RESUMEN
PURPOSE: Mental health (MH) is a critical public health issue. Arab immigrants/refugees (AIR) may be at high risk for MH problems owing to various unique stressors, such as post-September/11 demonization. Despite the growing AIR population in Western countries, there is a lack of AIR-MH research in these nations. The CAN-HEAL study examined MH experiences and needs among AIR in Ontario, Canada. METHODS: This study employed a cooperative community-based participatory research and integrated knowledge translation approach. The study used photovoice, qualitative interviews and a questionnaire survey. Sixty socio-demographically diverse AIR adults partook in this study. The research was informed by the "social determinants of health" framework and the "years since immigration effect" (YSIE) theory. RESULTS: The term "mental health" was deemed offensive for participants aged > 30 years. Participants proposed other culturally-appropriate words including "well-being" and "emotional state". The prevalence of poor mental well-being in the sample was alarming (55%). Of first-generation immigrant participants, 86.8% reported negative changes in MH since migration. The negative changes are not straightforward; they are complex and dynamic, and mainly related to micro/macro-aggression, cross-cultural pressures, dissatisfaction with the health and social care system, and poor living conditions. Intersections between different socio-demographic factors (e.g., gender, length of residency, income, parenthood, religion) amplified the negative changes in MH and exacerbated inequities. CONCLUSIONS: MH needs among AIR are distinct and intersectionality aggravated inequities. Culturally and structurally competent healthcare and structural/policy reformation are required to tackle MH inequities. This can be fulfilled through intersectoral cooperation and including AIR in decision-making.
RESUMEN
Nutritional psychiatry suggests that diet quality impacts one's mental health (MH). The relationship between food/nutrition and MH may be particularly salient for immigrants/refugees who often experience high risk for household food insecurity and MH challenges. An innovative collaborative community-based participatory research and integrated knowledge translation approach was adopted to explore food/nutrition needs as they relate to MH among Arab immigrants/refuges (AIR) in Ontario, Canada. The goal was to co-identify areas that require social change and co-produce applicable knowledge for service improvement. The CAN-HEAL study used a multi-methodological approach, employing qualitative interviews, photovoice and a questionnaire survey. A combination of three sampling approaches (convenience, snowball and purposive) was used to recruit sixty socio-demographically-diverse adult AIR participants. The research was guided by an integrated bio-psycho-socio-cultural framework. Participants reported various socio-economic and structural barriers to nutritious eating. Food quality/safety was a significant concern and source of anxiety among AIR; food mislabeling, the widespread presence of genetically/chemically modified foods and expired/rotten food products were associated with negative MH. Participants experienced an alarming prevalence of food insecurity (65%), which was associated with negative MH. Intersections among age, gender, religion, socio-economic status, parenthood, disability, and place of residence played a considerable role in how nutrition, food security, and dietary intake impacted AIR's MH and caused substantial disparities within the AIR community. The food/nutrition-MH relationship among AIR is multi-faceted, and various psycho-socio-cultural pathways/processes were found to shape MH. Intersectoral collaboration between health and non-health sectors is needed to implement a co-proposed socio-political and community-level action plan to achieve nutrition and health equity for AIR and other similar marginalized groups.
