Immigration and food insecurity: social and nutritional issues for recent immigrants in Montreal, Canada

The prevalence of food insecurity amongst refugees and asylum seekers during, and prior to, their early resettlement period in Australia: A cross-sectional analysis of the 'Building a New Life in Australia' data

With over 100 million humanitarian migrants globally, there is increasing pressure on high-income countries to offer resettlement opportunities. Humanitarian migrants face many challenges during pre-settlement and resettlement. One challenge is food insecurity (FI). The Building a New Life in Australia (BNLA) longitudinal cohort study gathered data from migrating units, that is, a group of humanitarian migrants included on the same visa application (n = 1599). Data were gathered in five annual waves (2013-2018). Data included food security status in four pre-settlement situations and during resettlement. The results of this secondary analysis of BNLA Wave One indicate that FI was highest in refugee camps (71%), followed by bridging visas (30%), community detention (17%), immigration detention (11%), and during early resettlement (9%). During early resettlement, respondents who were male, those from Afghanistan or Iran, and those living in a single person household reported the highest prevalence of FI. An association was found between having spent time on a bridging visa and FI during early resettlement (p < 0.01). This study's results are an important step in understanding the scale of FI and which sub-groups are most vulnerable, so the resources and policies of high-income countries can better meet food security needs during resettlement.

Food insecurity, nutrition insecurity, and self-reported health among newcomer Manitoba youth: A cross-sectional study

Many youth in Manitoba are not food secure. Newcomer youth may be more vulnerable to food insecurity. Further, it has been suggested that being food secure does not ensure a nutritionally adequate diet. This study examined survey data from 1,347 grade nine students to describe and compare food security by newcomer status. Survey data were also used to compare the dietary intakes, eating behaviors, and self-reported health of newcomer youth by food security status. Food security status between newcomer and non-newcomer youth was not significantly different, however, being food secure was not enough to have optimal nutritional health and well-being.

Exploring Barriers to Food Security Among Immigrants: A Critical Role for Public Health Nutrition

Upon moving to a new country and new food environment, 2 important public health issues may be experienced by immigrants as they adapt to their new country of residence, namely a higher prevalence of food insecurity and/or a decline in overall health over time postimmigration. Therefore, improving the food environment experienced by new migrants may be an effective strategy to reduce long-term health complications and improve well-being postimmigration. The aim of this paper is to discuss the potential barriers experienced by new immigrants in the access, availability, and utilization of familiar culturally appropriate foods and the subsequent impact on their food security status. Culturally appropriate foods are foods commonly consumed as part of cultural food traditions and are often staples within the diet; however, limited availability of and/or access to these foods can reduce food security. By understanding the barriers to food security and challenges that may be faced by immigrants and refugees, dietitians will be better equipped to assist these individuals in accessing culturally familiar foods and improve quality of life. In this capacity, dietitians can play a critical public health nutrition role by serving as a conduit for new immigrants to access community resources and navigate a new food environment.

What factors are associated with food security among recently arrived refugees resettling in high-income countries? A scoping review

OBJECTIVE

Refugees are vulnerable to food insecurity (FI). This is attributable to a combination of inequitable social determinants and cultural differences. In 2019, 92 % of refugee resettlement (host country provides residency/citizenship) occurred in high-income countries, but little is known about the factors impacting their food security status in this setting. The review's objective was to therefore thematically identify factors affecting food security among refugees resettling in high-income countries.

DESIGN

This review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Between May-July 2020 and February 2021, peer-reviewed studies focused on FI, and published in English from 2000-2020, were searched on Medline, CINAHL, Scopus, Informit, PsychArticles, Proquest and EmBase.

SETTING

Only studies set in high-income countries were included.

PARTICIPANTS

Fifty percent or more of study participants had to be refugees who had resettled within 5 years.

RESULTS

Twenty studies from six high-income countries were included. Culturally based food practices and priorities, confidence in navigating local foodways and transport, level of community connections and capabilities in local language and food preparation were key themes associated with food security.

CONCLUSIONS

Utilising the four themes of culture, confidence, community and capabilities, there is an opportunity to improve the cultural sensitivity of measurement tools, develop understanding of how community-based resources (such as social capital) can be leveraged as food security buffers and modify existing food security initiatives to better serve refugee needs.

