Non-immigrant Population Research Articles

Predictors of Unintentional Injuries in Paediatric Immigrants in Ontario

Abstract BACKGROUND: Unintentional injury is a frequent reason for emergency department visits and is the leading cause of death for Canadian children. Injury is associated with a number of socio-demographic variables but it is not known whether being an immigrant changes this risk. OBJECTIVES: To examine the association between family immigrant status and unintentional injury; and to test this relationship within immigrants by refugee status. DESIGN/METHODS: Retrospective population-based cross-sectional study of children ages 0 to 14 years residing in Ontario, Canada from 2008 to 2012, using linked health administrative databases and Citizenship and Immigration Canada’s Permanent Resident Database. The main exposure was immigration status (immigrant or child of an immigrant vs. Canadian born). Secondary exposure was refugee status. Main outcome measure was unintentional injury events (emergency department visits, hospitaliza-tions, deaths), annualized. Data were analyzed using Poisson regression models to estimate risk ratios (RR) for unintentional injuries. RESULTS: There were 11 464 317 injuries per year. Non-immigrant children sustained 12051 injuries/100 000 and immigrants had 6837 injuries/100 000, annually. In adjusted models, immigrants had a significantly lower risk of injury compared with non-immigrant children (RR 0.60; 95% confidence interval [CI] 0.57, 0.63). Overall, the most materially deprived neighbourhood quintile was associated with a higher rate of injury (RR 1.13; 95% CI 1.07, 1.02, quintile 5 vs. 1) whereas within immigrants, material deprivation was associated with a lower rate of injury (RR 0.96; 95% CI 0.94, 0.98, quintile 5 vs. 1). Other predictors of injury included age (0 to 4 years: RR 0.84; 95% CI 0.81, 0.88; 5 to 9 years: RR 0.70; 95% CI 0.67, 0.73), male sex (RR 1.30; 95% CI 1.26, 1.35), and rural residence (RR 1.50; 95% CI 1.43, 1.57). Injury rates were lower in immigrants across all types of unintentional injuries. Within immigrants, refugees had a higher risk of injury compared with non-refugees (RR 1.12; 95% CI 1.10, 1.14). This risk was particularly high for motor vehicle accidents (RR = 1.58; 95% CI 1.46, 1.71) and scald burns (RR 1.23; 95% CI 1.11, 1.35). CONCLUSION: Risk of unintentional injury is lower among immigrants compared with Canadian-born children. These findings support a healthy immigrant effect. Socioeconomic status has a different effect on injury risk in immigrant and non-immigrant populations, suggesting alternative causal pathways for injuries in immigrants. Risk of unintentional injury is higher in refugees versus non-refugee immigrants, highlighting a population in need of targeted injury prevention strategies.

The melting-pot and the economic integration of immigrant families: ancestral and generational variations in Australia

The melting-pot argument, whereby economically heterogeneous multi-cultural societies, characterised by high levels of immigration from a variety of origins, become more homogeneous over time, has attracted much attention, especially in North America. Australia has similarly experienced major waves of immigration from a wide range of cultural backgrounds. This paper reports successful tests of hypotheses, derived from the melting-pot model, that economic integration of immigrant groups there has also resulted in reduced inter-group occupational and income differences across successive generations, but that the pace of integration can vary across ethnic groups. Using a bespoke tabulation from the 2011 Australian census we explore differences among ten immigrant (ancestry) groups in their educational qualifications, and their occupational and income distributions, using a recently developed method to identify significant patterns within large contingency tables. We find that by the third generation there were no substantial differences either across the ten groups chosen to represent four main waves of immigration to Australia or between these groups and the non-immigrant population.

A Scoping Review of Immigrant Experience of Health Care Access Barriers in Canada.