Asunto(s)
Emigrantes e Inmigrantes , Refugiados , Adulto , Humanos , Salud Mental , Árabes , Canadá , OntarioRESUMEN
Epidemiological evidence suggests that regular physical activity (PA) positively impacts individuals' mental health (MH). The PA-MH relationship may be critical among immigrants owing to psycho-social-cultural influences. This scoping review of 61 studies employed a holistic bio-psycho-socio-cultural framework to thoroughly investigate the complex relationship between PA (across life domains) and immigrants' MH in Western countries. A systematic search of five electronic databases (Medline, PubMed, Embase, PsycINFO and Anthropology Plus) was conducted to locate relevant articles. No limitations were applied to study design, age, gender, home country, MH condition or PA type. A bio-psycho-socio-cultural-informed conceptual model guided the analysis of the multi-domain PA-MH relationship. Immigrant PA-MH studies were conducted and reported most commonly in the USA (38%), Australia (18%), and Canada (11%). Overall, PA was positively related to MH. Each domain-specific PA appeared to be associated with unique MH-promoting pathways/mechanisms. Leisure-related PA may support MH by enhancing self-agency and minimizing risky behaviors, whilst travel- and domestic-related PA may promote self-accomplishment and physical engagement. Ethnic sports appeared to enhance resilience. Occupational-related PA was associated with either positive or negative MH, depending on the type of occupation. A bio-psycho-socio-cultural-informed model is required to gain an encompassing and integrated understanding of immigrants' health. The first iteration of such a model is presented here, along with an illustration of how the model may be used to deepen analysis and understanding of the multi-domain PA-MH relationship among immigrants and inform public health planners and practitioners.
Asunto(s)
Emigrantes e Inmigrantes , Deportes , Humanos , Salud Mental , Ejercicio Físico , Salud PúblicaRESUMEN
Epidemiological evidence suggests that diet and nutrition not only impact individuals' physical health but also shape their mental health (MH). The nutrition/diet-MH relationship may be critical among immigrants due to socioeconomic and sociocultural factors. Despite the complex nutrition/diet-MH relationship, most scholarship in this area employs a biomedical perspective. This scoping review of 63 studies deployed a holistic bio-psycho-socio-cultural framework to examine the relationship between diet/nutrition and immigrants' MH. Five automated databases (Embase, PubMed, Medline, PsycINFO and Anthropology Plus) were systematically searched for relevant articles from Western countries. A bio-psycho-socio-cultural conceptual model guided the analysis of the multi-faceted diet/nutrition-MH relationship. Consumption of fruit/vegetables, unsaturated fats, vitamin D-rich foods and whole grains was significantly positively related to MH. Reported pathways included enhanced self-esteem and ability to stay physically active. Energy-dense food consumption emanating from unhealthful dietary acculturation to the Western lifestyle was associated with poor MH through various mechanisms, including exhaustion and worry about developing non-communicable diseases. Food insecurity and related hunger were significantly positively associated with depression and anxiety among immigrants through different pathways, including family conflicts, homesickness, social exclusion, feelings of shame/stigma, and helplessness related to not affording nutritious foods that meet one's cultural dietary requirements. Ethnic food consumption appeared to mitigate MH issues and enhance immigrants' well-being. A bio-psycho-socio-cultural-informed model is needed to gain an in-depth and encompassing understanding of immigrant MH as it relates to diet/nutrition. The first iteration of such a model is presented in this review alongside an illustration of how it may be used to strengthen an analysis and understanding of the multi-faceted diet/nutrition-MH relationship amongst immigrants and inform public health professionals and dieticians/practitioners.
Asunto(s)
Emigrantes e Inmigrantes , Salud Mental , Humanos , Dieta , Frutas , VerdurasRESUMEN
Indigenous households are 90 times more likely to be without running water than non-Indigenous households in Canada. Current primary indicators of water quality and security for Indigenous Peoples are based on federal boil water advisories, which do not disaggregate at household levels to identify who is most at risk within or between communities. A mixed methods approach was used to assess the level of water insecurity and perceptions of water access by gender and age for a sample of households in Six Nations of the Grand River First Nations in Ontario, Canada. A household survey captured water security using the Household Water InSecurity Experiences (HWISE) scale and Likert-type responses to perceptions of water access, contextualized using semi-structured individual and group interviews. From 2019 to 2020, 66 households participated in the survey, 18 individuals participated in semi-structured individual interviews, and 7 individuals participated in 3 semi-structured group interviews. The survey sample demonstrated high levels of household water insecurity (57.5%, n = 38). Interviews revealed that women were more dissatisfied with their drinking water situations due to quality, source, and cost, though they shared water sharing as a coping strategy. Women faced more physical and mental barriers accessing water for their households, due to their roles as caretakers of their family and knowledge protectors for their communities. Generational divides were found in interviews about what qualified as "good water," with older participants understanding it as relating to traditional water sourcing, and younger participants wanting clean, accessible tap water. Taken together, the participants demonstrated a frustration with the sub-standard drinking water on reserve.
