South Asian Canadians Research Articles

A Randomized Trial Assessing the Effectiveness of Ezetimibe in South Asian Canadians with Coronary Artery Disease or Diabetes: The INFINITY Study

Background. There is a paucity of data regarding the effectiveness and safety of lipid-lowering treatments among South-Asian patients. Methods. Sixty-four South-Asian Canadians with coronary artery disease or diabetes and persistent hypercholesterolemia on statin therapy, were randomized to ezetimibe 10 mg/day co-administered with statin therapy (EZE + Statin) or doubling their current statin dose (STAT2). Primary outcome was the proportion of patients achieving target LDL-C (<2.0 mmol/L) after 6 weeks. Secondary outcomes included the change in lipid profile and the incidence of treatment-emergent adverse events through 12 weeks. Exploratory markers for vascular inflammation were assessed at baseline and 12 weeks. Results. At 6 weeks, the primary outcome was significantly higher among the EZE + Statin patients (68% versus 36%; P = 0.031) with an OR (95% CI) of 3.97 (1.19, 13.18) upon accounting for baseline LDL-C and adjusting for age. At 12 weeks, 76% of EZE + Statin patients achieved target LDL-C compared to 48% (P = 0.047) of the STAT2 patients (adjusted OR (95% CI) = 3.31 (1.01,10.89)). No significant between-group differences in exploratory markers were observed with the exception of CRP. Conclusions. Patients receiving ezetimibe and statin were more likely to achieve target LDL-C after 6 and 12 weeks compared to patients doubling their statin dose. Ezetimibe/statin combination therapy was well tolerated among this cohort of South-Asian Canadians, without safety concerns.

South Asian Canadian Young Men and Women’s Interest Development in Science: Perception of Contextual Influences

The purpose of this descriptive case study was to examine the contextual and cultural influences on interest development in science for 24 Canadian South Asian young adults. Within this study, aspects pertaining to socialization with respect to self-efficacy and outcome expectations of engaging in the sciences, are consistent with existing formulations on South Asian families. Additionally, the study provides information as to the relationship between South Asian young adults’ cultural identification to contend with decision-making and perceptions of efficacy (individual and collective efficacy). Finally, this study broadens our understanding of how South Asians develop an interest in the sciences and the support of parents and siblings in helping participants prepare for their future. Implications for counselling practice and future research are discussed.

Cardiac medication prescribing and adherence after acute myocardial infarction in Chinese and South Asian Canadian patients

BackgroundFailure to adhere to cardiac medications after acute myocardial infarction (AMI) is associated with increased mortality. Language barriers and preference for traditional medications may predispose certain ethnic groups at high risk for non-adherence. We compared prescribing and adherence to ACE-inhibitors (ACEI), beta-blockers (BB), and statins following AMI among elderly Chinese, South Asian, and Non-Asian patients.MethodsRetrospective-cohort study of elderly AMI survivors (1995-2002) using administrative data from British Columbia. AMI cases and ethnicity were identified using validated ICD-9/10 coding and surname algorithms, respectively. Medication adherence was assessed using the 'proportion of days covered' (PDC) metric with a PDC ≥ 0.80 indicating optimal adherence. The independent effect of ethnicity on adherence was assessed using multivariable modeling, adjusting for socio-demographic and clinical characteristics.ResultsThere were 9926 elderly AMI survivors (258 Chinese, 511 South Asian patients). More Chinese patients were prescribed BBs (79.7% vs. 73.1%, p = 0.04) and more South Asian patients were prescribed statins (73.5% vs. 65.2%, p = 0.001). Both Chinese (Odds Ratio [OR] 0.53; 95%CI, 0.39-0.73; p < 0.0001) and South Asian (OR 0.78; 95%CI, 0.61-0.99; p = 0.04) patients were less adherent to ACEI compared to Non-Asian patients. South Asian patients were more adherent to BBs (OR 1.3; 95%CI, 1.04-1.62; p = 0.02). There was no difference in prescribing of ACEI, nor adherence to statins among the ethnicities.ConclusionDespite a higher likelihood of being prescribed evidence-based therapies following AMI, Chinese and South Asian patients were less likely to adhere to ACEI compared to their Non-Asian counterparts.

