Healthy Weight Advantage Lost in One Generation Among Immigrant Elementary Schoolchildren in Multi-Ethnic, Disadvantaged, Inner-City Neighborhoods in Montreal, Canada

Determinants, Prevention, and Incidence of Cardiovascular Disease Among Immigrant and Refugee Populations

Immigration policies shape the composition, socioeconomic characteristics, and health of migrant populations. The health of migrants is also influenced by a confluence of social, economic, environmental, and political factors. Immigrants and refugees often face various barriers to accessing health care because of factors such as lack of familiarity with navigating the health care system, language barriers, systemic racism, and gaps in health insurance. Social determinants of health and access to primary care health services likely influence the burden of cardiovascular risk factors among immigrants. The relatively low burden of many cardiovascular risk factors in many immigrant populations likely contributes to the generally lower incidence rates of acute myocardial infarction, heart failure, and stroke in immigrants compared with nonimmigrants, although cardiovascular disease incidence rates vary substantially by country of origin. The "healthy immigrant effect" is the hypothesis that immigrants to high-income countries, such as Canada, are healthier than nonimmigrants in the host population. However, this effect may not apply universally across all immigrants, including recent refugees, immigrants without formal education, and unmarried immigrants. As unfolding sociopolitical events generate new waves of global migration, policymakers and health care providers need to focus on addressing social and structural determinants of health to better manage cardiovascular risk factors and prevent cardiovascular disease, especially among the most marginalized immigrants and refugees.

Birth and Health Outcomes of Children Migrating With Parents: A Systematic Review and Meta-Analysis

Objective

To examine the birth and health outcomes of children migrating with parents internationally and domestically, and to identify whether the healthy migration effect exist in migrant children.

Methods

Five electronic databases were searched for cross-sectional, case-control, or cohort studies published from January 1, 2000 to January 30, 2021and written by English language, reporting the risk of health outcomes of migrant children (e.g., birth outcome, nutrition, physical health, mental health, death, and substance use) We excluded studies in which participants' age more than 18 years, or participants were forced migration due to armed conflict or disasters, or when the comparators were not native-born residents. Pooled odd ratio (OR) was calculated using random-effects models.

Results

Our research identified 10,404 records, of which 98 studies were retrained for analysis. The majority of the included studies (89, 91%) focused on international migration and 9 (9%) on migration within country. Compared with native children, migrant children had increased risks of malnutrition [OR 1.26 (95% CI 1.11-1.44)], poor physical health [OR 1.34 (95% CI 1.11-1.61)], mental disorder [OR 1.24 (95% CI 1.00-1.52)], and death [OR 1.11 (95% CI 1.01-1.21)], while had a lower risk of adverse birth outcome [OR 0.92 (95% CI 0.87-0.97)]. The difference of substance use risk was not found between the two groups.

Conclusion

Migrant children had increased risk of adverse health outcomes. No obvious evidence was observed regarding healthy migration effect among migrant children. Actions are required to address the health inequity among these populations.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/#myprospero, identifier: CRD42021214115.

Children's longitudinal bodyweight in Australia: Influence of migrant mothers' long-term residency, attachment to, and level of childhood overweight in country-of-birth

Immigration creates opportunities and imposes constraints associated with acculturation. We used the Australian national longitudinal survey of children aged 2 to 17 to evaluate the influence of mothers' long-term residency in Australia, mothers' attachment to country-of-birth, and macro indicators of childhood overweight environment at mothers' country-of-birth on children's longitudinal bodyweight. Both mothers' long-term exposure to the Australian environment and attachment to country-of-birth were associated with increased children's bodyweight z-scores. The childhood overweight environment in mothers' country-of-birth continued to influence their children's bodyweight after immigration. A better understanding of factors related to mothers' migration and children's bodyweight status is necessary to identify risk factors and migrant sub-groups needing extra support.

