Differences in health behaviours between immigrant and non-immigrant groups: a protocol for a systematic review

Health behaviours are important determinants of health and adoption of unhealthy behaviour is considered as one of the mechanisms through which immigrants' health changes over time in the host country. The change in health behaviours over time can contribute either to improving or worsening the overall health status of immigrants. Despite being the important mediators for the change in overall health status and chronic health conditions, no previous review (either general or systematic) has examined differences in key health behaviours simultaneously between immigrants and non-immigrants. This study aims to provide a systematic overview of the current global literature on differences in key health behaviours (that is, tobacco smoking, physical activity and alcohol drinking) between immigrant and non-immigrant groups.

Prevention of alcohol and other drug problems in culturally and linguistically diverse communities

Australia has long been known as a multicultural society. In 2009 around one-quarter of Australia’s population was born overseas and immigrants come from more than 200 countries. While most of Australia’s migrants come from New Zealand, the United Kingdom, India or China, the fastest growing immigrant populations are from sub-Saharan and northern Africa, and the Middle East. Immigrants from a non-English speaking country, as well as their children and grandchildren, are commonly referred to as culturally and linguistically diverse (CLD) as a way of acknowledging differences in ethnic identity and affiliation, as well as cultural and language practices and preferences. Culturally and linguistically diverse groups in Australia face many health challenges, one of which is a potential vulnerability to alcohol and other drug (AOD) use.

The primary aim of this paper is to identify and evaluate primary prevention programs and initiatives aimed at preventing AOD harms in CLD communities.

Holy days after migration

In Zavoj, a mountainous village in the Republic of Macedonia, the Day of the Holy Mother is the most significant day in the village's ritual calendar. Over the last two decades the festival has been transformed due to emigration, but importantly, many Zavoj emigrants return to the village for the festival. Added to this are several other celebrations related to holy days that take place in the village. The focus of this paper will be the Mala Sveta Bogorodica (minor Holy Mother) festivity, and the sacred sites on the Old Zavoj Road. A very active church committee draws together the emigrants and produces a new type of village community and new types of social practices. Parallel to this, is the dramatic transformation of the architecture of the village. From data of recent field work, this paper will explore the emigrant gathering in Zavoj, and why the village becomes a place for the celebration of holy days after migration.

Ischaemic heart disease and Australian immigrants: the influence of birthplace and language skills on treatment and use of health services

Admission rates for ischaemic heart disease (IHD), and the use of invasive cardiovascular procedures, separation mode and length of stay (LOS) were compared between Australians from non-English speaking background (NESB; n=8627) and English speaking background (ESB; n=13162) aged 20 years and over admitted to Victorian urban public hospitals. The study covered the period from 1993 to 1998. It was found that, compared with their ESB counterparts, the incidence of admission for acute myocardial infarction was significantly higher for NESB men and women before and after controlling for confounding factors. The age-adjusted ratios for NESB women compared with their ESB counterparts ranged from 1.23 to 1.89 for cardiac catheterisation, from 0.23 to 0.27 for percutaneous transluminal coronary angioplasty (PTCA), and from 1.04 to 1.80 for coronary artery bypass grafting (CABG).
Procedure rates were comparable in men for cardiac catheterisation and CABG but higher for PTA rates in NESB men (OR: 1.29, 95%CI: 1.11-1.50) than their ESB counterparts. Both NESB men (β=0.04, 95%CI: 0.01-0.07) and women (β=0.03, 95%CI: 0.02-0.08) experienced significantly longer hospital stays than their ESB counterparts. These findings indicate there may be systematic differences in patients’ treatment and service utilisation in Victorian public hospitals. The extent to which physicians’ bias and
patients’ choice could explain these differences requires further investigation.

A culturally appropriate diet and lifestyle intervention can successfully treat the components of metabolic syndrome in female Pakistani immigrants residing in Melbourne, Australia