Altered health status and quality of life in South Asians with coronary artery disease

People of South Asian (SA) ancestry are susceptible to coronary artery disease (CAD). Although studies suggest that SA with CAD has a worse prognosis compared with Europeans, it is unknown whether corresponding differences in functional status and quality-of-life (QOL) measures exist. Accordingly, we compared symptoms, function, and QOL in SA and European Canadians with CAD using the Seattle Angina Questionnaire (SAQ). Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease, an outcomes registry that captures patients undergoing cardiac catheterization in Alberta, Canada, we identified 635 SA and 18,934 European patients with angiographic CAD from January 1995 to December 2006 who reported health status outcomes using the SAQ at 1 year after the index catheterization. To obtain comparable clinical variables among SA and Europeans, we used a propensity score-matching technique. One-year adjusted mean (SD) scores were significantly lower in SA compared with European Canadians for most SAQ domains: exertional capacity (75 [23] vs 80 [23], P = .011), anginal stability (77 [28] vs 77 [27], P = .627), anginal frequency (86 [23] vs 88 [20], P < .001), treatment satisfaction (86 [19] vs 89 [16], P < .001), and SAQ QOL (71 [24] vs 76 [21], P < .001). These results could not be accounted for by differences in baseline QOL scores or changes in health status from baseline to 1 year. South Asian Canadians with established CAD have significantly worse health status outcomes at 1 year after angiography compared with European Canadians. Further studies are warranted to improve functional outcomes in SA with CAD.

Prevalence and Characteristics of Substance Use Among Chinese and South Asians in Canada

This study examines Canadian Alcohol and Drug Use Monitoring Survey data to assess substance use prevalence among Chinese (n = 254), South Asians (n = 245), and Caucasians (n = 14,943). South Asians and Chinese reported less current drinking than Caucasians, and South Asians reported less current drinking than Chinese. South Asians and Chinese reported less cannabis use and any illicit drug use than Caucasians. Compared to Caucasians, Chinese reported less cigarette smoking and South Asians reported less use of any pain relievers. Additional research focusing on immigration and acculturation is warranted to further explore substance use patterns of South Asian and Chinese populations in Canada.

HIV-related stigma among South Asians in Toronto

Objectives. This paper explores the nature of HIV-related stigma among South Asians in Toronto, its consequences for people living with it and its role in determining access to HIV services. Design. The study is based on data from four focus group discussions with members of an HIV outreach organization, HIV-positive men and women, and women of different ages from the mainstream South Asian community. The questions were adapted from the Explanatory Model Interview Catalog that has been widely used to assess health-related stigma. Results. HIV-related stigma was found to be high in Toronto's South Asian community. Respondents perceived it to be greater among South Asians than in other Canadian communities. South Asian families were said to harbor the most stigma, often rejecting HIV-positive members. Differences were noted between first- and second-generation South Asian migrants in knowledge about, and stigma toward, HIV. Women living with HIV were found to be particularly disadvantaged and stigmatized. Because of stigma, many people living with HIV concealed their illness and avoided HIV-related services. Conclusion. Major gaps in knowledge about HIV among Canadian South Asians, and a considerable amount of stigma against people living with HIV, were found. The implications of stigma were highly problematic for people living with HIV, impeding access to services and social support. The paper concludes with recommendations to address stigma, based on suggestions from the study's participants.