Asunto(s)
Agua Potable , Femenino , Abastecimiento de Alimentos , Humanos , Ontario , Factores Socioeconómicos , Inseguridad HídricaRESUMEN
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.
Asunto(s)
Emigrantes e Inmigrantes , Salud Mental , Humanos , Estado de SaludRESUMEN
Poor mental health (MH) is a substantial public health problem, affecting over 13% of the population worldwide. Arabic-speaking immigrants and refugees (ASIR) are at high risk of MH problems due to intercultural adjustment stress, racism and discrimination. This scoping review of 49 studies explored pre- and post-migration MH determinants among ASIR in North America. Pre-migration MH determinants were politically related. English illiteracy was a significant triggering factor for distress and depression. Post-migration sociocultural MH protective factors included positive ethnic identity, spirituality, family support and social cohesion. Resilience, expressed as hope, significantly protected ASIR against depression and distress. MH triggering factors, emanating from social inequalities, were domestic violence, discrimination, stigmatization and poverty. Mixed-methods studies are needed to inform culturally-congruent, MH-promoting and resilience-building interventions. Intersectoral collaboration and Healthy Public Policy, based on the WHO Health in All Policies framework, are required to address social and health inequities, reducing MH challenges among ASIR.
Asunto(s)
Emigrantes e Inmigrantes , Refugiados , Humanos , Salud Mental , América del Norte , Factores Protectores , Refugiados/psicologíaRESUMEN
OBJECTIVES: Gestational weight gain (GWG) is increasingly monitored in the United States and Canada. While promoting healthy GWG offers benefits, there may be costs with over-surveillance. We aimed to explore these costs/benefits. METHODS: Quantitative data from 350 pregnant survey respondents and qualitative focus group data from 43 pregnant/post-partum and care-provider participants were collected in the Mothers to Babies (M2B) study in Hamilton, Canada. We report descriptive statistics and discussion themes on GWG trajectories, advice, knowledge, perceptions, and pregnancy diet. Relationships between GWG monitoring/normalization and worry, knowledge, diet quality, and sociodemographics-namely low-income and racialization-were assessed using χ2 tests and a linear regression model and contextualized with focus group data. RESULTS: Most survey respondents reported GWG outside recommended ranges but rejected the mid-20th century cultural norm of "eating for two"; many worried about gaining excessively. Conversely, respondents living in very low-income households were more likely to be gaining less than recommended GWG and to worry about gaining too little. A majority had received advice about GWG, yet half were unable to identify the range recommended for their prepregnancy BMI. This proportion was even lower for racialized respondents. Pregnancy diet quality was associated with household income, but not with receipt or understanding of GWG guidance. Care-providers encouraged normalized GWG, while worrying about the consequences of pathologizing "abnormal" GWG. CONCLUSIONS: Translation of GWG recommendations should be done with a critical understanding of GWG biological normalcy. Supportive GWG monitoring and counseling should consider clinical, socioeconomic, and community contexts.
Asunto(s)
Dieta , Ganancia de Peso Gestacional , Conocimientos, Actitudes y Práctica en Salud , Adulto , Canadá , Femenino , Humanos , Ontario , Embarazo , Estados Unidos , Adulto JovenRESUMEN
The Developmental Origins of Health and Disease (DOHaD) hypothesis derives from the epidemiological and basic/mechanistic health sciences. This well-supported hypothesis holds that environment during the earliest stages of life-pre-conception, pregnancy, infancy-shapes developmental trajectories and ultimately health outcomes across the lifespan. Evolutionary anthropologists from multiple subdisciplines are embracing synergies between the DOHaD framework and developmentalist approaches from evolutionary biology. Even wider dissemination and employment of DOHaD concepts will benefit evolutionary anthropological research. Insights from experimental DOHaD work will focus anthropologists' attention on biochemical/physiological mechanisms underpinning observed links between growth/health/behavioral outcomes and environmental contexts. Furthermore, the communication tools and wide public appeal of developmentalist health scientific research may facilitate the translation/application of evolutionary anthropological findings. Evolutionary Anthropology, in turn, can increase mainstream DOHaD research's use of evolutionary theory; holistic, longitudinal, and community-based perspectives; and engagement with populations whose environmental exposures differ from those most commonly studied in the health sciences.
