Parkinson's Disease Among Immigrant Groups and Swedish-Born Individuals: A Cohort Study of All Adults 50 Years of Age and Older in Sweden.

BACKGROUND: There is a lack of studies of Parkinson's disease (PD) in immigrants. OBJECTIVE: To study the association between country of birth and incident PD in immigrants in Sweden versus Swedish-born individuals. METHODS: Study population included all adults aged 50 years and older in Sweden (n = 2775736). PD was defined as having at least one registered diagnosis of PD in the National Patient Register. The incidence of PD in different first-generation immigrant groups versus Swedish-born individuals was assessed by Cox regression, expressed as hazard ratios (HRs) and 95% confidence intervals (CI). The models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, neighbourhood socioeconomic status and co-morbidity. RESULTS: Totally 35833 individuals had an incident diagnosis of PD (20401 men and 15432 women). Incidence rates per 100,000 person-years were for all Swedish-born 95.9 and for all foreign-born 60.1; for all men 112.3 and for all women 73.4, with a male to female ratio of 1.53, with the highest incidence rates for the group 80-84 years of age. After adjusting for potential confounders, the overall relative risk of PD was lower in immigrant men (HR 0.78; 95% CI 0.74-0.82) and women (HR 0.92; 95% CI 0.87-0.98). Among immigrant subgroups, a higher risk of PD was found among women from Finland (HR 1.13; 95% CI 1.05-1.23). CONCLUSION: In general, the risk of PD was lower in first-generation immigrant men and women compared to Swedish-born. The only group with a higher risk of PD was women from Finland.

Associations of nutrition and body composition with cardiovascular disease risk factors in soldiers during a 6-month deployment.

OBJECTIVES: This observational follow-up study investigated the associations of nutrition and body composition with cardiovascular disease (CVD) risk factors, including pro-inflammatory biomarkers, in soldiers during a 6-month deployment. MATERIAL AND METHODS: Thirty-five male soldiers were assessed at months 0, 3 and 6, and their parameters, i.e., M±SD, were as follows: age 30.0±8.7 years, height 179±6 cm, and BMI 24.2±2.5 kg/m2. Three-day food diaries were used for monitoring macronutrient intake. Body composition was estimated using bioimpedance. Fasting blood samples for lipids and pro-inflammatory biomarkers were collected, and blood pressure measurements were performed. RESULTS: Carbohydrate intake increased and protein intake decreased at month 3 (p = 0.034, p < 0.001), while body composition remained stable. Systolic blood pressure increased at month 6, while other CVD risk factors remained within the reference values. Fat mass and body fat percentage were associated positively with total and low density lipoprotein (LDL) cholesterol concentrations at all measurement points. A negative association was found between the change in fiber intake vs. the change in total (r = -0.36, p = 0.033) and LDL cholesterol (r = -0.39, p = 0.019). CONCLUSIONS: Lower fiber intake and a greater amount of body fat were associated with high total and LDL cholesterol concentrations. Nevertheless, the measured CVD risk factors remained within the reference values, except for the higher systolic blood pressure. A regular screening of body composition and a higher consumption of fiberrich foods may promote cardiometabolic health in soldiers. Int J Occup Med Environ Health. 2020;33(4):457-66.

Association Between Psychosocial Problems and Unhealthy Health Behavior Patterns Among Finnish Adolescents.

The aim of the study was to investigate how psychosocial problems in childhood and adolescence associate with an unhealthy health behavior pattern among adolescents in Northern Finland. The study population consisted of 4350 participants, drawn from the Northern Finland Birth Cohort 1986 Study. Health behavior patterns were assessed in adolescence and psychosocial problems in childhood and adolescence. Logistic regression analyses were performed to determine the associations. Several psychosocial problems predicted greater likelihood of engaging in unhealthy health behavior pattern. Externalizing problems in childhood predicted greater likelihood of engaging in unhealthy behavior patterns for girls. For both genders, externalizing problems and inattention in adolescence were associated with unhealthy health behavior patterns. Boys and girls with externalizing problems both in childhood and adolescence had an increased risk of unhealthy patterns. Psychosocial problems contribute to unhealthy lifestyles and should therefore be acknowledged when designing and targeting health promotion strategies aimed at adolescents.