Canadian population-based surveys report comparable access to health care services between immigrant and non-immigrant populations, yet other research reports immigrant-specific access barriers. A scoping review was conducted to explore research regarding Canadian immigrants' unique experiences in accessing health care, and was guided by the research question: "What is currently known about the barriers that adult immigrants face when accessing Canadian health care services?" The findings of this study suggest that there are unmet health care access needs specific to immigrants to Canada. In reviewing research of immigrants' health care experiences, the most common access barriers were found to be language barriers, barriers to information, and cultural differences. These findings, in addition to low cultural competency reported by interviewed health care workers in the reviewed articles, indicate inequities in access to Canadian health care services for immigrant populations. Suggestions for future research and programming are discussed.

Spatial sorting of African Immigrants in the French Public Housing Market

This paper documents the existence of sorting patterns based on region of origin in the French public housing market (HLM). We provide evidence that first-generation African immigrants who benefit from the program tend to live in poorer neighborhoods than their French-born counterparts, once controlled for the broader geographical area of residence. This differential is comparable in magnitude to the one observed in the private rental market, even though the pricing of a public rental is almost uncorrelated with its location characteristics. Whereas we cannot rule out the possibility that this sorting partly reflects the specificity of African immigrants’ housing demand, we mitigate this concern by using information on the HLM offers that were previously rejected by the households and on the households’ declared level of satisfaction regarding their current neighborhood. Given that about half of African immigrants live in HLM (against one sixth of the non-immigrant population), this finding has possibly strong consequences on African immigrants’ segregation and welfare in France.

Benefit and Adherence of the Disease Management Program “Diabetes 2”: A Comparison of Turkish Immigrants and German Natives with Diabetes

There is an ongoing debate about equity and equality in health care, and whether immigrants benefit equally from services as the non-immigrant population. The study focuses on benefits from and adherence to the diabetes mellitus type 2 (DM 2) disease management program (DMP) among Turkish immigrants in Germany. So far, it has not been researched whether this group benefits from enrollment in the DMP as well as diabetics from the non-immigrant population. Data on the non-immigrant sample (N = 702) stem from a survey among members of a German health insurance, the Turkish immigrant sample (N = 102) was recruited in the area of Hamburg. Identical questions in both surveys enable comparing major components. Regarding process quality, Turkish diabetics do not differ from the non-immigrant sample; moreover, they have significantly more often received documentation and diabetes training. In terms of outcome quality however, results display a greater benefit on behalf of the non-immigrant sample (e.g., blood parameters and body mass index), and they also met more of the DMP criteria. This underlines the need of diabetics with Turkish background for further education and information in order to become the empowered patient as is intended by the DMP as well as to prevent comorbidities.

Abstract 156: Assessing the readiness and interest towards electronic means of communication among patients at Federally Qualified Health Centers.

Background: Some research has been done into using mobile phones as a means of communication with patients. It has been shown to improve medication adherence among chronically ill patients. As of December 2012 , more than 89% of the US inhabitants have mobile broadband subscriptions .This opens up the potential for Smartphone applications and also patient portals, above and beyond text messaging for patient communication. Objectives: To assess the readiness, interest and barriers of low income minority patients with diabetes mellitus (DM) and cardiovascular disease (CVD) towards adopting 1) Text messaging , Smartphone applications , Patient portals as means of communication with providers. 2)Compare technology adoption in immigrant versus non-immigrant populations. Methods: This study is part of the Office- Guidelines Applied to Practice (Office-GAP) project, designed to improve secondary prevention of heart disease for DM and CVD patients in FQHCs (Federally Qualified Health Centers) in Michigan. We analyzed 119 out of the 242 patients that participated in Office-GAP group visits (June 2013-January 2014) and completed the questionnaire. The questionnaire evaluated their readiness , interest and barriers towards electronic means of communication . Chart abstraction was performed for relevant data by trained research assistants. Descriptive analysis was performed on the cross sectional data thus obtained. Results: Study population is 53 % (63 of 119) non-immigrant , 47% (56 of 119) immigrant. Mean age is 53.69 (33.07% males) and 57.1% (68 of 119) of our patient population has a cellphone with non-immigrants having higher access (74.6 vs 37.5%) compared to immigrants. Text messages can be sent and received by 37.8% (45 of 119) with 21.1% (25 of 118) having to pay extra charges for texts and 25.7% (30 of 117) want texts from the doctors office. A landline is available to 54% (64 of 119) and 48.2% (56 of 116) want voicemails. Out of our population with both a landline and cellphone 57 %(60 of 106) prefer landline. Only 10 % (12 of 119) of our population can use a computer very well and 55% (65 of 119) cannot use a computer at all , 35%(42 of 119) have access to internet and email and 52.3%(22 of 42) want emails from their doctors office. Seven percent (4 of 58) would like to have access to their medical information online by means of a patient portal. Three percent (2 of 58) have a smartphone and 1.7% (1 of 58) would like a Smartphone application for accessing their medical records. Conclusion: Minority and low-income patients with DM and CVD may eventually be ready for adopting more technology as a means of communication with their provider as technology gets cheaper and trivialized . Current readiness and interest to adoption is lower among immigrant compared to non immigrant population. More research is needed to determine the barriers to adopting technology for secondary prevention of heart disease.