Asunto(s)
Antropología Física , Evolución Biológica , Investigación Biomédica , HumanosRESUMEN
Sub-standard nutrition is a leading risk factor for many non-communicable diseases and causes 11 million diet-related deaths annually worldwide. Arabic-speaking immigrants and refugees (ASIR) are at high risk for poor nutrition due to socio-cultural and economic-ecological factors. We reviewed the literature to explore the impact of acculturation on ASIR's dietary practices and to investigate barriers vs. facilitators to healthy eating among them. Five electronic databases (PsycINFO, Medline, Anthropology Plus, Embase and Sociology Database) were systematically searched. Only English articles from North America (the US and Canada), Europe, Australia and New Zealand were included. Twenty-four studies were included for evidence synthesis. North America is substantially ahead of Europe in ASIR-nutrition research, whereas Australia and New Zealand are lacking in this type of research. Acculturation into a Western lifestyle was associated with positive and negative changes to ASIR's diet, with increased fruit/vegetable intake, but also a significant increase in consumption of low nutrient, energy-dense foods. Personal barriers to healthful eating related to lack of nutrition awareness and language issues, whereas improved nutrition education was a strong facilitator. Children's preferences and religious dietary proscriptions were key sociocultural barriers to nutritious eating, whereas availability/accessibility of ethnic grocery stores was a powerful facilitator. Within North America, but not Europe, unaffordability of healthy foods and lack of genetically modified food labelling were leading barriers to eating nutritiously. Community-engaged and mixed methods research on diet, nutrition and food (in)security among ASIR is required to inform the design of effective, culturally acceptable dietary interventions. Western societies need to introduce major changes in food policy and financial support for progressive programs to ensure equitable access to nutritious, culturally appropriate food for ASIR and other similar minority groups.
Asunto(s)
Emigrantes e Inmigrantes , Refugiados , Australia , Canadá , Niño , Dieta , Europa (Continente) , Humanos , Lenguaje , Nueva ZelandaRESUMEN
Environmental factors affecting development through embryogenesis, pregnancy, and infancy impact health through all subsequent stages of life. Known as the Developmental Origins of Health and Disease (DOHaD) hypothesis, this concept is widely accepted among health and social scientists. However, it is unclear whether DOHaD-based ideas are reaching the general public and/or influencing behaviour. This study thus investigated whether and under what circumstances pregnant people in Canada are familiar with DOHaD, and if DOHaD familiarity relates to eating behaviour. Survey responses from pregnant people from Hamilton, Canada, were used to assess respondents' knowledge of DOHaD (hereafter, DOHaDKNOWLEDGE ) compared with their knowledge of more general pregnancy health recommendations (Pregnancy GuidelineKNOWLEDGE ). The survey also characterized respondents' pregnancy diet quality and sociodemographic profiles. We fit two multiple, linear, mixed regression models to the data, one with DOHaDKNOWLEDGE score as the dependent variable and the other with diet quality score as the dependent. In both models, responses were clustered by respondents' neighbourhoods. Complete, internally consistent responses were available for 330 study-eligible respondents. Relative to Pregnancy GuidelineKNOWLEDGE , respondents had lower, more variable DOHaDKNOWLEDGE scores. Additionally, higher DOHaDKNOWLEDGE was associated with higher socio-economic position, older age, and lower parity, independent of Pregnancy GuidelineKNOWLEDGE . Diet quality during pregnancy was positively associated with DOHaDKNOWLEDGE , adjusting for sociodemographic factors. A subset of relatively high socio-economic position respondents was familiar with DOHaD. Greater familiarity with DOHaD was associated with better pregnancy diet quality, hinting that translating DOHaD knowledge to pregnant people may motivate improved pregnancy nutrition and thus later-life health for developing babies.
