Search

European discourse on linguistic minorities reflect the construction of inter-ethnic boundaries between national (such as Dutch or French), indigenous minorities (such as Basque, Catalan or Frisian), and immigrant minorities (Arabic, Berber or Turkish). In the European public discourse on immigrant minority groups, two major characteristics emerge: immigrant minority groups are often referred to as foreigners ("étrangers," "Ausländer") and as being in need of integration. It is common practice to refer to immigrant minority groups in terms of non-national residents and to their languages in terms of non-territorial, non-regional, non-indigenous, or non-European languages. This conceptual exclusion rather than inclusion in the European public discourse derives from a restrictive interpretation of the notions of citizenship and nationality. Based on the empirical evidence derived from Language Rich Europe project, a phenomenological perspective on ethnic minorities and inter-ethnic boundary construction will be presented in this paper.

Studies on immigrant fertility typically compare immigrants and natives or different migrant groups at the same destination but rarely immigrants of the same origins in different destination countries. In this paper, we look at immigrants from multiple origins in multiple destination countries simultaneously, using the European Union Labour Force Survey to compare female immigrants from ten areas of origin in eight destination countries in Europe. Our results indicate a strong origin effect. However, they also suggest that when women migrate to a context where the fertility norm is different from that in their origin, they adjust their behaviors accordingly, which indicates that policy and normative context play an important role in shaping migrants' fertility. From a policy perspective, this is important because it suggests that the fertility of immigrant women, who are exposed to different norms and normative contexts, can resemble that of native women at the destination. Our findings contribute to strengthening the role of destination in shaping fertility behavior and highlighting the importance of looking at all the possible combinations of immigrants coming from and going to different fertility regimes. [ABSTRACT FROM AUTHOR]

Purpose – In this paper, the authors aim to assess whether immigrants are more likely to receive welfare payments relative to natives across a range of European countries. They also seek to examine relative rates of poverty across immigrants and natives. Design/methodology/approach – The authors use data from the European Union Statistics on Income and Living Conditions for 2007. They present descriptive statistics and results from probit regressions. Findings – The authors find very little evidence that immigrants are more likely to receive welfare payments when all payments are considered together. This is true whether they use descriptive analysis or regression analysis in which they control for relevant characteristics such as age, gender and education. They do find evidence of higher rates of poverty among immigrants. Research limitations/implications – As the data used do not give an indication of the length of time an immigrant has been in a destination country, the authors are unable to assess whether their observed patterns change with length of stay. Social implications – The results run counter to what seems to be a popular perception, namely, that immigrants are intensive users of welfare. Hence, attitudes may be altered. Originality/value – While other papers may have considered this issue, to the authors' knowledge, none have linked the poverty and welfare analyses. The findings raise the possibility that welfare systems are failing to keep immigrants out of poverty and this is important in the context of the inclusion agenda. [ABSTRACT FROM AUTHOR]

Recent terrorist attacks in many cities of Europe such as London, Madrid, Paris, Nice and Brussells lead to strenghtening of the anti-immigrant attitudes in European public opinion and political life. Under these circumstances, migration and migrants with their security implications are highly politicized and even securitized issues for the European Union and the countries of Europe through political discourses, bureuacratic practices and media visuals. So, migrationrelated issues are increasingly integrated into discourses and policies arranging domains of insecurity. Migration was largely considered as a contribution to the economic reconstruction of Europe until the 1990s. However, in the last couple of decades, it has been perceived as a security threat. This perception is constructed by combinig migration with socio-economic problems, crime, cultural problems and finally terrorism. Therefore, migration, immigrants and asylum-seekers are now the objects of securitization process in Europe. They are portrayed as a threat to the cultural identity, welfare state and internal security of the West and the EU. On the other hand, in order to avoid the contradiction in terms of main values of the EU, the struggle against the migration issue is required to re-emphasise the liberal practices by preserving identical differences in a cosmopolitan policy. Because, emphasizing restrictions and control implies a negative portrayal of groups of immigrants. Such a policy risks sustaining public expressions of racism and xenophobia in the present political context. This paper argues that measures taken by the individual countries of Europe and the EU for the migration and immigrants should not be in contradiction with main values such as multiculturalism, human rights, democracy and inclusive social structure on which the EU is based on. [ABSTRACT FROM AUTHOR]

This paper deals with the skills related to the early reading acquisition in two countries that share language. Traditionally on reading readiness research there is a great interest to find out what factors affect early reading ability, but differ from other academic skills that affect general school learnings. Furthermore, it is also known how the influence of pre-reading variables in two countries with the same language, affect the development of the reading. On the other hand, several studies have examined what skills are related to reading readiness (phonological awareness, alphabetic awareness, naming speed, linguistic skills, metalinguistic knowledge and basic cognitive processes), but there are no studies showing whether countries can also influence the development of these skills.Our main objective in this study was to establish whether there were differences in the degree of acquisition of these skills between Spanish (119 children) and Peruvian (128 children), five years old children assessed in their own countries and after controlling Economic, Social and Cultural Status (ESCS). The results show that there are significant differences in the degree of acquisition of these skills between these two samples. It's especially relevant, in these results, that the main predictor in a regression study was the country of origin, explaining a higher percentage of variance than other variables such as age differences, in months, or gender. These findings corroborate the results obtained in other studies with migrant population. [ABSTRACT FROM AUTHOR]

