Population Migration Research Articles

Health inequities in cardiac care and cardiovascular guideline concordance in Australian migrant populations: data correlation for culturally and linguistically diverse populations (DatCALD) project

Abstract Background Evidence of inequities in acute cardiac care and concordance with cardiovascular guidelines in migrant populations have not been well documented in Australia. Additionally, knowledge of correlations between clinical data and population health data of these marginalised groups is seriously lacking. Purpose To establish an interactive population health atlas and perform data correlations to determine health inequities in cardiac care provision in emergency departments (EDs) and examine guideline concordance in migrant populations. Methods This study correlated population health data derived from public health surveillance systems with the clinical data of migrant populations in Australia. The interactive atlas has been established and data correlations between relevant variables have been produced. Degree of correlations were presented as a correlation coefficient (r). Results The evidence revealed a strong relationship between migrant status and poor cardiac care provision. Migrant populations who were born overseas in non-English-speaking (NES) countries were less likely to access universal health coverage in Australia (Medicare) and were more likely to live with socioeconomic disadvantage (r= 0.24). Birthplaces of migrants were associated with longer processing time for cardiac care in ED, including time to meet an ED doctor and total ED stay time (Figure 1). Migrant populations were less likely to receive cardiac care at triage within the recommended timeframe of 10 minutes (r= -0.35), whereas the Australian-born group were more likely to reach ED treatment within 10 minutes (r= -0.52). Interestingly, migrants who were born in English speaking countries had the strongest relationship with an ED stay longer than the recommended time of four hours (r= -0.42). An association between migrant populations and non-concordance with guidelines for management of chest pain was evident (Figure 2). The population born overseas in NES countries, resident in Australia ≥ 5 years had the strongest correlation with non-concordance (r= 0.50); whereas the Australian-born population were the most likely to meet the concordance guideline. The evidence suggested that permanent migrants entering Australia between 2000-2006 under family and skill stream visas have a higher likelihood of non-concordance with guidelines for chest pain management (r= 0.50) compared to those of this group who arrived in Australia after 2006. Conclusions Health inequities in cardiac care in ED and concordance with cardiovascular guidelines have been found to be associated with migrant status at varying degrees, related to their birthplace and duration of residency. Universal health coverage and sociocultural factors are related to those health inequities. Addressing these determinants of health, normalizing cultural competence and increase health service accessibility are recommended to promote and sustain health equities and wellbeing in these disadvantaged populations.Birthplace and ED provisionBirthplace and non-concordance

Unmet healthcare needs in migrant population in Finland: comparative analysis between 2014 and 2022

Abstract Background Timely access to health services is one of the cornerstones of universal health coverage. However, various individual and structural factors remain as barriers to meet this goal. Access to physician services remains a concern for migrant populations, with a substantial proportion experiencing unmet healthcare needs, surpassing rates observed in the general population of Finland. This study aims to assess temporal changes in unmet healthcare needs among migrants in Finland across the years 2014, 2018, and 2022, investigating potential disparities across population groups. Methods Three nationally representative datasets derived from cross-sectional surveys are used; Survey on work and well-being among people of foreign origin 2014-2015 (UTH), Survey on well-being among foreign-born population 2018-2019 (FinMonik) and National survey on health, well-being, and service use among foreign-born population 2022-2023 (MoniSuomi). We analysed data from individuals aged 20 to 64 years. Multivariate logistic regression analysis, adjusting for sociodemographic and socioeconomic factors, is employed to compare unmet healthcare needs in migrant populations with the Finnish general population. Results A significant increase was found in unmet healthcare needs among migrant populations in Finland from 2014 to 2022. Prevalence rates rose from 25.0% in 2014 to 24.9% in 2018 and reached 33.7% in 2022. Preliminary analysis suggests that younger age, migration from the Middle East and Africa, and refugee status are associated with higher odds of experiencing unmet healthcare needs. Conclusions The escalating prevalence of unmet healthcare needs between 2014 and 2022 among migrant populations in Finland is a cause for concern. This research underscores the urgent need for policymakers, healthcare providers, and community advocates to address healthcare inequities and ensure equitable access to healthcare, to ensure universal health coverage for all individuals in Finland. Key messages • The prevalence of unmet healthcare needs between 2014 and 2022 among migrant populations in Finland has escalated, compared to the Finnish general population. • Preliminary analysis suggests that younger age, migration from the Middle East and Africa, and refugee status are associated with higher odds of experiencing unmet healthcare needs.

