Neighbourhood recent immigration and hospitalization in Toronto, Canada

Recent immigrants to Canada tend to initially settle in low-income urban core areas. The relationships among immigration, neighbourhood effects and health are poorly understood. This study explored the risk of hospitalization in high recent-immigration areas in Toronto compared to other Toronto neighbourhoods. The study used 1996 hospitalization and census data. Regression was used to examine the effects of recent immigration on neighbourhood hospitalization rates. Most hospitalization categories showed significantly higher rates of admission as the proportion of recent immigrants increased. Income was also significantly associated with all categories of hospitalization except surgical admissions. Average household income was almost 60% lower (dollar 36,122) in the highest versus the lowest immigration areas (dollar 82,641) suggesting that, at the neighbourhood level, the effects of immigration and income may be difficult to disentangle. These findings have important implications for health care planning, delivery, and policy.     

Examining the gender, ethnicity, and age dimensions of the healthy immigrant effect: Factors in the development of equitable health policy

This study expands on previous research on the healthy immigrant effect (HIE) in Canada by considering the effects of both immigrant and visible minority status on self-rated health for males and females in mid-(45-64) and later life (65+). The findings reveal a strong HIE among new immigrant middle-aged men, particularly non-Whites. For older men of color the reality is strikingly different: they are disadvantaged in health compared to their Canadian-born counterparts, even when a number of demographic, economic, and lifestyle factors are controlled. Health outcomes for immigrant women are in contrast to that of immigrant men. Among middle-aged women, immigrants, regardless of their ethnicity or number of years since immigration, are much more likely to report poor health compared to the Canadian-born. And, for older women, recent non-white immigrants are more likely to report better health compared to Canadian-born women, although this finding is explained by differences in demographic, economic, and lifestyle factors. Overall, the findings demonstrate the importance of considering the intersections of age, gender, and ethnicity for policymakers in assessing the health of immigrants.     

Physical activity and immigrant status: evidence from the Canadian Community Health Survey

BACKGROUND: The immigrant population in Canada is diverse and growing, yet little is known about their physical activity behaviour and how it changes as they adapt to a Canadian lifestyle. This study extends the surveillance of physical activity in Canada to include the influence of time since immigration within and between ethnic groups. METHODS: Pooled data from cycles 1.1 (2000/01) and 2.1 (2003) of the cross-sectional Canadian Community Health Survey (ages 20-64 y; N = 171,513) were used for this study. Weighted prevalences of self-reported leisure-time physical activity (> or = 3 kcal x kg(-1) x day(-1) (kkd)) were calculated, and unadjusted and adjusted (age, income, education, BMI) multiple logistic regression models were used to quantify the odds of being physically active (PA) (> or = 3 kkd) by time since immigration (recent immigrant < or = 10 yrs, immigrant >10 yrs, non-immigrant) within and between ethnic groups (White referent group). RESULTS: The prevalence of recent immigrants (< or = 10 yrs) being PA (> or = 3 kkd) by ethnicity was: White (21%), Other (19%), Black (19%), Latin American (17%), West Asian/Arab (16%), East/Southeast Asian (14%), South Asian (11%). Recent immigrant Black men and White women had the highest prevalence of being PA (M = 27%, F = 18%) while South Asian men and women had the lowest prevalence (M = 14%, F = 9%). There is a gradient in the prevalence of being PA with recent immigrants (16%) < immigrants (20%) < non-immigrants (24%). Ethnic differences in the prevalence of being PA by time since immigration show similar patterns for men and women. Controlling for age, income, education and BMI had only small effects on the odds of being physical active across ethnicities and immigrant status. CONCLUSION: These results suggest that physical activity levels vary according to immigrant status and self-ascribed ethnicity in Canadian adults. Strategies to promote physical activity and prevent physical inactivity should consider both ethnicity and time since immigration.     

Cultural correlates of eating attitudes: a comparison between native-born and immigrant university students in Israel

OBJECTIVE: This study explores the association between gender and exposure to Western culture and attitudes toward eating. METHOD: Four hundred and ninety-nine university students participated in the study: 216 Israeli natives, 153 new immigrants (3 years or less since immigration) from the Former Soviet Union (FSU), and 130 veteran immigrants from FSU (4-15 years since immigration). Attitudes toward eating were measured using the Eating Attitude Test - EAT-26. RESULTS: Israeli born women had higher weight and body mass index (BMI) than did new immigrant women. Higher scores on the EAT-26 were found among women than among men. Among women only, native-born Israelis and veteran immigrants were more likely to have positive EAT-26 scores (19.6%, 18.8%) than were new immigrant women (7.9%), indicating disordered eating attitudes. Part of the differences in EAT-26 scores was explained by differences between the groups on age and BMI; however, even after adjustment the differences remained significant on the bulimia subscale. CONCLUSION: The results suggest a rapid cultural effect in attitudes toward eating that may reflect a tendency toward eating disorders as well as a difference in the proportion of obesity. It seems that the veteran immigrants have adopted Western cultural norms and eating patterns in a way that has erased the differences in tendency toward eating disorders between them and the Israeli born women.     