Marc Maufort and Caroline de Wagter, eds. Signatures of the Past: Cultural Memory in Contemporary Anglophone North American Drama

MARC MAUFORT and CAROLINE DE WAGTER, eds. Signatures of the Past; Cultural Contemporary Anglophone North American Drama Bruxelles, Bern, Berlin, Frankfurt am Main, New York, Oxford, Wein: P.I.E. Peter Lang, 2008. 314 pp. Originating a conference at the Universite Libre de Bruxelles 2007, this inclusive collection of critical essays on postmodern and postcolonial Canadian and American drama English provides a detailed consideration of In his Introduction, Marc Maufort acknowledges both the genetic and generic affinity between the dramatic production of the two countries (11) and the and divergence respect to identities, exilic predicaments, and multi-ethnic subject positions (11-12), leaving the field wide open for the following twenty essays. Although he offers the proviso the notion of 'cultural memory' is not only an attribute of ethnic difference (14), most of the essays focus on minority cultures both countries, placed opposition to an assumed homogenous white majority In this collection, the recurrent motif of interculturalism is positioned both positively and negatively: the Canadian essays construct intercultural ism as conciliatory, whereas the Latina (American) essays view it as a form of cultural genocide. Only a few of the essays undertake useful cross-border comparisons which identify and similarity terms of cultural memory. Craig Walker's opening piece, 'Hopeful Memories and Doomed Freaks.' Evolutionary Overtones Canadian and American Drama, draws on the environics research of Michael Adams Fire and Ice (2003) to launch a provocative analysis of four Canadian performances which embody patterns of hope and fulfillment, and six American plays which enact harsher Darwinian principles with respect to survival terms of their monstrous protagonists. Other critical border crossings, however, occlude historical differences, as is the case Jacqueline Petropoulos's 'The Ground on Which I Stand'. Rewriting History, African Canadian Style, which interprets Djanet Sears's Adventures of a Black Girl Search of God and Harlem Duet terms of drawing on African American culture as part of the larger project of rewriting and reclaiming blackness an African Canadian and diasporic context (80). Harry f. Elam's Remembering Africa, Cultural Memory more convincingly places Djanet Sears an American context, a comparison with Lorraine Hansberry and Suzan-Lori Parks, implicitly demonstrating Sears's acknowledged debt to Hansberry. Although these acclaimed women playwrights (32) differ many respects, their plays position cultural memory in service of identity construction and racial repositioning the present (32). His essay, like many the collection, is informed by Diana Taylor's The Archive and the Repertoire and Paul Connerton's How Societies Remember, which insist on the performativity of cultural memory. Ric Knowles elaborates on Taylor's thesis Performing Intercultural the Diasporic Present. The Case of Toronto. He begins with the questionable categorical assertion that [a]ll memory bridges difference (49), and then clearly establishes his terminology, distinguishing interculturalism from Canada's much vaunted policy of multiculturalism, which he believes commodif[ies] or exoticiz[es] difference (49) and which constructs memory as nostalgic. He effectively mines Toronto's complex intercultural performance ecologies(49) for his diverse case studies, which move from the individual effort to suture a divided cultural identity to the communal building of shared cultural memory, to the actual constitution of new forms of community through prosthetic' memory-making (52): Fish Eyes by South Asian Canadian Anita Majumbar, Singkil by Filipina Canadian Catherine Hernandez, The Sheep and the Whale by Moroccan Canadian Ahmed Ghazali, and The Scrubbing Project by the Turtle Gals Performance Ensemble. …

The Role of Culture in Intergenerational Value Discrepancies Regarding Intergroup Dating

This study examined cultural and generational differences in views on intergroup dating relationships among members of younger and older generation South Asian and European Canadians and the role of mainstream and heritage cultural identities in shaping these views. In response to a scenario describing an intergroup dating conflict between a young adult and his or her parents, as well as on self-report measures of attitudes toward intergroup dating, South Asian Canadians and members of the older generation exhibited less favorable views on intergroup dating compared to European Canadians and members of the younger generation. Moreover, Canadian identity was consistently associated with more favorable views on intergroup dating, and this relationship was stronger for the South Asians. By comparing members of younger and older generation immigrants to their majority culture counterparts, the study adds a developmental layer to views on minority-majority group romantic relationships.