Vaccine-preventable diseases in migrants to Europe: a systematic review

Abstract Migrant populations in Europe are at increased risk of under-immunisation and therefore likely to be at high risk of vaccine-preventable diseases (VPD), yet the relationship between migration and VPD incidence is not fully understood. This study aimed to explore the prevalence of VPDs in migrant populations in Europe and to define at-risk groups. Following PRISMA guidelines, Embase, MEDLINE and Global Health were searched for peer-reviewed papers published from 1st January 2010. Inclusion criteria comprised primary research on VPD cases (measles, mumps, rubella, diphtheria, pertussis, tetanus) among migrants to/within EU/EEA and Switzerland. We defined migrants as foreign-born nationals. Forty-seven eligible studies from 15 EU/EEA countries and Switzerland were included, with a total of 1357 migrant VPD cases reported. Analysis revealed 1357 migrant cases across measles (28 publications; 926 cases), pertussis (9; 267 cases), mumps (9; 107 cases), diphtheria (11; 67 cases), rubella (2; 6 cases imported from Romania and Pakistan), tetanus (2; 2 cases). Over-representation of measles cases was observed among migrant children and adolescents, predominantly from the WHO Europe region (particularly Bulgaria, Bosnia and Herzegovina and Serbia). Migrants of East African origin were over-represented among diphtheria cases. This study underscores the association between migration and VPD cases in EU/EEA and Switzerland, establishing a clear association between European migrant children and adolescents in measles outbreaks, and adult migrants from East Africa in diphtheria cases. This study suggests strengthening systems for targeted catch-up vaccination for migrants is imperative upon arrival in European countries to align them with national schedules, alongside the need to improve data collection and surveillance systems to inform effective public health interventions. Key messages • Migrant populations in Europe face heightened risk of vaccine-preventable diseases and need to be better incorporated into catch-up vaccination initiatives on arrival. • Improved data collection and surveillance systems are crucial for informing effective public health interventions targeting migrant populations.

Understanding labour exploitation as a social determinant of health in migrant populations – insights from the Danish population-based registers

Abstract Despite recent global events such as the COVID-19 pandemic and the Qatar world cup drawing attention to the significant loss of human lives of labour migrants in precarious working conditions, evidence on the comparative mortality of migrant workers remains sparse and inconsistent. Studying the comparative mortality of migrant workers with local workers is challenging for several reasons. Data on migrants’ employment conditions and health outcomes are often incomplete, and when available captured in separate databases. In addition, there is a need to disentangle the healthy migrant effect from the healthy worker effect, which presents challenges in the selection of reference populations and temporality when studying mortality of migrants. In view of such challenges, Denmark provides an ideal context to study labour migration and mortality. The Danish population-based registers offer linked longitudinal data on migrants’ employment history and mortality outcomes. Denmark’s migrant integration policy also has a history of weaving immigration and labour policies, and migrants in Denmark continue to be prone to labour exploitation in high-risk industries such as construction and agriculture. This presentation shall use Denmark as a case study to compare the mortality outcomes of migrant workers with Danish workers to better understand labour exploitation as a social determinant of health.

Scoping Review of Health Literacy Interventions among Migrant Communities in Europe

Abstract Background The increase in migration trends in Europe has brought attention to the significant health disparities between migrant and native populations, which are largely rooted in social determinants of health such as economic difficulties, language barriers, and limited access to services. Tailored health literacy (HL) interventions can serve as an intermediate factor between social determinants of health and health outcome, thereby holding great potential for addressing these disparities. Despite a growing body of research on migrant health, there remains a gap in our understanding of effective HL interventions for this population. Methods A scoping review was conducted following the Joanna Briggs Institute (JBI) updated guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Electronic searches were carried out across five databases (PubMed, SCOPUS, Web of Science, PsychINFO, and CINHAL) and supplemented by a manual search. We included European studies on migrant HL interventions, conducted between 2011 and 2023, and published in English or Portuguese language. Results Out of 1018 records, 7 studies met eligibility criteria. Predominantly situated in Northern and Western Europe (85.5%), interventions primarily targeted female migrants (71.4%) through in-person courses (42.9%). Identified intervention strengths included culturally adapted content, migrant engagement, and access to written materials. Gaps included mental health interventions and community outreach. Conclusions This scoping review provides a comprehensive overview of HL interventions targeting migrant populations, highlighting their characteristics, strengths, and gaps. These findings serve as a foundational step towards developing guidelines for effective HL interventions within migrant communities. Key messages • Most European health literacy interventions for migrants target women and are conducted in North or West Europe. • Cultural adaptation and community engagement are key strengths of migrant health literacy interventions, yet gaps remain in mental health support and community outreach efforts.