Immigrants' mental health service use compared to that of native Finns: a register study.

PURPOSE: Many aspects related to migration might predispose immigrants to mental health problems. Yet immigrants have been shown to underuse mental health services. The aim of this study was to compare the intensity of psychiatric care, as an indicator of treatment adequacy, between natives and immigrants living in Finland. METHODS: We used nationwide register data that included all the immigrants living in Finland at the end of 2010 (n = 185,605) and their matched controls. Only those who had used mental health services were included in the analyses (n = 14,285). We used multinomial logistic regression to predict the categorized treatment intensity by immigrant status, region and country of origin, length of residence, and other background variables. RESULTS: Immigrants used mental health services less than Finnish controls and with lower intensity. The length of residence in Finland increased the probability of higher treatment intensity. Immigrants from Eastern Europe, sub-Saharan Africa, the Middle East, and Northern Africa were at the highest risk of receiving low-intensity treatment. CONCLUSIONS: Some immigrant groups seem to persistently receive less psychiatric treatment than Finnish-born controls. Identification of these groups is important and future research is needed to determine the mechanisms behind these patterns.

Impact of a person-centred group intervention on life satisfaction and engagement in activities among persons aging in the context of migration‡.

Background: There is a growing need to support the health and wellbeing of older persons aging in the context of migration.Objectives: We evaluated whether a group-based health promotion program with person-centred approach, maintained or improved life satisfaction and engagement in activities of older immigrants in Sweden.Methods: A randomised controlled trial with post-intervention follow-ups at 6 months and 1 year was conducted with 131 older independently living persons aged ≥70 years from Finland and the Balkan Peninsula. Participants were randomly allocated to an intervention group (4 weeks of group intervention and a follow-up home visit) and a control group (no intervention). Outcome measures were life satisfaction and engagement in activities. Chi-square and odds ratios were calculated.Results: The odds ratios for maintenance or improvement of life satisfaction (for social contact and psychological health) were higher in the person-centred intervention group. More participants in the intervention group maintained or improved their general participation in activities compared with the control group. However, no significant between-group differences were found.Conclusion: Person-centred interventions can support older person's capability to maintain their health in daily life when aging in migration. Further research is needed with a larger sample and longer intervention period to determine the effectiveness of the intervention.

Cross-Cultural Evaluation of Antonovsky's Orientation to Life Questionnaire: Comparison Between Australian, Finnish, and Turkish Young Adults.

Antonovsky's concept "sense of coherence" (SOC) and the related measurement instrument "The Orientation to Life Questionnaire" (OLQ) has been widely applied in studies on health and well-being. The purpose of the present study is to investigate the cultural differences in factor structures and psychometric properties as well as mean scores of the 13-item form of Antonovsky's OLQ among Australian (n = 201), Finnish (n = 203), and Turkish (n = 152) students. Three models of factor structure were studied by using confirmatory factor analysis: single-factor model, first-order correlated-three-factor model, and the second-order three-factor model. Results obtained in all three countries suggest that the first- and second-order three-factor models fitted the data better that the single-factor model. Hence, the OLQ scoring based on comprehensibility, manageability, and meaningfulness scales was supported. Scale reliabilities and inter-correlations were in line with those reported in earlier studies. Two-way analyses of variance (gender × nationality) with age as a covariate showed no cultural differences in SOC scale scores. Women got higher scores on the meaningfulness scale than men, and age was positively related to all SOC scale scores indicating that SOC increases in early adulthood. The results support the three-factor model of OLQ which thus should be used in Australia, Finland, and Turkey instead of a single-factor model. Need for cross-cultural studies taking into account cultural correlates of SOC and its relation to health and well-being indicators as well as studies on gender differences in the OLQ are emphasized.

Moving From Knowledge to Action in Partnership: A Case Study on Program Adaptation to Support Optimal Aging in the Context of Migration.