Effects of ethnic presence in the commercial and public service advertising Perception and attitudes on national non-immigrant population in Spain

The aim of this research is to ascertain whether the presence of people from different ethnic backgrounds in commercials and institutional advertising influences the attitudes of native receptors, helping to change the level of persuasion of the advertising message based on the source. This study carried out an experiment by selecting two ads in press - one from a commercial campaign and one from a public service campaign - and creating four versions of the two approaches by introducing different ethnic sources (Spanish, Latin American, North African and sub-Saharan). These were shown to 124 young native Spanish people, to understand their perception of and attitude towards them. The results show that there is a differential perception of the ads based on whether these are commercial or public service in nature. We also found a differential attitude toward the ad, depending on which source of which ethnicity appears as a character.

Abstract 135: Low Income Patients With Diabetes: High Risk For Uncontrolled Hypertension?

Introduction: Cardiovascular disease and not hyperglycemia is the major cause of mortality in patients with diabetes mellitus (DM). Hypertension is particularly burdensome in low income groups, where the prevalence of uncontrolled hypertension is higher than the general population. Federally Qualified Health Centers (FQHCs) provide care for low income and medically underserved populations (both immigrant and non-immigrant population). Objectives: 1) to determine the rate and predictors of Blood Pressure (BP) control in patients with diabetes and hypertension. 2) to identify differences by immigration status in BP control among patients attending FQHCs. Methods: The Office Guidelines Applied to Practice (Office-GAP) study is a cluster randomized trial designed to improve cardiovascular care for minority and low income populations in outpatient clinical settings. Office-GAP intervention included: provider training, patient education in a group visit, and use of Office-GAP checklist and patient decision aids during office visits. We describe baseline patient characteristics (prior to any intervention) in the FQHC sites. Retrospective review was performed of charts of all patients with hypertension, coronary artery disease and or, diabetes mellitus (DM) from September 2010 to December 2012. Hypertension was defined as Systolic BP>140 mmHg (>130 mm Hg in DM patients) and diastolic BP > 90 mmHg (>80 mm Hg in DM patients). A multivariable logistic regression was used to assess the effects of potential predicators on BP control. Results: Of 242 patients identified, 169 had DM, and 166 had hypertension. The mean age was 54.47 ± 11.91 years and 44.39 % were men (99 of 223). Of the total sample, 178 (73.55%, 178 of 242) were non-immigrants, 23.87 % (53 of 222) were covered by Medicaid, 40.99% (91 of 222) by Medicare, 39.19 % (87 of 222) by county outpatient insurance; 33.06% (70 of 242) were Black, 34.71 % (84 of 242) White and 32.23% (78 of 242) formed other races (Hispanics, Somalis, Nepalese). BP control was 36.73% (83 of 226) 95% CI = [30.44, 43.02] and 27.22% (46 of 169) 95% CI = [20.51, 33.93] in total sample and DM patients respectively. BP control among immigrants was 32.2% (19 of 59) 95% CI = [20.28, 44.12] vs. 38.32% (64 of 167) 95% CI = [30.95, 45.69] in non-immigrants. A logistic regression model identify the DM status as the sole significant predictor associated with BP control, with patients without DM having the best BP control (p-value<0.0001). This effect of DM on BP control remained significant even after adjusted for other predictors. Conclusions: We found that significant number of patients attending FQHCs do not have their BP controlled. Immigration status did not play any role in BP control; however BP control among patients with DM was substantially lower than the whole sample. This underscores the urgent need for strategies to improve BP control in FQHCs, particularly among diabetic patients.