Interventions’ transferability assessment to strengthen Vaccination Uptake Among Migrants in Greece

Abstract Background Migrant children in Greece face significantly lower vaccination coverage rates for MMR and HPV compared to their counterparts. To address this disparity, our research focuses on selecting and adapting evidence-based interventions tailored to the specific needs of different migrant communities staying in Greece, guided by the PIET-T framework. Methods Using a stakeholder-engaged approach, we involved 26 key stakeholders to select evidence-based interventions relevant to the Greek context. These interventions underwent detailed analysis, considering their effectiveness, cultural appropriateness, and potential for transferability within the PIET-T framework. Key stakeholders provided input on intervention feasibility and country- and context-specific adaptation. Results Three interventions were identified as promising for MMR and HPV vaccination uptake: two health promoter interventions and a school-based vaccination one. The health promoter intervention was adapted so to involve health professionals and trusted community members delivering culturally sensitive education and navigation support, addressing barriers such as language and lack of information. The original school-based program implements education sessions and on-site vaccinations, leveraging the trusted environment of schools to reach parents and children. On-site vaccinations were omitted since they were not relevant to the Greek context due to legal barriers. Conclusions Our stakeholder-engaged approach, guided by the PIET-T framework, ensures interventions are tailored to the specific needs and contexts of different migrant communities in Greece. By prioritizing cultural sensitivity and community involvement, we aim to enhance MMR and HPV vaccination uptake and improve health outcomes among migrant populations.

5.I. Scientific session: Epidemiological insights into vaccine hesitancy in Europe: building bridges and overcoming barriers

Abstract Vaccine hesitancy remains a pivotal challenge in public health, undermining immunization efforts and the containment of infectious diseases across Europe. This scientific session aims to dissect the complex nature of vaccine hesitancy, uncovering epidemiological trends and barriers to vaccine acceptance, particularly in diverse demographic contexts. The objective is to facilitate a comprehensive understanding among public health stakeholders and to foster actionable strategies through enriched dialogue and interaction. This session will delve into recent studies and projects that highlight the variability of vaccine hesitancy within Europe. First, an exploration of COVID-19 vaccine acceptance will reveal how sociodemographic factors influence vaccine-related behaviors across 20 European nations. This will be complemented by an analysis of targeted interventions designed to enhance vaccine uptake among migrant populations, drawing lessons from the RIVER-EU project. Additionally, a focus on national efforts to combat measles vaccine hesitancy will provide a case study on the challenges and successes in altering public health narratives. Based on the feedback received on last year’s session, the format is intended not only to provide a platform to present empirical evidence and insights but also to encourage a participatory environment where attendees can exchange ideas and propose innovative solutions. For this reason, the session will engage the audience through an interactive discussion period at the end of each of the three presentations, stimulating thought-provoking dialogues that could lead to effective and innovative public health practices. Fostering international and interdisciplinary collaboration in the field of vaccine hesitancy is key for continued monitoring and reporting on the vaccine hesitancy phenomenon and inspiring actionable solutions. Key messages • Sociodemographic factors are associated with vaccine hesitancy across Europe indicating the potential for targeted strategies. • A platform to share insights and inspire actionable public health solutions to combat vaccine hesitancy amomg European public health professionals is needed.

Rheumatic heart disease: an ongoing public health concern in vulnerable communities

Abstract Background Acute rheumatic fever (ARF) results from an autoimmune response triggered by group A streptococcus (GAS) infection (1). Severe or recurrent ARF episodes can cause permanent heart valve damage, leading to complications including heart failure, stroke, arrhythmias, carditis, and decompensation during pregnancy (2). Purpose Rheumatic fever (RF) remains a public health concern in Australia, particularly among Indigenous, migrant populations and socioeconomically disadvantaged communities. Europe and various regions worldwide have experienced significant migration from areas with a high prevalence of RHD (3). Amongst the more than 1 million asylum seekers who arrived in Europe in 2015, an estimated 1% could potentially be affected by RHD (3). This migration influx underscores the pressing need for the implementation of strategies in health policy and practice. We aimed to outline the attributes of our RF-RHD cohort to aid in the formulation of a Model of Care (MoC). Methods Cases were identified on a quarterly basis either through the NSW Public Health Rapid, Emergency, Disease, and Syndromic Surveillance (PHREDSS) system or via clinical diagnoses reported to the Public Health Unit (PHU) from January 2015 to June 2023. Demographic profiles, clinical particulars, and patient outcomes were collected from patients in the South Western Sydney Local Health District (SWSLHD), NSW, Australia. Results A total of 45 cases were reported (Table 1). This consisted predominantly of females with an average age at diagnosis of 14 years. A majority were obese (69%). Most were in the Maori and Pacific Islander populations (62%), while a smaller portion of patients were of Aboriginal or Torres Strait Islander descent (9%) (Australian Indigenous community). Notably, 84% of patients diagnosed with ARF subsequently progressed to RHD. Among the reported cases, 16 patients underwent valvular surgery, 2 patients progressed to end-stage heart failure, and there was 1 mortality. 39% (11) of female patients were pregnant during the study period, with 6 (55%) of these patients decompensating during their pregnancy (Table 2). Conclusion Rheumatic fever persists as a public health concern on a global scale. Our findings emphasize the need for a high index of clinical awareness in considering RF/RHD in socioeconomically disadvantaged communities. In our setting, there is a disproportionate burden of disease among the Pacific Islander population. The high occurrence of cardiac decompensation during pregnancy, underscores the need for close monitoring in this demographic. Despite the prevalence of rheumatic fever predominantly affecting young patients in vulnerable groups, we found a significant proportion of individuals lost to follow-up or not connected with Cardiology services. Addressing rheumatic fever requires a comprehensive approach that encompasses improved healthcare accessibility, targeted health education initiatives, and socioeconomic interventions.