This case study explored how a researcher-community partnership contributed to program adaptations when implementing person-centered group-based health promotion services to older people who have migrated to Sweden. The study was conducted over 3 years and various data sources were used: focus groups, individual interviews, documents, and archive material. Findings from different data sources and partners' perspectives were triangulated to an overall case description using an iterative process. Adaptations were shaped through a dynamic process, negotiating toward suitable solutions that culminated in actions taken to adapt or inhibit adaptations. The negotiations were driven by the interplay within and between three reasons to adapt. The partners' opportunities to influence the negotiation process depended on establishing common ground to shape adaptations. Practical implications are provided on how to move from knowledge to action when implementing person-centered group-based health promotion to support optimal aging in the context of migration.

Cross-cultural, population-based study on adolescent body image and eating distress in Japan and Finland.

This cross-sectional population-based survey compares the prevalence of self-reported body image and eating distress symptoms among adolescents in Japan and Finland, and associations between emotional/behavioral problems, body image and eating distress from a cross-cultural perspective. The study included 1,840 Japanese and 1,135 Finnish 8th grade students. The self-reported questionnaire included the Body Image and Eating Distress Scale and Strengths and Difficulties Questionnaire (SDQ). The female adolescents from both Finland and Japan reported much greater dissatisfaction with, and concern about, their bodies than the males and Japanese females expressed even higher distress than Finnish females. High levels of body image and eating distress were associated with psychiatric problems measured with the SDQ. There was a significant three-way interaction effect of body image and eating distress, gender and country with SDQ peer problems and prosocial behavior.

The Incidence of Nonaffective, Nonorganic Psychotic Disorders in Older People: A Population-based Cohort Study of 3 Million People in Sweden.

BACKGROUND: There are limited data on the epidemiology of very late-onset schizophrenia-like psychosis (VLOSLP) and how this relates to potential risk factors including migration, sensory impairment, traumatic life events, and social isolation. METHODS: We followed up a cohort of 3 007 378 people living in Sweden, born 1920-1949, from their 60th birthday (earliest: January 15, 1980) until December 30 2011, emigration, death, or first recorded diagnosis of nonaffective psychosis. We examined VLOSLP incidence by age, sex, region of origin, income, partner or child death, birth period, and sensory impairments. RESULTS: We identified 14 977 cases and an overall incidence of 37.7 per 100 000 person-years at-risk (95% CI = 37.1-38.3), with evidence that rates increased more sharply with age for women (likelihood ratio test: χ2(6) = 31.56, P < .001). After adjustment for confounders, rates of VLOSLP were higher among migrants from Africa (hazard ratio [HR] = 2.0, 95% CI = 1.4-2.7), North America (HR = 1.4, 95% CI = 1.0-1.9, P = .04), Europe (HR = 1.3, 95% CI = 1.2-1.4), Russian-Baltic regions (HR = 1.6, 95% CI = 1.4-1.9), and Finland (HR = 1.6, 95% CI = 1.5-1.7). VLOSLP risk was highest for those in the lowest income quartile (HR = 3.1, 95% CI = 2.9-3.3). Rates were raised in those whose partner died 2 years before cohort exit (HR = 1.1, 95% CI = 1.0-1.3, P = .02) or whose child died in infancy (HR = 1.2, 95% CI = 1.0-1.4, P = .05), those without a partner (HR = 1.9, 95% CI = 1.8-1.9) or children (HR = 2.4, 95% CI = 2.3-2.5), and those whose child had a psychotic disorder (HR = 2.4, 95% CI = 2.2-2.6). INTERPRETATION: We identified a substantial burden of psychosis incidence in old age, with a higher preponderance in women and most migrant groups. Life course exposure to environmental factors including markers of deprivation, isolation, and adversity were associated with VLOSLP risk.

Distribution and evaluation of sense of coherence among older immigrants before and after a health promotion intervention - results from the RCT study promoting aging migrants' capability.