This study was designed to test the effectiveness of a culturally appropriate diet and lifestyle intervention to treat metabolic syndrome in female Pakistani immigrants residing in Melbourne, Australia. Forty Pakistani women with metabolic syndrome (aged 20-50 years) completed a 12-week culturally appropriate diet and exercise program. Results indicate that, before intervention, participants were sedentary, taking 4000 ± 22.6 steps per day, and had an obese-classified body mass index (BMI) of 29.2 ± 0.46 kg/m2 (BMI was categorized in accordance with guidelines specifically designed for Asians) and high waist circumference of 132 ± 25.95 cm. Participants were hypertensive (systolic, 135 ± 1.3 mm Hg; diastolic, 86 ± 0.68 mm Hg), were dyslipidemic (total cholesterol, 6.8 ± 0.15 mmol/L; triglycerides, 2.9 ± 0.09 mmol/L), and had elevated blood glucose (6.4 ± 0.33 mmol/L) and fasting blood insulin (45 ± 6.3 μU/mL) levels. After the 12-week culturally appropriate intervention, activity increased (8600 ± 596.7 steps per day, P < .05); and BMI (27.8 ± 0.45 kg/m2), blood pressure (systolic, 125 ± 1.4 mm Hg; diastolic, 80 ± 0.6 mm Hg), cholesterol (5.5 ± 0.1 mmol/L), blood glucose (5.9 ± 0.33 mmol/L), and blood insulin (24.14 ± 1.8 μU/mL) levels were all significantly reduced (P < .05). This study revealed that the Pakistani female migrants who had metabolic syndrome and its components can successfully be treated via a culturally appropriate diet and lifestyle intervention. The success of the current program raises the possibility that other high-risk ethnic groups can also be treated with a culturally appropriate program.

Over and undernutrition in the children of Australian immigrants : assessing the influence of birthplace of primary carer and english language use at home on the nutritional status of 4-5-year-olds

Objective. To document the relationship between childhood nutrition status and ethnicity (defined as the birthplace of primary carer and English language use at home) using a nationally representative sample of 4- to 5-year-old children. Design and participants. Cross-sectional population survey of 4 983 4- to 5-year-old children (2 537 boys and 2 446 girls) as part of Wave 1 (2004) of the Longitudinal Study of Australian Children. Main outcome measures. Overweight/obesity and thinness using the newly published body mass index cut-off points of Cole (2007). Results. In total, 20.6% (95%CI 19.5, 21.7) of children aged 4 to 5 years were estimated to be overweight or obese, while 1.0% (95%CI 0.8, 1.3) was thin. Unadjusted analyses showed a significant relationship between childhood overweight/obesity and primary carer's country of birth (χ2=15.9, p<0.01), but the significance became minimal after adjusting for socio-economic and demographic factors. The adjusted model suggests that boys of primary carer's born in Europe (excluding UK and Ireland) were less likely to be overweight/obese than boys whose primary carers were born in Australia, but the overall effect size was negligible. No difference was found for girls. In addition, boys who mainly spoke English at home were less likely to be overweight/obese (OR=0.49; 95%CI 0.27, 0.88; p=0.017) and thin (OR=0.27; 95%CI 0.12, 0.62; p=0.002) than boys who spoke a language other than English at home. No difference was found for girls. Conclusions. There is a relationship between main language spoken at home and nutritional status in 4-5-year-old boys but not girls. The use of English language at home may be a protective factor for normal weight in young boys. After adjustment for socio-economic and demographics characteristics, there was a negligible relationship between overweight/obesity in children and their primary carer's country of birth.

Feminine transports and transformations : textual performances of Australian women convicts and emigrants from 1788 to 1850

While scholars have critiqued early representations of the white colonial female in the form of the novel, short story, or historical narrative, analyses of poetry tend to be located only on that produced in Australia and often in light of a nascent national identity. This article examines how poetic renditions of the desolate woman might be viewed as part of imperialism's mythologising process, displacing more worrying versions of womanhood in relation to the new colonies. While social anxieties over the identity of the white colonial female would result in highly controlled productions of the female convict and female emigrant, this article demonstrates how they also prove unstable and point to a disruptive reality beyond language.

Effectiveness of prevention programmes for obesity and chronic diseases amongst immigrants to developed countries - a systematic review

Objective: To determine whether interventions tailored specifically to  particular immigrant groups from developing to developed countries  decrease the risk of obesity and obesity-related diseases.

Design: Databases searched were MEDLINE (1966–September 2008), CINAHL (1982–September 2008) and PsychINFO (1960–September 2008), as well as Sociological Abstracts, PsychARTICLES, Science Direct, Web of Knowledge and Google Scholar. Studies were included if they were randomised control trials, ‘quasi-randomised’ trials or controlled before-and-after studies. Due to the heterogeneity of study characteristics only a narrative synthesis was undertaken, describing the target population, type and reported impact of the intervention and the effect size.

