Characteristics and health determinants of foreign born population. With special emphasis on sexually transmitted infections and longitudinal studies in europe and spain

Resumen

In Europe, international migrant population has presented a relevant increase for the last years, definitely contributing to shape a new socio-demographic reality with new health needs. In Spain, the immigration flow was intense and massive with a wide diversity of geographical areas of origin and cultures in a short time. Health status of migrant population is related to a complex and dynamic interaction of multiple factors related to the country of origin, the migration process and the host country. For hosting countries is essential to improve monitorization and better understanding of health status and risk factors among foreign-born population, needing more research data for improving knowledge on migrant health and on health determinants and how these evolve according with time of residence in the host country. Our research focused on relevant topics for Public Health. This thesis is aimed to improve the knowledge on health status of Spanish and European foreign born population, to identify barriers and facilitators of participation of this population in a cohort health study, and to design and implementate a prospective cohort health study in our site of study. Mobile populations are considered key groups for the control of HIV infection and others STIs and on Neisseria gonorrhoeae infection resistant to antimicrobials, and specific sub-groups of foreign born population may be especially vulnerable to these pathologies. The works on facilitators of participation in a cohort health study are important contributions on a relevant and poorly studied area, particularly in Spain. The research that we carried out on HIV and other STIs and Neisseria gonorrhoeae infection improved the available knowledge on the health status of foreign-born population, and particularly on the frequency of antimicrobial resistances within foreign-born population participating in Euro-GASP. Our conclusions might contribute to reinforce the currently ongoing Euro-GASP (the European surveillance system) and promote surveillance for the whole European Region. Moreover, they will also contribute to stress the relevance of improving the reporting of variables associated with foreign-born population such as country of birth within the European surveillance systems. The systematic review of longitudinal cohort studies on migrant population and the qualitative study on barriers of participation to health research, aimed at contributing to facilitate and improve participation of foreign-born population to health research, and in particular in prospective cohort studies. Our experience and main study outcomes of these researches were applied to the PELFI cohort Badalona/SC and facilitated its implementation. The successful implementation of the PELFI cohort Badalona/SC shows the viability of implementing a cohort of foreign-born families from different geographical origins using different community recruiting strategies such as “opportunistic captation” and “snow ball”, minimizing barriers of participation, and studying foreign-born families rather than individuals. The research on facilitators of participation of foreign born population in health research is a strong point, due to “identification, participation and re-contacting of foreign-born population is considered more difficult than for native population, and collaborates to maintain migrant populations under-represented and excluded in health research”. The implementation of a cohort on foreign born families and the suggestion of data collection for facilitating participation and retention rates (face to face on-line interviews, linkage of database records) on this population are also a strong point, due to the small number of these studies, and its important logistical and budget difficulties. Prospective cohort studies will contribute to improve monitorization and better understanding of health status and risk factors among migrant population in Europe and in Spain, as well as for providing useful information for the elaboration of interventions that contribute to improving the health status of foreign-born population and to increase the cost-effectiveness of existing health resources.