[Improving the experience of racialized immigrant seniors in Quebec]. / Améliorer l'expérience des personnes âgées immigrantes racialisées au Québec.

In Quebec, racialized immigrant seniors (AIRs) are a significant presence in long-term care facilities (CHSLDs) in the Greater Montreal area. To identify interventions that best meet their needs, this study interviewed 12 RIAs, including their families, about their experience in CHSLDs. The results show that RIAs face three challenges: food, clothing and play. Addressing these issues could improve their LTRCC experience.

Emergency department care experiences among members of equity-deserving groups: quantitative results from a cross-sectional mixed methods study.

BACKGROUND: Emergency departments (EDs) serve an integral role in healthcare, particularly for vulnerable populations. However, marginalized groups often report negative ED experiences, including stigmatizing attitudes and behaviours. We engaged with historically marginalized patients to better understand their ED care experiences. METHOD: Participants were invited to complete an anonymous mixed-methods survey about a previous ED experience. We analysed quantitative data including controls and equity-deserving groups (EDGs) - those who self-identified as: (a) Indigenous; (b) having a disability; (c) experiencing mental health issues; (d) a person who uses substances; (e) a sexual and gender minority; (f) a visible minority; (g) experiencing violence; and/or (h) facing homelessness - to identify differences in their perspectives. Differences between EDGs and controls were calculated with chi squared tests, geometric means with confidence ellipses, and the Kruskal-Wallis H test. RESULTS: We collected a total of 2114 surveys from 1973 unique participants, 949 controls and 994 who identified as equity-deserving. Members of EDGs were more likely to attribute negative feelings to their ED experience (p < 0.001), to indicate that their identity impacted the care received (p < 0.001), and that they felt disrespected and/or judged while in the ED (p < 0.001). Members of EDGs were also more likely to indicate that they had little control over healthcare decisions (p < 0.001) and that it was more important to be treated with kindness/respect than to receive the best possible care (p < 0.001). CONCLUSION: Members of EDGs were more likely to report negative ED care experiences. Equity-deserving individuals felt judged and disrespected by ED staff and felt disempowered to make decisions about their care. Next steps will include contextualizing findings using participants' qualitative data and identifying how to improve ED care experiences among EDGs to make it more inclusive and better able to meet their healthcare needs.

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.

[Ethnicity and immigration status: How are they associated with work and depressive symptoms?] / Ethnicité et statut d'immigrant : quelle association avec le travail et les symptômes dépressifs ?

BACKGROUND: The purpose of this research is to determine whether, in the Canadian workforce, cultural identity traits, particularly ethnicity and immigrant status, might modify the association of work with depressive symptoms. METHOD: Data were derived from the nine cycles of the National Population Health Survey (NPHS) conducted by Statistics Canada. Based on a sample of 6477 workers, multilevel regression models were brought into being. Analyses were adjusted for family-related factors, non-work social support, and personal characteristics. RESULTS: After accounting for potential confounders, ethnicity and work-related factors were distinctly and directly associated with depressive symptoms. Workers belonging to visible minorities had significantly fewer depressive symptoms than their Caucasian counterparts. Unlike Caucasians, they were more often overqualified, less in a position to use their skills, and largely without decision-making authority. On the other hand, all analyses having to do with immigrant status led to inconclusive results. CONCLUSION: Ethnicity seems to have some bearing on the association of work with depressive symptoms among members of the Canadian workforce. It might be beneficial to carry out targeted interventions aimed at improving working conditions according to ethnicity and situations involving professional overqualification.

Churning races in Canada: Visible minority response change between 2006 and 2011.

Why do most people have stable responses to census race questions, while some do not? Using linked Canadian data, we examine personal, social, and economic characteristics that predict response stability as White or as one of six large visible minority groups, versus a change in response to/from White or to/from another visible minority group. Response change rates in Canada are generally comparable to those in the US, UK, and New Zealand. Likely reflecting the centuries-old hegemony of Whites in these countries, White is the most stable response group in Canada as well as the US, UK, and New Zealand. Multiple-race response groups are among the newest and least stable response groups. Social statuses and experiences (mixed ethnic heritage, immigration status, and exposure to own-group members) are generally more predictive of race response stability and change than economic (income level and change in income) or personal statuses (education, age). This highlights the socially-constructed nature of race group boundaries. Joining and leaving a group are often predicted by the same status/characteristic and in the same direction, hinting that the status/characteristic adds complexity to the race-related experiences of constituents.

Exposure to fine particulate matter air pollution in Canada.