Immigration, Social Environment and Onset of Psychotic Disorders

The recent decade has been characterized by a resurging interest for socio-environmental determinants of psychotic disorders, largely as a result of findings from studies of migration and psychotic disorders. This contribution reviews recent meta-analytic findings which confirm higher incidence rates of schizophrenia and related disorders among first- and second-generation immigrants than in non-immigrant populations, as well as substantial risk variation according to both ethnic minority groups and host society contexts. The relevance of social contexts in the onset of psychosis is also suggested by incidence variation according to the neighbourhood level ethnic density. While limited, an emerging literature suggests potential variations in psychotic-like experiences and at-risk mental states according to ethnic minority status. We then discuss the meaning of findings from migrant studies, as well as integrative models that attempt to account for ethnic variations in the incidence of psychosis and psychotic-like phenomena. In conclusion, there remain numerous gaps in our understanding of the relation between migration, ethnicity, social contexts and the onset of psychosis and we propose future research avenues to address these. In particular, there is a need for multilevel approaches integrating disciplines and methodologies across the psychosis continuum.

HIV/AIDS profile and realities at a regional antiretroviral therapy clinic in Jerusalem: 12 years analysis

The diagnosis of HIV, quality of follow-up, and treatment among immigrants are greatly influenced by cultural factors and access to the healthcare system. Israel, an immigrant-based society, features 3 cardinal HIV-positive patient groups, namely non-immigrant Israelis, legal immigrants (mainly from Ethiopia), and illegal African work-immigrants. While the first 2 groups are covered by a national health insurance, the latter group depends on an unstructured system of antiretroviral therapy (ART) supply. In the early 1990s, a national mentoring programme was implemented for legal immigrants. The programme involves community-based Ethiopian mentors who follow HIV-positive Ethiopians. In this retrospective cohort study we reviewed the files of HIV-positive patients diagnosed between 1995 and 2007, focusing on comparison between HIV-positive non-immigrant populations with both legal Ethiopian immigrants and the often overlooked illegal immigrants. Our results point to a substantial rate of loss to follow-up among the illegal immigrants. When comparing non-immigrants to legal immigrants, both feature similar adherence to follow-up, exposure and response to ART, despite profound cultural differences. Our results suggest that ethnic-related obstacles in HIV diagnosis and treatment may be overcome by 'cultural mediators', yet, addressing the silent mass of HIV-positive illegal work-immigrants, who are deprived of such programme benefits, poses a major challenge to Western health authorities.

Estados de ansiedad, depresión y factores relacionados en la población adulta inmigrante latinoamericana en Canarias

