Systemic and Individual Factors That Shape Mental Health Service Usage Among Visible Minority Immigrants and Refugees in Canada: A Scoping Review.

There exists considerable research which reports that mental health disparities persist among visible minority immigrants and refugees within Canada. Accessing mental health care services becomes a concern which contributes to this, as visible minority migrants are regarded as an at-risk group that are clinically underserved. Thus, the purpose of this review is to explore the following research question: "what are the barriers and facilitators for accessing mental health care services among visible immigrants and refugees in Canada?". A scoping review following guidelines proposed by Arksey and O'Malley (International Journal of Social Research Methodology 8(1): 19-32, 2005) was conducted. A total of 45 articles published from 2000 to 2020 were selected through the review process, and data from the retrieved articles was thematically analyzed. Wide range of barriers and facilitators were identified at both the systemic and individual levels. Unique differences rooted within landing and legal statuses were also highlighted within the findings to provide nuance amongst immigrants and refugees. With the main layered identity of being a considered a visible minority, this yielded unique challenges patterned by other identities and statuses. The interplay of structural issues rooted in Canadian health policies and immigration laws coupled with individual factors produce complex barriers and facilitators when seeking mental health services. Through employing a combined and multifaceted approach which address the identified factors, the findings also provide suggestions for mental health care providers, resettlement agencies, policy recommendations, and future directions for research are discussed as actionable points of departure.

Community-based physical activity and/or nutrition interventions to promote mobility in older adults: An umbrella review.

Background: Physical activity and a healthy diet are important in helping to maintain mobility and quality of life with aging. Delivery of physical activity and nutrition interventions in a group setting adds the benefits of social participation. Several published systematic reviews have explored a broad range of PA and/or nutrition interventions for older adults, making it challenging to bring together the best scientific evidence to inform program design and to inform multicomponent intervention development. This umbrella review aims to identify group-based physical activity and nutrition interventions for community-dwelling older adults that improve mobility. Methods: Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Sociological Abstracts) were searched from inception to April 28, 2020. Eligibility criteria included systematic reviews exploring the effectiveness of physical activity and/or nutrition interventions, delivered in a group setting for community-dwelling older adults. Two reviewers independently performed eligibility screening, critical appraisal (using AMSTAR 2) and data extraction. The GRADE approach was used to assess the overall certainty of the evidence. Older adult/provider research partners informed data synthesis and results presentation. Results: In total, 54 systematic reviews (1 high, 21 moderate, 32 low/critically low quality) were identified; 46 included physical activity only, and eight included both physical activity and nutritional supplements. No reviews included nutrition interventions alone. Combined aerobic/resistance, general physical activity, and mind-body exercise all improved physical function and balance (moderate-high certainty). Aerobic/resistance training improved aerobic capacity (high certainty). Resistance training and general physical activity improved muscle strength (moderate certainty). Aerobic/resistance training and general physical activity are likely to reduce falls among older adults (moderate certainty). There was no evidence of benefit for nutritional supplementation with physical activity. Conclusions: Multicomponent group-based physical activity interventions can improve measures of mobility in community-dwelling older adults. We found no reviews focused on nutrition only, highlighting a gap in the literature.

The EMBOLDEN Co-design study: Partnering with older adults and communities to develop a community program to enhance mobility.