Asunto(s)
Dieta/métodos , Conocimientos, Actitudes y Práctica en Salud , Fenómenos Fisiologicos Nutricionales Maternos , Estado Nutricional , Complicaciones del Embarazo/epidemiología , Adulto , Canadá/epidemiología , Femenino , Humanos , EmbarazoRESUMEN
The presentation of osteoporosis as a woman's disease in prevention information influences how osteoporosis is perceived and how prevention information is internalized and applied. Using the Health Belief Model as a framework, gendered perceptions of osteoporosis were investigated in Canadian young adults to inform the design of prevention programs. A combination of the Osteoporosis Health Belief Scale (OHBS) and semi-structured interviews were used to explore participants' perceptions of osteoporosis severity, susceptibility, and motivation to engage in prevention activities. Sixty multiethnic men and women aged 17-30 years living in Hamilton, Ontario, Canada participated in the study. While the findings from the OHBS indicated that both genders scored high for self-efficacy, the results from the qualitative interviews showed ambivalent attitudes toward prevention behaviors, indicating a disconnect between quantitative and qualitative findings. Perceptions related to severity and susceptibility revealed that while osteoporosis was generally viewed as a woman's disease, perceived individual risk of disease was a negotiation between larger gender constructs of osteoporosis and a variety of risk factors. This study indicates that osteoporosis prevention programs should consider actively acknowledging gendered and youth-based conceptions of osteoporosis in order to increase prevention behaviors in the whole population to reduce future disease.
Asunto(s)
Conductas Relacionadas con la Salud/fisiología , Promoción de la Salud/métodos , Osteoporosis/prevención & control , Percepción/fisiología , Medicina Preventiva/métodos , Adolescente , Adulto , Canadá/epidemiología , Susceptibilidad a Enfermedades , Femenino , Identidad de Género , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Motivación , Osteoporosis/epidemiología , Osteoporosis/psicología , Investigación Cualitativa , Factores de Riesgo , Autoeficacia , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: To identify the relationship between perceptions of Ca and vitamin D consumption and actual intakes to inform the design of osteoporosis prevention education. DESIGN: An FFQ was used to approximate usual monthly Ca and vitamin D intakes among a group of young Canadians. Qualitative interviews and a food card pile sort activity explored individuals' perceptions of nutrient intakes. The FFQ was used to assess nutrient adequacy for individual participants and the qualitative interviews and pile sort were analysed using thematic content analysis. SETTING: Hamilton, Canada. SUBJECTS: Sixty participants aged 17-30 years, representing varying levels of educational attainment. RESULTS: Seventy-eight per cent of young adults who consumed inadequate vitamin D perceived their intake as adequate, compared with 57 % for Ca. Thematic analysis revealed three major themes that contributed to young adults' understandings of intake: belief their diet was correct, absence of symptoms and confusion over nutrient sources. CONCLUSIONS: The majority of participants perceived themselves as consuming adequate amounts of Ca and vitamin D, when they were actually consuming inadequate amounts according to FFQ findings. These perceptions were related to low engagement in prevention activities. Prevention education must motivate young adults to question the adequacy of their micronutrient intakes and design tailored programmes that are geared to a young adult audience.