BACKGROUND: The migration process can be a threat to a person's sense of coherence (SOC) and to their ability to experience life as comprehensible, manageable, and meaningful. Seen from a salutogenic perspective, this may have a negative impact on the experience of health. PURPOSE: We describe the distribution of SOC and its components among older persons with an immigrant background now aging in Sweden. In addition, we evaluated whether a group-based health promotion program with a person-centered approach could support the SOC among older persons in this group. MATERIALS AND METHODS: A randomized controlled trial with postintervention follow-ups at 6 and 12 months was conducted with 131 independently living persons aged ≥70 years from Finland and the Balkan Peninsula. Participants were randomly allocated to an intervention group (4 weeks of group intervention and one follow-up home visit) and a control group (no intervention but access to ordinary health care services). The outcome measure was the SOC measured by SOC-13. Chi-square and ORs were calculated. RESULTS: There was a significant improvement in total SOC scores for the intervention group at 6-month follow-up. Also, the ORs for the SOC components were higher in the person-centered intervention group. However, we found no significant between-group differences nor did the effect last until the 12-month follow-up. CONCLUSION: Persons who have lived a long time in a host country after migration seem to have a SOC similar to native-born persons. Interventions with a person-centered approach could support the SOC by capturing individual life situations. Such interventions could support older persons by making everyday life more comprehensible and manageable and helping them to cope with challenges in daily life caused by aging.

Which anthropometric measures best indicate type 2 diabetes among Russian, Somali and Kurdish origin migrants in Finland? A cross-sectional study.

OBJECTIVES: To compare the performance of body mass index (BMI), waist-to-height ratio (WHtR), waist circumference (WC) and waist-to-hip ratio (WHR) in detecting type 2 diabetes among Russian, Somali and Kurdish (born in Iraq/Iran) origin migrants and Finns. DESIGN AND PARTICIPANTS: Cross-sectional study comparing health examination survey data of Russian, Somali and Kurdish origin migrants (n=917) aged 30-64 years who took part in the Migrant Health and Wellbeing Survey with the general Finnish population in the Health 2011 Survey (n=887). Participants were randomly selected from the National Population Register. SETTING: Six cities in Finland, where a substantial majority of migrants live. OUTCOME MEASURES: Anthropometric measures included objectively measured BMI, WHtR, WC and WHR. Type 2 diabetes was defined based on self-report, laboratory measures of glycated haemoglobin and register data. Test performance was assessed using receiver operating characteristics curves, using area under the curve (AUC) as a measure of accuracy. RESULTS: Among Finns, test performance was highest for WC (AUC=0.81, 95% CI 0.74 to 0.87) and WHtR (AUC=0.81, 95% CI 0.75 to 0.87). Test performance was similar for BMI (AUC=0.80, 95% CI 0.67 to 0.92), WC (AUC=0.79, 95% CI 0.67 to 0.91) and WHtR (AUC=0.70, 95% CI 0.66 to 0.93) among Russians. WC and WHtR had highest test performance also among Somali (AUC=0.74, 95% CI 0.64 to 0.84 for WC and AUC=0.75, 95% CI 0.65 to 0.85 for WHtR) and Kurds (AUC=0.71, 95% CI 0.61 to 0.81 for WC and AUC=0.70, 95% CI 0.59 to 0.80 for WHtR).Among migrants, WHR had the poorest test performance. CONCLUSION: WC and WHtR performed overall the best across all study groups, however, accuracy of detection was lower particularly among Somali and Kurds. Currently used diabetes risk assessment tools assume a strong association between anthropometrics and diabetes. These tools need to be validated among non-Western populations.

Immigrants' use of health care in their country of origin: the role of social integration, discrimination and the parallel use of health care systems.