Context: Physical mobility and social participation are requisite for independence and quality of life as one ages. Barriers to mobility lead to social isolation, poor physical and mental health, all of which are precursors to frailty. To date, most mobility-enhancing interventions in older adults have been designed by researchers without citizen input and delivered in controlled settings; their translation to real-world contexts is often impractical and rarely occurs. Objectives: i) To engage older adults and community service providers to qualitatively explore priorities, needs, enablers and barriers to mobility and community participation faced by older adults, and ii) To co-design an evidence-informed, feasible, acceptable group intervention to support mobility and promote health among older adults facing health inequities. Study Design: Adapted experience-based co-design, conducted in collaboration with a Strategic Guiding Council comprised of older adults and service providers. Setting: Community-based. Population studied: Community-dwelling older adults (55+) and local health and social service providers. Outcome Measures: EMBOLDEN's Strategic Guiding Council and the research team collectively interpreted qualitative study findings, together with results of completed systematic reviews and an environmental scan, to determine priority design features of a community-based mobility-enhancing intervention to enable health and well-being in older adults in Hamilton, ON. Results: Eighteen diverse older adults and 16 service providers completed persona scenario interviews. These lived experience perspectives were analyzed, interpreted, and integrated with research and local evidence in the intervention co-design process. Priority design features for the intervention included duration, intensity, mode of delivery, characteristics of interventionists, and implementation strategies. Findings highlighted key strategies related to participant motivation, recruitment, and engagement, as well as important equity, diversity, and inclusion considerations. Conclusions: Partnering with diverse stakeholders is critical to identifying optimal design features of a community-based intervention to promote mobility. Ultimately, we aim to implement and evaluate a health promoting intervention that is sustainable, scalable, addresses health inequities, and effectively improves the lives of older adults.

Predictors of Postpartum Depression Among Immigrant Women in the Year After Childbirth.

BACKGROUND: Immigrant women are at increased risk for postpartum depression (PPD). The factors that influence PPD among immigrant women are poorly understood. The purpose of this study was to identify individual- and community-level factors predictive of PPD among immigrant women living in a large Ontario city at 6 weeks, 6 months, and 1 year postpartum. METHODS: The study involved a secondary analysis of a prospective cohort study, The Ontario Mother and Infant Study 3. This study included 519 immigrant women who were recruited from two hospitals in one urban city and delivered full-term singleton infants. Women completed a written questionnaire in hospital, followed by structured telephone interviews at 6 weeks, 6 months, and 1 year after hospital discharge. Generalized estimating equations were used to explore factors associated with PPD, measured using the Edinburgh Postnatal Depression Scale (EPDS) and two thresholds for depression (≥12 and ≥9). RESULTS: Rates of PPD at all time points were 8%-10% for EPDS scores of ≥12. For EPDS scores of ≥9, rates of PPD more than doubled at all time points. A lack of social support was strongly associated with PPD in all analyses. Living in Canada for ≤2 years, poor perceptions of health, and lower mental health functioning were other important predictors of PPD. Living in communities with a high prevalence of immigrants and low income also was associated with PPD. CONCLUSIONS: Complex individual and community-level factors are associated with PPD in immigrant women. Understanding these contextual factors can inform a multifaceted approach to addressing PPD.

Acculturation and nutritional health of immigrants in Canada: a scoping review.

Although recent immigrants to Canada are healthier than Canadian born (i.e., the Healthy Immigrant Effect), they experience a deterioration in their health status which is partly due to transitions in dietary habits. Since pathways to these transitions are under-documented, this scoping review aims to identify knowledge gaps and research priorities related to immigrant nutritional health. A total of 49 articles were retrieved and reviewed using electronic databases and a stakeholder consultation was undertaken to consolidate findings. Overall, research tends to confirm the Healthy Immigrant Effect and suggests that significant knowledge gaps in nutritional health persist, thereby creating a barrier to the advancement of health promotion and the achievement of maximum health equity. Five research priorities were identified including (1) risks and benefits associated with traditional/ethnic foods; (2) access and outreach to immigrants; (3) mechanisms and coping strategies for food security; (4) mechanisms of food choice in immigrant families; and (5) health promotion strategies that work for immigrant populations.

Exploring the relationship between food access and foodborne illness by using spatial analysis.