COVID-19-related worries: A longitudinal study comparing migrants and non-migrants in Norway

Abstract Background Health- and economic-related worries during the COVID-19 pandemic contributed to worsening of mental health, particularly affecting migrants in vulnerable situations. However, this differential impact was only clear some months into the pandemic, and there is little evidence about any differences in health and economic worries between migrants and non-migrants as the pandemic developed. To close this knowledge gap, we assessed the changes in COVID-19-related worries reported by migrants compared to non-migrants in Norway throughout the pandemic. Methods Our study analyzed data from three time points (April-20, January-21, March-22) for 25,305 participants of the Bergen in Change study, including 509 (2%) migrants from Asia, Africa, or Latin America (LATAM), and 1250 (5%) migrants from other regions. Worries were assessed using questions on COVID-19 infection fear, job security, and economic stability. Analysis methods included descriptive analysis, chi-squared, Sankey plots, and logistic regression, adjusting for age, gender, education, and type of work. Results Migrants from Asia, Africa and LATAM reported health worries more often than non-migrants [OR (95%CI) 1.9 (1.3-2.8)] without clear changes over time, 0.9 (0.7-1.3). Migrants from Asia, Africa, and LATAM, as well as from other regions, also reported economic worries significantly more often than non-migrants [3.1 (2.5-3.9) and 2.1 (1.8-2.4) respectively] at baseline. Each additional year into the pandemic increased the odds of economic worries by a factor of 1.3 (1.0-1.6) for migrants from Asia, Africa, and LATAM compared to non-migrants. The odds ratio for migrants from other regions over time was stable, 1.0 (0.9-1.1). Conclusions Migrants, especially those from Asia, Africa, and LATAM, reported more pandemic- related worries than non-migrants, and this persisted over time. Identifying and understanding these worries could guide preventive measures to enhance mental health in migrant population. Key messages • Throughout the pandemic, migrants reported more COVID-19-related worries than non-migrants, a trend that persisted over time and was greater among migrants from Asia, Africa, and Latin America. • Identifying the differential impact of COVID-19 on migrants’ groups and understanding the factors involved is essential for guiding healthcare interventions to improve migrant health.

Awareness and knowledge about Female Genital Schistosomiasis among European healthcare workers

Abstract Background Female Genital Schistosomiasis (FGS) is a gynaecological manifestation of persistent infection with Schistosoma haematobium, which can lead to severe consequences, such as miscarriage and infertility. It is estimated to affect 56 million women globally, mostly in sub-Saharan Africa (SSA). Most migrants in Europe are female, often from SSA and therefore at risk of FGS, hence healthcare workers (HCWs) knowledge of FGS is essential for the provision of adequate care. This study aims to assess awareness and knowledge of FGS among European HCWs to inform strategies to improve the management of migrant health. Methods In June 2023 - January 2024 we conducted a cross-sectional online survey targeting medical doctors (MDs), nurses and midwives (NMs) working in fields of infectiology, gynaecology, urology, family, travel, internal or occupational medicine. The prevalence of FGS awareness and knowledge was estimated, Poisson regression was used to identify factors associated with MDs’ awareness of FGS. Results Among 922 surveyed HCWs, 43.7% (CI95%: 39.6-47.9) of MDs and 12.0% (CI95%: 8.8-16.0) NMs have heard about FGS. FGS awareness among MDs was associated with work in clinics for migrants (prevalence ratio (PR)=1.33, CI95%: 1.10-1.59) and specialization, being lower for gynaecology (PR = 0.67; CI95%:0.51-0.88), and family medicine (PR = 0.42, CI95%:0.30-0.59). Among MDs, 7.1% (CI95%: 5.1- 9.5) had medium knowledge, while 25.3% (CI95%: 21.8-29.0) had low, and 67.6% (CI95%: 63.7-71.4) no knowledge on symptoms, complications or diagnostic tools for FGS. FGS knowledge was mostly acquired through academic curricula (34.7%), scientific literature (28.4%) and conferences (25.6%). Conclusions The study shows limited awareness of FGS among European MDs and NMs, and highlights that European HCWs may not be adequately prepared to deal with diseases that are gaining relevance on the European continent due to the global connectivity and the dynamic nature of our societies. Key messages • In Europe, the health specialities that are the first point of patient access to the health system show a low level of awareness and knowledge of Female Genital Schistosomiasis. • Rising knowledge of FGS among European HCWs through academic curricula and continuous medical education is important to ensure adequate diagnosis and management of disease in migrant populations.