AIMS: The objective of this study was to elucidate the utilisation of Russian health care by immigrants of Russian origin living in Finland (cross-border health care). The study examined the association of cross-border health care with social integration and discrimination. Moreover, it studied whether cross-border health care was used as an alternative to the host-country's healthcare system. METHODS: Data from the Finnish Migrant Health and Wellbeing Survey (Maamu) were utilised. The number of respondents of Russian origin was 545. The main analytical method was logistic regression. The outcome variable was based on a survey item on seeking physician's treatment or help abroad during the last 12 months. Social integration was measured multi-dimensionally, and the indicator was extracted by multiple correspondence analysis. Ethical approval for the study was obtained from the Ethical Committee of the Uusimaa Hospital Region. RESULTS: We found that 15.4% of the respondents had visited a physician in Russia during the last 12 months. 10.4% had experienced discrimination in Finnish health services during their stay in Finland. Stronger social integration predicted less frequent utilisation of cross-border health care. Experiences of discrimination or unfairness were associated with higher odds for seeking cross-border health care. Cross-border health care was typically used in parallel to the Finnish services. CONCLUSIONS: Our findings on integration and discrimination emphasise the importance of general integration policy as well as cultural competence in health care. Parallel use of healthcare systems entails both risks (e.g double medication, problems of follow-up) and opportunities (e.g. sense of agency), which should be further investigated.

Evaluation of occupational physical load during 6-month international crisis management operation.

OBJECTIVES: Generally, operational military duties are associated with a variety of stressors, such as prolonged physical activity (PA). However, limited information is available on the occupational workload or changes in PA during international military operations. Thus, the aim of the study was to investigate the changes in body composition, stress biomarkers, PA, and heart rate (HR) responses of 79 male soldiers during a 6-month international crisis management operation. MATERIAL AND METHODS: Measurements were conducted 3 times in South-Lebanon during the operation. Body composition was assessed by the bioelectrical impedance method. Blood samples were analyzed for serum testosterone, sex-hormone binding globulin (SHBG), cortisol and insulin-like growth factor. Saliva sampling was used for analyzing stress biomarkers, cortisol and α-amylase. Heart rate and physical activity were monitored by a recordable belt and tri-axial accelerometer, respectively. RESULTS: Increases in muscle mass (39.2±4.1 vs. 39.5±4.2 kg, p < 0.05) and testosterone (15.9±4.6 vs. 17.2±4 nmol/l, p < 0.01), and reductions in PA variables (e.g., daily step count 9472±2547 vs. 8321±2720, p < 0.05) were observed during the first half (i.e., PRE-MID) of the study. The increase in muscle mass remained significant during the latter half (PRE-POST, 39.2±4.1 vs. 39.6±4.4 kg, p < 0.05), but also fat mass increased (MID-POST, 10.6±4.6 vs. 11.0±4.7 kg, p < 0.05) while SHBG (MID-POST, 31.8±12.1 vs. 26.6±13.2 nmol/l, p < 0.01) and cortisol (MID-POST, 445±116 vs. 400±123 nmol/l, p < 0.05) decreased. With the exception of increased concentration of salivary α-amylase (PRE-POST, 36.5±33.7 vs. 55.1±39.7 U/ml), the acute stress biomarkers and HR responses remained unchanged. Furthermore, the low quantity of PA, low HR values and subjective ratings of exertion refer to rather light physical workload. CONCLUSIONS: Due to the operatively calm nature of the working environment, the present soldiers did not express any significant signs of physical overload during the study period. Int J Occup Med Environ Health 2018;31(2):185-197.

Real-world costs of autosomal dominant polycystic kidney disease in the Nordics.

BACKGROUND: There is limited real-world data on the economic burden of patients with autosomal dominant polycystic kidney disease (ADPKD). The objective of this study was to estimate the annual direct and indirect costs of patients with ADPKD by severity of the disease: chronic kidney disease (CKD) stages 1-3; CKD stages 4-5; transplant recipients; and maintenance dialysis patients. METHODS: A retrospective study of ADPKD patients was undertaken April-December 2014 in Denmark, Finland, Norway and Sweden. Data on medical resource utilisation were extracted from medical charts and patients were asked to complete a self-administered questionnaire. RESULTS: A total of 266 patients were contacted, 243 (91%) of whom provided consent to participate in the study. Results showed that the economic burden of ADPKD was substantial at all levels of the disease. Lost wages due to reduced productivity were large in absolute terms across all disease strata. Mean total annual costs were highest in dialysis patients, driven by maintenance dialysis care, while the use of immunosuppressants was the main cost component for transplant care. Costs were twice as high in patients with CKD stages 4-5 compared to CKD stages 1-3. CONCLUSIONS: Costs associated with ADPKD are significant and the progression of the disease is associated with an increased frequency and intensity of medical resource utilisation. Interventions that can slow the progression of the disease have the potential to lead to substantial reductions in costs for the treatment of ADPKD.