Results: Thirteen studies met the inclusion criteria. Ten out of thirteen (77 %) studies focused on diabetes, seven (70 %) of which showed significant improvement in addressing diabetes-related behaviours and glycaemic control. The effect on diabetes was greater in culturally tailored and facilitated interventions that encompassed multiple strategies. Six out of the thirteen studies (46 %) incorporated anthropometric data, physical activity and healthy eating as ways to minimise weight gain and diabetes-related outcomes. Of the six interventions that included anthropometric data, only two (33 %) reported improvement in BMI Z-scores, total skinfold thickness or proportion of body fat. Only one in three (33 %) of the studies that included cardiovascular risk factors reported improvement in diastolic blood pressure after adjusting for baseline characteristics. All studies, except four, were of poor quality (small sample size, poor internal consistency of scale, not controlling for baseline characteristics).

Conclusions: Due to the small number of studies included in the present review, the findings that culturally tailored and facilitated interventions produce better outcomes than generalised interventions, and that intervention content is more important than the duration or venue, require further investigation.

Undiagnosed and potentially lethal parasite infections among immigrants and refugees in Australia

Background: Intestinal parasite infections are a major cause of ill health in many resource-poor countries. This study compares the types and rates of these infections and their risk factors in recently arrived and long-term immigrants in Australia.

Method: Cross-sectional surveys of 127 East African and 234 Cambodian immigrants and refugees were undertaken in 2000 and 2002, respectively, to assess the burden of intestinal parasites and collect demographic information. Serum samples were assessed for eosinophilia and Strongyloides stercoralis and Schistosoma antibodies, and feces examined for ova, cysts, and parasites.

Results: Intestinal parasites were identified in 77/117 fecal samples from East African and in 25/204 samples collected from Cambodian participants. Eleven percent (14/124) of East Africans and 42% (97/230) of Cambodians had positive or equivocal serology for S stercoralis. Schistosoma serology was positive or equivocal in 15% (19/124) of East African participants.

Conclusion: Potentially serious intestinal parasite infections are common among recent and longer term immigrants despite multiple visits to health care providers. Immigrants and refugees from high-risk countries would benefit from comprehensive health checks soon after resettlement.

Bauman, strangerhood and attitudes towards immigrants among the Australian population

Through an investigation of the idea of the stranger, this article seeks to blend theory with empirical research. It does this in three ways. First, it engages with a social theory of the stranger articulated in the work of Zygmunt Bauman. Second, it examines data from the Australian Election Study surveys between 1996 and 2007 in order to explore attitudinal changes towards groups of immigrants. The findings from this survey suggests that attitudes towards immigrants in general have fluctuated in Australia, despite the negative effects of economic globalization, the growth in neoliberal economic reforms and terrorist attacks in the West. Third, drawing on Bauman's theory of the stranger we provide an interpretation of these fluctuating attitudes through the idea of the hybrid stranger. Finally, we argue that a more nuanced understanding of these attitudes towards immigrants in Australia is possible when a theory of the stranger is informed by a discussion on the constitution of host self, the influence of the media, the role of government policy, and the impact of class and geography.

Prayers and pastures : Moidart emigrants in Victoria, 1852-1920

In 1852 thirty-seven Households from working class Catholic backgrounds emigrated from Moidart, Scotland, to the Colony of Port Phillip in Australia. This study personalises and contextualises the experiences of three generations in Scotland, on board ship and in Victoria concluding that upward mobility and economic security were achievable.

Migrant housing in the city and the village : from Melbourne to Zavoj

This paper will discuss the kinds of communities that evolve through historical practices of migration. The migrant house is associated with a new architecture that hod appeared in the cities of immigration of the new worlds (Melbourne, Toronto, Chicago). It is perceived as a stereotypical symbolisation of immigrants from Southern European origins that had arrived in the decades following the Second World War. The appearance of houses built by returning migrants in sites of origin suggests other traiectories, other modes of travel, and other forms of community. Central to the thesis of this paper is the testimony of two types of migrant houses. The study draws on theories of migration that address the site of departure, the site of arrival, and the question and conflict of return which is at the centre of the migrant's imaginary. This study will examine the migrant houses in the village of emigration (Zavoj in Macedonia), migrant houses built by returning emigrants. A study of the two houses of migration implicates a set of networks, forces, relations, circumscribing a large global geopolitical and cultural field that questions our understandings of diaspora, the binary structure of dwelling/travelling, and the fabric and fabrication of community. In addition, the paper will explore the notion of house as an imaginary landscape, a psychic geography narrated through migratory travels.