There is some evidence that neighborhood deprivation increases residents' risk of foodborne illnesses. Because urban areas with the least available access to adequate amounts of nutritious or affordable food options (or "food deserts") also tend to be the most deprived areas within a city, it is hypothesized that food access and foodborne illness risk are linked. However, the complexity of tracking numbers and sources of gastrointestinal (GI) illnesses often leads researchers to speculate about reasons for disproportionate rates of pathogen outbreaks among demographic groups. This study explores the suitability of existing data to examine associations between food deserts and the spatial distribution of GI illnesses in Hamilton, Ontario, Canada. A spatial analysis by using GIS software methodology was used to identify and map food retail outlets and accessibility, as well as GI illness outbreaks and sales of antidiarrhea, antinausea, and rehydration products (used as a proxy for GI cases) within the city, based on available data. Statistical analysis of the maps shows no statistical relationship between location, access to food outlets, and rates of GI illness. The analysis points to shortfalls and gaps in the existing data, which leaves us unable to draw conclusions either supporting or refuting our hypothesis. This article includes recommendations to improve the current system of illness reporting and to continue to refine the definition and process of mapping food access issues. A more comprehensive set of data would enable municipalities to more easily identify groups most at risk, depending on exposures and the type of pathogen, and reduce the occurrence of foodborne disease.

Discrimination and the health of immigrants and refugees: exploring Canada's evidence base and directions for future research in newcomer receiving countries.

Research and practice increasingly suggests discrimination compromises health. Yet the unique experiences and effects facing immigrant and refugee populations remain poorly understood in Canada and abroad. We review current knowledge on discrimination against newcomers in Canada, emphasizing impacts upon health status and service access to identify gaps and research needs. Existing knowledge centers around experiences within health-care settings, differences in perception and coping, mental health impacts, and debates about "non-discriminatory" health-care. There is need for comparative analyses within and across ethno-cultural groups and newcomer classes to better understand factors shaping how discrimination and its health effects are differentially experienced. Women receive greater attention in the literature given their compounded vulnerability. While this must continue, little is known about the experiences of youth and men. Governance and policy discourse analyses would elucidate how norms, institutions and practices shape discriminatory attitudes and responses. Finally, "non-discriminatory health-care" interventions require critical evaluation to determine their effectiveness.

An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality.

BACKGROUND: Water and sanitation access are known to be related to newborn, child, and maternal health. Our study attempts to quantify these relationships globally using country-level data: How much does improving access to water and sanitation influence infant, child, and maternal mortality? METHODS: Data for 193 countries were abstracted from global databases (World Bank, WHO, and UNICEF). Linear regression was used for the outcomes of under-five mortality rate and infant mortality rate (IMR). These results are presented as events per 1000 live births. Ordinal logistic regression was used to compute odds ratios for the outcome of maternal mortality ratio (MMR). RESULTS: Under-five mortality rate decreased by 1.17 (95%CI 1.08-1.26) deaths per 1000, p < 0.001, for every quartile increase in population water access after adjustments for confounders. There was a similar relationship between quartile increase of sanitation access and under-five mortality rate, with a decrease of 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. Improved water access was also related to IMR, with the IMR decreasing by 1.14 (95%CI 1.05-1.23) deaths per 1000, p < 0.001, with increasing quartile of access to improved water source. The significance of this relationship was retained with quartile improvement in sanitation access, where the decrease in IMR was 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. The estimated odds ratio that increased quartile of water access was significantly associated with increased quartile of MMR was 0.58 (95%CI 0.39-0.86), p = 0.008. The corresponding odds ratio for sanitation was 0.52 (95%CI 0.32-0.85), p = 0.009, both suggesting that better water and sanitation were associated with decreased MMR. CONCLUSIONS: Our analyses suggest that access to water and sanitation independently contribute to child and maternal mortality outcomes. If the world is to seriously address the Millennium Development Goals of reducing child and maternal mortality, then improved water and sanitation accesses are key strategies.

Psychological distress among immigrants and visible minorities in Canada: a contextual analysis.

BACKGROUND: 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. AIM: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Spatial analysis of air pollution and childhood asthma in Hamilton, Canada: comparing exposure methods in sensitive subgroups.

