Diverse perspectives on social determinants of multicultural adolescents: A focus group study

Abstract Background As Korea transforms into a multicultural society, social vulnerability of the multicultural adolescents (MAs) puts them at risk for poor health and health disparities. However, there is shortage of evidence on social determinants of health (SDH), which refers to the circumstances of people from birth to death, which affects their health outcomes, for MAs. Thus, this study aims to explore the SDH of MAs from diverse stakeholders’ perspectives. Methods This qualitative study comprised 17 focus group interviews with 99 participants (MAs, peers, parents, teachers, neighbors, and community leaders), conducted from June to September 2020. The directed content analysis was conducted using the Minority Health and Health Disparities Research Framework with a high rigor level based on the four criteria of Lincoln and Guba’s trustworthiness. Results The participants addressed SDH of MAs in five domains: biological (vulnerability and mechanism); behavioral (health behavior, family/school/peer functioning, and policies and laws); physical/built environment (school/community environment); sociocultural environment (MAs'/parental sociodemographic, language proficiency, MAs'/parental acculturation, social network, and response to/interpersonal/local/societal structural discrimination); and health care system (insurance coverage, MAs'/parental health literacy, availability of services, and health care policies). However, limited SDH in biological and physical/built environment domains were identified. Conclusions SDH in sociocultural environment domain and interpersonal influence level were the most commonly addressed. Interpersonal discrimination of both MAs and parents were found to be the most important SDH. These findings suggest that future programs to enhance MAs’ health may be targeted toward reducing discrimination and involving their parents. Key messages • Sociocultural environment was found to be the most salient SDH domain to affect MAs’ health. • SDH of MAs are linked to discrimination and their parents’ sociocultural aspects such as acculturation.


Background:
Reports from all over the world have shown great ethnic disparities in COVID-19 morbidity and mortality.Recent European studies have found discrepancies between higher risk of admission and intensive care treatment among ethnic minorities but lower mortality rates compared to the ethnic majority.This study will elucidate the ethnic differences in disease severity upon admission as a possible factor in explaining these discrepancies.

Methods:
A retrospective cohort study of 1442 patients admitted with COVID-19 at three hospitals in Copenhagen, Denmark, between 1st February 2020 and 31st May 2022.Clinical, demographic and ethnicity data were extracted from health care records and collected using REDCap.Severity upon admission (< 24 hours) was assessed as 1) oxygen need, 2) oxygen administration and 3) need for intensive care.

Results:
Ethnicity was registered on 1341 patients (57,0% Danish, 34,8% non-Western).Over all, preliminary descriptive analyses show patients of non-Western origin had symptoms of COVID-19 for a longer period (8,0 vs 6,7 days, p < 0,0001) and had a higher oxygen need (7,0L vs 5,2L, p = 0,02) upon admission compared to patients of Danish origin.A higher percentage of patients of non-Western origin needed high flow oxygen administration upon admission (30,2% vs 22,9%, p = 0,006) and were transferred to the ICU within the first 24 hours (4,9% vs 2,2 %, p = 0,02) compared to patients of Danish origin.Further analysis will be done, including biochemistry and link to registers in order of obtaining more accurate info on country of birth and migration status.We will do logistic regression regarding ethnic differences in severity of COVID-19 upon admission adjusting for comorbidities, age, sex and BMI.

Conclusions:
Preliminary data on disease severity of COVID-19 upon admission show some ethnic disparities.Language barriers, low health literacy or the fear of stigma might explain this.

Background:
As Korea transforms into a multicultural society, social vulnerability of the multicultural adolescents (MAs) puts them at risk for poor health and health disparities.However, there is shortage of evidence on social determinants of health (SDH), which refers to the circumstances of people from birth to death, which affects their health outcomes, for MAs.Thus, this study aims to explore the SDH of MAs from diverse stakeholders' perspectives.

Methods:
This qualitative study comprised 17 focus group interviews with 99 participants (MAs, peers, parents, teachers, neighbors, and community leaders), conducted from June to September 2020.The directed content analysis was conducted using the Minority Health and Health Disparities Research Framework with a high rigor level based on the four criteria of Lincoln and Guba's trustworthiness.

Results:
The participants addressed SDH of MAs in five domains: biological (vulnerability and mechanism); behavioral (health behavior, family/school/peer functioning, and policies and laws); physical/built environment (school/community environment); sociocultural environment (MAs'/parental sociodemographic, language proficiency, MAs'/parental acculturation, social network, and response to/interpersonal/ local/societal structural discrimination); and health care system (insurance coverage, MAs'/parental health literacy, availability of services, and health care policies).However, limited SDH in biological and physical/built environment domains were identified.Conclusions: SDH in sociocultural environment domain and interpersonal influence level were the most commonly addressed.Interpersonal discrimination of both MAs and parents were found to be the most important SDH.These findings suggest that future programs to enhance MAs' health may be targeted toward reducing discrimination and involving their parents.

Key messages:
Sociocultural environment was found to be the most salient SDH domain to affect MAs' health.SDH of MAs are linked to discrimination and their parents' sociocultural aspects such as acculturation.

Aim:
To examine whether individuals who migrated to Sweden as refugees in childhood are more likely to experience poor mental and general health and violence in adulthood, compared to individuals born in Sweden, or who were migrants but not refugees.

Methods:
This study included 151,614 individuals who answered the Swedish National Public Health Survey in 2018 or 2020.We grouped the participants into refugees in childhood, migrants in childhood, or non-migrants.Information about outcomesmental health, general health, and risk behaviors -was collected through questionnaires.We analyzed the associations using logistic regressions.

Results:
Overall, having been a refugee in childhood was generally not associated with poor general health and mental ill-health, risk behaviors, or exposure to violence, compared to those who were migrants or born in Sweden.However, there were some exceptions.For example, young men, who were refugees in childhood, had a higher likelihood of suicide attempts than non-migrants.Interestingly, childhood refugees and childhood migrants were less likely to use drugs and to have risky alcohol use as adults, compared to non-migrants, but were more likely to be risk gamblers.

Conclusions:
Being a refugee in childhood was not, in general, associated with negative health consequences in adulthood with some exceptions, such as gambling, that will be discussed in the presentation.

Key messages:
In this study, refugee experience in childhood is not, in general, associated with worse health outcomes in adulthood.
There are certain risk groups that need to be highlighted such as young males with refugee experience in childhood.

Conclusions:
Maternal and perinatal health was poor in undocumented migrants, varying by birthplace.Social determinants, health coverage and outcomes showed vulnerability and inequality compared to the general population.

Key messages:
Tailored interventions are needed: outreach health promotion on safe motherhood and neonatal care, healthcare provider training, cultural mediation, translation, and functional language learning.A systematic monitoring and evaluation system needs to routinely collect, integrate, and analyze data on key indicators.
15th European Public Health Conference 2022