Impact of recent welfare and immigration reforms on use of Medicaid for prenatal care by immigrants in California

This study investigates the impact of the recent welfare and immigration changes on the use of Medicaid by low-income pregnant immigrant women in California. The study presents findings from interviews with government officials, safety-net prenatal care providers, and immigrant advocates who serve low-income pregnant Asian and Latina immigrants at the national, state, or local levels. These informants spoke of policy actions that affect immigrants' abilities to use Medicaid for coverage of prenatal care. These actions include (1) the sharing of information between the California Department of Health Services and the federal Immigration and Naturalization Service, (2) the slow and confusing implementation of the reforms, and (3) the intimidating Medicaid eligibility process. The findings demonstrate how the policies changed the immigrant women's relationship with safety-net prenatal care providers, and sparked intense actions on the part of their advocates to sustain the women's access to perinatal care.     

Neighbourhood context and abuse among immigrant and non-immigrant women in Canada: findings from the Maternity Experiences Survey

Objectives

To examine the relationship between neighbourhood deprivation and concentration of immigrants, and abuse among immigrant women versus non-immigrant women.

Methods

Using data from the Canadian Maternity Experiences Survey (un-weighted sample N?=?5,679 and weighted sample N?=?68,719) linked to the neighbourhoods Census data, we performed contextual analysis to compare abuse prevalence among: immigrants ≤5?years, immigrants >5?years and Canadian-born. We identified two level effect modifiers: living in high (≤15?% of households at or below low-income cut-off- [LICO]) versus low-income (>15?% below LICO) neighbourhoods and living in high (≥25?%) versus low immigrant (<25?%) neighbourhoods. Individual socioeconomic position (SEP), family variables and neighbourhood SEP or percentage of immigrants were considered in different logistic regression models.

Results

Immigrant women were less likely to experience abuse even upon adjustment for individual SEP, family variables and neighbourhood characteristics. The protective effect of the neighborhood was stronger among immigrant women living in low-income and high immigrant neighborhoods, irrespective of length of stay in Canada.

Conclusion

Policies and interventions to reduce abuse among immigrant women need to consider neighbourhood’s SEP and concentration of immigrants.     

Revisiting the immigrant paradox in reproductive health: the roles of duration of residence and ethnicity

The immigrant paradox refers to the contrasting observations that immigrants usually experience similar or better health outcomes than the native-born population despite socioeconomic disadvantage and barriers to health care use. This paradox, however, has not been examined simultaneously in relation to varying degrees of exposure to the receiving society and across multiple outcomes and risk factors. To advance knowledge on these issues, we analysed data of the Maternity Experiences Survey, a nationally representative cross-sectional survey of 6421 Canadian women who delivered singleton infants in 2006-07. We compared the prevalence of adverse pregnancy outcomes and related risk factors according to women's ethnicity and time since migration to Canada. We calculated prevalences and prevalence ratios (PR) with 95% confidence intervals. Compared to Canadian-born women of European descent, recent immigrants were at lower risk of preterm delivery and morbidity during pregnancy despite having the highest prevalence of low income and low support during pregnancy among all groups, but the paradox was not observed among immigrants with a longer stay in Canada. In contrast, recent immigrants were at higher risk of postpartum depression. Immigrants of non-European origin also had higher prevalence of postpartum depression, irrespective of their length of residence in Canada, but immigrants from European-origin countries did not. Exposure to Canada was also positively associated with higher alcohol and tobacco consumption and body mass index. Canadian-born women of non-European descent were at higher risk of preterm birth and hospitalisation during pregnancy than their European-origin counterparts. Our findings suggest that the healthy migrant hypothesis and the immigrant paradox have limited generalisability. These hypotheses may be better conceptualised as outcome-specific and dependent on immigrants' ethnicity and length of stay in the receiving country.     