Connecting masculinities and physical activity among senior South Asian Canadian immigrant men

Connecting masculinities and physical activity among senior South Asian Canadian immigrant men

Cultural factors facilitating cardiac rehabilitation participation among Canadian South Asians: A qualitative study

South Asians experience high rates of cardiovascular disease, yet participate in cardiac rehabilitation (CR) at low rates. Drawing on the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model, this qualitative descriptive study sought to identify cultural factors facilitating South Asians' participation in CR programs. Two semistructured interviews were conducted with each of 16 Canadian South Asian participants enrolled in a 12-month CR program. Transcribed data were analyzed for common themes, and categorized in terms of predisposing, enabling, and reinforcing factors. Primary cultural facilitators included descriptions of CR as a "medically supervised" program, family and physician support, and previous knowledge of CR via members of the South Asian community. Previous research identified barriers to CR participation in the South Asian community, and this study is the first to identify facilitators. Results suggest that families should be included in patient-education sessions, CR should be reinforced by healthcare providers, and the provider team should recognize cultural preferences.

Impact of culture on use of Western health services by older South Asian Canadians.

South Asians are the largest visible minority group in Canada, but little research is available, particularly on the older adults and their use of Western health services. This study examined the effects of the predisposing, enabling, need, and cultural factors on the use of Western health services by older South Asian immigrants. Using a modified version of the Andersen-Newman service utilization model, the specific effects of cultural factors on use of Western health services were examined. A random sample of 220 South Asians 55 years and older were interviewed in Calgary using a structured telephone survey. Hierarchical regression analysis showed that the cultural factors were as important as the need factors in explaining the proportion of variance in the use of Western health services. Being a Hindu, immigrated to Canada for a longer period of time, fewer access barriers related to cultural incompatibility, a lower level of agreement with traditional South Asian health beliefs, and a stronger South Asian ethnic identity were significantly related to the use of more types of Western health services. The findings signify the importance of developing strategies for providing culturally competent health promotion, prevention, and intervention, and health care services.

Impact of Culture on Use of Western Health Services by Older South Asian Canadians

Objective: South Asians are the largest visible minority group in Canada, but little research is available, particularly on the older adults and their use of Western health services. This study examined the effects of the predisposing, enabling, need, and cultural factors on the use of Western health services by older South Asian immigrants. Method: Using a modified version of the Andersen-Newman service utilization model, the specific effects of cultural factors on use of Western health services were examined. A random sample of 220 South Asians 55 years and older were interviewed in Calgary using a structured telephone survey. Results: Hierarchical regression analysis showed that the cultural factors were as important as the need factors in explaining the proportion of variance in the use of Western health services. Being a Hindu, immigrated to Canada for a longer period of time, fewer access barriers related to cultural incompatibility, a lower level of agreement with traditional South Asian health beliefs, and a stronger South Asian ethnic identity were significantly related to the use of more types of Western health services. Conclusions: The findings signify the importance of developing strategies for providing culturally competent health promotion, prevention, and intervention, and health care services. Key words: Culture; service utilization; western health services; South Asian; elderly; older adults

