Adolescent health and adaptation in Canada: examination of gender and age aspects of the healthy immigrant effect

Mental Health of Immigrant Children and Adolescents (6-17 Years) in Canada: Evidence from the Canadian Health Measures Survey

BACKGROUND

Studies indicate a higher prevalence of mental health problems among immigrants, but findings on immigrant children and adolescents are mixed. We sought to understand the magnitude of differences in mental health indicators between immigrant and non-immigrant children and adolescents in Canada and the influence of age, sex, household income, and household education.

METHODS

We completed a secondary analysis of data from the Canadian Health Measures Survey, using a pooled estimate method to combine data from four survey cycles. A weighted logistic regression was used to estimate the unadjusted and adjusted odds ratios with 95% confidence intervals.

RESULTS

We found an association between the mental health of immigrant versus non-immigrant children and adolescents (6-17 years) as it relates to emotional problems and hyperactivity. Immigrant children and adolescents had better outcomes with respect to emotional problems and hyperactivity/inattention compared to non-immigrant children and adolescents. Lower household socioeconomic status was associated with poorer mental health in children and adolescents.

CONCLUSION

No significant differences in overall mental health status were evident between immigrant and non-immigrant children and adolescents in Canada but differences exist in emotional problems and hyperactivity. Sex has an influence on immigrant child mental health that varies depending on the specific mental health indicator.

Understanding the Healthy Immigrant Effect in the Context of Mental Health Challenges: A Systematic Critical Review

The "Healthy Immigrant Effect" (HIE) suggests that immigrants have a health advantage over the domestic-born which vanishes with increased length of residency. Most HIE research focuses on physical health, with less attention given to mental health (MH). This systematic review of 58 MH studies examines whether there is a MH advantage among immigrants and explores changes in immigrants' MH, besides critically assessing the use of HIE theory. Inconsistent evidence was detected regarding the presence of MH advantage, whereas consistent, convincing evidence was revealed for a decline in immigrants' MH over years. Although the HIE theory can help reveal MH disparities, this theory alone does not explain the reasons for these disparities nor inform about potential avenues to improve immigrants' MH. A paradigm shift is needed to incorporate other potential theoretical concepts/frameworks, including the "Health Inequalities Action" framework, for a broader understanding of MH issues and to inform effective, culturally-sensitive interventions.

Immigrants, Ethnicity, and Adherence to Secondary Cardiac Prevention Therapy: A Substudy of the ISLAND Trial

Background

The objective of this study was to evaluate adherence to guideline-recommended cardiac secondary prevention therapies by immigration and ethnicity.

Methods

We conducted a retrospective substudy of the Interventions Supporting Long-Term Adherence and Decreasing Cardiovascular Events (ISLAND) randomized controlled trial. A cohort of 1642 participants was analyzed. Patients were categorized based on their self-reported immigrant status as being Canadian or foreign born and based on their visual minority status (as European or a visual minority). We used logistic regression to examine associations between these patient characteristics of interest and patient adherence to statin medication 1 year after myocardial infarction (MI) and completion of cardiac rehabilitation, adjusting for age, sex, and comorbidities.

Results

The dataset included outcome data on 1049 (64%) Canadian-born patients and 593 (36%) immigrants. There were 347 (21%) who identified as a visual minority. We report a nonsignificant trend in statin adherence 1 year after MI favouring foreign-born participants compared with Canadian-born participants (odds ratio [OR], 1.26; 95% confidence interval [CI], 0.91-1.68). Visual minorities were found to have no significant difference in statin adherence 1 year after MI compared with participants of European ethnicity (OR, 1.04; 95% CI, 0.72-1.51). Neither immigration status (OR, 0.91; 95% CI, 0.72-1.15) nor visual minority status (OR, 0.97; 95% CI, 0.73-1.28) were associated with cardiac rehabilitation completion.

Conclusions

Our findings offer limited support that immigrants with > 10 years of Canadian residency exposure experience greater adherence to statins 1 year after MI. Further research is required to better inform our understanding of secondary prevention strategy among immigrant populations.

Secular trends in adolescents' diagnosed health status and healthcare consultation: examinations of Canadian national surveys from 2007 to 2016

OBJECTIVES

The objective of this study was to investigate secular trends in adolescent health status and healthcare consultations.

STUDY DESIGN

The design of this study is cross-sectional comparisons of population survey outcomes.