Assessment of educational misclassification in register-based data on Finnish immigrants in Sweden.

AIM: In population registers, information on completed schooling is either missing or misclassified for a large proportion of newly arrived immigrants. It is unclear how quickly the information is updated and whether misclassification, i.e., that the wrong level of education is recorded, biases empirical estimates. METHODS: We use unique linked Swedish and Finnish register data to determine the extent of such mismeasurement. By running logistic regressions on zero earnings, we also illustrate how mismeasurement might influence the estimated effects of education on health or labour market outcomes. RESULTS: We find a considerable bias in estimates based on Swedish records of educational attainment during immigrants' first few years in the country. Misclassification is additionally very common, even when information on educational attainment exists. CONCLUSIONS: These findings suggest that research and policies using recently arrived immigrants' completed schooling as a determinant of socioeconomic integration need to be interpreted with care.

Supporting decision-making by a health promotion programme: experiences of persons ageing in the context of migration.

This study is part of the Promoting Aging Migrants' Capabilities programme that applied person-centred group meetings and one individual home visit to prolong independence in daily activities among people ≥70 years who had migrated to Sweden from Finland or the Western Balkan region. With the purpose to understand programme outcomes, the study aimed to explore the participants' everyday experiences of using health-promoting messages exchanged during the programme. Using a grounded theory approach, 12 persons aged 70-83 years were interviewed six months to one year after their participation in the programme. The participants experienced how using health-promoting messages was a dynamic process of how to make decisions on taking action to satisfy health-related needs of oneself or others immediately or deferring action. Five sub-processes were also identified: gaining inner strength, meeting challenges in available resources, being attentive to what is worth knowing, approaching health risks, and identifying opportunities to advocate for others. The results suggest that the programme could develop personal skills to support older people who have migrated to overcome health-related challenges. They further demonstrate the importance of supporting their health literacy before personal resources hinder action, and call for research on programmes to overcome environmental barriers to health.

Factors associated with cervical cancer screening participation among immigrants of Russian, Somali and Kurdish origin: a population-based study in Finland.

BACKGROUND: Previous studies revealed low participation in cervical cancer screening among immigrants compared with non-immigrants. Only a few studies about factors associated with immigrants' lower participation rates have been conducted in European countries that have universal access for all eligible women. Our study aimed to explore factors associated with cervical screening participation among women of Russian, Somali, and Kurdish origin in Finland. METHODS: We used data from the Migrant Health and Well-being Survey, 2010-2012. Structured face-to-face interviews of groups of immigrants aged 25-60 yielded 620 responses concerning screening participation in the previous five years. Statistical analysis employed logistic regression. RESULTS: The age-adjusted participation rates were as follows: among women of Russian origin 73.9% (95% CI 68.1-79.7), for Somalis 34.7% (95% CI 26.4-43.0), and for Kurds 61.3% (95% CI 55.0-67.7). Multiple logistic regressions showed that the most significant factor increasing the likelihood of screening participation among all groups was having had at least one gynecological check-up in the previous five years (Odds ratio [OR] = 6.54-26.2; p < 0.001). Other factors were higher education (OR = 2.63; p = 0.014), being employed (OR = 4.31; p = 0.007), and having given birth (OR = 9.34; p = 0.014), among Kurds; and literacy in Finnish/Swedish (OR = 3.63; p = 0.003) among Russians. CONCLUSIONS: Our results demonstrate that women who refrain from using reproductive health services, those who are unemployed and less educated, as well as those with poor language proficiency, might need more information on the importance of screening participation. Primary and occupational healthcare services may have a significant role in informing immigrant women about this importance.

Mental health among older refugees: the role of trauma, discrimination, and religiousness.