Rate of Cervical Cancer Screening Associated with Immigration Status and Number of Years Since Immigration in Ontario, Canada

Cervical cancer screening is a vital public health measure intended to reduce the morbidity and mortality from what is a largely preventable cancer. Previous Canadian studies have documented that immigrants have significantly lower Papanicolaou (Pap) testing rates than women born in Canada. However, the impact of number of years since immigration is less clear. Data were taken from the 2007–2008 Canadian Community Health Survey. Responses from 16, 706 women living in Ontario, Canada were included. The focus was on self-reported Pap testing rates within the last 3 years, immigrant status and number of years since immigration. A robust Poisson regression model was used to determine prevalence ratios (PR) with 95 % confidence intervals (CIs) after adjustment for covariates. The results demonstrated that recent immigrant women (less than 10 years in Canada) were less likely to have had a Pap test in the past 3 years than those who were Canadian-born (PR = 0.77; 95 % CI: 0.71, 0.84). In contrast, immigrants who had lived in Canada for 10 years or longer showed similar compliance with recommended Pap testing intervals as non-immigrants. Higher income, higher level of education, younger age and being married were independently associated with better Pap testing rates. A strategy targeting recent immigrants to Canada is needed to promote Pap testing in this population and reduce their risk of invasive cervical cancer.     

Inadequacy of cervical cancer screening among urban recent immigrants: a population-based study of physician and laboratory claims in Toronto, Canada

OBJECTIVE: In Canada, Pap smears are recommended from 18 to 69. Self-reported socioeconomic gradients in screening have been documented in North America but there have been few direct measures of Pap smear use among immigrants or socially disadvantaged groups. Our purpose was to investigate whether socioedemographic factors are related to cervical cancer screening in Toronto, Canada. METHOD: Pap smears were identified using fee and laboratory codes in Ontario physician service claims for 3 years (2000-2002 inclusive) for women aged 18-66. Area-level socioeconomic factors were derived from the 2001 census. At the individual level, recent registrants for health coverage, over 80% of whom are expected to be recent immigrants, were identified as women first registering after January 1, 1993. RESULTS: Among 724,584 women, 55.4% had Pap smears within 3 years. Recent immigration, visible minority, foreign language, low income and low education were all associated with significantly lower area rates. Recent registrants had much lower rates than non-recent registrants (36.9% versus 60.9%). CONCLUSION: Pap smear rates in Toronto fall below those dictated by evidence-based practice. Recent registrants, a largely immigrant group, have particularly low rates. Efforts to improve coverage need to emphasize women who recently immigrated and those with socioeconomic disadvantage.     

Gender and national origin differences in healthcare utilization among U.S. Immigrants from Mexico,China, and India

Objectives: To examine gender and national origin differences in the healthcare utilization of immigrants from the three largest populations in the U.S. today (Mexico, China, and India) and to determine if barriers to utilization operate similarly across groups.

Methods: The analysis uses nationally-representative data from the 2003 New Immigrant Survey (NIS) to compare utilization behaviors among legal permanent residents from Mexico, China, and India (n?=?2244). Conceptually, the study draws on Andersen’s Behavioral Model to hypothesize gender and national origin differences in utilization based on factors that might predispose, enable, or necessitate healthcare. Multivariate logistic regression models are used to predict the odds of having seen a doctor in the past year and to test whether obstacles to utilization differ across immigrant groups.

Results: Chinese immigrants are less likely than Mexican and Indian immigrants to have seen a doctor in the past year, a finding that is largely driven by a lack of health insurance. Female immigrants are more likely than males to have done so, despite having fewer resources that enable access to care (e.g. income, English proficiency). Moreover, the relationship between gender and utilization is moderated by English language proficiency: among immigrants with low levels of proficiency, women are significantly more likely than men to have seen a doctor in the past year, while no difference exists between men and women who are proficient in English. This pattern is most evident among Mexican, and to a lesser extent, Indian immigrants.

Conclusions: Barriers to immigrant healthcare utilization vary by gender and national origin. Research will need to continue documenting such variation in order to better inform policy makers and health practitioners of potential solutions for improving health outcomes in increasingly diverse immigrant communities.     

Duration of residence was not consistently related to immigrant mortality

OBJECTIVE: This paper aimed to examine immigrant mortality according to duration of residence in the Netherlands and to compare duration-specific mortality levels to levels of mortality in the native Dutch population. STUDY DESIGN AND SETTING: For the years 1995-2000, we linked the national cause of death register, that contains information on deaths of legal residents, to the municipal population register, that contains information on all legal residents. We studied mortality in relation to period of immigration by means of directly standardized mortality rates and Poisson regression. RESULTS: All cause mortality was not related to year of immigration among Turkish and Moroccan men and women, and among Surinamese women. Among Surinamese men and among Antilleans/Aruban men and women, mortality was higher in more recent immigrants. Part of their excess mortality was due to their relatively low socioeconomic status. For most specific causes of death, no consistent relation with duration of residence was observed. CONCLUSION: A consistent relation between duration of residence and immigrant mortality was only observed in some immigrant groups. The results suggest that the healthy migrant effect or adaptation of health-related behaviors were no predominant determinants of immigrant mortality in the Netherlands.     