Barriers and facilitators to meeting recommended physical activity levels among new immigrant and refugee children in Saskatchewan, Canada

Newcomers are often healthy when they arrive in Canada, yet experience health declines shortly thereafter, possibly due to lifestyle changes. As part of the Healthy Immigrant Children study, this mixed-methods study aims to analyze possible predictors of physical activity among 300 newcomer children, and explore their lived experiences using a sub-sample of 19 parents and 24 service providers. Data collection involved questionnaires concerning socioeconomic status and physical activity, anthropometric measurements, and in-depth interviews. Participants aged 5 years and older largely met physical activity recommendations (82.9%), while none of the 3-4-year-olds did. Males were more active than females, especially among older ages. Many participants engaged in too much screen time (53.4-90.0%). Age and income predicted physical activity among males, while parents' education level was the only significant predictor among females. Barriers to physical activity included: recreational physical activity being an unfamiliar concept, gender limitations, financial resources, safety concerns, and children's preference for screen time. Schools played a central role in newcomer children's health by providing accessible opportunities for physical activity. Newcomer families preferred to have their children involved in culturally relevant physical activities. Given the growing newcomer population, it is important to support active lifestyle practices among them. Novelty: About 83% of newcomer children aged 5 years and older met physical activity recommendations, while none of the 3-4-year-olds did. Age and income predicted males' physical activity, while parents' education level predicted females' physical activity. Schools provide accessible opportunities for newcomer children to engage in physical activity.

Chronic health disparities among refugee and immigrant children in Canada

There are knowledge gaps in our understanding of the development of chronic disease risks in children, especially with regard to the risk differentials experienced by immigrants and refugees. The Healthy Immigrant Children study employed a mixed-methods cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3-13 years who had been in Canada for less than 5 years. Quantitative data regarding socioeconomic status, food security, physical activity, diet, and bone and body composition and anthropometric measurements were collected. Qualitative data regarding their experiences with accessing health care and their family lifestyle habits were gathered through in-depth interviews with the parents of newcomer children. Many newcomers spoke about their struggles to attain their desired standard of living. Regarding health outcomes, significantly more refugees (23%) had stunted growth when compared with immigrants (5%). Older children, those with better-educated parents, and those who consumed a poorer-quality diet were at a higher risk of being overweight or obese. Sixty percent of refugees and 42% of immigrants had high blood cholesterol. Significant health concerns for refugee children include stunting and high blood cholesterol levels, and emerging trends indicate that older immigrant children from privileged backgrounds in low-income countries may be more at risk of overweight and obesity. A variety of pathways related to their families' conceptualization of life in Canada and the social structures that limit progress to meeting their goals likely influence the development of health inequity among refugee and immigrant children. Public health initiatives should address these health inequities among newcomer families.

Are immigrants healthier than native-born Canadians? A systematic review of the healthy immigrant effect in Canada

OBJECTIVES

Immigrants are typically healthier than the native-born population in the receiving country and also tend to be healthier than non-migrants in the countries of origin. This foreign-born health advantage has been referred to as the healthy immigrant effect (HIE). We examined evidence for the HIE in Canada.

DESIGN

We employed a systematic search of the literature on immigration and health and identified 78 eligible studies. We used a narrative method to synthesize the HIE across different stages of the life-course and different health outcomes within each stage. We also examined the empirical evidence for positive selection and duration effects - two common explanations of migrants' health advantage and deterioration, respectively.

RESULTS

We find that the HIE appears to be strongest during adulthood but less so during childhood/adolescence and late life. A foreign-born health advantage is also more robust for mortality but less so for morbidity. The HIE is also stronger for more recent immigrants but further research is needed to determine the critical threshold for when migrants' advantage disappears. Positive selection as an explanation for the HIE remains underdeveloped.

CONCLUSIONS

There is an absence of a uniform foreign-born health advantage across different life-course stages and health outcomes in Canada. Nonetheless, it remains the case that the HIE characterizes the majority of contemporary migrants since Canada's foreign-born population consists mostly of core working age adults.

The "Hispanic mortality paradox" revisited: Meta-analysis and meta-regression of life-course differentials in Latin American and Caribbean immigrants' mortality

The literature on immigrant health has repeatedly reported the paradoxical finding, where immigrants from Latin American countries to OECD countries appear to enjoy better health and greater longevity, compared with the local population in the host country. However, no previous meta-analysis has examined this effect focusing specifically on immigrants from Latin America (rather than Hispanic ethnicity) and we still do not know enough about the factors that may moderate the relationship between immigration and mortality. We conducted meta-analyses and meta-regressions to examine 123 all-cause mortality risk estimates and 54 cardiovascular mortality risk estimates from 28 publications, providing data on almost 800 million people. The overall results showed that the mean rate ratio (RR) for immigrants vs. controls was 0.92 (95% CI, 0.84-1.01) for all-cause mortality and 0.73 (CI, 0.67-0.80) for cardiovascular mortality. While the overall results suggest no immigrant mortality advantage, studies that used only native born persons as controls did find a significant all-cause mortality advantage (RR, 0.86; 95% CI, 0.76-0.97). Furthermore, we found that the relative risk of mortality largely depends on life course stages. While the mortality advantage is apparent for working-age immigrants, it is not significant for older-age immigrants and the effect is reversed for children and adolescents.