Latent tubercolosis infection in the migrant population: an Italian surveillance experience

Abstract Background The Special Reception Center (“Centro Accoglienza Straordinario” or CAS in Italian) concept was born in Italy in 2014 to receive the large number of migrants arriving in Italy. There are around 3100 centres are in Italy, of which 200+ in Tuscany. Each Center’s objective is to support migrants’ social integration through Italian language and job orientation courses. On arrival at a facility, migrants undergo diagnostic and lab tests to highlight potentially infectious diseases; among these, tuberculosis is one of the most frequently encountered. Therefore, the objective of the study is to estimate the prevalence of Latent Tuberculosis Infections (LTBIs) among migrants hosted in CAS centers. Methods From May-December 2023, Amiata Senese, Val d’Orcia and Valdichiana Senese Public Health Unit staff, according to national and departmental guidelines, implemented a number of health surveillance protocols, with close attention to latent tuberculosis infection. This protocol includes the Mantoux TB skin test at the CAS: in case of positivity, subjects are directed to further exams (chest X-ray, TB-IGRA blood test, infectious disease specialist consultation) in order to implement a therapy. Results From May-December 2023, 259 migrants (241 males and 18 females) received the TB skin tests. Average subject age was 26. Pakistan was the most represented nation of origin with 130 migrants (50%), followed by Bangladesh (9.7%) and Ivory Coast (7.3%). 77 migrants showed a positive TB skin test result (29.7%): of these 56 (i.e. 21.6% of the migrants screened) were also positive to the TB-IGRA blood test and treated for LTBI. Conclusions The high prevalence of LTBIs found in the referenced CAS indicates the need to continue/extend these surveillance protocols. Implementing successfully this procedure requires the involvement of a range of professionals from the socio-health sector within a process necessarily coordinated by the Disease Prevention Department. Key messages • Screening and surveillance of infectious diseases among migrant population represent a major public health issue for European health systems. • Detection and treatment of Latent Tubercolosis Infections require a multiprofessional and integrated approach, coordinated by the Disease Prevention Department.

Don’t pass me by: Tackling vaccine hesitancy among migrants via the RIVER-EU project

Abstract Literature research has suggested that vaccination hesitancy (VH) has been increasing in recent years across migrant populations. It poses various challenges, including risks of outbreaks, and re-emergence of diseases. Nevertheless, only few studies provide an insight of the interventions successful in tackling VH among these groups. This presentation will describe a multi-country research enterprise that aims to respond to these needs. The “RIVER-EU - Reducing Inequalities in Vaccine uptake in the European Region - Engaging Underserved communities” project (funding from EU’s Horizon 2020, Grant Agreement No. 964353) involves several underserved communities, such as Ukrainian migrants (UMs) in Poland, migrants and refugees in Greece, females with Turkish/Moroccan migration background in the Netherlands and the marginalized Roma communities in Slovakia. The project aims at improving child and adolescent HPV/MMR vaccination among these communities by implementing tailored interventions, suitable for each target country. The focus is on removing health system barriers to vaccination. The data regarding VH are an important by-product of the RIVER-EU project, and shows the connection between perceived access barriers and VH. A project-based approach to combat VH among UMs in Poland will serve as a case study to demonstrate the complex process of development of adequate interventions, that could be used to support this migrant group, with disturbingly low vaccination uptake. However, this presentation will go beyond this case study findings - a review of the existing evidence will help generalize our results. Overall, this presentation will show to how investigating various drivers of under-immunization helps to assess what approaches, strategies and interventions are effective to combat VH among marginalized migrant groups.