Orientations to motherhood and male partner support among women in Mexico and Mexican-origin women in the United States

Previous studies suggest that favorable pregnancy outcomes among Mexican immigrant women in the United States may be attributed to a protective sociocultural orientation, but few have explored the attitudes and values that shape Mexican women's perceptions of motherhood. This exploratory study examines orientation towards motherhood among Mexican and Mexican-origin women living in Mexico and the United States and their perceptions of their male partners' attitudes and roles. Focus groups were conducted with 60 pregnant low-income women in rural and urban communities in Mexico with high rates of migration to the US, among immigrant communities in rural and urban California and with US-born women of Mexican descent (Mexican Americans) in urban California. Notable differences were observed between women in Mexico and the US and between immigrant and Mexican American women in California as more women articulated life plans. Life plans seemed to reflect both processes of individuation and changing gender roles. While participants in Mexico largely abided by the conventional discourse on motherhood and domesticity, immigrants in California alternated between this ethos and the discourse of working mother, depending on financial resources. In contrast, Mexican American participants assumed multiple roles. These differing orientations may be linked to other factors, including fertility control, the amount and type of partner support, and stress during pregnancy.     

Gender differences in depressive symptoms among older Korean American immigrants

Despite consistent reports over many years of a greater prevalence of depression among women, mechanisms underlying the gender difference remain unclear. Mechanisms relevant to immigrant elderly populations are virtually unexplored. The present study examined gender variations in depressive symptoms using a community sample of 230 older Korean American immigrants (M(age) = 69.8; standard deviation = 7.05) in Florida. We were interested in examining not only mean differences but gender differences in the impact of demographic variables (age, marital status, and education), health constraints (chronic conditions and functional disability), and personal resources (sense of control, social network, and acculturation) on depressive symptoms. Consistent with previous literature, women scored higher on depressive symptoms than men. In a hierarchical regression model, women and those with more chronic conditions, greater functional disability, and lower sense of control were found to have more depressive symptoms. The interaction of gender-by-chronic conditions was found to be significant, and further analysis indicated that the association of chronic conditions with mental well-being was stronger for women. The findings suggest that among older Korean immigrants, women are at particular risk of declining psychological well-being in the face of physical health problems and call attention to the need for interventions designed to promote their physical and mental health.     

Migration-related health inequalities: Showing the complex interactions between gender,social class and place of origin

In this paper, we briefly review theories and findings on migration and health from the health equity perspective, and then analyse migration-related health inequalities taking into account gender, social class and migration characteristics in the adult population aged 25–64 living in Catalonia, Spain. On the basis of the characterisation of migration types derived from the review, we distinguished between immigrants from other regions of Spain and those from other countries, and within each group, those from richer or poorer areas; foreign immigrants from low-income countries were also distinguished according to duration of residence. Further stratification by sex and social class was applied. Groups were compared in relation to self-assessed health in two cross-sectional population-based surveys, and in relation to indicators of socio-economic conditions (individual income, an index of material and financial assets, and an index of employment precariousness) in one survey. Social class and gender inequalities were evident in both health and socio-economic conditions, and within both the native and immigrant subgroups. Migration-related health inequalities affected both internal and international immigrants, but were mainly limited to those from poor areas, were generally consistent with their socio-economic deprivation, and apparently more pronounced in manual social classes and especially for women. Foreign immigrants from poor countries had the poorest socio-economic situation but relatively better health (especially men with shorter length of residence). Our findings on immigrants from Spain highlight the transitory nature of the ‘healthy immigrant effect’, and that action on inequality in socio-economic determinants affecting migrant groups should not be deferred.     