BACKGROUND: Exposure to ambient fine particulate matter (PM2.5) has been associated with a greater risk of non-accidental, cardiovascular and respiratory mortality in Canada. Research based on Canadian cohorts suggests that exposure to PM2.5 varies by demographic and socioeconomic characteristics. Studies of NO2, another pollutant, indicate that persons of lower socioeconomic status and some visible minority groups have greater exposure in urban centres. DATA AND METHODS: National residential PM2.5 was estimated from a ~1 km² spatial layer for respondents to the 2006 Census long-form questionnaire. Weighted PM2.5 estimates from personal-level estimates were determined for white, Aboriginal, visible minority and immigrant populations, as well as for socioeconomic groups (household income, educational attainment) and stratified by urban core, urban fringe and rural residence. Descriptive statistics were provided for selected comparisons. RESULTS: In Canada, PM2.5 exposure was 1.61 µg/m³ higher for visible minority (versus white) populations, and 1.55 µg/m³ higher for immigrants (versus non-immigrants). When the relatively high percentages of these groups in large cities were taken into account, exposure differences in urban cores were much smaller. Exposure among urban immigrants did not decrease substantially with time since immigration (< 0.5 µg/m³ between any two years). In urban cores, residents of low-income households had marginally higher exposure (0.56 µg/m³) than did people who were not in low-income households. INTERPRETATION: Differences between specific population groups in exposure to PM2.5 are due, at least in part, to higher percentages of these groups living in urban cores where air pollution levels are elevated.

Associations between gentrification, census tract-level socioeconomic status, and cycling infrastructure expansions in Montreal, Canada.

Background: Cycling infrastructure investments support active transportation, improve population health, and reduce health inequities. This study examines the relationship between changes in cycling infrastructure (2011-2016) and census tract (CT)-level measures of material deprivation, visible minorities, and gentrification in Montreal. Methods: Our outcomes are the length of protected bike lanes, cyclist-only paths, multi-use paths, and on-street bike lanes in 2011, and change in total length of bike lanes between 2011 and 2016 at the CT level. Census data provided measures of the level of material deprivation and of the percentage of visible minorities in 2011, and if a CT gentrified between 2011 and 2016. Using a hurdle modeling approach, we explore associations among these CT-level socioeconomic measures, gentrification status, baseline cycling infrastructure (2011), and its changes (2011-2016). We further tested if these associations varied depending on the baseline level of existing infrastructure, to assess if areas with originally less resources benefited less or more. Results: In 2011, CTs with higher level of material deprivation or greater percentages of visible minorities had less cycling infrastructure. Overall, between 2011 and 2016, cycling infrastructure increased from 7.0% to 10.9% of the road network, but the implementation of new cycling infrastructure in CTs with no pre-existing cycling infrastructure in 2011 was less likely to occur in CTs with a higher percentage of visible minorities. High-income CTs that were ineligible for gentrification between 2011 and 2016 benefited less from new cycling infrastructure implementations compared to low-income CTs that were not gentrified during the same period. Conclusion: Montreal's municipal cycling infrastructure programs did not exacerbate socioeconomic disparities in cycling infrastructure from 2011 to 2016 in CTs with pre-existing infrastructure. However, it is crucial to prioritize the implementation of cycling infrastructure in CTs with high populations of visible minorities, particularly in CTs where no cycling infrastructure currently exists.

Visible minority status and occupation were associated with increased COVID-19 infection in Greater Vancouver British Columbia between June and November 2020: an ecological study.

Background: The COVID-19 pandemic has highlighted health disparities, especially among specific population groups. This study examines the spatial relationship between the proportion of visible minorities (VM), occupation types and COVID-19 infection in the Greater Vancouver region of British Columbia, Canada. Methods: Provincial COVID-19 case data between June 24, 2020, and November 7, 2020, were aggregated by census dissemination area and linked with sociodemographic data from the Canadian 2016 census. Bayesian spatial Poisson regression models were used to examine the association between proportion of visible minorities, occupation types and COVID-19 infection. Models were adjusted for COVID-19 testing rates and other sociodemographic factors. Relative risk (RR) and 95% Credible Intervals (95% CrI) were calculated. Results: We found an inverse relationship between the proportion of the Chinese population and risk of COVID-19 infection (RR = 0.98 95% CrI = 0.96, 0.99), whereas an increased risk was observed for the proportions of the South Asian group (RR = 1.10, 95% CrI = 1.08, 1.12), and Other Visible Minority group (RR = 1.06, 95% CrI = 1.04, 1.08). Similarly, a higher proportion of frontline workers (RR = 1.05, 95% CrI = 1.04, 1.07) was associated with higher infection risk compared to non-frontline. Conclusion: Despite adjustments for testing, housing, occupation, and other social economic status variables, there is still a substantial association between the proportion of visible minorities, occupation types, and the risk of acquiring COVID-19 infection in British Columbia. This ecological analysis highlights the existing disparities in the burden of diseases among different visible minority populations and occupation types.

Transnational caring in times of COVID-19: The experiences of visible minority immigrant carer-employees.

Globalization and immigration policies between Canada and immigrant-sending nations have heightened transnational caregiving. The research objective is to explore the experiences of visible minority immigrant transnational carer-employees (VMI TCEs) before and during the pandemic. In this study, participants reside in the mid-sized city of London, Ontario and engage in paid employment or volunteering while providing unpaid care to family members and/or friends abroad. Interviews and arts-based methodology were used to collect data from 29 VMI TCEs from 10 countries. Intersectionality theory informed thematic analysis and three themes emerged: (1) The nuances of providing transnational care, (2) The impact of geographic dislocation on care and wellbeing, and (3) Caregiving during COVID-19. Findings highlight the fluidity of transnational caregiving, in that participants both shape and are impacted by time-space dimensions. Study results may be used to inform culturally sensitive adaptions to the existing standard for organizations to be more inclusive of and accommodating to carer-employees. Findings can also inform the implementation or improvement of programs and services offered by the government, immigration resettlement agencies, employers and other stakeholders working with people who may share similar experiences to VMI TCEs. The creation of accessible and appropriate resources for this group of people will better support them in resettling outside of major urban cities in Ontario and other provinces across Canada.

