From Alienation to Assimilation: Exploring Jhumpa Lahiri’s The Namesake

Jhumpa Lahiri’s novel The Namesake is a kaleidoscope of the different shades of the individual relationships, the conflicts and confusions of the characters along with the cultural dilemma of the immigrants. The novel explores the diasporic conflict of the hyphenated identities of Indian-Americans. The immigrants in the novel live a confused existence as Indian-American, American-Indian and Overseas-Born-Indian. Being a foreigner is a sort of lifelong pregnancy for Ashima- a perpetual wait, a constant burden and an on-going responsibility. The novel focuses on cross-cultural conflicts, trauma and aspirations of the two generations of expatriates, Ashoke and Ashima who are not inclined towards getting Americanised, while Gogol and Sonia, the second-generation migrants face the intense pressure to be loyal to the old world and fluent to the new.

Type 2 diabetes risks and determinants in second-generation migrants and mixed ethnicity people of South Asian and African Caribbean descent in the UK

Aims/hypothesis Excess risks of type 2 diabetes in UK South Asians (SA) and African Caribbeans (AC) compared with Europeans remain unexplained. We studied risks and determinants of type 2 diabetes in first- and second-generation (born in the UK) migrants, and in those of mixed ethnicity. Methods Data from the UK Biobank, a population-based cohort of ~500,000 participants aged 40–69 at recruitment, were used. Type 2 diabetes was assigned using self-report and HbA1c. Ethnicity was both self-reported and genetically assigned using admixture level scores. European, mixed European/South Asian (MixESA), mixed European/African Caribbean (MixEAC), SA and AC groups were analysed, matched for age and sex to enable comparison. In the frames of this cross-sectional study, we compared type 2 diabetes in second- vs first-generation migrants, and mixed ethnicity vs non-mixed groups. Risks and explanations were analysed using logistic regression and mediation analysis, respectively. Results Type 2 diabetes prevalence was markedly elevated in SA (599/3317 = 18%) and AC (534/4180 = 13%) compared with Europeans (140/3324 = 4%). Prevalence was lower in second- vs first-generation SA (124/1115 = 11% vs 155/1115 = 14%) and AC (163/2200 = 7% vs 227/2200 = 10%). Favourable adiposity (i.e. lower waist/hip ratio or BMI) contributed to lower risk in second-generation migrants. Type 2 diabetes in mixed populations (MixESA: 52/831 = 6%, MixEAC: 70/1045 = 7%) was lower than in comparator ethnic groups (SA: 18%, AC: 13%) and higher than in Europeans (4%). Greater socioeconomic deprivation accounted for 17% and 42% of the excess type 2 diabetes risk in MixESA and MixEAC compared with Europeans, respectively. Replacing self-reported with genetically assigned ethnicity corroborated the mixed ethnicity analysis. Conclusions/interpretation Type 2 diabetes risks in second-generation SA and AC migrants are a fifth lower than in first-generation migrants. Mixed ethnicity risks were markedly lower than SA and AC groups, though remaining higher than in Europeans. Distribution of environmental risk factors, largely obesity and socioeconomic status, appears to play a key role in accounting for ethnic differences in type 2 diabetes risk. Graphical abstract

A mixed method study design to explore the adherence of haematological cancer patients to oral anticancer medication in a multilingual and multicultural outpatient setting: The MADESIO protocol

Background Patients with haematologic malignancies are increasingly treated by oral anticancer medications, heightening the challenge of ensuring optimal adherence to treatment. However, except for chronic myelogenous leukaemia or acute lymphoid leukaemia, the extent of non-adherence has rarely been investigated in outpatient settings, particularly for migrant population. With growing numbers of migrants in Belgium, identifying potential differences in drug use is essential. Also, previous research regarding social determinants of health highlight important disparities for migrant population. Difficulties in communication between health caregivers and patients from different cultural and ethnic backgrounds has been underlined. Methods Using a sequential mixed method design, the MADESIO protocol explores the adherence to oral anticancer medications in patients with haematological malignancies and among first and second generation migrants of varied origin. Conducted in the ambulatory setting, a first quantitative strand will measure adherence rates and associated risk factors in two sub-groups of patients with haematological malignancies (group A: first and second generation migrants and group B: non-migrants). The second qualitative strand of this study uses semi-structured interviews to address address the patients’ subjective meanings and understand the statistical associations observed in the quantitative study (strand one). MADESIO aims to provide a first assessment of whether and why migrants constitute a population at risk concerning adherence to oral anticancer medications. Discussion Our protocol is designed to provide a comprehensive understanding of adherence in a specific population. The methodological choices applied allow to explore adherence among patients from diverse linguistic and cultural backgrounds. A particular emphasis has been paid to minimize the biases and increase the reliability of the data collected. Easily reproductible, the MADESIO design may help healthcare services to screen adherence to Oral anticancer medications and to guide providers in choosing the best strategies to address medication adherence of migrants or minority diverse population.

Linked Lives: Exploring the Narratives of Second-Generation Migrants in Nepal

This article describes the narratives of second-generation migrants in Nepal. The paper explores the reasons for migration as shared with their offspring by first-generation migrants. The article also shares the narratives by second-generation migrants on experiences of family, school, community, and the State. Second-generation migrants or adult offspring of first-generation migrants from Tibet and India comprised the sampling frame for the qualitative study. Data were collected through a non-probability sampling technique, and in-depth semi-structured interview schedules were used. Nine in-depth interviews were conducted for the study. Thematic analysis was employed to examine the data. Key reasons to migrate to Nepal featured in the narratives of the migrants were opportunities for business, availability of good education, and a suitable climate in Nepal. Furthermore, lack of opportunities for employment and education and instances of violence at their place of origin pushed the migrants towards Nepal. Most of the interviewees shared having solid bonds with their families. They shared mixed experiences (both encouraging and humiliating) at school and varied experiences in their interaction with the broader society (both supportive and conflicting). Furthermore, all interviewees shared challenges in dealing with or receiving help from the Nepali State.