Racial Differences in the Incidence of Colorectal Cancer

Colon cancer is one of the most common cancers and the second most common cause of cancer mortality in Western societies. Population screening has been introduced as a means to reducing its impact; however, there are little or no data on the incidence of this disorder in the different populations that comprise the Canadian population. To retrospectively determine the incidence of colorectal cancer in selected racial populations of British Columbia. The British Columbia Cancer Agency database was used to retrieve information on the incidence of cancers occurring during the years 1994 to 1998, with the British Columbia and national population censuses used to derive the age-specific and age-standardized incidence rates of colorectal cancers. Surnames were used to identify the origin of individuals from South Asian and Chinese backgrounds. For the Caucasian Canadian (C) population, the weighted age-standardized incidence rate ranged from 51.99 per 100,000 in 1995, to 57.68 per 100,000 in 1998. For Chinese Canadians (CC), the range was 39.2 per 100,000 in 1996, to 31.2 per 100,000 in 1998. For South Asian Canadians (SAC), the range was 7.40 per 100,000 in 1994, to 24.85 per 100,000 in 1998. The RR for the development of cancer were significantly different when comparing C versus CC (RR 1.9; 95% CI 1.58 to 2.31; P<0.001), C versus SAC (RR 7.1; 95% CI 4.20 to 12.0; P<0.0001) and CC versus SAC (RR 3.7; 95% CI 2.14 to 6.5; P<0.0001). Significant differences in the incidence of colorectal cancers have been defined for the first time in various racial subgroups in British Columbia. This finding may have important implications for both screening and understanding of the environmental factors influencing the biology of these lesions. Because SAC have among the highest incidence of atherosclerotic heart disease and diabetes, it suggests that unidentified genetic and/or environmental protective factors are capable of countering the traditionally recognized risk of high saturated fat intake for the development of colorectal cancer.

Differences in social support and illness perceptions among South Asian and Caucasian patients with coronary artery disease

Social support and illness perceptions may affect recovery from a cardiac event or procedure. Previous research has found that patients of South Asian origin with coronary artery disease (CAD) have lower levels of social support and may perceive different causes of their condition. The purpose of this study was to quantitatively investigate differences in social support and illness perceptions between Caucasian and South Asian patients with CAD. A total of 562 inpatients with CAD (53 [9%] South Asian) were recruited from 2 hospitals. The Medical Outcomes Study social support scale and Illness Perception Questionnaire were administered to examine ethnocultural differences in total social support and subscales, and in illness perceptions subscales, including causes of illness. South Asian participants had significantly lower levels of tangible (P=.001) and emotional/informational support (P < .001) compared with Caucasian participants. South Asians were less likely than Caucasians to believe they have personal control over their illness (P < .001). Trends were observed, with South Asian participants being more likely to attribute their condition to stress/worry (P=.04) and poor medical care in the past (P=.02) and less likely to attribute their illness to aging (P=.03) compared with Caucasian participants. Lower levels of social support among South Asians in Canada may have negative effects on recovery and prognosis. Our results support qualitative findings suggesting South Asians perceive their illness to be a result of fate or related to stress. Future studies should investigate interventions targeted at modifying illness perceptions among this group in an attempt to improve risk-reducing behavior and secondary prevention use.

Connecting masculinities and physical activity among senior South Asian Canadian immigrant men

Senior South Asian (SA) men experience many health challenges which may be exacerbated by immigration. However, little is known about the health practices of this subgroup of men, including how they conceptualize connections between exercise, health and illness. An ethnographic qualitative study including fieldwork and participant observations at South Asian men's groups (SAMGs) based in British Columbia (BC), Canada and individual interviews with 36 attendees (group leaders and non-leader group members) were conducted to better understand how masculinity (as it intersects with culture, social class and age) informs and influences men's physical activity. The findings indicated that few men linked exercise with specific illnesses; however, age-induced musculoskeletal impairment and a cold, wet Canadian climate were the main restrictors of men's physical activity. Traditional SA cultures and in some cases economic hardship influenced men's preference for walking to socially connect with other men, while strenuous activity was detailed in nostalgic ways as a previously used tool for securing paid labor. The results indicate varying masculine identities, roles and relations in how men conceptualized and embodied physical activity, some of which were incongruent with Western ideals about men and exercise. Collectivism was a prevailing SA cultural norm for participants, which should be thoughtfully considered in the design and distribution of exercise-based health promotion programs targeted to senior SA Canadian immigrant men.

