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Anton Kunst for the MEHO mortality working group

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1 The MEHO project Mortality of migrant groups in different European countries
Anton Kunst for the MEHO mortality working group Departments of Public Health of AMC Amsterdam & Erasmus MC Rotterdam This project is funded under the framework of Public Health Programme of the European Commission (contract number )

2 “Young Moroccans have 10 times more risk of schizophrenia”
Migrants are usually compared to native populations: headlines of newspapers “Young Moroccans have 10 times more risk of schizophrenia” “ More suicide attempts by Turkish and Surinamese” “Elderly migrants more often depressive” Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

3 Looking at other European countries: what can be learned?
If migrant-native inequalities are similar across Europe: - identify common European patterns - generalise results from individual countries If migrant-native inequalities differ between countries: - learn from countries with small inequalities - identify the role of “national” factors Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

4 Objective Specific objective: To assess whether European countries have similar migrant-native inequalities in mortality General aim: To explore the potentials of an international data set created in the MEHO project Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

5 Data sets constructed in MEHO (1)
Countries: Scotland, England/Wales, Denmark, Sweden, Netherlands, Belgium, France, Spain, Italy, Estonia, Latvia Mostly cross-sectional studies, around the year 2000 Longitudinal studies: Denmark, Sweden, Netherlands, Belgium Nationally representative populations Data problems carefully evaluated Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

6 Data sets constructed in MEHO (2)
Measure of ethnicity and migrant status: self-identity (Estonia, Latvia) nationality (Italy) country of birth of subjects and their parents (other) Country-of-birth groupings aimed to cover largest immigrants groups per country great diversity between European countries Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

7 Preliminary data analysis
Age group 40 to 54 years Age-standardised mortality rates (indirect standardisation) Ratio to the rates for native population (=SMR) All-cause mortality only Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

8 Results (1) Migrant-native inequalities: migrants from Latin America and China
Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

9 Results (2) Migrant-native inequalities: migrants from Turkey and Morocco
Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

10 Results (3) Absolute mortality rates of Moroccan and native populations
Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

11 Results (4) Migrant-native inequalities: migrants from SSA and Poland
Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

12 Results (4) Migrant-native inequalities: migrants from SSA and Poland
Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

13 Results (5) Absolute mortality rates of SSA migrants and native populations
Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

14 Results (6) Absolute mortality rates of migrants from specific SSA countries
Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

15 Summary Do European countries have similar migrant-native inequalities in mortality? - yes: migrants from Latin America, China - partly: migrants from Morocco and Turkey (larger in Denmark) - no: migrants from Poland (larger in Spain) Sub-Saharan Africa (larger in France) Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

16 Looking at other European countries: what can be learned?
If migrant-native inequalities are similar across Europe: - identify common European patterns - generalise results from individual countries If migrant-native inequalities differ between countries: - learn from countries with small inequalities - identify the role of “national” factors Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

17 Does it matter where migrants move to?
Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

18 Further work in the MEHO mortality part
Analyses of specific causes of death: - infectious diseases - cancer - cardiovascular diseases - diabetes mellitus Analysis of specific groups - Polish immigrants to 7 countries - Russians in Estonia, Latvia and adjacent Russia Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.

19 Factors that may influence migrant-native inequalities
Factors related to migration flows: - different origins: countries, or groups with countries - different migration flows: e.g. Polish Factors related to host country: - general host environment, including epidemiology - position of migrants with host society Our search strategy is based on the guidelines provided in the Cochrane Reviewer’s Handbook. We developed documents where we outlined the scope of the reviews, based on the listed criteria. I’ll briefly go through these criteria, but also have the documents outlining them so you can look at them in more detail. Outcomes of interest Dietary behaviours- we examined several dietary outcomes that have been shown to be associated with overweight/obesity through the energy balance pathway. These were identified as being key dietary determinants of overweight/obesity in the WHO report, “The challenge of obesity in the WHO European region and the strategies for response”. Briefly, the dietary behaviours we focussed on were: energy intake, energy density, fat intake, fibre intake, fruit and vegetable consumption, sugar-rich drinks (e.g. soft drinks) and takeaway foods. Physical activity- we decided to deal primarily with leisure time physical activity (LTPA). This was on the basis of two main considerations- occupations are becoming more homogeneous in terms of LTPA due to mechanisation, secondly LTPA is more amenable to intervention. The LTPA outcomes we decided to use are any of those that assess the duration, frequency or intensity of LTPA. Socioeconomic position Studies must have included occupation, employment status, education, income (either individual or household level), indicators of material resources (e.g. housing tenure, car ownership) or area-based indicators of SEP. Countries We considered all EU member states (as of October 2007) as well as Norway. Age 18 years or over. Studies that exclusively examined population sub-groups (e.g. pregnant women, ethnic minorities) were excluded. Literature We only included peer reviewed literature. Study type Intervention and experimental studies were excluded as we are primarily interested in estimate of inequalities in these behaviours in the ‘normal state’.


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