Introduction Immigration is a vital stressful event that could be a higher risk of suffering a mental illness. Objective To compare the prevalence of anxiety-depression in the Latin-American immigrant population living in the Canary Islands and compare them with the non-immigrant population. Material and Method Exploratory analysis of dates and the relationship between variables, including the qualitative analysis. Results The study included 125 patients, with a mean age of 38.9 years (SD: 12.07), of whom 73.6% were women, 42.4% married and 77.6% employed. A total of 44% suffered anxiety (95% CI: 0.527-0.353) and 63.2% had depression (95% CI: 0.714-0.546). Abuse was reported by 13.6% and the 19.2% had psychopathological symptoms in childhood. A history of mental illness was reported in 64.6%. Depression was associated with “marital status” ( P = .012), “family situation” ( P = .0001), “time in Spain” (5.75 years± 3.88 vs. 7.50 years± 7.39 P = .002) and “reason for immigration” ( P = .050). Anxiety was associated with “age” (41.1 years± 12.51 vs. 37.2 years± 11.5 P = .070) and “unemployment” ( P = .014). Anxiety-depression with “abuses” (76.5 vs. 23.5% P = .004), (100 vs. 0% P = .001), “psychopathological symptoms in childhood” (62.5 vs. 37.5% P = .042), (83.3 vs. 16.7% P = .023) and “clinical history of mental illness” (68.4 vs. 31.6% P = .001), (84.2 vs. 15.8% P = .001). “Clinical history of mental illness”, “abuses” and “unemployment” are risk factors for anxiety. Depression is associated with “family situation” as a protective factor and “clinical history of mental illness” and “psychopathological symptoms in childhood” as a risk factor. The qualitative analysis showed “relationships”, “vision of society” and “hope of going back home” as positive factors. Conclusions The prevalence of anxiety is no different to the general population, and the migration factors do not appear to modify our study.

Adverse Pregnancy Outcomes Among Foreign-Born Canadians

ObjectiveNumerous non-Canadian studies have shown that immigrant women experience higher rates of adverse maternal and perinatal events than the general non-immigrant population. Limited information about the pregnancy outcomes of immigrant Canadian women is available. MethodsWe conducted a retrospective cohort study at St. Michael's Hospital between October 2002 and June 2006 to estimate the risk of adverse obstetrical and perinatal outcomes among foreign-born women residing in Toronto. The main study outcomes were the incidences of preterm delivery between 32 and 36 completed weeks’ gestation, low infant birth weight, and delivery by Caesarean section. ResultsCompared with Canadian-born women, those who were foreign-born had an associated adjusted odds ratio of 0.85 (95% CI 0.64 to 1.14) for preterm delivery, 1.92 (95% CI 1.29 to 2.85) for low infant birth weight, and 1.16 (95% CI 1.01 to 1.34) for delivery by Caesarean section. ConclusionIn this study, foreign-born women had a non-significantly lower risk of preterm birth, but a significantly higher risk of low birth weight infants and Caesarean section than Canadian-born women. In this urban setting, recent immigrant women have worse pregnancy outcomes, warranting increased attention to this group during antenatal and intrapartum care.

How are the Children of Visible Minority Immigrants Doing in the Canadian Labour Market?

This paper examines the performance of the children of immigrants (2nd generation immigrants) to Canada using data from the 2006 Census. As the composition of immigration inflows has shifted after 1980 from the traditional European source countries to the Third World, the analysis focuses on the labour market performance of 2nd generation visible minority immigrants of whom there were 398 thousand aged15 and over who reported employment income in the Census. An encouraging fact revealed by the data is that 2nd generation visible minority immigrants are becoming more highly educated than 2nd generation non-visible minority immigrants and than non-immigrants – 46.2 per cent of 2nd generation visible minority between 25 and 44 earning employment had earned university certificates or degrees compared to 31 per cent of non-visible minority 2nd generation immigrants and 24 per cent of non-immigrants in the same age groups. But, while 2nd generation visible minority immigrants obtained more education than 2nd generation non-visible minority immigrants and non-immigrants, their performance as a group did not measure up in the labour market. In the 25 to 44 age group, accounting for the largest number of 2nd generation visible minority immigrants, they only earned on average $39,814, whereas 2nd generation non-visible minority immigrants earned $45,352 and non-immigrants 40,358. The labour market performance varies significantly among different visible minority groups. 2nd generation Chinese immigrants in the 25 to 44 age group actually earned $48,098, which was actually more than 2nd generation non-visible minority immigrants and non-immigrants. Because of the large number of Chinese included as 2nd generation immigrants, this buoyed up the overall average and masked the unfortunate fact that many other visible minority groups are doing much worse than average overall and falling short of non-immigrants. A troubling aspect of the performance of 2nd generation immigrants, except for Chinese and Japanese, is the extent to which they earn substantially less than non-immigrants and especially non-visible minority immigrants for any given level of education. The paper thus provides no grounds for complacency that the children of the recent, particularly non-Asian visible minority, immigrants who are performing so poorly in Canada’s labour market will catch up with non-immigrant groups, particularly given that their parents are currently performing much worse than earlier visible minority immigrants in the labour market. And it is unlikely that 2nd generation visible minority immigrants as a group will earn enough to make up for the current earnings shortfall experienced by their parents in recent cohorts of underperforming immigrants. Furthermore, the lower earnings of many visible minority groups for any given level of education are likely to continue be used as justification for more affirmative action programs. This will adversely affect the non-visible minority and non-immigrant population, and could become a source of increasing social tension.