Access to health-care in Canadian immigrants: a longitudinal study of the National Population Health Survey

Immigrants often lose their health advantage as they start adapting to the ways of the new society. Having access to care when it is needed is one way that individuals can maintain their health. We assessed the healthcare access in Canadian immigrants and the socioeconomic factors associated with access over a 12-year period. We compared two measures of healthcare access (having a regular doctor and reporting an unmet healthcare need in the past 12 months) among immigrants and Canadian-born men and women, aged more than 18 years. We applied a logistic random effects model to evaluate these outcomes separately, in 3081 males and 4187 females from the National Population Health Survey (1994-2006). Adjusting for all covariates, immigrant men and women (white and non-white) had similar odds of having a regular doctor than the Canadian-born individuals (white immigrants: males OR: 1.32, 95% C.I.: 0.89-1.94, females OR: 1.14, 95% C.I.: 0.78-1.66; non-white immigrants: males OR: 1.28, 95% C.I.: 0.73-2.23, females OR: 1.23, 95% C.I.: 0.64-2.36). Interestingly, non-white immigrant women had significantly fewer unmet health needs (OR: 0.32, 95% C.I.: 0.17-0.59). Among immigrants, time since immigration was associated with having access to a regular doctor (OR per year: 1.02, 95% C.I.: 1.00-1.04). Visible minority female immigrants were least likely to report an unmet healthcare need. In general, there is little evidence that immigrants have worse access to health-care than the Canadian-born population.     

Cancer Incidence Among Canadian Immigrants, 1980–1998: Results from a National Cohort Study

Canadian immigrants have lower overall cancer risk than the Canadian-born population. Less is known about risks for immigrant subgroups and site-specific cancers. Linked administrative data sets were used to compare cancer incidence between subgroups of immigrants to Canada and the general Canadian population. The study involved 128,962 refugees and 241,010 non-refugees. Standardized incidence ratios (SIRs) were calculated for all-site and site-specific cancers by immigration categories and regions of birth. Relative to the general Canadian population, incidence of all-site cancer was lower among immigrants overall, by sex and refugee status (non-refugee SIRs 0.25: men, 0.24: women; refugee SIRs 0.31: both). Significantly higher SIRs resulted for liver, nasopharyngeal and cervical cancers, including liver cancer among South-East Asian and North-East Asian immigrants, and nasopharyngeal cancer among North-East Asian non-refugees. Hypothesized explanations for variation in cancer incidence include earlier viral infection in the country of origin.     

Immigration as a crisis tendency for HIV vulnerability among racialised women living with HIV in Ontario,Canada: an anti-oppressive lens

South Asian immigrant women in Canada face unique structural barriers that influence their HIV vulnerability. Using an intersectional and anti-oppressive lens, we explored the role of immigration in bringing about changes in gender roles and the structure of gender relations and their effect on HIV risk among immigrant women as they experienced crisis tendencies in the face of hegemonic masculinity. Informed by Connell’s theory of gender, the study entailed in-depth interviews with 12 self-identified South Asian immigrant women living in the Greater Toronto Area, in Ontario, Canada. A thematic analysis yielded four themes: power relations, emotional relations, gendered division of labour and social norms. Our findings revealed interdependencies between immigration and each of structural, individual and normative factors (the themes) as they pertain to crisis tendencies when patriarchy is disrupted. Given the rapid increase in global immigration, the connections between transnationalism and hegemony, and the established link between immigration and HIV, future research should extend this work to other immigrant communities.     

Symptom experience during menopausal transition: low income Korean immigrant women.

The symptoms experienced during menopausal transition of a vulnerable group of women, low income Korean immigrants, are described in this paper. The findings demonstrated that (a) the types of the symptoms that the women reported were different from those reported by Western women; (b) the women tended to normalize their symptoms; and (c) their symptom experience was influenced by immigration transition and its contextual variables. We suggest that symptom experience of immigrant women during menopausal transition be understood within the contexts of their immigration transition, and that their own views of normality of the menopausal transition be respected.     

The epidemiology of thyroid disorders in a seaport community in southern Sweden

The prevalence of thyroid disorders was studied in two birth cohorts (1928 and 1941) of men and women living in Malm?, a non-iodine deficient area. In the 1928 cohort, the prevalence of thyroid disorders was 11.5% overall (mean 2.4% , women 20.3%), and higher among immigrant women (20.7%) than among women of the native population, e.g. women born in and still living in Malm? (14.7%). In the 1941 cohort, the overall prevalence of thyroid disorders was 7.9% (men 1.5%, women 14.1%); and the prevalence of goiter was lower among immigrant women (9.5%) than among women of the native population (15.0%). Among the native population, the prevalence of goiter did not differ significantly between the two cohorts, whereas among immigrant women it was significantly greater in the 1928 cohort. The findings suggest that, although iodine deficiency is the most probable cause of goiter among immigrants of the 1928 cohort, where the native population is concerned (both men and women), some other goitrogenic factor(s) must be involved.