Exploring food security among recently resettled Syrian refugees: results from a qualitative study in two Canadian cities

Purpose

This study aims to provide a qualitative in-depth account of the status and experience of food insecurity for Syrian refugee households in Toronto and Saskatoon, Canada. The study considers the range of geographic, socio-economic, cultural and gendered components shaping and determining the barriers and management of food insecurity.

Design/methodology/approach

The study included 54 semi-structured interviews with refugee families in Toronto and Saskatoon who resettled in Canada after November 2015. In addition, 15 semi-structured in-person or telephone interviews were conducted with settlement and support agencies to measure their capacity to respond to issues of food insecurity for Syrian refugees.

Findings

Syrian refugees reported experiencing food insecurity as part of the broader resettlement journey, including in the transitional phase of refuge and in each settlement context in Canada. Income status in Canada was reported as a key barrier to food security. Low-income barriers to food security were experienced and shaped by factors including food affordability, physical access and availability and the extent of familial or other support networks including sponsorship relationships. Participants also reported how managing food insecurity contributed to the intensification of gender expectations.

Originality/value

The analysis reveals food insecurity as both an income and non-income based concern for refugees during the process of resettlement. The study also highlights the importance of considering variations between primary barriers to food security identified by Syrian families and key informants as critical to the development of strategies designed to mitigate the impacts of resettlement on food security.

Prevalence and determinants of food insecurity in migrant Sub-Saharan African and Caribbean households in Ottawa, Canada

Purpose

Food insecurity (FI) is an important social determinant of health and is linked with higher health care costs. There is a high prevalence of FI among recent migrant households in Canada. The purpose of this paper is to evaluate the prevalence of FI in Sub-Saharan African and Caribbean migrants in Ottawa, and to explore determinants of FI in that population.

Design/methodology/approach

A cross-sectional study was conducted among 190 mothers born in Sub-Saharan Africa or the Caribbean living in Ottawa and having a child between 6 and 12 years old. Health Canada’s Household Food Security Survey Module was used to evaluate participants’ food security in the past 12 months. χ2 tests and multivariate logistic regression analyses were used to measure determinants of FI (n=182).

Findings

A very high rate of FI (45.1 percent) was found among participants. When numerous determinants of FI were included in a multivariate model, household FI was associated with Caribbean origin, low education attainment, lone motherhood, living in Canada for five years or less and reliance on social assistance.

Originality/value

These findings highlight the need for FI to be explicitly addressed in migrant integration strategies in order to improve their financial power to purchase sufficient, nutritious and culturally acceptable foods. Enhancing migrants’ access to affordable child care and well-paid jobs, improving social assistance programs and providing more affordable subsidized housing programs could be beneficial.

Preliminary validation and piloting of a comprehensive measure of household food security in Australia

OBJECTIVE

To investigate the psychometric properties, validity and reliability of a newly developed measure of food insecurity, the Household Food and Nutrition Security Survey (HFNSS), among an Australian population.

DESIGN

Cross-sectional study.

SETTING

Metropolitan areas of Melbourne, Australia, identified as very high, high or medium vulnerability in the 2008 Vulnerability Assessment for Mortgage, Petrol and Inflation Risks and Expenditure index.

SUBJECTS

A convenience sample of 134 adults (117 females and fifteen males, aged over 18 years).

RESULTS

Rasch modelling and factor analysis identified four items for exclusion. The remaining items yielded excellent reliability among the current sample and assessed three underlying components: the adult experience of food insecurity (component one), initial/periodic changes to children's food intakes (component two) and progressive/persistent decreases in children's food intakes (component three). Compared with the widely used US Department of Agriculture Food Security Survey Module, the HFNSS identified a significantly higher proportion of food insecurity; this is likely due to the HFNSS's identification of food insecurity due to reasons other than (and including) limited financial access.

CONCLUSIONS

The HFNSS may be a valid and reliable tool for the assessment of food insecurity among the Australian population and provides a means of assessing multiple barriers to food security beyond poor financial access (which has been identified as a limitation of other existing tools). Future research should explore the validity and reliability of the tool among a more representative sample, as well as specifically among vulnerable population subgroups.