METHODS

Canadian national population data from 2007 to 2016 (T1 N = 14,223; T2 N = 14,247; T3 N = 13,532; T4 N = 13,184; T5 N = 11,122; Total N = 66,308) were examined to find trends in health diagnosis (chronic illnesses and mental disorders) and healthcare consultation (general health practitioners and mental health professionals). Controlling demographics, Multivariate analysis of covariances (MANCOVAs) and correlations were carried out to compare differences by age group (A1: 12-14 years N = 25,180; A2: 15-17 years N = 25,825; A3: 18-19 years N = 15,303) and gender (girls N = 32,388; boys N = 33,920) across survey years.

RESULTS

Steady increases were found in diagnosed mental disorders and consultations with a mental health professional (MP) for girls, while chronic illnesses remained stable and general practitioner consultations declined for all adolescents over these years. Gender disparity in MP consultations grew with age, much more in recent years, whereas chronic illness diagnoses curved down for all in midadolescence. More integrated relations between health status and healthcare utilization were noted in T5 than in T1.

CONCLUSIONS

Differential secular trends were shown for adolescent physical versus mental health statuses and relevant healthcare consultations. Although girls' and older adolescents' mental health declined over the years, a positive direction was also found for improved awareness of mental health.

The impact of parental migration on injuries among left behind young people aged 10 years to 24 years in Botswana

There has been little evidence of the relationship between children and absence of parents in Botswana literature; and it is still the case that absence of parents increases the risk of injuries to their children. The aim of this study is to investigate the impact of parental migration among left behind young people aged 10 years to 24 years in Botswana and examine patterns of injuries from immigrant families. This is a population-based crosssection from which a dataset was created by compiling data from two different sources for the period of 2010 to 2015. All the variables were transformed into natural logarithms so as to avoid outliers and normalize the variables. All statistical modeling was carried out using Statistical Analysis System version 6.1. Left behind young people were associated with higher risk of injuries especially in motor vehicle accidents 391(40%), fire 264 (27%), and burns 162 (16%) except for drowning, machinery and poisoning. Parental migration is the most important issue in the total number of injuries. Correlation coefficient shows that non-left behind, the greater the chance to be classified under the poisoning cases (r = 0.888) and is lower compared to the left behind (r = 0.471). This study shows clearly that injuries take an insufficiently high toll on children's health and on society. Additionally, if parental migration trends continue, Botswana's burden of injuries are expected to rise in the next 10 years.

Trends in mental health service utilisation in immigrant youth in Ontario, Canada, 1996-2012: a population-based longitudinal cohort study

OBJECTIVE

To describe trends in mental health service use of youth by immigration status and characteristics.

DESIGN

Population-based longitudinal cohort study from 1996 to 2012 using linked health and administrative datasets.

SETTING

Ontario, Canada.

PARTICIPANTS

Youth 10-24 years, living in Ontario, Canada.

EXPOSURE

The main exposure was immigration status (recent immigrants vs long-term residents). Secondary exposures were region of origin and refugee status.

MAIN OUTCOME MEASURE

Mental health hospitalisations, emergency department (ED) visits and outpatient visits within consecutive 3-year time periods. Poisson regression models estimated rate ratios (RR).

RESULTS

Over 2.5 million person years per period were included. Rates of recent immigrant mental health service utilisation were at least 40% lower than long-term residents (p<0.0001).Mental health hospitalisation and ED visit rates increased in long-term residents (hospitalisations, RR 1.09 (95% CI 1.08 to 1.09); ED visits, RR 1.15 (1.14 to 1.15)) and recent immigrants (hospitalisations RR 1.05 (1.03 to 1.07); ED visits, RR 1.08 (1.05 to 1.11)). Mental health outpatient visit rates increased in long-term residents (RR 1.03 (1.03 to 1.03)) but declined in recent immigrant (RR 0.94 (0.93 to 0.95)). Comparable divergent trends in acute care and outpatient service use were observed among refugees and across most regions of origin. Recent immigrant acute care use was driven by longer-term refugees (hospitalisations RR 1.12 (1.03 to 1.21); ED visits RR 1.11 (1.02 to 1.20)).

CONCLUSIONS

Mental health service utilisation was lower among recent immigrants than long-term residents. While acute care use is increasing at a faster rate among long-term residents than recent immigrants, the decrease in outpatient mental health visits in immigrants highlights a potential emerging disparity in access to preventative care.