BACKGROUND: Variations in air pollution exposure within a community may be associated with asthma prevalence. However, studies conducted to date have produced inconsistent results, possibly due to errors in measurement of the exposures. METHODS: A standardized asthma survey was administered to children in grades one and eight in Hamilton, Canada, in 1994-95 (N approximately 1467). Exposure to air pollution was estimated in four ways: (1) distance from roadways; (2) interpolated surfaces for ozone, sulfur dioxide, particulate matter and nitrous oxides from seven to nine governmental monitoring stations; (3) a kriged nitrogen dioxide (NO2) surface based on a network of 100 passive NO2 monitors; and (4) a land use regression (LUR) model derived from the same monitoring network. Logistic regressions were used to test associations between asthma and air pollution, controlling for variables including neighbourhood income, dwelling value, state of housing, a deprivation index and smoking. RESULTS: There were no significant associations between any of the exposure estimates and asthma in the whole population, but large effects were detected the subgroup of children without hayfever (predominately in girls). The most robust effects were observed for the association of asthma without hayfever and NO2LUR OR = 1.86 (95%CI, 1.59-2.16) in all girls and OR = 2.98 (95%CI, 0.98-9.06) for older girls, over an interquartile range increase and controlling for confounders. CONCLUSION: Our findings indicate that traffic-related pollutants, such as NO2, are associated with asthma without overt evidence of other atopic disorders among female children living in a medium-sized Canadian city. The effects were sensitive to the method of exposure estimation. More refined exposure models produced the most robust associations.

The short-term health of Canada's new immigrant arrivals: evidence from LSIC.

OBJECTIVES: The objectives of the current paper are to address the timing of declines in health after arrival in the host country, and to document differences in health status by immigrant arrival group (economic immigrants, family reunification, and refugees). DESIGN: Statistics Canada's Longitudinal Survey of Immigrants to Canada captures health and other attributes of a cohort of immigrant arrivals to Canada at six months, two years, and four years after arrival. Descriptive and multivariate methods are applied to this data file in order to ascertain changes in health status in the period immediately after arrival. RESULTS: Significant declines in health status are noted within as little as two years post-arrival. In addition, refugees are observed to have lower levels of health and are more likely to transition to a state of poor health, while economic immigrants report the highest levels of self-assessed health. CONCLUSION: The health status of new arrivals, measured by self-assessed health, physical health, and mental health, declines quickly after arrival. Refugees generally experience the lowest levels of health.

A land use regression model for predicting ambient concentrations of nitrogen dioxide in Hamilton, Ontario, Canada.

This paper reports on the development of a land use regression (LUR) model for predicting the intraurban variation of traffic-related air pollution in Hamilton, Ontario, Canada, an industrial city at the western end of Lake Ontario. Although land use regression has been increasingly used to characterize exposure gradients within cities, research to date has yet to test whether this method can produce reliable estimates in an industrialized location. Ambient concentrations of nitrogen dioxide (NO2) were measured for a 2-week period in October 2002 at > 100 locations across the city and subsequently at 30 of these locations in May 2004 to assess seasonal effects. Predictor variables were derived for land use types, transportation, demography, and physical geography using geographic information systems. The LUR model explained 76% of the variation in NO2. Traffic density, proximity to a highway, and industrial land use were all positively correlated with NO2 concentrations, whereas open land use and distance from the lake were negatively correlated with NO2. Locations downwind of a major highway resulted in higher NO2 levels. Cross-validation of the results confirmed model stability over different seasons. Our findings demonstrate that land use regression can effectively predict NO2 variation at the intraurban scale in an industrial setting. Models predicting exposure within smaller areas may lead to improved detection of health effects in epidemiologic studies.

Health status and health care of immigrants in Canada: a longitudinal analysis.

OBJECTIVES: This paper focuses upon health status, need for care, and use of health care from 1994/95 to 2000/01 in the Canadian foreign-born population. METHODS: Using Statistics Canada's longitudinal National Population Health Survey, descriptive and survival analyses are used to explore immigrant health status and health care. RESULTS: The health status of immigrants quickly declines after arrival, with a concomitant increase in use of health care services. However, survival analysis of the risk of a change to poor health indicates no difference between immigrants and the native-born. Similarly, there is no difference in the risk of hospital use between the two populations. CONCLUSIONS: The health status of recent immigrant arrivals is observed to decline towards that of the native-born population, while health care utilization increases. However, increased use may not be sufficient to offset declines in health, meaning that need for health care within the immigrant population may be unmet.