Migration and psychotic disorders

The incidence of psychotic disorders is extremely high in several immigrant groups in Europe. This article describes the epidemiological evidence for increased incidence rates among immigrants compared with nonimmigrant populations and explores possible explanations for this excess risk. Potential causes not only involve factors acting at the level of the individual, but encompass the broader social context of neighborhoods and ethnic groups. Growing up and living in a disadvantaged ethnic minority position, characterized by a low social status, high degree of discrimination against the group and low neighborhood ethnic density, may lead to an increased risk of psychotic disorders, especially when individuals reject their minority status and when their social resources are insufficient to buffer the impact of adverse social experiences. Future research should refine measures of the social context, adopt a life-course perspective and should integrate social and neurobiological pathways.

Attachment, Coping, Acculturative Stress, and Quality of Life Among Haitian Immigrants

This study investigated the relationship between attachment, coping, acculturative stress, and quality of life (QOL) in a sample of Haitian immigrants in the United States. Results indicated that an increase in years living in the United States and greater anxiety attachment were negatively associated with QOL and that higher levels of adaptive coping were associated with higher QOL and lower levels of acculturative stress. Implications for counseling and recommendations for future research are discussed.

Westernization and tobacco use among young people in Delhi, India

Few studies have explored the relationship between acculturation and health in non-immigrant populations. The purpose of this study was to investigate the relationship between "westernization" and tobacco use among adolescents living in Delhi, India. A bi-dimensional model of acculturation was adapted for use in this study to examine (a) whether young people's identification with Western culture in this setting is related to tobacco use, and (b) whether their maintenance of more traditional Indian ways of living is related to tobacco use. Multiple types of tobacco commonly used in India (e.g., cigarettes, bidis, chewing tobacco) were considered. Socioeconomic status (SES), gender, and grade level were examined as potential effect modifiers of the relationship between "westernization" and tobacco use. The study was cross-sectional by design and included 3512 students in eighth and tenth grades who were enrolled in 14 Private (higher SES) and Government (lower SES) schools in Delhi, India. A self-report survey was used to collect information on tobacco use and "westernization." The results suggest that young people's identification with Western influences may increase their risk for tobacco use, while their maintenance of traditional Indian ways of living confers some protection. Importantly, these effects were independent of one another. Boys benefitted more from protective effects than girls, and tenth graders gained more consistent benefits than eighth graders in this regard, too. Negative effects associated with identification with Western ways of living were, in contrast, consistent across gender and grade level. The positive and negative effects of acculturation on adolescent tobacco use held for all tobacco products considered here. Future interventions designed to curb youth tobacco use in India may benefit by paying closer attention to cultural preferences of these young consumers.