Influence of country of birth and ethnicity on body mass index among Canadian youth: a national survey

BACKGROUND

The body mass index (BMI) of youth often changes when they immigrate to a new country as a result of the adoption of new behaviours, a process called acculturation. We investigated whether BMI differs by country of birth (Canada v. other countries) and ethnicity, both individually and together. We also examined whether time since immigration and health-related behaviour explain any observed BMI differences.

METHODS

Data sources were the Canadian Health Behaviour in School-Aged Children study and the Canada Census of Population. Participants were youth in grades 6-10 (weighted sample n = 19 272). A questionnaire was used to assess participants' sociodemographic characteristics, height, weight and health-related behaviour. We calculated BMIs from participants' self-reported heights and weights and used World Health Organization growth references to determine BMI percentiles.

RESULTS

Based on self-reported heights and weights, BMI percentiles for foreign-born youth were lower than those of youth born in Canada (-4, 95% confidence interval [CI] -6 to -2). This difference did not decrease with time since immigration. Similarly, BMI percentiles were lower among East and Southeast Asian youth than their peers from the Canadian host culture (-4, 95% CI -6 to -2). Finally, BMI percentiles for foreign-born Arab and West Asian youth and East Indian and South Asian youth were lower than their Canadian-born peers of the same ethnicity (-14, 95% CI -22 to -7; -8, 95% CI -14 to -3).

INTERPRETATION

Immigrant generation and ethnicity were related to BMI among Canadian youth, both independently and together. Some ethnic groups showed differences by country of birth, i.e., East Indian and South Asian, while others showed no such difference, i.e., East and Southeast Asian. There was no association with time since immigration. Our findings reinforce the need to investigate country of birth and ethnicity when considering the determinants of childhood BMI.

The immigration effect on obesity and overweight in Israeli Jewish male adolescents born 1970-1993

PURPOSE

The aim of the study was to assess the relationship between age of arrival of male pediatric immigrant populations in Israel and their risk for subsequent high-weight morbidity at adolescence.

METHODS

The study analyzed a pooled cross section of 89,744 foreign-born male Jewish study participants, who were born in the former Soviet Union or Ethiopia (1970-1993) and immigrated in childhood to Israel. Each participant's body mass index was measured at approximately 17 years of age. Odds ratios were calculated for obesity and overweight according to age on arrival to Israel. A total of 52,503 Israel-born participants with origins in those same countries were measured at the same age and used as references. A total of 52,258 native Israelis without known immigrating ancestry were also used for comparison. The risk stratification accounted for possible socio-demographic confounders and birth year.

RESULTS

Foreign-born immigrants had decreased risk for obesity and overweight relative to Israeli-born immigrants when measured at the age of 17 years. However, those who arrived in Israel during infancy and early childhood (before the age of 3 years) had greater risk for high weight compared with those immigrating during late childhood and adolescence.

CONCLUSIONS

Although generally protective against obesity and overweight relative to native, these beneficial effects of immigration are diminished for those arriving in early childhood rather than later in adolescence.

Anthropometric measurements in Canadian children: a scoping review

OBJECTIVE

The objective of the current study was to identify what forms of anthropometric measurement are currently being utilized with Canadian children and youth and what are the gaps in the literature on this topic.

METHODS

The current study utilized a scoping review methodology in order to achieve the study objectives. Online databases Medline and PubMed and CINAHL were used to search articles from the last decade (2002-2012) that addressed Canadian children aged 2-18 years.

SYNTHESIS

50 studies were included in this review. A variety of anthropometric measurements were identified, including body mass index, waist circumference, hip-to-waist ratio, among others. Six of the included studies (12%) utilized nationally representative data from large-scale studies. BMI was the most reported form of measurement with 88% of studies collecting it. Waist circumference was a distant second with 20% of studies reporting it. Several gaps in the literature exist with regards to First Nations (FN) research; many of the measurement methods were not used. Additionally, FN accounted for only 2.5% of the study's sample. The majority of studies took place in Quebec (29%) and Ontario (27%).