Vitamin D Sufficiency of Canadian Children Did Not Improve Following the 2010 Revision of the Dietary Guidelines That Recommend Higher Intake of Vitamin D: An Analysis of the Canadian Health Measures Survey

In 2010, the dietary guidelines for vitamin D for Canadians and Americans aged 1-70 years were revised upward. It is unknown whether the vitamin D status of Canadian children improved after 2010. We compared the prevalence of vitamin D sufficiency (25-hydroxy vitamin D (25(OH)D) concentration of ≥50 nmol/L), 25(OH)D concentration and the frequency of consuming vitamin D-rich foods among children aged 6-18 years-old using data from the nationally representative 2007/2009 and 2012/2013 Canadian Health Measures Surveys. Associations of sociodemographic, anthropometric, seasonal, and regional variables with achieving vitamin D sufficiency, 25(OH)D concentration, and consumption of vitamin D-rich foods were assessed using multiple logistic and linear regression models. 79% and 68% of children in 2007/2009 and 2012/2013 respectively, were vitamin D sufficient. The main dietary source of vitamin D was milk. Between 2007/2009 and 2012/2013, the frequency of milk and fish consumption declined, but egg and red meat consumption was unchanged. Age, income, weight status, season and ethnicity were associated with 25(OH)D concentration and vitamin D sufficiency. Vitamin D status declined after the upward revision of dietary guidelines for vitamin D, consequently, dietary intake was inadequate to meet sufficiency. Public health initiatives to promote vitamin D-rich foods and supplementation for Canadian children are needed.

Vitamin D deficiency and sufficiency among Canadian children residing at high latitude following the revision of the RDA of vitamin D intake in 2010

Recently, countries at high latitudes have updated their vitamin D recommendations to ensure adequate intake for the musculoskeletal health of their respective populations. In 2010, the dietary guidelines for vitamin D for Canadians and Americans aged 1–70 years increased from 5 μg/d to 15 μg/d, whereas in 2016 for citizens of the UK aged ≥4 years 10 μg/d is recommended. The vitamin D status of Canadian children following the revised dietary guidelines is unknown. Therefore, this study aimed to assess the prevalence and determinants of vitamin D deficiency and sufficiency among Canadian children. For this study, we assumed serum 25-hydroxy vitamin D (25(OH)D) concentrations <30 nmol/l as ‘deficient’ and ≥50 nmol/l as ‘sufficient’. Data from children aged 3–18 years (n 2270) who participated in the 2012/2013 Canadian Health Measures Survey were analysed. Of all children, 5·6% were vitamin D deficient and 71% were vitamin D sufficient. Children who consumed vitamin D-fortified milk daily (77 %) were more likely to be sufficient than those who consumed it less frequently (OR 2·4; 95% CI 1·7, 3·3). The 9% of children who reported taking vitamin D-containing supplements in the previous month had higher 25(OH)D concentrations (β 5·9 nmol/l; 95% CI 1·3, 12·1 nmol/l) relative to those who did not. Children who were older, obese, of non-white ethnicity and from low-income households were less likely to be vitamin D sufficient. To improve vitamin D status, consumption of vitamin D-rich foods should be promoted, and fortification of more food items or formal recommendations for vitamin D supplementation should be considered.

Measurement of the dimensions of food insecurity in developed countries: a systematic literature review

OBJECTIVE

Food insecurity is a salient health issue comprised of four dimensions - food access, availability, utilization and stability over time. The aim of the present study was to conduct a systematic literature review to identify all multi-item tools that measure food insecurity and explore which of the dimensions they assess.

DESIGN

Five databases were searched (CENTRAL, CINAHL plus, EMBASE, MEDLINE, TRIP) for studies published in English since 1999. Inclusion criteria included human studies using multi-item tools to measure food security and studies conducted in developed countries. Manuscripts describing the US Department of Agriculture Food Security Survey Module, that measures 'food access', were excluded due to wide acceptance of the validity and reliability of this instrument. Two authors extracted data and assessed the quality of the included studies. Data were summarized against the dimensions of food insecurity.

SETTING

A systematic review of the literature.