Asunto(s)
Calcio de la Dieta/administración & dosificación , Educación en Salud , Encuestas Nutricionales/estadística & datos numéricos , Osteoporosis/prevención & control , Vitamina D/administración & dosificación , Adolescente , Adulto , Canadá , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Adulto JovenRESUMEN
PURPOSE: This study compares knowledge and practice of infant vitamin D supplementation among immigrant, refugee, and Canadian-born mothers. METHOD: Focus group discussions with 94 mothers of children aged 0 to 3 years recruited from early childhood centers and a refugee health clinic. FINDINGS: Both immigrant and Canadian-born mothers indicated good knowledge and use of infant vitamin D supplementation. In contrast, Canadian government-assisted refugees were less likely to supplement with vitamin D. The main source of information about vitamin D was public health prenatal classes. Many mothers reported inconsistent guidance from health care providers. DISCUSSION AND CONCLUSIONS: Exclusively breastfed infants of refugees may be more at risk of vitamin D deficiency. All mothers require clear recommendations, both in clinical and public health settings. IMPLICATIONS FOR PRACTICE: Mothers, both new Canadian and Canadian-born, require clear and consistent messaging from health professionals. Refugee mothers, however, require more educational support to promote infant vitamin D supplementation.
Asunto(s)
Suplementos Dietéticos/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Madres/estadística & datos numéricos , Vitamina D/uso terapéutico , Canadá/etnología , Preescolar , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Femenino , Grupos Focales , Humanos , Lactante , Madres/psicología , Refugiados/psicología , Refugiados/estadística & datos numéricos , Deficiencia de Vitamina D/tratamiento farmacológicoRESUMEN
There has been a meteoric rise over the past two decades in the medical research and media coverage of the so-called global childhood obesity epidemic. Recently, in response to this phenomenon, there has been a spate of books and articles in the fields of critical sociology and cultural studies that have argued that this "epidemic" is socially constructed, what Natalie Boero (2007) dubs a "postmodern epidemic." As an anthropologist who has studied child nutrition and obesity in relation to poverty and the school environment, I am concerned about both the lack of reflexivity among medical researchers as well as critical scholars' treatment of the problem as entirely socially constructed. In this article I present both sides of this debate and then discuss how wee can attempt to navigate a middle course that recognizes this health issue but also offers alternative approaches to those set by the biomedical agenda.
Asunto(s)
Obesidad/epidemiología , Terminología como Asunto , Adolescente , Índice de Masa Corporal , Canadá/epidemiología , Niño , Preescolar , Política de Salud , Promoción de la Salud , Humanos , Obesidad/psicología , Sobrepeso/clasificación , Prejuicio , Factores de Riesgo , Factores Socioeconómicos , Estados Unidos/epidemiologíaRESUMEN
PURPOSE: Food consumption was investigated in children attending three elementary schools in urban Hamilton, Ontario. METHODS: Dietary data were collected from 92 children in grades 2 to 4 through 24-hour dietary recalls (39% participation rate). Servings of four food groups were compared with recommended daily servings in Canada's Food Guide. RESULTS: The majority of students did not consume the recommended five daily servings of vegetables and fruit. On average, they consumed a high number of servings of "other foods," which were not included in the four food groups. More than 50% of the students did not consume the recommended daily servings of milk products, and only a small proportion (21%) drank milk during school lunch. CONCLUSIONS: We recommend that primary school educators promote the consumption of vegetables and fruits and milk products at school, either through healthy snack programs or educational programs.
Asunto(s)
Encuestas sobre Dietas , Conducta Alimentaria , Política Nutricional , Estudiantes/psicología , Niño , Fenómenos Fisiológicos Nutricionales Infantiles , Femenino , Preferencias Alimentarias/psicología , Frutas , Humanos , Masculino , Recuerdo Mental , Necesidades Nutricionales , Ontario , Instituciones Académicas , VerdurasRESUMEN
Epigenetic and life history approaches to child growth are centered on the relationship between the organism and its environment. However, defining and operationalizing the concept of environment is challenging, in light of the multiple variables that influence growth. Moreover, the concept of adaptation as it applies to child growth is seldom considered in the developed country context. This paper presents a study of children living in three neighborhoods in the City of Hamilton, Ontario, Canada. Two of the communities are considered adverse environments on the basis of low socioeconomic status, and their inner city, industrial location. In contrast to children living in the higher socioeconomic status area, children in these adverse environments display negative growth indicators, i.e., somewhat constrained linear growth in one and risk for overweight and obesity in both. Although both these inner city neighborhoods constitute adverse environments, they differ in ways that have a significant impact on children's growth. We argue for a definition of "adverse environment" that is broadly based, incorporating a range of physical, social, and temporal factors that are highly localized and sensitive to community-level influences on growth and health. As well, we consider whether higher prevalence of overweight and obesity is adaptive in any way to these adverse environments and conclude that they are more likely to be deleterious than adaptive in either the long or short term.