OBJECTIVES: The aim of this study was to examine, first, how past traumatic stress and present acculturation indices, and discrimination are associated with mental health; and, second, whether religiousness can buffer the mental health from negative impacts of war trauma. METHOD: Participants were 128 older (50-80 years) Somali refugees living in Finland. They reported experiences of war trauma and childhood adversities, and filled-in questionnaires of perceived ethnic discrimination, religiousness (beliefs, attendance, and observance of Islamic faith), and symptoms of posttraumatic stress disorder (PTSD), depressive (BDI-21), psychological distress (GHQ-12), and somatization (SCL-90). RESULTS: Symptom-specific regression models showed that newly arrived refugees with non-permanent legal status and severe exposures to war trauma, childhood adversity, and discrimination endorsed greater PTSD symptoms, while only war trauma and discrimination were associated with depressive symptoms. Results confirmed that high religiousness could play a buffering role among older Somalis, as exposure to severe war trauma was not associated with high levels of PTSD or somatization symptoms among highly religious refugees. CONCLUSION: Health care should consider both unique past and present vulnerabilities and resources when treating refugees, and everyday discrimination and racism should be regarded as health risks.

Viewing oneself as a capable person - experiences of professionals working with older Finnish immigrants.

The proportion of older immigrants in the population is expected to increase in Sweden. Research indicates that older immigrants face the double burden of frailty, caused by a weaker health status, and the immigration process. Health promotion interventions can be used to prevent frailty and support healthy ageing in this population. Healthcare professionals are a crucial part of health promotion and the present study aimed to explore healthcare professionals' experiences of health in context of daily life among older immigrants to and provide a basis for the development of a health promotion intervention targeted at older immigrants. Four focus group discussions were conducted with professionals who worked with home-dwelling older people from Finland, currently living in Sweden. Participants represented a variety of healthcare professions. Data were analysed using qualitative content analysis. The healthcare professionals perceived that health in daily life was (i) connected to the view of oneself as a capable person and (ii) participants strove to maintain their own origin. The findings highlighted that when planning for health promotion interventions for older immigrants, the point of departure should be to recognise the person as a person and the background of immigration is not the first issue to address. Therefore, a person-centred health promotion intervention is recommended to open a dialogue between healthcare professionals and older immigrants, so that a common view of the intervention can be reached.

A social network analysis of substance use among immigrant adolescents in six European cities.

BACKGROUND: Social integration and the health of adolescents with a migration background is a major concern in multicultural societies. The literature, however, has paid little attention to the wider determinants of their health behaviours, including the composition of their social networks. The aim of this study was to describe the composition of adolescents' social networks according to migration background, and to examine how social networks are associated with substance use. METHOD: In 2013, the SILNE study surveyed 11,015 secondary-school adolescents in 50 schools in six European cities in Belgium, Finland, Germany, Italy, the Netherlands, and Portugal, using a social network design. Each adolescent nominated up to five of their best and closest friends. Migration status was defined as first-generation migrants, second-generation migrants, and speaking another language at home. We computed two groups of network structural positions, the centrality of individual adolescents in networks, and the homophily of their social ties regarding migration (same-migration). Multilevel logistic regression was used to model the association between network structural position and smoking, alcohol use, and cannabis use. RESULTS: Compared with non-migrant adolescents, adolescents with migration backgrounds had similar relationship patterns. But almost half their social ties were with same-migration-background adolescents; non-migrants had few social ties to migrants. For adolescents with a migration background, a higher proportion of social ties with non-migrants was associated with increased use of cannabis (OR = 1.07, p = 0.03) and alcohol (OR = 1.08, p < 0.01), but not with increased smoking (p = 0.60). Popular migrant adolescents were at less risk of smoking, alcohol use, and cannabis use than popular non-migrant adolescents. CONCLUSION: Homophily of social ties by migration background is noticeable in European schools. The tendency of migrant adolescents to have same-migration social ties may isolate them from non-migrant adolescents, but also reduces their risky health behaviours, in particular cannabis and alcohol use.