Purpose – Economic theory predicts that unemployment benefits may increase expected income and reduce its volatility, thereby attracting immigrants to countries which implement such programs. This article aims to explore whether and how changes in countries' unemployment benefit spending (UBS) affect immigration. Design/methodology/approach – Data are collected for 19 European countries over the period 1993-2008. The relationship between immigration flows and UBS is first tested using the OLS technique. Instrumental variable (IV) and generalised method of moments (GMM) are then used to address reverse causality. Findings – While the OLS estimates suggest the existence of a moderate within-country welfare magnet effect for the inflows of non-EU immigrants, the IV approach reveals that the impact is substantially smaller and statistically insignificant when GMM techniques are implemented. Research limitations/implications – Since information on the immigrants' country of origin is not available, it is not possible to exclude that for immigrants coming from certain areas, unemployment benefits constitute a strong incentive to immigrate. This hypothesis awaits further research, once detailed data is available. Originality/value – This paper complements previous literature on immigration and welfare by exploring the endogenous nature of welfare spending. The empirical results provide insights into the interaction between immigration and welfare policies. [ABSTRACT FROM AUTHOR]

Purpose – This paper's main purpose is to evaluate immigrants' demand for social assistance and services and identify the key barriers to social and labor market inclusion of immigrants in the European Union. Design/methodology/approach – An online primary survey of experts from NGOs and public organizations working on immigrant integration in the member states of the European Union was carried out. The data is analyzed using simple comparative statistical methods; the robustness of the results is tested by means of logit and ordered logit statistical models. Findings – The authors find that the general public in Europe has rather negative attitudes towards immigrants. Although the business community views immigrants somewhat less negatively, barriers to immigrant labor market inclusion identified include language and human capital gaps, a lack of recognition of foreign qualifications, discrimination, non-transparent labor markets and institutional barriers such as legal restrictions for foreign citizens. Exclusion from higher education, housing and the services of the financial sector aggravate these barriers. Changes in the areas of salaried employment, education, social insurance, mobility and attitudes are seen as desired by members of ethnic minorities. The current economic downturn is believed to have increased the importance of active inclusion policies, especially in the areas of employment and education. These results appear to be robust with respect to a number of characteristics of respondents and their organizations. Research limitations/implications – The authors' findings are not limited to the sample studied, which is supported by their robustness analysis. However an extended opinion survey of the ethnic minority population is required to more accurately examine the problems faced by diverse groups of immigrants across EU member states. Practical implications – The findings of the study call for more effective diversity management and integration strategies to ensure non-discrimination and better integration of ethnic minorities into the labor markets of member states. Originality/value – There are few studies using primary survey data that have identified a wide range of barriers and challenges to economic integration faced by ethnic minorities in an enlarged European Union. The cross-national opinion survey uniquely reflects views and suggestions of practitioners and immigrant minorities themselves. [ABSTRACT FROM AUTHOR]

Drawing mainly on qualitative evidence gathered from interviews with migrant handymen and with labour-using households in the UK, this paper analyses how this migration typifies economic and social divisions within Europe and embodies conflicting tensions between economic and social policies at an interpersonal level. By supplying household services, migrant handymen enable labour-using households to alleviate time pressures and conflicts in time priorities arising from tensions between economic expectations regarding working hours and work commitment, and social expectations regarding contemporary ideas of active parenting. Similarly to the outsourcing of feminized domestic labour and care, these tensions are in part resolved for labour-using households by extending class divisions across national boundaries while leaving gender divisions changed but not transformed and in some instances exacerbating work/ life tensions among the migrants. These broad findings are complicated by differential desires and capabilities around fathering practices among fathers in labour-using households and among the migrants, and economic differentiation among the migrant population. Although we cannot tell from our study whether such movement reinforces or redresses uneven development, what we can say is that existing cohesion policies are insufficient to redress uneven development, and individual responses including migration can reinforce existing social divisions. Further, existing social policies for promoting gender equality fail to recognize or redress the deeply embedded gendered norms. [ABSTRACT FROM AUTHOR]

The Constitution of the Italian Republic asserts the principle of solidarity in a particularly evident manner and marks one of the clearest instances and one of the most strongly enshrined manifestations of that principle within Europe. The centrality and pervasive way this watchword of the contemporary political and legal lexicon is used takes on a particular depth in the light of the immense tragedy of the migrants crossing the Mediterranean Sea, who for several years now have been knocking on the doors of Europe day after day, with a profound effect on the Old Continent. The word solidarity has taken on an even more dramatic depth since Russia launched an unprovoked war of aggression against its peaceful neighbour, Ukraine, resulting in a significant armed conflict in Europe and an increase in the number of refugees and asylum-seekers from Ukraine. In contrast to the weak and uncertain European solidarity towards those migrants who reach its southern boundaries, the EU's solidarity towards the Ukrainian people has been clear and evident. [ABSTRACT FROM AUTHOR]