Children of Immigrants: Family and Socioeconomic Indicators for Affluent Countries

Affluent countries around the world are experiencing an unprecedented demographic shift that involves rapid change in the ethnic composition of the population, due to large scale immigration from low and middle income countries, combined with the rapid aging of the non-immigrant population. Because these immigrants and their children often differ from the non-immigrant population in physical appearance, language, religion, and culture, increasing attention is focusing on the integration and inclusion of these groups. To provide a framework for interpreting the new indicators presented in this article, we draw on ideas recently set forth by the European Union. These efforts provide a broad and comprehensive framework for discussing indicators in this article pertaining to the demographic circumstances of children in immigrant families, and to various aspects of their integration, including language, civic participation, education, employment, and housing. While indicators presented here do not directly measure integration and inclusion, they do portray the lives of children in immigrant families compared with the lives of children in native-born families along civic, social, and economic dimensions that are relevant to the assessment of integration and inclusion, shedding light on the extent to which children in immigrant families in the eight settlement countries covered in this study have access to the resources necessary to participate fully in the societies of their adopted homelands. The eight countries included in this study are Australia, France, Germany, Italy, the Netherlands, Switzerland, the United Kingdom, and the United States.

Psychological Distress Among Immigrants and Visible Minorities in Canada: a Contextual Analysis

Immigrants to Canada are less likely to report depression compared with the non-immigrant population. This healthy migrant effect has not so far been explained by demographic and socioeconomic determinants of health. The present study examined whether the psychological health advantage of immigrants varied across Canadian health regions and investigated the hypothesis of immigrant density as a determinant of immigrant mental health advantage. Data from the 2000-2001 Canadian Community Health Survey were used to build multi-level models estimating variation in depression within and between health regions by immigrant/visible minority status. Immigrant and visible minority residents were less likely to experience depression compared with the general population. Depression varied across health regions and the extent of variation was greater for visible minorities. The likelihood of depression decreased with increasing percentage of immigrants in the region among visible minority participants but not among whites. The protection against depression afforded by immigrant and visible minority status in Canada appears to depend on contextual factors, notably the percentage of immigrants in the region. Future work should seek to better characterize the experiences of visible minorities in different settings.

Poids, santé générale et santé mentale: la situation de divers sous-groupes d’immigrants au Canada

Recent immigrants to Canada tend to be healthier than the non-immigrant population. Less is known about the health of different ethnic, cultural, and linguistic subgroups of immigrants in Canada. Data were taken from the 2005 Canadian Community Health Survey (Cycle 3.1). We used multiple logistic regression to examine associations for three immigrant characteristics (1-time since immigration, 2-visible minority status, 3-knowledge of an official language) and three health outcomes (1-self-rated general health, 2-self-rated mental health, 3-body mass index (BMI)) for Montreal, Toronto, and Vancouver, accounting for socio-demographic characteristics. Recent immigrants belonging to a visible minority have a lower likelihood of reporting poor general (OR 0.72, 95% CI 0.54-0.97) and mental (OR 0.64, 95% CI 0.43-0.96) health and BMI > or = 25 (OR 0.51, 95% CI 0.43-0.61) relative to non-immigrants. These associations were not present for recent immigrants not belonging to a visible minority. Immigrants who cannot converse in an official language have a higher likelihood of reporting poor general health (OR 1.49, 95% CI 1.06-2.10) relative to non-immigrants. In Toronto and Vancouver (but not Montreal), immigrants were less likely to have an elevated BMI. This study supports a healthy immigrant effect in Canada. However, the healthy immigrant effect is only present in certain subgroups of immigrants. These findings are important for the planning of health services targeting immigrants.

Comparison of African American and Afro-Caribbean Older Adults' Self-Reported Health Status, Function, and Substance Use

African American and Afro-Caribbean elders differ in regard to ethnic group membership, place of birth, and years of residence in the United States. In this study, the authors compare self-rated health status, function, and reports of substance use in these two groups. Fifty low-income African American and fifty low-income Afro-Caribbean adults older than 55 were matched on gender, income, and age (within a range of 3 years) for this study. Self-reported mental and physical health (SF-8), function (basic and independent activities of daily living), and tobacco and alcohol use were measured. Significant differences between the two ethnic groups were found on four of the SF-8 domains, the physical health summary measure, and tobacco use but not on the mental health summary measure, function, or alcohol use. The differences that emerged suggest a more positive health status and healthier behavior in the immigrant Afro-Caribbean group. Results may be explained by the healthy immigrant effect relating to better health of immigrant as opposed to nonimmigrant populations.