Adolescent immigrants, the impact of gender on health status

Background

: Although studies have described the 'healthy immigrant effect' in adults, far fewer have examined the 'healthy immigrant effect' for adolescents living in immigrant families. Those few studies that did, noted conflicting results, and also differed on whether gender confounds the results. : This cross-sectional study was informed by the community-based participatory research (CBPR) approach in which researchers obtained the expertise and guidance on instrument design and study implementation. Data collection of self-administered surveys was completed between May 2015 and December 2015 on adolescents. Comparisons were made among six groups based on gender and immigrant status. : Of the total sample ( n = 618), more than a third were first or second generation immigrant adolescents ( n = 239). Comparisons among six groups, categorized by gender and immigrant status (i.e. first generation immigrants, second generation immigrants, native born), indicated many differences. However, when the differences were taken into account using logistic regression models, excellent health status was least likely to be reported by second generation immigrant males (versus native born adolescent females) ( P < 0.01), even after adjusting for the independent associations found for psychological symptoms ( P < 0.0001), not smoking ( P < 0.05) and having normal BMI ( P < 0.05). : This study demonstrates the relative disadvantage of second generation immigrant boys, but not first generation boys or first and second generation immigrant girls relative to their native counterparts. Reasons for the gap may be differences in support services and/or parental expectations; however further studies are needed to confirm these possibilities.

Migration and social determinants of mental health: Results from the Canadian Health Measures Survey

OBJECTIVES

Studies worldwide point to increased risk of mental health problems among immigrants. However, the data on Canadian immigrants' mental health are ambiguous. To address this, we examined the relationship of both self-perceived mental health and reported diagnosis of mood disorders with age, gender, migration status, time since migration, and social determinants of health factors.

METHODS

We analyzed three cycles of the Canadian Health Measures Survey. Our outcome variables were self-perceived mental health and reported diagnosis of mood disorders. We used weighted logistic regression to model time since migration conditional on age, gender, income, community belonging, education, and employment status for 12 160 participants aged 15-79 years.

RESULTS

Recent (within 5 years) migrants reported better self-perceived mental health (odds ratio 3.98, 95% confidence interval [CI]: 2.06-7.70) but this effect disappeared with longer time since immigration. Other predictors were older age, higher income, better sense of community belonging, and being employed. Similarly, diagnosis of mood disorders was less likely to be reported in recent migrants (odds ratio 0.23, 95% CI: 0.10-0.53) with some weak evidence that this was also seen among longer-term migrant residents (&gt;10 years). Diagnosis was also associated with older age, being a woman, lower income, weak sense of community belonging, and being unemployed.

DISCUSSION

Our findings indicate that migrants to Canada do not have worse mental health in general, though health and social policies need to attend to the socio-economic determinants, such as low income, unemployment, and a poor sense of community belonging, which contribute to population health outcomes.

The shrinking health advantage: unintentional injuries among children and youth from immigrant families

BACKGROUND

Immigrants typically arrive in good health. This health benefit can decline as immigrants adopt behaviours similar to native-born populations. Risk of injury is low in immigrants but it is not known whether this changes with increasing time since migration. We sought to examine the association between duration of residence in Canada and risk of unintentional injury.

METHODS

Population-based cross-sectional study of children and youth 0 to 24 years in Ontario, Canada (2011-2012), using linked health and administrative databases. The main exposure was duration of Canadian residence (recent: 0-5 years, intermediate: 6-10 years, long-term: >10 years). The main outcome measure was unintentional injuries. Cause-specific injury risk by duration of residence was also evaluated. Poisson regression models estimated rate ratios (RR) for injuries.

RESULTS

999951 immigrants were included with 24.2% recent and 26.4% intermediate immigrants. The annual crude injury rates per 100000 immigrants were 6831 emergency department visits, 151 hospitalizations, and 4 deaths. In adjusted models, recent immigrants had the lowest risk of injury and risk increased over time (RR 0.79; 95% CI 0.77, 0.81 recent immigrants, RR 0.90; 95% CI 0.88, 0.92 intermediate immigrants, versus long-term immigrants). Factors associated with injury included young age (0-4 years, RR 1.30; 95% CI 1.26, 1.34), male sex (RR 1.52; 95% CI 1.49, 1.55), and high income (RR 0.93; 95% CI 0.89, 0.96 quintile 1 versus 5). Longer duration of residence was associated with a higher risk of unintentional injuries for most causes except hot object/scald burns, machinery-related injuries, non-motor vehicle bicycle and pedestrian injuries. The risk of these latter injuries did not change significantly with increasing duration of residence in Canada. Risk of drowning was highest in recent immigrants.