ABSTRACT: The enlargement of the European Union (EU) and the subsequent global economic recession has drawn attention to individual-level attitudes towards immigrants across Europe. In this context, using the European Social Survey (ESS), we compared Irish attitudes towards immigrants with those in 12 other European countries at 3 critical moments in time – prior to large immigration flows in 2002; at the height of the economic boom in 2006; and after the global financial crash in 2008. Our descriptive analysis examines whether significant changes in attitudes towards immigrants has occurred in the EU as a whole and within individual countries over time. We predicted that fluctuations in economic condition such as the rise in unemployment would affect attitudes towards immigrants. This relationship receives some support from our findings. In Ireland, positive attitudes to immigrants between 2006 and 2010 decreased and negative attitudes increased, on all attitudinal measures, more sharply than in any of the other European countries. Taking the 12 countries as a whole, attitudes have tended to polarise particularly with regard to allowing access to immigrants and their impact on the economy. This research reveals worrying trends in attitudes to immigrants in European countries, particularly in light of the importance of immigrants to the European labour market, both currently and in the future. [ABSTRACT FROM AUTHOR]

Copyright of Marmara: Journal of European Studies / Avrupa Araştırmaları Dergisi is the property of Marmara University, European Union Institute and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Teorija in Praksa is the property of Teorija in Praksa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Estudios sobre el Mensaje Periodistico is the property of Universidad Complutense de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Throughout much of Europe, new waves of immigration have raised concerns about cultural fragmentation and disunity, interethnic conflict, and growing antipathy toward immigrants. Our goal is to provide evidence of uneven patterns of immigrant population distribution and residential integration, both within and between countries of the European Union. Our analyses focus on the spatial concentration of the foreign-born population in 27 countries and 1396 sub-regional areal units (called NUTS3), which in turn are nested within larger economic and cultural regions (i.e., NUTS2). Estimates of new forms of multiscale segregation (i.e., using the index of dissimilarity) are calculated from data drawn from Eurostat and a variety of other sources. Descriptive multivariate models of population concentration or macro-segregation center on key economic (i.e., GDP per capita), social (i.e., education), and ecological (i.e., urbanization) predictors of segregation within and between European countries. New forms of spatial segregation are expressed demographically in substantial regional heterogeneity among immigrants throughout Europe. Multivariate analyses indicate that immigrant-native patterns of population concentration and distribution vary widely between and within European countries with very different economies, demographic conditions, and histories of immigration. In almost all European countries, immigrants from outside of Europe are less spatially integrated with the native population than are immigrants from other countries within Europe. Differences in immigrant-native spatial integration are clearly reflected in the large numbers of immigrant regional "hot spots," which are driven by public policy and idiosyncratic political considerations at the national and regional levels. Our comparative approach provides an overview of country-to-country differences in European immigrant settlement patterns and multiscale patterns of integration and segregation. [ABSTRACT FROM AUTHOR]

What is the impact of unemployment on far-right party support? This article develops a framework that links unemployment to far-right party support, while taking into account both the heterogeneity of the workforce and the role of labour market policies. More specifically, we focus on unemployment as a driver of economic insecurity and examine its effect on outsider and insider labour market groups. We identify the extent to which two labour market policies—unemployment benefits and Employment Protection Legislation (EPL)—mediate the effect of unemployment on economic insecurity, thus limiting the impact of unemployment on far-right party support. We carry out a large N analysis on a sample of 14 Western and 10 Eastern European countries between 1991 and 2013. We find that unemployment only leads to higher far-right support when unemployment benefits replacement rates are low. The results with regard to the mediating effect of EPL are more complex as EPL only mediates the impact of unemployment when we take into account the share of foreign-born population in the country. [ABSTRACT FROM AUTHOR]

How pervasive is labor market discrimination against immigrants and what options do policymakers and migrants have to reduce it? To answer these questions, we conducted a field experiment on employer discrimination in Sweden. Going beyond existing work, we test for a large range of applicant characteristics using a factorial design. We examine whether migrants can affect their employment chances—by adopting citizenship, acquiring work experience, or signaling religious practice—or whether fixed traits such as country of birth or gender are more consequential. We find little systematic evidence that immigrants can do much to reduce discrimination. Rather, ethnic hierarchies are critical: callback rates decline precipitously with the degree of ethno-cultural distance, leaving Iraqis and Somalis, especially if they are male, with much reduced employment chances. These findings highlight that immigrants have few tools at their disposal to escape ethnic penalties and that efforts to reduce discrimination must address employer prejudice. [ABSTRACT FROM AUTHOR]

We provide a systematic assessment of various methods to position political parties on immigration, a policy domain that does not necessarily overlap with left–right and is characterized by varying salience and issue complexity. Manual and automated coding methods drawing on 283 party manifestos are compared – manual sentence-by-sentence coding using a conventional codebook, manual coding using checklists, automated coding using Wordscores, Wordfish and keywords. We also use expert surveys and the Comparative Manifesto Project (CMP), covering the main parties in Austria, Belgium, France, Ireland, the Netherlands, Spain, Switzerland and the United Kingdom, between 1993 and 2013. We find high levels of consistency between expert positioning, manual sentence-by-sentence coding and manual checklist coding and poor or inconsistent results with the CMP, Wordscores, Wordfish and the dictionary approach. An often-neglected method – manual coding using checklists – offers resource efficiency with no loss in validity or reliability. [ABSTRACT FROM AUTHOR]

