Up in smoke? Limited evidence of a smoking harm paradox in 17-year cohort study.

BACKGROUND: Socioeconomic differences in the impact of alcohol consumption on health have been consistently reported in the so-called "alcohol harm paradox" (i.e., individuals from higher socioeconomic backgrounds (SES) drink more alcohol than individuals from lower SES, but the latter accrue more alcohol-related harm). Despite the severe health risks of smoking however, there is a scarcity of studies examining a possible "smoking harm paradox" (SHP). We aim to fill this gap. METHODS: We conducted a prospective cohort study with adolescents from the Norwegian Longitudinal Health Behaviour Study (NLHB). Our study used data from ages 13 to 30 years. To analyse our data, we used the random-intercept cross-lagged panel model (RI-CLPM) with smoking and self-reported health as mutual lagged predictors and outcomes as well as parental income and education as grouping variables. Parental income and education were used as proxies for adolescent socioeconomic status (SES). Smoking was examined through frequency of smoking (every day, every week, less than once a week, not at all). General health compared to others was measured by self-report. RESULTS: Overall, we found inconclusive evidence of the smoking harm paradox, as not all effects from smoking to self-reported health were moderated by SES. Nevertheless, the findings do suggest that smoking predicted worse subjective health over time among individuals in the lower parental education group compared with those in the higher parental education group. This pattern was not found for parental income. CONCLUSIONS: While our results suggest limited evidence for a smoking harm paradox (SHP), they also suggest that the impact of adolescent smoking on later subjective health is significant for individuals with low parental education but not individuals with high parental education. This effect was not found for parental income, highlighting the potential influence of parental education over income as a determinant of subjective health outcomes in relation to smoking.

Integration Is Correlated With Mental Health Help-Seeking From the General Practitioner: Syrian Refugees' Preferences and Perceived Barriers.

Despite a seemingly higher need, refugees in Europe tend to underuse mental health (MH) services. To better understand this underuse, it is important to understand refugees' willingness and ability to seek help from their general practitioner (GP) when experiencing MH problems. We employed a combined vignette and survey design to explore how the GP fits into the larger context of help-seeking preferences among a sample of Syrian refugees in Norway (n = 92), and what barriers they perceive in accessing help from the GP. We also examined how indicators of integration relate to seeking help from the GP. We take an exploratory approach. Participants were presented a vignette of an individual with symptoms in line with ICD-10 and DSM-5 criteria for depression. Participants were somewhat likely to seek help from the GP; however, seeking help from one's relationship with Allah/God and one's partner was preferred. Furthermore, while the GP was rated a somewhat likely help-seeking source, most participants indicated an average of two barriers to seeking help from the GP. Finally, social ties to the majority population in the form of social integration and feelings of connectedness with the host country (psychological integration) were positively correlated with likelihood of seeking help from the GP. Taken together, these findings suggest that the GP is considered a viable source of help among Syrians with a refugee background in the current sample, but that this may be influenced by perceived barriers and social as well as psychological integration. Addressing these barriers and promoting psychosocial integration with the host country are key to facilitating access and usage amongst refugees in need of MH services.

General Practitioners' Experiences of Clinical Consultations With Refugees Suffering From Mental Health Problems.

Refugees suffer from higher rates of certain mental health problems than non-refugee migrants and the native population of their host country. General practitioners (GPs) in Norway and many other European countries are the first contact person for settled refugees in need of non-emergency medical support. This includes psychiatric support, although GPs are not typically specialists in psychiatry. The aim of this study is to investigate how GPs experience working with refugees suffering from mental health problems, with a specific focus on perceived challenges and facilitators. We conducted semi-structured interviews with 15 GPs working in Norway (7 females). Participants ages ranged from 29 to 67 (M = 41.7 years, SD = 11.1) with work experience ranging from 2 to 39 years (M = 13.6 years, SD = 12.1). Interviews were analysed thematically using the qualitative data analysis computer software package NVivo 12. The main challenges presented by GPs relate to language barriers, mismatched expectations, different understandings of health and illness, and the GP feeling unprepared to work with this patient group. The main facilitating themes related to establishing trust and finding the work meaningful. The themes presented in this study highlight areas of interest for future research, and should inform training programmes to improve health care for both clinicians and refugee patients.