Addressing vulnerable groups in (public) health and humanitarian crises using RCCE-IM strategies

Abstract Background Vulnerable groups, including older people, infants and children, women, people with disabilities, migrant populations, individuals with marginalized sexual and gender identities, etc., become more fragile in public health and humanitarian crises. These groups’ vulnerability limits their access to health care and other services. Labeling, stigmatization, stereotyping, and other negative consequences contribute to the burden. Concurrent with the motto of the World Health Organization, “Leaving no one behind,’ it reminds us of the need for equality and equity-based models to reach these vulnerable groups in such crises. Methods Existing scientific literature and perspectives were synthesized. Results Novel Coronavirus Disease (COVID-19) contains various experiences. Since the pandemic, the need for interdisciplinary approaches and strategies has become more apparent based on the complexity and intersectionality of the determinants of the crisis. In this regard, Risk Communication (RC), Community Engagement (CE) and Infodemic Management (IM) strategies before, during, and after crises might be used to respond to and mitigate the hazards. Preparation plans before the crisis are almost the most effective intervention. However, “during” and “after” crises need considerable steps of RCCE-IM as well. Listening to the concerns of the vulnerable populations, avoiding discriminatory language, providing correct and timely information, using effective communication strategies, using tools to build resilience, and engaging with the community should be built and/or strengthened among the vulnerable groups. Conclusions Addressing structural vulnerabilities with public and global health perspective might provide us with more sustainable and efficient solutions. In this presentation, answers will be provided on how to use RCCE-IM strategies in structural vulnerability and the strengths and weaknesses of the system with the proposed solutions based on the global situation.

8.M. Skills building seminar: Mental health and substance use in Europe

Abstract The impact of social factors on individual and population mental health are well established (Kirkbride, et al., 2024). The same social factors may trigger the substance use behavior developing into substance use disorders. Mental health disorders can contribute to the substance use and substance use disorders with worsening effects over time (EMCDDA, 2016). This association between substance use, substance use disorders and mental health disorders is a key objective for the scientific consideration and policy development. Respective phenomena are universal and a broader perspective would be useful for a better understanding of how the issue of comorbidities of substance use and mental disorders are addressed on a European level. Identification of the substance use problem, especially among populations in vulnerable situations, like migrants, becomes utterly important. Heterogenous systematic reviews show that there is a need for socially and culturally refugee sensitive instruments to measure the substance use in migrants. Oftentimes substance use is followed by the substance use disorders and drug use related infections. Injecting drug use is also a risk factor for having drug use related infections, such as hepatitis B and C, HIV, tuberculosis. Assessment of risk behaviour patterns among people who inject drugs may contribute to a higher participation in treatment and health programmes, reduce the burden of substance use and tackle comorbidities of substance use and mental health disorders. The skill building seminar aims to increase the knowledge and capacities on substance use and comorbidities, applied methodological approaches and tools in different European contexts. This workshop will support researchers, policy makers, public health planners by providing evidence base to address substance use and mental health issues. The added value of this workshop is based on the structure, content and mode of presentations - presentations will be followed by questions from participants and short discussions. The workshop will start with the general introduction to the topic of comorbidities of substance use and mental health disorders (EUPHA-PMH and EUDA). Then the European level perspective on comorbidities of substance use and mental health disorders will be presented including recent policy developments (1 presentation by Linda Montanari, EUDA). It will be supported with research results from the study conducted in Germany on substance use assessment tool development in migrant population (2 presentation by Kim-Julian Behr, Germany) and behavioural risk factor assessment study among people who inject drugs in Lithuania (3 presentation by Marija Jakubauskiene, Lithuania). Key messages • Participatory approach is useful to address the substance use problem in assessment tool development and further monitoring. • Better understanding of comorbidity of substance use and mental disorders leads to a more effective prevention.

Co-creating stigma-prevention strategies for mental health interventions with migrant populations

Abstract Background The ADVANCE project aims to address mental health disparities among people in a situation of vulnerability in Europe. Through a co-creation approach, workshops were conducted to devise stigma prevention strategies during the implementation of mental health promotion interventions for migrant populations in Italy and Denmark. Methods The methodology involved two rounds of scenario-based workshops, a participatory method that elicit expert opinions to solve local problems and anticipate future ones. Round 1 included two separate workshops with (1) end-users and umbrella organizations, and (2) healthcare practitioners and decision-makers, to ensure diverse perspectives and minimize the impact of power imbalances. Participants brainstormed strategies to minimize stigma and optimize the intervention scenario. In Round 2, a mixed-group workshop was held to refine the strategies. Workshops occurred in Copenhagen and Verona in March 2024. Content analysis of the data was carried out. Results In Denmark, discussions emphasized tailored presentation of the intervention promoting shared experiences and normalizing mental health challenges, language sensitivity, participation through self-identification, and attention to relational aspects in intervention delivery to combat stigma effectively and enhance acceptability and engagement with the intervention. In Italy, proposed strategies included group exercises to raise awareness and promote open dialogue about cultural differences, language barriers, and discrimination. Discussions also considered the intersectionality of stigma, including factors like gender, socioeconomic status, and sexual orientation. Common themes included language sensitivity, facilitator training, and inclusive and safe spaces. Conclusions Scenario-based workshops can be a valuable tool to facilitate the co-creation of stigma-prevention strategies while involving all stakeholders in promoting effective mental health interventions. Key messages • Co-creation approach fostered stakeholder collaboration, yielding tailored strategies that promote inclusivity, acceptability and engagement with mental health interventions for migrant populations. • Context-specific approaches that emphasize trust, confidentiality and cultural sensitivity were prioritised to tackle stigma when implementing interventions and promoting mental health equity.