Background: A growing body of research indicates that cross-cultural competence in nurses can improve migrant patients’ health-related outcomes, but little is known about the potential benefits of cross-cultural competence on the nurses’ own well-being. Objective: To examine whether cross-cultural competence (empathy, skills, positive attitudes, and motivation) is associated with perceived time pressure at work, psychological distress, and sleep problems among registered nurses in Finland, and whether there are differences in these potential associations between native and foreign-born nurses. Methods: The present cross-sectional study was based on a sample of 212 foreign-born nurses licensed to practice in Finland and a random sample of 744 native Finnish nurses. Data were collected with a questionnaire and analyzed using multiple linear regression and structural equation modeling (SEM). Results: Of all four dimensions of cross-cultural competence, only empathy was associated with perceived time pressure (β = –0.13, p = .018), distress (β = –0.23, p < .001), and sleep problems (β = –0.14, p = .004) after the adjustment for gender, age, employment sector, and frequency of interacting with patients and colleagues from different cultures. There were no differences between native and foreign-born nurses in these observed associations (all ps > .05). Conclusions: Cross-cultural empathy may protect against perceived time pressure, distress, and sleep problems in both native and foreign-born nurses. Thus, the promotion of this component of cross-cultural competence among nursing personnel should be encouraged. [ABSTRACT FROM AUTHOR]

Objective: To quantify inequalities in zoster vaccine uptake by determining its association with socio-demographic factors: age, gender, ethnicity, immigration status, deprivation (at Lower-layer Super Output Area-level), care home residence and living arrangements. Method: This population-based cohort study utilised anonymised primary care electronic health records from England (Clinical Practice Research Datalink) linked to deprivation and hospitalisation data. Data from 35,333 individuals from 277 general practices in England and eligible for zoster vaccination during the two-year period (2013–2015) after vaccine introduction were analysed. Logistic regression was used to obtain adjusted odds ratios (aOR) for the association of socio-demographic factors with zoster vaccine uptake for adults aged 70 years (main target group) and adults aged 79 years (catch-up group). Results: Amongst those eligible for vaccination, 52.4% (n = 18,499) received the vaccine. Socio-demographic factors independently associated with lower zoster vaccine uptake in multivariable analyses were: being older (catch-up group: aged 79 years) aOR = 0.89 (95% confidence interval (CI):0.85–0.93), care home residence (aOR = 0.64 (95%CI: 0.57–0.73)) and living alone (aOR = 0.85 (95%CI: 0.81–0.90)). Uptake decreased with increasing levels of deprivation (p-value for trend<0.0001; aOR most deprived versus least deprived areas = 0.69 (95%CI: 0.64–0.75)). Uptake was also lower amongst those of non-White ethnicities (for example, Black versus White ethnicity: aOR = 0.61 (95%CI: 0.49–0.75)) but was not lower among immigrants after adjusting for ethnicity. Lower uptake was also seen amongst females compared to men in the catch-up group. Conclusions: Inequalities in zoster vaccine uptake exist in England; with lower uptake among those of non-White ethnicities, and among those living alone, in a care home and in more deprived areas. Tailored interventions to increase uptake in these social groups should assist in realising the aim of mitigating vaccination inequalities. As care home residents are also at higher risk of zoster, improving the uptake of zoster vaccination in this group will also mitigate inequalities in zoster burden. [ABSTRACT FROM AUTHOR]

Traditional economic interpretations have not been successful in explaining differences in saving rates across countries. One hypothesis is that savings respond to cultural specific social norms. The accepted view in economics so far is that culture does not have any effect on savings. We revisit this evidence using a novel dataset, which allows us to study the saving behavior of up to three generations of immigrants in the United Kingdom. Against the backdrop of existing evidence, we find that cultural preferences are an important explanation for cross-country differences in saving behavior, and their relevance persists up to three generations. [ABSTRACT FROM AUTHOR]

Several scholars have concluded that ethnic diversity has negative consequences for social trust. However, recent research has called into question whether ethnic diversity per se has detrimental effects, or whether lower levels of trust in diverse communities simply reflect a higher concentration of less trusting groups, such as poor people, minorities, or immigrants. Drawing upon a nationally representative sample of the German population (GSOEP), we make two contributions to this debate. First, we examine how ethnic diversity at the neighborhood level–specifically the proportion of immigrants in the neighborhood–is linked to social trust focusing on the compositional effect of poverty. Second, in contrast to the majority of current research on ethnic diversity, we use a behavioral measure of trust in combination with fine-grained (zip-code level) contextual measures of ethnic composition and poverty. Furthermore, we are also able to compare the behavioral measure to a standard attitudinal trust question. We find that household poverty partially accounts for lower levels of trust, and that after controlling for income, German and non-German respondents are equally trusting. However, being surrounded by neighbors with immigrant background is also associated with lower levels of social trust. [ABSTRACT FROM AUTHOR]

This article investigates the interconnections between migration to Europe for asylum and the multiple ‘crises’ of the border regime that have occurred in recent decades. Drawing on 22 months of ethnographic research with refugees in Italy and Germany, the article highlights the tensions between migration policy and legislation at the structural level and the agency of refugees. The case study focuses on a protest staged by refugees in Berlin and the active involvement of its civil-society supporters. The everyday practices of refugees, including building relationships with local residents, cross-border mobility within Europe and ‘inhabiting’ the grey zones where different national jurisdictions intersect, generate frictions that open up spaces of autonomy: the ‘interstices’. Territorial, social and judicial interstices develop out of the power relations in Europe’s migration ‘battleground’. [ABSTRACT FROM AUTHOR]