CONCLUSIONS

Risk of all-cause and most cause-specific unintentional injuries in immigrants rises with increasing time since migration. This indicates the need to develop strategies for maintaining the immigrant health advantage over time while balancing the desire to support integration, active living, and healthy child development.

Effects of acculturation, coping strategies, locus of control, and self-efficacy on chronic pain: study of Chinese immigrant women in Italy - insights from a thematic field analysis

Chronic pain represents a common public health concern worldwide. It is a complex phenomenon, owing to the interaction of different factors, including biological, physiological, psychological, environmental, and social variables. Some groups, such as women and immigrants, are particularly vulnerable. However, little is known about how Chinese women in Italy live with and face chronic pain. The present study aimed at filling this knowledge gap by examining the burden of chronic pain in Chinese immigrants in Italy in terms of acculturation processes, perceived control over disease, social networks, and coping strategies. A qualitative approach was used, performing a thematic field analysis. We interviewed 82 Chinese women from different Italian towns (Genoa, Milan, Turin, Bologna, Florence, and Prato) in depth. The sense of belonging to the host culture was strong in our sample. However, this did not simply reflect or translate into a linear engagement with medical systems, as health care pathways were more complex and dual (both Chinese and Western). Chinese women who felt deeply rooted in the Italian environment did not discontinue the use of traditional Chinese medicine. Chronic pain extensively and adversely affected daily life, particularly interfering with work. Coping strategies were mainly adaptive behaviors, being problem focused or maladaptive, relying upon “cope and avoid” mechanisms. Chinese women preferred to use traditional Chinese remedies rather than conventional medicine, while using the Italian system in emergencies. Perceived control over chronic pain was usually external. Finally, Chinese women with chronic pain benefit from social networks and support, which were mainly composed of Chinese peers. In conclusion, our findings underline the tremendous burden of chronic pain affecting all aspects of Chinese women’s lives. Health care workers and providers should be aware of the complexity of chronic pain Therefore, a holistic approach, involving different stakeholders, should be adopted when managing chronic pain and approaching immigrant patients.

Aggression and related stressful life events among Chinese adolescents living in rural areas: A cross-sectional study

BACKGROUND

Aggression is a serious problem for both individuals and society. Despite progress in aggression research, its persistence among adolescents living in rural areas remains to be investigated. We evaluate the prevalence of aggression and the association between stressful life events and aggression in a nationwide, school-based sample of adolescents living in rural areas of China.

METHODS

A sample of 13,495 Chinese rural students (7065 boys and 6430 girls; 11-20 years old) was selected from 15 representative rural areas from 5 provinces in China using stratified randomized cluster sampling. Aggression, stressful life events, neglect, emotional management, social support, and demographic characteristics were assessed via self-report questionnaires. Multivariate logistic regressions were used to estimate the association of stressful life events and aggression after controlling for confounds.

RESULTS

The prevalence of aggressive behavior among Chinese adolescents living in rural areas was 24.3%. Regression analyses indicated that the odds of aggression were negatively influenced by chronic long-term stressors related to interpersonal problems (OR=2.03, 95% CI [1.75-2.36]), health adaptation difficulties (OR=1.21, 95% CI [1.09-1.34]), and other troubles (OR=1.93, 95% CI [1.74-2.14]), even after adjustment for parental neglect, emotional management, social support, and other relevant factors.

LIMITATIONS

This study was cross-sectional; thus, it is necessary to validate the causal relationship between stressful life events and aggression via follow-up studies.

CONCLUSIONS

Aggression was prevalent among Chinese adolescents living in rural areas, and interpersonal problems, health adaption difficulties, and other troubles were considered potential independent risk factors for aggression.

Initial medication non-adherence: prevalence and predictive factors in a cohort of 1.6 million primary care patients

AIMS

Adherence to medicines is vital in treating diseases. Initial medication non-adherence (IMNA) - defined as not obtaining a medication the first time it is prescribed - has been poorly explored. Previous studies show IMNA rates between 6 and 28% in primary care (PC). The aims of this study were to determine prevalence and predictive factors of IMNA in the most prescribed and expensive pharmacotherapeutic groups in the Catalan health system.

METHODS

This is a retrospective, register-based cohort study which linked the Catalan PC System (Spain) prescription and invoicing databases. Medication was considered non-initiated when it was not collected from the pharmacy by the end of the month following the one in which it was prescribed. IMNA prevalence was calculated using July 2013-June 2014 prescription data. Predictive factors related to patients, general practitioners and PC centres were identified through multilevel logistic regression analyses. Missing data were attributed using simple imputation.