SUBJECTS

The majority of tools were developed in the USA and had been used in different age groups and cultures.

RESULTS

Eight multi-item tools were identified. All of the tools assessed the 'food access' dimension and two partially assessed the dimensions 'food utilization' and 'stability over time', respectively. 'Food availability' was not assessed by existing tools.

CONCLUSIONS

Current tools available for measuring food insecurity are subjective, limited in scope, with a majority assessing only one dimension of food insecurity (access). To more accurately assess the true burden of food insecurity, tools should be adapted or developed to assess all four dimensions of food insecurity.

Do acculturation strategies have impacts on the self-declared health, well-being and lifestyle of first-generation allophone immigrants in Montreal, Canada?

Purpose

– The purpose of this paper is to understand to what extent, the process of acculturation and the strategies which ensue from it can affect the self-declared health as regards the lifestyle, the physical activity, the diet and the well-being of first-generation immigrants living in the Montreal region (Quebec, Canada).

Design/methodology/approach

– A supervised survey was administered to adult allophones immigrants attending French-language courses, autumn 2011 (506 valid surveys). The authors discuss the concept and the validation of their acculturation model and its relevance in regard of the purposes of the research.

Findings

– The indicator allowed to clearly identify three groups that differentiate on numerous variables of the survey. Independently of the acculturations strategies adopted by the respondents, the authors observe a deterioration of the self-declared overall state of health, development of sedentary living, a fairly high level of stress and depressive episode within the entire sample. However, the group isolated as “retention” has consistently the lowest scores on all these variables. In terms of public health and health social inequalities issues these results are worrisome. The “assimilation” group have the highest scores and the “integration” group consistently shows and intermediate “balancing” position.

Originality/value

– The authors claim that the strategies of acculturation are not always the expression of a free will. They are also the product of constraints specific to the host society and are just as much the result of the pre-migratory socialization. This is especially the case of the “retention” group and more specifically of women. The negative effects of social, cultural and economic constraints of the host society on overall health, well-being and lifestyle as well as adaptation strategies should be monitored in a more systematic manner in recent immigrant populations and be specifically addressed in immigrant integration policies and programmes.

Immigration, ethnicity, and avoidable mortality in Canada, 1991-2006

OBJECTIVE

Avoidable mortality is a well-recognized, but less studied indicator of the performance of the health system. First, the study seeks to establish whether immigrants overall and selected foreign-born ethnic groups (Western Europeans, South Asians, Chinese, and Filipinos) have an advantage over nonimmigrants in avoidable mortality. Second, it assesses the effect of sociodemographic and socioeconomic factors on any observed differences by duration of residence.

DESIGN

Deaths grouped by cause of death and by behavioral risk factors, namely smoking-related and alcohol-related, were derived from the 1991 Canadian Census Cohort: Mortality and Cancer Follow-up. The analysis estimated age-standardized mortality rates (ASMRs), rate ratios, and rate differences and also fitted hazard regression models for the overall Canadian-born population and for selected foreign-born ethnicities by sex. Predictors were assessed at baseline.

RESULTS

Compared to the Canadian-born persons, foreign-born men and women had lower ASMRs for overall avoidable mortality and also for selected causes of avoidable mortality. The only exception to this overall trend was for ischemic heart disease among South Asian women. Except for the order of prominence, the three leading causes of death for nonimmigrant and immigrant men and women overall were ischemic heart diseases, smoking-related diseases, and neoplasms. A similar pattern was observed among the ethnic groups, except for circulatory heart diseases replacing ischemic heart diseases and smoking-related diseases among Chinese and Filipino women, respectively. In the hazard regression analysis, the risk of avoidable mortality was lower for immigrants overall and selected ethnicities irrespective of the duration in Canada compared to nonimmigrants. These differences persisted even with adjustment for sociodemographic and socioeconomic factors.

CONCLUSION

Immigrants overall and the selected ethnicities enjoy an advantage over nonimmigrants in avoidable mortality. However, for certain causes of death especially ischemic heart disease mortality among South Asian women, immigrants appeared worse-off than nonimmigrants. The results suggest differential access to and use of health services, differences in protective health-related behavior, and the healthy immigrant effect.