Background: In 2015, 3,674 new HIV diagnoses were notified in Germany; 16% of those newly diagnosed cases originated from sub-Saharan Africa (sSA). One quarter of the newly diagnosed cases among migrants from sSA (MisSA) are notified as having acquired the HIV infection in Germany. In order to reach MisSA with HIV testing opportunities, we aimed to identify which determinants influence the uptake of HIV testing among MisSA in Germany. Methods: To identify those determinants, we conducted a quantitative cross-sectional survey among MisSA in Germany. The survey was designed in a participatory process that included MisSA and other stakeholders in HIV-prevention. Peer researchers recruited participants to complete standardized questionnaires on HIV knowledge and testing. We conducted multivariable analyses (MVA) to identify determinants associated with ever having attended voluntary HIV testing; and another MVA to identify determinant associated with having had the last voluntary HIV test in Germany. Results: Peer researchers recruited 2,782 participants eligible for inclusion in the MVA. Of these participants, 59.9% (1,667/2,782) previously had an HIV test. For each general statement about HIV that participants knew prior to participation in the study, the odds of having been tested increased by 19% (OR 1.19; 95%-CI: 1.11–1.27). Participants reporting that HIV is a topic that is discussed in their community had 92% higher odds of having been tested for HIV (OR 1.92; 95%-CI: 1.60–2.31). Migrants living in Germany for less than a year had the lowest odds of having had their last HIV test in Germany (OR 0.17; 95%-CI: 0.11–0.27). Additionally, MisSA 18 to 25 years (OR 0.55; 95%-CI: 0.42–0.73) and participants with varied sexual partners and inconsistent condom use (OR 0.75; 95%-CI: 0.44–0.97) had significantly lower odds of having had their last HIV test in Germany. Discussion: Through participatory research, we were able to show that knowledge about HIV and discussing HIV in communities increased the odds of having attended HIV testing among MisSA. However, recent migrants and young sexually active people are among the least reached by testing offers in Germany. Community-based interventions may present opportunities to reach such migrants and improve knowledge and increase discussion about HIV. [ABSTRACT FROM AUTHOR]

Background: The incidence of multiple sclerosis (MS) changes from generation to generation in ethnically different immigrants compared with native-born people. We aimed to determine whether there are generational changes in MS phenotypes among North African immigrants in France. Methods: Cohort study with data from a population-based MS registry to compare the clinical characteristics of 80 first (NAG1) and 167 second (NAG2) generation North Africans with MS living in France with 5200 native-born Europeans. Adjusted Cox models were used to test the association between scores of 3 and 6 on the expanded disability status scale (EDSS) and the “origin/generation” variable. Results: Cox models for EDSS scores 3 and 6 showed a higher risk of score 3 (hazard ratio = 1.738, 95% confidence interval 1.237 to 2.444; P = .002) and 6 (hazard ratio = 2.372, 95% confidence interval 1.626 to 3.462; P<.0001) for NAG1 than Europeans. Being NAG2 was not significantly associated with higher hazards of scores 3 and 6. Conclusions: We found two different phenotypes among NAG1 and NAG2 MS patients in France. NAG1, but not NAG2, have a higher risk of disability than Europeans. This raises the question of environmental factors in MS expression, and advocates appropriate patient management according to generation in immigrants. [ABSTRACT FROM AUTHOR]

Background: Migrant and ethnic minority groups are often assumed to have poor health relative to the majority population. Few countries have the capacity to study a key indicator, mortality, by ethnicity and country of birth. We hypothesized at least 10% differences in mortality by ethnic group in Scotland that would not be wholly attenuated by adjustment for socio-economic factors or country of birth.Methods and Findings: We linked the Scottish 2001 Census to mortality data (2001-2013) in 4.62 million people (91% of estimated population), calculating age-adjusted mortality rate ratios (RRs; multiplied by 100 as percentages) with 95% confidence intervals (CIs) for 13 ethnic groups, with the White Scottish group as reference (ethnic group classification follows the Scottish 2001 Census). The Scottish Index of Multiple Deprivation, education status, and household tenure were socio-economic status (SES) confounding variables and born in the UK or Republic of Ireland (UK/RoI) an interacting and confounding variable. Smoking and diabetes data were from a primary care sub-sample (about 53,000 people). Males and females in most minority groups had lower age-adjusted mortality RRs than the White Scottish group. The 95% CIs provided good evidence that the RR was more than 10% lower in the following ethnic groups: Other White British (72.3 [95% CI 64.2, 81.3] in males and 75.2 [68.0, 83.2] in females); Other White (80.8 [72.8, 89.8] in males and 76.2 [68.6, 84.7] in females); Indian (62.6 [51.6, 76.0] in males and 60.7 [50.4, 73.1] in females); Pakistani (66.1 [57.4, 76.2] in males and 73.8 [63.7, 85.5] in females); Bangladeshi males (50.7 [32.5, 79.1]); Caribbean females (57.5 [38.5, 85.9]); and Chinese (52.2 [43.7, 62.5] in males and 65.8 [55.3, 78.2] in females). The differences were diminished but not eliminated after adjusting for UK/RoI birth and SES variables. A mortality advantage was evident in all 12 minority groups for those born abroad, but in only 6/12 male groups and 5/12 female groups of those born in the UK/RoI. In the primary care sub-sample, after adjustment for age, UK/RoI born, SES, smoking, and diabetes, the RR was not lower in Indian males (114.7 [95% CI 78.3, 167.9]) and Pakistani females (103.9 [73.9, 145.9]) than in White Scottish males and females, respectively. The main limitations were the inability to include deaths abroad and the small number of deaths in some ethnic minority groups, especially for people born in the UK/RoI.Conclusions: There was relatively low mortality for many ethnic minority groups compared to the White Scottish majority. The mortality advantage was less clear in UK/RoI-born minority group offspring than in immigrants. These differences need explaining, and health-related behaviours seem important. Similar analyses are required internationally to fulfil agreed goals for monitoring, understanding, and improving health in ethnically diverse societies and to apply to health policy, especially on health inequalities and inequities. [ABSTRACT FROM AUTHOR]