Asunto(s)
Desarrollo Infantil/fisiología , Ambiente , Pesos y Medidas Corporales , Canadá/epidemiología , Niño , Estudios Transversales , Femenino , Humanos , Masculino , Factores SocioeconómicosRESUMEN
This study addresses links between economic and nutritional variation in an urban North American setting. We employed a mixed-methods approach including mapping, semi-structured interviews, and food outlet surveys to investigate the public health impact of variation in the cost and availability of food between two socioeconomically distinct neighbourhoods of the City of Hamilton, Ontario, Canada. Food cost in supermarkets was not found to be higher in the low-income neighbourhood, though it was much higher in the variety stores that predominate in the low-income neighbourhood. Moreover, there was a very low availability of produce in the variety stores. Reduced fresh produce availability and lower incomes have the potential to negatively influence public health in the less-affluent study area by increasing the difficulty of acquiring healthy foods.
Asunto(s)
Dieta/economía , Abastecimiento de Alimentos/economía , Alimentos/economía , Características de la Residencia/clasificación , Costos y Análisis de Costo , Dieta/clasificación , Alimentos/clasificación , Abastecimiento de Alimentos/estadística & datos numéricos , Humanos , Entrevistas como Asunto , Encuestas Nutricionales , Estado Nutricional/fisiología , Ontario , Áreas de Pobreza , Factores Socioeconómicos , Población UrbanaRESUMEN
Much of what we know about the determinants of access to health care comes from studies undertaken at a large scale, such as between cities, regions/counties/provinces/states and countries. This paper examines local level variations in access to and utilization of health care services across four distinct neighbourhoods in Hamilton, Ontario, Canada. Survey data (n = 1500) were analysed using logistic regression to explore the potential relationships between neighbourhood and health care utilization and unmet health care need. Results show some relationships between neighbourhood of residence and levels of reported utilization as well as unmet need, even when controlling for predisposing, enabling, and need factors (i.e. Age, gender, household composition, income, education, perceived gp visit time) as well as health status. Findings from this empirical study suggest a finer lens is required to examine the mechanisms through which place impacts access to and utilization of care, one that recognizes the roles of compositional, contextual and collective aspects of neighbourhood.
Asunto(s)
Accesibilidad a los Servicios de Salud , Características de la Residencia , Adolescente , Adulto , Estudios Transversales , Recolección de Datos , Atención a la Salud/organización & administración , Atención a la Salud/estadística & datos numéricos , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , OntarioRESUMEN
The differential impact of diarrhea, respiratory infections, and protozoan parasitism on growth is investigated among children under five years of age living in periurban Kathmandu, Nepal. The children's parents are all carpet-making workers who live in an environment with crowded living conditions, poor sanitation, and contaminated water. Anthropometric data, both cross-sectional and longitudinal, were collected over a 9-month period. Morbidity data were gathered from maternal reports, and a subsample of children's stools were examined for gastrointestinal parasites. In a comparison of current growth status and growth velocity for children with and without diarrhea and respiratory infections, it is found that body weight is most affected by infections, particularly for children under 24 months of age. For a subsample of children whose stools were tested for parasites, there is a statistically significant association between stunting (low height-for-age) and the presence of a protozoan gastrointestinal parasite. It is concluded that although growth faltering is associated with diarrhea and respiratory infections, the impact of these infections is of less importance for long-term linear growth retardation than is infection by protozoan gastrointestinal parasites.