CONCLUSION

Body mass index is the most reported method of anthropometric measurement used for children. Efforts should be taken by health care practitioners and researchers to collect other forms of measurement in order to assist in understanding the validity of other measures and their value when used with children. Furthermore, attention needs to be focused on utilizing and studying various forms of anthropometric measurement across all Canadian regions and populations.

Body image, body dissatisfaction and weight status in children from Emilia-Romagna (Italy): comparison between immigrant and native-born

BACKGROUND

Cross-sectional study among immigrant and native children from Emilia-Romagna (Italy).

AIM

The purpose of the present study was to examine the relative contribution of weight status, ethnicity and sex on body dissatisfaction in a sample of children from Emilia-Romagna (Italy).

SUBJECTS AND METHODS

Primary school children (226 immigrants and 1206 Italians) aged 6-11 years were measured: immigrant children were divided into Asians, Africans, Latin Americans and East Europeans. Height and weight were measured and Body Mass Index (BMI) was calculated. Body image perception was assessed using Body Silhouette Charts. A body dissatisfaction score (BDS) was derived by subtracting the "ideal self" from the "self" score.

RESULTS

Weight status disorders were higher in immigrants than in native-born males; Italian females had higher prevalence of underweight and overweight and lower prevalence of obesity than immigrants peers. BDS rose with the increase of weight status categories.

CONCLUSIONS

Awareness of body image size and increasing body dissatisfaction with higher weight status is established in childhood, regardless of ethnicity and gender.

Population-based trends in overweight and obesity: a comparative study of 2,148,342 Israeli male and female adolescents born 1950-1993

BACKGROUND

The epidemic of obesity has been identified as a major source of morbidity, not just in developed countries but globally, in adults as well as at younger ages.

OBJECTIVE

The aims of this study were to describe trends in obesity and overweight in Israeli adolescents and observe temporal changes and association by risk factors.

METHODS

The research analyzed records of 2,148,342 Jewish adolescents, over a span of 44 years and included data for individual body measurements, place of residence, area of origin and education levels. Body mass index (BMI) was measured by professionals, calculated and categorized as overweight or obesity according to age- and gender-specific BMI curves established in recent years. We processed the data in multinomial logistic regression model and calculated odds ratios for various risk factors.

RESULTS

Obesity and overweight are on the rise for male and female adolescents born from the mid-1960s onwards, and especially for men from the 1980s onwards. Risk factors for male adolescents include lower socioeconomic status, inferior education levels and Western origins (vs. Asian, African or Israeli origins). Risk modifiers for women were similar, except for African origins, which were associated with increased risk rather than decreased risk. Asian and Israeli origins were protective for both genders, and education was more strongly associated with obesity for women.

CONCLUSIONS

We recommend stronger preventive efforts directed at adolescents as a whole, and particularly vulnerable groups with lower education levels and poverty, or those with specific geographical origins. Gender disparities are evident and should be considered in these efforts and in further research.

Childhood and family influences on body mass index in early adulthood: findings from the Ontario Child Health Study

BACKGROUND

Overweight and obesity are steadily increasing worldwide with the greatest prevalence occurring in high-income countries. Many factors influence body mass index (BMI); however multiple influences assessed in families and individuals are rarely studied together in a prospective design. Our objective was to model the impact of multiple influences at the child (low birth weight, history of maltreatment, a history of childhood mental and physical conditions, and school difficulties) and family level (parental income and education, parental mental and physical health, and family functioning) on BMI in early adulthood.

METHODS

We used data from the Ontario Child Health Study, a prospective, population-based study of 3,294 children (ages 4-16 years) enrolled in 1983 and followed up in 2001 (N = 1,928; ages 21-35 years). Using multilevel models, we tested the association between family and child-level variables and adult BMI after controlling for sociodemographic variables and health status in early adulthood.

RESULTS

At the child level, presence of psychiatric disorder and school difficulties were related to higher BMI in early adulthood. At the family level, receipt of social assistance was associated with higher BMI, whereas family functioning, having immigrant parents and higher levels of parental education were associated with lower BMI. We found that gender moderated the effect of two risk factors on BMI: receipt of social assistance and presence of a medical condition in childhood. In females, but not in males, the presence of these risk factors was associated with higher BMI in early adulthood.

CONCLUSION

Overall, these findings indicate that childhood risk factors associated with higher BMI in early adulthood are multi-faceted and long-lasting. These findings highlight the need for preventive interventions to be implemented at the family level in childhood.