Hospitals in Germany employ increasing numbers of foreign-born and foreign-trained (FB&FT) physicians. Studies have investigated how FB&FT physicians experience their professional integration into the German healthcare system, however, the perspectives of stakeholders working with and shaping the work experiences of FB&FT physicians in German hospitals have so far been neglected. This study explores relevant stakeholders’ opinions and attitudes towards FB&FT physicians—which likely influence how these physicians settle in—and how these opinions were formed. We conducted a qualitative interview study with 25 stakeholders working in hospitals or in health policy development. The interviews were analyzed within a constructivist research paradigm using methods derived from Grounded Theory (situational analysis as well as open, axial and selective coding). We found that stakeholders tended to focus on problems in FB&FT physicians’ work performance. Participants criticized FB&FT physicians’ work for deviating from presumably shared professional standards (skill or knowledge and behavioral standards). The professional standards invoked to justify problem-focused statements comprised the definition of an ideal behavior, attitude or ability and a tolerance range that was adapted in a dynamic process. Behavior falling outside the tolerance range was criticized as unacceptable, requiring action to prevent similar deviations in the future. Furthermore, we derived three strategies (minimization, homogenization and quality management) proposed by participants to manage deviations from assumed professional standards by FB&FT physicians. We critically reflect on the social processes of evaluation and problematization and question the legitimacy of professional standards invoked. We also discuss discriminatory tendencies visible in evaluative statements of some participants as well as in some of the strategies proposed. We suggest it will be key to develop and implement better support strategies for FB&FT physicians while also addressing problematic attitudes within the receiving system to further professional integration. [ABSTRACT FROM AUTHOR]

Background: Increasing the proportion diagnosed with and on treatment for chronic hepatitis C (CHC) is key to the elimination of hepatitis C in Europe. This study contributes to secondary prevention planning in the European Union/European Economic Area (EU/EEA) by estimating the number of CHC (anti-HCV positive and viraemic) cases among migrants living in the EU/EEA and born in endemic countries, defining the most affected migrant populations, and assessing whether country of birth prevalence is a reliable proxy for migrant prevalence.Methods: Migrant country of birth and population size extracted from statistical databases and anti-HCV prevalence in countries of birth and in EU/EEA countries derived from a systematic literature search were used to estimate caseload among and most affected migrants. Reliability of country of birth prevalence as a proxy for migrant prevalence was assessed via a systematic literature search.Results: Approximately 11% of the EU/EEA adult population is foreign-born, 79% of whom were born in endemic (anti-HCV prevalence ≥1%) countries. Anti-HCV/CHC prevalence in migrants from endemic countries residing in the EU/EEA is estimated at 2.3%/1.6%, corresponding to ~580,000 CHC infections or 14% of the CHC disease burden in the EU/EEA. The highest number of cases is found among migrants from Romania and Russia (50-60,000 cases each) and migrants from Italy, Morocco, Pakistan, Poland and Ukraine (25-35,000 cases each). Ten studies reporting prevalence in migrants in Europe were identified; in seven of these estimates, prevalence was comparable with the country of birth prevalence and in three estimates it was lower.Discussion: Migrants are disproportionately affected by CHC, account for a considerable number of CHC infections in EU/EEA countries, and are an important population for targeted case finding and treatment. Limited data suggest that country of birth prevalence can be used as a proxy for the prevalence in migrants. [ABSTRACT FROM AUTHOR]