A matter of measurement? Segregation and all-cause mortality in Sweden’s three metropolitan regions

Abstract Background Residential segregation can be operationalized and measured in many ways, along distinct dimensions. There are multiple mechanisms through which segregation and health mutually affect each other. Consequently, contextual health effects of segregation may vary depending on how segregation is measured. Methods We used longitudinal Swedish register data to compare associations between local measures of residential segregation (migrant density, migrant isolation, and the mutual information index) and all-cause mortality among the adult migrant and native-born populations in Sweden’s three largest metropolitan regions between 2004-2016. Results Among migrants, modest positive mortality gradients were observed across measures of migrant density and isolation, where a higher level of segregation was associated with higher risks of all-cause mortality (Q5 RR ranged from 1.08-1.20 across cities and measures). However, these effects were largely attenuated by individual-level socioeconomic factors, and reversed when further controlling for neighborhood economic deprivation (Q5 RR ranged from 0.74-0.87). Among the native-born, a positive gradient for mortality was found (Q5 RR ranged from 1.31-1.45), although this was reduced when accounting for neighborhood deprivation (Q5 RR ranged from 1.01 -1.11). For both migrants and the native-born, the mutual information index showed no clear association with mortality, although a mortality advantage is observed for migrants in the most segregated areas after individual and neighborhood level adjustments (Q5 RR ranged from 0.73-0.86). Conclusions Our findings show that the manner in which residential segregation is conceptualized and operationalized alters associations with health. However, individual and other contextual level confounders are important determinants which influences the patterns. Much of the negative health effects of residential segregation can be perceived through the lack of economic opportunities. Key messages • Associations between segregation and all-cause mortality depends on how segregation is conceptualized and measured. • The mortality disadvantage observed in local areas with high migrant density may be attributed to the lack of economic opportunities in the neighborhood.

Exploring the mental health impact of asylum-seeking of sexual minority men: a qualitative study

Abstract Background Sexual minority individuals, often called LGBTQ+, encounter significant danger and violence in some countries worldwide. This forces many to seek asylum in a range of European countries. The study aimed to explore the experiences of seeking asylum and its implications for the mental health of sexual minority forced migrant men in Sweden. Methods An exploratory qualitative approach was used, and 15 adult gay and bisexual cisgender men were interviewed individually. Participants were recruited through a combination of purposeful, convenience, and snowball sampling. Systematic text condensation was used to analyze data. The analysis was conducted in close collaboration with three migrants with lived experience. Results The asylum-seeking process proved emotionally challenging, involving procedures with negative impacts on mental health. Challenges included disclosing intimate information during asylum interviews and enduring long periods of uncertainty with limited information on asylum case progress. Fundamental to participants’ experiences were the behaviors and attitudes of the professionals involved in legal procedures. Disrespectful and homophobic conduct during asylum interviews, enacted by interpreters and caseworkers, had been experienced by participants. The accuracy of interpretation emerged as crucial, possibly influencing the outcome of asylum claims as well as participants’ comfort in sharing information. Conclusions Sexual minority men seeking asylum in Sweden find themselves in an unfamiliar and emotionally challenging position. The challenges highlighted in this study implicates that the stressful asylum process may lead to health burdens among this population. The study emphasizes the critical role of a safe, affirming and supportive environment for asylum seekers. Further research is needed to develop effective support methods to ensure the health and well-being of sexual minority forced migrant populations during the asylum process. Key messages • The stressful asylum process may lead to health burdens among forced migrant sexual minority men. • There is a need for public health action to develop effective support methods addressing the mental health challenges faced by sexual minority forced migrants during their asylum process.

