Title: The effect of perceived discrimination on the health of immigrant workers in Spain

Transcription

1 Author's response to reviews Title: The effect of perceived discrimination on the health of immigrant workers in Spain Authors: Andrés A. Agudelo-Suárez Elena Ronda-Pérez Diana Gil-González Carmen Vives-Cases Ana M. García Carlos Ruiz-Frutos Emily Felt Fernando G. Benavides Version: 4 Date: 25 July 2011 Author's response to reviews: see over

2 Alicante, 25th July 2011 Mr. Jimmar Dizon on behalf of Dr. Jean Adams Editorial Team BMC Public Health Dear Mr Dizon Please find attached the revised paper entitled The effect of perceived discrimination on the health of immigrant workers in Spain". Also I am unloading a document detailing how it has responded to the reviewers' comments. I hope all the information may be clear and the comments of the reviewers are responded. Kind regards, Andrés A. Agudelo- Suárez Corresponding author

3 Responses to the reviewers Manuscript title: The effect of perceived discrimination on the health of immigrant workers in Spain ID: Date: Jul/2011 Reviewer's report (1) Title: The effect of perceived discrimination on the health of immigrant workers in Spain Version: 2 Date: 6 July 2011 Reviewer: Yin Paradies Reviewer's report: I am satisfied that the authors have adequately addressed the comments and concerns noted by both reviewers. Thank you very much for your opinion about the paper and the comments. Level of interest: An article whose findings are important to those with closely related research interests Quality of written English: Acceptable Statistical review: No, the manuscript does not need to be seen by a statistician. Reviewer's report (2) Title: The effect of perceived discrimination on the health of immigrant workers in Spain Version: 2 Date: 17 July

4 Reviewer: Leslie Hausmann Reviewer's report: In general, I feel the authors have adequately addressed the comments I noted in my initial review of their manuscript. I agree with the authors that the revised version is much improved. In reviewing their revision, I noted several minor editorial suggestions, which I classify as minor essential revisions. 1. P. 6: In a first approach, through a qualitative study; which was performed by means of 84 interviews and 12 focus groups covering representative immigrant communities in Spain (Romanians, Moroccans, Ecuadorians, Colombians and Sub-Saharan Africans); the immigrant population interviewed stated that discrimination from bosses and other employees, as well as discrimination experienced in daily surroundings, affects their job security and their physical and mental health [7]. It is also important to establish the prevalence of discrimination in immigrants with working experience in Spain and the specific association between the discrimination experienced, the employment and working conditions and the health status of immigrant workers. For this reason, and in the same way that has been explored in other scientific literature, the indicator used to measure discrimination is perceived discrimination [25, 26]. This study will contribute to illuminating how health inequalities are reproduced. Accordingly, in this study we analyse the relationship between different categories of immigrants perceived discrimination and a selection of self- reported health indicators. Consider rewriting this section as: In a qualitative study consisting of 84 interviews and 12 focus groups with members of representative immigrant communities in Spain (Romanians, Moroccans, Ecuadorians, Colombians and Sub-Saharan Africans), we found that discrimination from bosses and other employees, as well as discrimination experienced in daily surroundings, affects the job security, physical health, and mental health of immigrants [7]. It is also important to establish the prevalence of discrimination in immigrants with working experience in Spain and the specific association between the types of discrimination experienced and the health status of immigrant workers. Accordingly, in this study we analyse the relationship between different categories of immigrants perceived discrimination and a selection of self- reported health indicators in a large sample of foreign-born workers in Spain. 3

5 2. P. 9: Surveys, which lasted an average of 30 minutes, were conducted by trained interviewers, and they made contact with immigrant workers in a variety of ways: through organisations that worked with immigrants; posters and direct recruitment in local stores, metro and bus stations, telephone centres, markets and neighbourhoods. Consider re-writing as: Surveys, which lasted an average of 30 minutes, were conducted by trained interviewers who made contact with immigrant workers through organisations that worked with immigrants, as well as through posters and direct recruitment in a variety of locations such as local stores, metro and bus stations, telephone centres, markets and neighbourhoods. 3. P. 10: and responses to the question: Have you ever had some of these problems? (A check list of different symptoms as follows: 3) musculoskeletal symptoms: muscle and/or joint pain, tingling, loss of strength and decreased sensitivity (yes/no); 4) headache (yes/no); 5) stress (yes/no); 6) insomnia (yes/no); and 7) anxiety (yes/no). Consider re-writing as: and responses to the question: Have you ever had some of these problems: 3) musculoskeletal symptoms: muscle and/or joint pain, tingling, loss of strength and decreased sensitivity (yes/no); 4) headache (yes/no); 5) stress (yes/no); 6) insomnia (yes/no); and 7) anxiety (yes/no). 4. P. 10: I do not understand the education level categories. Were there 3 levels (elementary school, secondary, and university) 2 (just elementary and secondary, which 4

6 includes university)? The use of punctuation in the description of education level is confusing. Thank you very much for the comment. The reviewer is right and we have corrected the use the punctuation in the description of education. There are three levels of the education categories. education level: 1) without studies/ primary or elementary school; 2) secondary: high school, college and/or bachelor's degree studies and 3) university: under or post graduated 5. P. 11: In order to search the most accurate model we used different kinds of classifications (1, 2, 3 and 4), and the research team decided to use three categories or components, considering Consider re-writing as: After testing 1, 2, 3, and 4-factor solutions, the research team decided to use a 3-factor solution, considering 6. P. 11: by means of matrices and the p value associated Consider re-writing as: by means of matrices and associated p values 7. P. 12: What do the authors mean when they say, These categories were not mutually exclusive.? We have added a phrase in order to explain what means not mutually exclusive. 5

7 These categories were not mutually exclusive (One person can perceive more than one type of discrimination). 8. P. 15: Consider deleting it would be worthwhile to mention that from the following sentence: However, it would be worthwhile to mention that sizeable segments of the population experienced discrimination due to physical appearance and related to the workplace. 9. P. 18: The phrase (the health situation of the situation is confusing and there needs to be a closing) added somewhere. We have rewritten the phrase in order to explain the idea of the temporality of the healthy migrant effect. (The health profile in immigrants with more time in Spain is similar to the native population in similar social classes) 10. P. 18: delete the word also from the sentence, methodology and informationgathering tools were also carefully designed by 11. P. 30: The following phrase in the note that was added to table 1 is confusing: it is assumed as a condition related with The way the authors explained in their response letter why they grouped public and private institutions with the workplace discrimination items was clearer. Thank you very much for the comment. The reviewer is right and we have rewritten the table note according to the explanation suggested for the reviewer (see below): 6

8 Consider revising the explanation in the Table note as follows: In the case of the item: For public and private institutions, it was grouped with the workplace related discrimination items because in our previous work we have noted that public and private institutions such as trade unions, organizations that work to defend workers rights, and government institutions that manage the legal situation of immigrant workers often have a direct impact on the workplace conditions of immigrants. Level of interest: An article whose findings are important to those with closely related research interests Quality of written English: Acceptable Statistical review: No, the manuscript does not need to be seen by a statistician. Declaration of competing interests: I declare that I have no competing interests 7