Objective: In European countries, chronic hepatitis B (CHB) disproportionately affects migrants from medium- and high-endemic areas and is largely underdiagnosed. To inform policy and improve screening strategies, we measured the timing of CHB diagnosis after migration and its determinants among sub-Saharan migrants living in the Paris metropolitan area (France). Design: The PARCOURS study is a retrospective life-event history survey conducted in health care services in 2012–2013 among 779 migrants from sub-Saharan Africa who were receiving care for CHB. We investigated the timing of CHB diagnosis from the time of arrival in France using the Kaplan-Meier method and characteristics associated with CHB diagnosis since the time of arrival in France using discrete-time multivariate logistic regression models. Results: The median CHB diagnosis occurred during the fourth year spent in France for men and during the second year spent in France for women. Among men, the probability of CHB diagnosis increased during years with (versus without) a temporary resident permit (aOR: 1.6, 95%CI: 1.1–2.2), a precarious accommodation (aOR: 1.7, 95%CI: 1.1–2.6), and hospitalization (aOR: 7.7, 95%CI: 3.4–15.1). Among women, CHB diagnosis was more likely to occur during years with unemployment (aOR: 1.9, 95%CI: 1.1–3.94), pregnancy (aOR: 6.6, 95%CI: 3.5–12.5) and hospitalization (aOR: 9.0, 95%CI: 2.95–32.3). For both sexes, the probability of CHB diagnosis was higher among those who migrated to France because they were threatened in their country. Conclusion: This study shows that social hardships (residential, economic, administrative) and contact with the health care system after arrival in France hasten access to a CHB diagnosis. [ABSTRACT FROM AUTHOR]

Objective: HIV testing is an important tool in the management of the HIV epidemic among key populations. We aimed to explore the dynamic of first-time HIV testing in France for sub-Saharan migrants after their arrival. Methods: ANRS-Parcours is a retrospective life-event survey conducted from 2012 to 2013 in healthcare facilities in the Paris region, among 926 sub-Saharan HIV-infected migrants and 763 non-infected migrants. After describing the time to first HIV test in France and associated circumstances, we performed a discrete-time logistic regression to analyze the influence of socioeconomic position, contact with the healthcare system and sexual behaviors, on first-time HIV testing in France in migrants who arrived after 2000. Results: Median first-time HIV testing occurred during the second year spent in France for non-infected men and women in both groups, and during the first year for men of the HIV group. The probability of testing increased with hospitalization and pregnancy for women of both groups. For non-infected men unemployment and absence of a residence permit were associated with an increased probability of HIV testing [respectively, OR = 2.2 (1.2–4.1) and OR = 2.0 (1.1–3.5)]. Unemployment was also associated with an increased probability of first-time HIV-testing for women of the HIV group [OR: 1.7 (1.0–2.7)]. Occasional and multiple sexual relationships were associated with an increased probability of first-time testing only for HIV-infected women [OR: 2.2 (1.2–4.0) and OR = 2.4 (1.3–4.6)]. Conclusion: Access to first HIV testing in France is promoted by contact with the health care system and is facilitated for unemployed and undocumented migrants after arrival.However, testing should be offered more systematically and repeated in order to reduce time between HIV infection and diagnosis, especially for deprived people which are particularly vulnerable regarding HIV infection. [ABSTRACT FROM AUTHOR]

Action on social determinants is a main component of the World Health Organization End Tuberculosis (TB) Strategy. The aim of the study was to collect information on socioeconomic characteristics and biomedical risk factors in migrant TB patients in Italy and compare it with data collected among Italian TB patients. A cross-sectional study was conducted among TB patients aged ≥18 years over a 12-months enrolment period in 12 major Italian hospitals. Information on education, employment, housing and income was collected, and European Union Statistics on Income and Living Conditions index was used to assess material deprivation. Among migrants, we also analyzed factors associated with severe material deprivation. Migrants were compared with younger (18–64 years) and older (65+ years) Italians patients. Out of 755 patients enrolled (with a median age of 42 years, interquartile range: 31–53), 65% were migrants. Pulmonary, microbiologically confirmed, and new cases were 80%, 73%, and 87% respectively. Prevalence of co-morbidities (i.e. diabetes, chronic kidney disease, neoplastic diseases and use of immunosuppressive drugs) was lower among migrants compared to Italian TB patients, while indicators of socioeconomic status, income and housing conditions were worst in migrants. Forty-six percent of migrants were severely deprived vs. 9% of Italians (p<0.0001, 11.3% and 5.5% among younger and older Italians, respectively). Among migrants, being male, older, irregular, unemployed, with a shorter time spent in Italy, a lower education level, and without a co-morbidity diagnosis were factors associated with severe material deprivation at multi-variable logistic regression. Moreover, socioeconomic indicators for Italian patients did not differ from those reported for the general Italian population, while migrant TB patients seem to have a higher prevalence of severe material deprivation than other migrants residing in Italy. Intervention to address the needs of this population are urgent. [ABSTRACT FROM AUTHOR]