RESULTS

Some 1.6 million patients with 2.9 million prescriptions were included in the study sample. Total IMNA prevalence was 17.6% of prescriptions. The highest IMNA rate was observed in anilides (22.6%) and the lowest in angiotensin-converting-enzyme (ACE) inhibitors (7.4%). Predictors of IMNA are younger age, American nationality, having a pain-related or mental disorder and being treated by a substitute/resident general practitioner in a resident-training centre.

CONCLUSIONS

The rate of IMNA is high when all medications are taken into account. Attempts to strengthen trust in resident general practitioners and improve motivation to initiate a needed medication in the general young and older immigrant population should be addressed in Catalan PC.

Unintentional injuries in children and youth from immigrant families in Ontario, Canada: a population-based cross-sectional study

BACKGROUND

Unintentional injury is the leading cause of childhood death. Injury is associated with a number of sociodemographic characteristics, but little is known about risk in immigrants. Our objective was to examine the association between family immigrant status and unintentional injury in children and youth.

METHODS

We performed a population-based, cross-sectional study involving children and youth (age 0-24 yr) residing in Ontario from 2008 to 2012. Multiple linked health and administrative databases were used to describe unintentional injuries by family immigrant status. Unintentional injury events (e.g., emergency department visits, admissions to hospital, deaths) were analyzed using Poisson regression models to estimate rate ratios (RRs) for injury by immigrant status.

RESULTS

Annualized injury rates were 11 749 emergency department visits per 100 000 population, 267 hospital admissions per 100 000 population and 12 deaths per 100 000 population. Injury rates were lower among immigrants across all causes of unintentional injury (adjusted RR 0.56, 95% confidence interval [CI] 0.54-0.59). Among nonimmigrants, lowest neighbourhood income quintile was associated with the highest rates (RR 1.13, 95% CI 1.08-1.18, quintile 5 v. 1); among immigrants, lowest income quintile was associated with the lowest rates of injury (RR 0.88, 95% CI 0.82-0.94, quintile 5 v. 1). Highest rates of injury for nonimmigrants were among adolescents (age 10-14 yr, RR 1.23, 95% CI 1.18-1.28; v. 20-24 yr), but for immigrants, was highest among young children (0-4 yr RR 1.23, 95% CI 1.16-1.31; v. 20-24 yr).

INTERPRETATION

Rates of unintentional injury are lower among immigrant than among Canadian-born children, supporting a healthy immigrant effect. Socioeconomic status and age have different associations with injury risk, suggesting alternative causal pathways for injuries in immigrant children and youth.

An evaluation of the healthy immigrant effect with adolescents in Canada: Examinations of gender and length of residence

BACKGROUND

The healthy immigrant effect, HIE, is the finding that immigrants initially arrive in the settlement society in the same or better health than their native-born counterparts, yet this advantage is lost as their length of residence increases. This phenomenon has been found among adult populations.

OBJECTIVE

The present study sought to extend the premise of HIE to adolescents in Canada.

METHODS

Utilizing national data sets of three years (Canadian Community Health Survey 2007, 2009, 2011; Statistics Canada), adolescents (aged 12-19), foreign-born immigrants (N = 2919) and native-born non-immigrants (N = 39,083), were compared for their perceived general health and mental health as well as diagnosed chronic illnesses and psychological illnesses. Multiple imputations were first carried out for the degrees of missing values, and multivariate analyses were conducted to find differences between non-immigrants and immigrants, and between recent and long-term immigrants to verify (1) whether immigrant adolescents show better health than their non-immigrant peers, (2) whether the health of immigrant adolescents vary with length of residence and gender, and (3) whether persistent trends would be shown across the three survey years.

RESULTS

After adjusting for age, visible minority status, household income and household size as covariates, immigrant adolescents indeed reported better health in all four measures in each survey year. Girls experienced more health problems regardless of immigrant status, especially for chronic and psychological illnesses. However, only in 2009 the long-term immigrant adolescents reported less favorite health than recent immigrants, and length of residence influenced boys' and girls' mental health in different directions.

CONCLUSIONS

The HIE was confirmed with national community population samples of adolescents in Canada: foreign-born immigrant adolescents experience better health than their native-born peers. However, understanding of the HIE needs to be further extended to encompass the influence of societal contexts and their impact on various segments of populations.