Experiences of South Asian Brides Entering Canada After Recent Changes to Family Sponsorship Policies

South Asians in Canada often apply the traditional custom of arranged marriage across international borders, leading to male sponsorship of family-chosen brides from their home countries. This qualitative study examined understandings of sponsorship and marital/resettlement experiences among English-proficient and non-English-proficient South Asian brides who entered Canada after recent immigration policy changes to reduce sponsored women's vulnerability to maltreatment. English-proficient women were aware of their rights and permanent resident status, and reported significant integration support. In contrast, non-English-proficient women misunderstood sponsorship and faced multiple barriers to participation in Canadian life, along with severe abuse and neglect.

South Asian Canadian Girls' Strategies of Racialized Belonging in Adolescence

In this article, I examine how second generation South Asian Canadian girls negotiate their racialized position in peer culture, through various strategies of accommodation, denial and resistance. I use feminist post-structuralist theories of discourse and positioning with feminist and narrative methods to analyze my interviews with ten subjects about their racialized adolescence. I argue that girls use certain strategies of accommodation—'passing', wannabe-ism, and strategic Otherness—to fit in without abandoning their ethnicized identities. Strategies of denial surface through girls' internalizing of dominant discourses of racism; this leads them to rationalize racism or invoke assimilationist narratives that hold minorities responsible for their own experiences of exclusion. Girls also use strategies of resistance in which they identify hegemonic discourses of belonging, speak openly about racism or criticize aspects of white culture in the context of South Asian community and family norms.

Relationship Satisfaction among South Asian Canadians: The Role of ‘Complementary-Equality’ and Listening to Understand

This study explored the ways in which adherence to traditional marital expectations in ones marriage was related to styles of interpersonal listening and marital satisfaction among IndoPakistanis living in a Western country. Participants (n = 114) were recruited from a large metropolitan city in Canada, were married, and their ages ranged from 19 to 67 years. They completed measures of marital satisfaction, listening styles, and traditional orientation to marriage. Results indicated that greater adherence to traditional marital beliefs were correlated with lower levels of interpersonal listening and marital satisfaction. However, closer examination of the traditional orientation subscales revealed that expectation of traditional husband and wife roles did not result in lower empathic listening in one’s marriage or lower marital satisfaction, but the lower degree to which one believed in upholding equality in undertaking such traditional roles did. Furthermore, empathic listening mediated the relationship between belief in equality in one’s relationship and marital satisfaction. The implications of these results for enhancing relationship satisfaction for Indo-Pakistanis are discussed.

The Liminality of Culture: Second Generation South Asian Canadian Identity and the Potential for Postcolonial Texts

This article problematizes the issues surrounding the schooling experiences of visible minority Canadians. It highlights some of the exclusionary practices through a critical examination of recalled memories as well as theories which support the notion that “visible minority” Canadian students experience feelings of “racelessness” and identity confusion in the face of exclusionary literacy practices in Canadian schools. This study is particularly significant in light of new research that questions the efficacy of official multiculturalism for the children of visible minority Canadians who exhibit “a more profound sense of exclusion than their parents” (Jimenez, Globe &amp; Mail, January 12, 2007, A1).

Cultural differences in the relationship between parenting and children's behavior.

Parent and teacher data for 14,990 children from the National Longitudinal Survey of Children and Youth were used in multilevel analyses to examine the relationship between ethnicity, children's aggression and emotional problems, and parenting. Using parent and teacher report, relationships between ethnicity and child behavior were present but modest. The association between parental harshness and child aggression differed between ethnic groups and across informants. Using teacher report of outcomes, parental harshness was positively related to child aggression in European Canadian families but negatively related in South Asian Canadian families. For all ethnic groups, parental harshness was positively related to children's aggression when parent report of outcomes was used, but relationships varied in strength across ethnic groups. The relationship of parental harshness with child emotional problems did not differ across groups, irrespective of informant. The results are discussed within the context of an ecological model of parenting.