Are migrant workers at greater risk of workplace deaths? A systematic review and meta-analysis

Abstract Background Globally, 170 million individuals migrate for work. Yet, evidence on their mortality risk remains unclear. Our aim was to synthesize global evidence on migrant worker mortality risk compared to local workers and to identify the multiple intersecting social determinants of mortality. Methods We conducted a systematic review of peer-reviewed literature which reported on mortality outcome of migrant workers. Studies published between 1 Jan 2000 to 17 Jan 2023 in English were searched in MEDLINE, Embase, PsycINFO, and Ovid Global Health. Meta-analysis using random effects model was used to calculate pooled estimates and narrative synthesis was used to develop a data-driven framework on intersectional social determinants. Results Out of 11,495 identified records, 44 were included, of which 11 were pooled in meta-analyses. The combined migrant worker death count was 44,338, with data from 16 countries, including migrants from agriculture, construction, and service industries. Compared to local workers, migrant workers had a higher risk of fatal occupational injury (pooled RR = 1.71, 95%CI: 1.22-2.38, I² = 99.4%), and a lower risk of all-cause mortality (pooled RR = 0.94, 95%CI: 0.88-0.99, I² = 90.7%). Key social determinants associated with increased mortality risk were either migration-related (e.g. lower language proficiency, undocumented status) or labour-related (e.g. precarious employment, labour migration policies) interacting over migrant workers’ life course. Conclusions As the largest evidence synthesis to date, these findings indicate that migrant workers have higher fatal occupational injury rates than local workers, indicating the need for tailored protections for migrant workers. These data confirm that the all-cause mortality advantage observed in migrant populations applies to the working population. Future interventions should be designed to address both migration- and labour-related determinants of migrant worker health. Key messages • Migrant workers have a higher risk of workplace fatality despite being generally healthier than local workers, explained by structural determinants such as precarious employment. • Future interventions must address migration- and labour-related social determinants of health at structural levels, such as extending labour protection laws to migrant workers.

Polish midwives’ experiences of providing maternity care to Ukrainian women in Poland

Abstract Background Migrants’ health has attracted the attention of researchers for many years, particularly from the perspective of barriers in access to healthcare systems. Providing high quality care to migrants and refugees, especially in contexts of significant and sudden arrivals, may be particularly challenging. Aim The aim of our research was to learn about the experiences and strategies of midwives providing maternity care for Ukrainian migrant women in Poland after the outbreak of the full-scale war in Ukraine. Methods Five focus group interviews with 32 midwives providing maternity care in Poland were conducted. The interviews were thematically analysed. Results Healthcare personnel experiences a number of barriers to the provision of high-quality care to the migrant population. Polish midwives expressed mainly experience of two groups of barriers on: (1) individual and interpersonal, (2) management and organization levels. Firstly, at the individual and interpersonal level midwives experienced: fear for life and well-being related to the threat of war in a neighbouring country, depleting resources and post-pandemic fatigue, language barriers, lack of knowledge on caring for woman fleeing the war. Secondly, at the management and organizational level midwives experienced: lack of organizational support, interpreting services and documentation in any other language than Polish. In the first months after the outbreak of the full-scale war in Ukraine, most strategies to improve the provision of maternity care for women fleeing the war took the form of grassroots initiatives by the staff of individual care units. Conclusions The Polish health care services need systemic solutions prepared jointly by state and local authorities and considering the voices of midwives to support the provision of high-quality care to migrant population. Key messages • Midwives were left to their own devices. • Midwives need better preparation for providing high-quality care to migrant population.

A Training-of-Trainers program for health facilitators fighting malaria in a vulnerable community

Abstract Background When Public Health is challenged by issues related to migrant and vulnerable populations, health facilitators’ profiles are crucial to accessing communities and increasing intervention effectiveness and acceptability. The French overseas region, French Guiana, is concerned with a migrant population living in vulnerable conditions far from healthcare and being a major reservoir of malaria. Curema is an intervention implemented to fight malaria in this population by distributing RDTs, and treatments after an appropriate training of participants. Facilitators from the community are employed to provide health education and enroll participants. Objectives An intensive theoretical-practical training program was realized to enable facilitators to master procedures related to the intervention. The training was designed using the CDC Training-of-Trainers (ToT) framework and adult learning principles. It was composed of initial and on-the-field training, both based on bidirectional, participative, and dynamic working spaces. A mixed-method evaluation was carried out to assess training effectiveness and quality. Results Group dynamics and adaptations driven by facilitators’ needs were key elements of a high-quality training program. Satisfaction was elevated for training format and learning results. Statistically significant improvements in knowledge level demonstrated good effectiveness. During the initial training, difficulties persisted regarding some tasks to be performed during the intervention: further on-the-job training addressed them, improving facilitators’ practices in the field. Conclusions High-quality, effective, and appropriate training programs are required for intervention involving facilitators’ profiles. Training design is crucial to achieve it. ToT model has been shown to allow high satisfaction, learning results, and good implementation in the field. Initial and on-the-job training are an indispensable continuum to sustain good practices and motivation. Key messages • If health facilitators from the community are actors in public health interventions, appropriate training is necessary to ensure good implementation. • ToT seems an optimal model for training health facilitators.