Background: International migration rapidly increased in the last decade, raising a renewed attention to its impact on public health. We evaluated differences in rubella immunization rate (RIR) between immigrant and Italian women of childbearing age and tried to identify the driving factors causing them. Methods: We analyzed data from the Italian behavioral surveillance system PASSI collected in 2011–2015 in a nationally representative sample of residents in Italy. The analysis was performed using log-binomial models to compare RIR between 41,094 Italian women and 3140 regular immigrant women of childbearing age (18–49 years), stratifying the latter by area of origin and length-of-stay in Italy (recent: ≤ 5-years; mid-term: 6-10-years; long-term: > 10-years). Results: Immigrant women showed a RIR of 36.0% compared to 60.2% among Italian women (RIR-ratio = 0.60, 95% confidence interval (CI): 0.57–0.63). Adjusting for demographic characteristics (i.e., sex, age and area of residence), socio-economic factors (i.e., education, occupation, family composition and economic status) and an indicator of the presence of at least one health-risk behavior (i.e., physical inactivity, current cigarette smoking, excessive alcohol consumption and excess weight) did not significantly change this difference (RIR-ratio = 0.56, 95% CI: 0.53–0.59). Recent immigrants (RIR-ratio = 0.47, 95% CI: 0.42–0.53) and immigrants from high migratory pressure countries (HMPC) in sub-Saharan Africa (RIR-ratio = 0.41, 95% CI: 0.31–0.56) and Asia (RIR-ratio = 0.42, 95% CI: 0.33–0.53) showed the greatest differences in RIR compared with Italian women. Conclusions: Differences in RIR between immigrant and Italian women were not explained by different demographic, socioeconomic and health-risk behaviors characteristics. As entitlement to free-of-charge immunization in Italy is universal, regardless of migration status, other informal barriers (e.g., cultural and barriers to information access) might explain lower RIRs in immigrant women, especially recent immigrants and those from HMPC in sub-Saharan Africa and Asia. Further investigations are needed to identify obstacles and appropriate promotion and access-enabling strategies for rubella immunization. [ABSTRACT FROM AUTHOR]

The borders of Europe do not only operate at territorial limits. This article argues for those identified as Roma, UK immigration control has shifted from gate-keeping at the territorial border to gate-keeping access to services through child welfare. Three factors have interrelated to foreground boundary-making in home encounters: European Union expansion, development of a post-welfare state and governmentalisation of vulnerable children. First this article examines how these three processes converge to activate the border through assessments of mothering in the home. Due to mothers’ particular migrant status, they are confronted with a choice between loss of motherhood or movement from the national territory. Second it illustrates how mothers engage in strategies of self-representation to negotiate bordering processes, requiring intensive work with a variety of actors. These actors are themselves located within racialised and gendered hierarchies. This article illustrates through ethnographic vignettes how the home is recast as a site of negotiating access to state forms where judgements of ‘good motherhood’ produce bordering effects. This represents a governing logic applied both to mothers and frontline workers resulting in stratified reproduction based on hierarchies of values. [ABSTRACT FROM AUTHOR]

Background: In the European Union/European Economic Area (EU/EEA), migrants from high-endemic countries are disproportionately affected by HIV. Between 2007 and 2012, migrants represented 39 % of reported HIV cases. There is growing evidence that a significant proportion of HIV acquisition among migrant populations occurs after their arrival in Europe.Discussion: Migrants are confronted with multiple risk factors that shape patterns of population HIV susceptibility and vulnerability, which simultaneously affect HIV transmission. Undocumented migrants incur additional risks for contracting HIV due to limited access to adequate health care services, protection and justice, alongside insecure housing and employment conditions. All EU/EEA countries have ratified a number of international and regional human rights instruments that enshrine access to health care as a human right that should be available to everyone without discrimination. From a clinical and public health perspective, early HIV care and treatment is associated with viral suppression, improved health outcomes and reductions in transmission risks. A current challenge of the HIV epidemic is to reach the highest proportion of overall viral suppression among people living with HIV in order to impact on HIV transmission. Although the majority of EU/EEA countries regard migrants as an important sub-population for their national responses to HIV, and despite the overwhelming evidence of the individual and public health benefits associated with HIV care and treatment, a significant number of EU/EEA countries do not provide antiretroviral treatment to undocumented migrants. HIV transmission dynamics in migrant populations depend on the respective weight of all risk and vulnerability factors to which they are exposed, which act together in a synergistic way. People who are not linked to HIV care will continue to unwillingly contribute to the on-going transmission of HIV. Following the recommendations of the European Union Agency for Fundamental Rights, ensuring access to HIV-care for all sub-populations, including undocumented migrants, would fulfil the human rights of those populations and also strengthen the control of HIV incidence among those not currently able to access HIV care. [ABSTRACT FROM AUTHOR]

Background: In 2015 the increased migratory pressure in Europe posed additional challenges for healthcare providers. The aim of this study was to inform the development of a "Resource Package" to support European Union (EU) member states in improving access to healthcare for refugees, asylum seekers and other migrants.Methods: A mixed method approach was adopted: i) interviews and focus groups were carried out to gather up-to-date information on the challenges the different healthcare providers were facing related to the refugee crisis; ii) to complement the results of the FGs, a literature review was conducted to collect available evidence on barriers and solutions related to access to healthcare for refugees and migrants.Results: The different actors providing healthcare for refugees and migrants faced challenges related to the phases of the migration trajectory: arrival, transit and destination. These challenges impacted on the accessibility of healthcare services due to legislative, financial and administrative barriers; lack of interpretation and cultural mediation services; lack of reliable information on the illness and health history of migrant patients; lack of knowledge of entitlements and available services; lack of organisation and coordination between services. These barriers proved particularly problematic for access to specific services: mental health, sexual and reproductive care, child & adolescent care and victim of violence care.Conclusions: The findings of this study show that solutions that are aimed only at responding to emergencies often lead to fragmented and chaotic interventions, devolving attention from the need to develop structural changes in the EU health systems. [ABSTRACT FROM AUTHOR]