Utilization of preventive care among migrants and non-migrants in Germany: results from the representative cross-sectional study ‘German health interview and examination survey for adults (DEGS1)’

Background In Germany, different health checks for adults are offered for primary and secondary prevention. Previous findings indicate that preventive care utilization varies according to social determinants, especially migration background. This study examined the extent to which migration background is associated with preventive care utilization, independent of factors like age and socioeconomic status and whether length of stay in Germany has a positive effect on the use of preventive care. Methods The first wave of the ‘German Health Interview and Examination Survey for Adults’ (DEGS1) is a comprehensive data collection facilitating the description of the utilization of general health checks, dental check-ups, skin cancer screening, and cervical cancer screening among people aged 18–79 years with and without migration background. Migration background was differentiated in first-generation migrants having immigrated to Germany themselves or second-generation migrants born in Germany. First-generation migrants were further differentiated by length of stay in Germany, and second-generation migrants as having one or two parents who were born abroad. Multivariate binary logistic regression models with average marginal effects were calculated to analyse the associations between preventive care utilization and migration background. Results The sample comprised 7987 participants, 1091 of whom had a migration background. Compared with non-migrants, women and men with migration background— particularly first-generation migrants with length of stay <=20 years in Germany — make less use of preventive care. This association was observed statistically independent from sociodemographic factors. For dental check-ups a significantly lower use was also found for first-generation migrants who have lived in Germany for more than 20 years and second-generation of migrants with two parents born abroad. Post-model predictions showed that the utilization rates of first-generation migrants are gradually converging to the average values for non-migrants. Conclusions Our findings suggest inequalities in realized access to preventive care for first-generation migrants particularly for those who have lived in Germany for 20 years or less. Barriers to the utilization of preventive care may be addressed by informing migrant communities about preventive health care services at an early stage after immigration using migrant-sensitive information strategies.

Citizenship, Indigeneity, and the Experiences of 1.5- and Second-Generation Fulani Herders in Ghana

Issues of indigeneity and citizenship rights for second-generation pastoralist migrants across the West African States have received little to no attention in migration and pastoralist studies. This article explores this under-researched area in the field of migration studies and revisits the highly contested migration–citizenship nexus among Fulani herders in the Shai-Osu-Doku and Agogo traditional areas of Ghana. The article captures the crises of citizenship facing descendants of Fulani herders and families, particularly in relation to their integration into local host communities. I argue that second-generation migrants remain at the margins, spatially and socio-politically defined, of both development and society. While they do not have any ties with their ancestral “home countries,” they are also considered non-citizens and face growing hostility in the places they call home. Being a citizen is not simply a static legal position, but a status developed through routine practices, building relations, and shared experiences.

Growing Up Between Cultures: How Second-Generation Migrants Perceive and Construct “Home”

The word “home” can refer to a house, a family, a country, or even to a feeling of safety and comfort. Through increased mobility, the conception of home as a static place loses its meaning. For second-generation migrants, the children of migrants, the concept of home is ambiguous. They can have transnational ties to their parents’ home country and the country they grew up in. The ambiguity leads second-generation migrants to construct home through reflective practices. Through in-depth interviews with eight second-generation migrants, we found that home is necessarily a complex and varied concept. The most important aspects to constructing a home are family (nuclear as well as extended family), a sense of community through shared values, and lastly reflective practices on what it means to grow up between cultures. While nuclear family provides the first safe space to create a feeling of home, feeling like part of a community is essential for feeling at home in a town or country. Some second-generation migrants find a community in the country they grew up in, while others feel rejected due to discrimination. In those cases, second-generation migrants search for cosmopolitan communities that share values of openness to difference.

Paediatric tuberculosis during universal and selective Bacillus Calmette–Guérin vaccination policy: a nationwide population-based retrospective study, Finland, 1995–2015

Introduction In 2006, the Bacillus Calmette–Guérin (BCG) vaccination policy in Finland changed from universal to selective. Aim We assessed the impact of the policy change on tuberculosis (TB) morbidity in children under 5 years and epidemiological trends of paediatric TB in Finland. Methods We conducted a nationwide, population-based, retrospective registry study of all newly diagnosed active TB cases younger than 15 years in Finland from 1995 to 2015 by linking data from the National Infectious Diseases Register, Finnish Care Register for Health Care, medical patient records and Finnish Population Information System. We compared the TB incidence rate ratio of under 5 year-olds with universal and selective BCG vaccinations with a Poisson log-linear model and analysed incidence trends among those younger than 15 years with a negative binomial model. Results We identified 139 paediatric TB cases: 50 native (including 24 second-generation migrants) and 89 foreign-born children. The TB rate of under 5 year-olds remained stable after changing to selective BCG vaccination (incidence rate ratio (IRR): 1.3; 95% confidence interval (CI): 0.7–2.3). TB rate in the native population under 15 years increased slightly (IRR = 1.06; 95% CI: 1.01–1.11). Discussion Paediatric TB cases in Finland were concentrated in families with migrant background from high-TB incidence countries. The native TB morbidity in under 5-year-olds did not increase after the BCG policy revision, suggesting that selective vaccinations can prevent TB in the most vulnerable age group in low-incidence settings. Second-generation migrants under 15 years in Finland with high TB risk are probably increasing.