators of alcohol use or alcohol-related harm in order to fully assess the consequences of such changes in alcohol availability.

Changes in volume of drinking after changes in alcohol taxes and travellers' allowances: results from a panel study.

AIMS: The aim of this paper is to study short-term changes in alcohol consumption by subgroups of the population in Denmark, Finland and southern Sweden following large-scale decreases in alcohol taxation in Denmark and Finland and large increases in travellers' allowances in Finland and Sweden. DESIGN: General population random samples surveyed before and after the changes, using northern Sweden as a control site. SETTING: Denmark, Finland, southern Sweden and northern Sweden. PARTICIPANTS: Respondents aged 16-69 years. MEASUREMENTS: Volume of drinking is the main measure reported. Changes are examined by gender, age, income and year 2003 consumption level. RESULTS: Consumption decreased or remained the same among women and men in all three study sites. Relative changes were similar across subgroups of age, gender and income in all countries. In absolute terms, there was a consistent differential change by age in Denmark, Finland and Southern Sweden, with the higher level of the young and lower level of the old converging. Women's and men's consumption converged in Finland and southern Sweden. The changes did not differ systematically by income. Changes were not larger among heavier drinkers. CONCLUSIONS: The results did not confirm expectations: an increase in consumption larger than that in the control site could not be shown in any of the countries or subgroups of the population. If there has been an effect -- as shown in aggregate data in Finland -- it seems to have been stronger among the old than the young and, in Finland and southern Sweden, among women rather than men.