Commonalities and Differences in the Experiences of Visible Minority Transnational Carer-Employees: A Qualitative Study.

This qualitative study explored the commonalities and differences among the experiences of visible minority Transnational Carer-Employees (TCEs) before and after COVID-19. TCEs are immigrants who live and work in the country of settlement while providing caregiving across international borders. Purposive and snowball sampling resulted in the participation of 29 TCEs of Pakistani, Syrian, African, and South American origin living in London, Ontario. Thematic analysis of the dataset using the ATLAS.ti software, Version 23.2.1., generated three themes: (1) feelings associated with transnational care; (2) employment experiences of TCEs; and (3) coping strategies for well-being. The results of the secondary analysis conducted herein suggested that there are more similarities than differences across the four cohorts. Many participants felt a sense of satisfaction at being able to fulfill their care obligations; however, a different outlook was observed among some Syrian and African origin respondents, who disclosed that managing care and work is overwhelming. Most TCEs also reported facing limited job options because of language barriers. While various interviewees experienced a lack of paid work and reduced income after COVID-19, a distinct perspective was noted from African descent TCEs as they expressed facing increased work demands after the pandemic. Participants additionally revealed four common coping strategies such as keeping busy, praying, family support, and staying active. Study implications include the promotion of Carer-Friendly Workplace Policies (CFWPs) that can facilitate the welfare of unpaid caregivers. This research is important as it may inform policymakers to create opportunities that may not only foster economic stability of TCEs and the Canadian economy, but also contribute towards a more equitable society.

Adapting and Scaling a Digital Health Intervention to Improve Maternal and Child Health Among Ethnic Minority Women in Vietnam Amid the COVID-19 Context: Protocol for the dMOM Project.

BACKGROUND: Due to interconnected structural determinants including low maternal health knowledge, economic marginalization, and remoteness from low-capacity health centers, ethnic minority women in remote areas of Vietnam face severe maternal, newborn, and child health (MNCH) inequities. As ethnic minorities represent 15% of the Vietnamese population, these disparities are significant. mMOM-a pilot mobile health (mHealth) intervention using SMS text messaging to improve MNCH outcomes among ethnic minority women in northern Vietnam-was implemented from 2013-2016 with promising results. Despite mMOM's findings, exacerbated MNCH inequities, and digital health becoming more salient amid COVID-19, mHealth has not yet been scaled to address MNCH among ethnic minority women in Vietnam. OBJECTIVE: We describe the protocol for adapting, expanding, and exponentially scaling the mMOM intervention qualitatively through adding COVID-19-related MNCH guidance and novel technological components (mobile app and artificial intelligence chatbots) and quantitatively through broadening the geographical area to reach exponentially more participants, within the evolving COVID-19 context. METHODS: dMOM will be conducted in 4 phases. (1) Drawing on a review of international literature and government guidelines on MNCH amid COVID-19, mMOM project components will be updated to respond to COVID-19 and expanded to include a mobile app and artificial intelligence chatbots to more deeply engage participants. (2) Using an intersectionality lens and participatory action research approach, a scoping study and rapid ethnographic fieldwork will explore ethnic minority women's unmet MNCH needs; acceptability and accessibility of digital health; technical capacity of commune health centers; gendered power dynamics and cultural, geographical, and social determinants impacting health outcomes; and multilevel impacts of COVID-19. Findings will be applied to further refine the intervention. (3) dMOM will be implemented and incrementally scaled across 71 project communes. (4) dMOM will be evaluated to assess whether SMS text messaging or mobile app delivery engenders better MNCH outcomes among ethnic minority women. The documentation of lessons learned and dMOM models will be shared with Vietnam's Ministry of Health for adoption and further scaling up. RESULTS: The dMOM study was funded by the International Development Research Centre (IDRC) in November 2021, cofacilitated by the Ministry of Health, and is being coimplemented by provincial health departments in 2 mountainous provinces. Phase 1 was initiated in May 2022, and phase 2 is planned to begin in December 2022. The study is expected to be complete in June 2025. CONCLUSIONS: dMOM research outcomes will generate important empirical evidence on the effectiveness of leveraging digital health to address intractable MNCH inequities among ethnic minority women in low-resource settings in Vietnam and provide critical information on the processes of adapting mHealth interventions to respond to COVID-19 and future pandemics. Finally, dMOM activities, models, and findings will inform a national intervention led by the Ministry of Health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/44720.

Understanding the Elevated Prevalence of Intimate Partner Violence in Interracial Relationships.

Research from the United States and Canada suggest that interracial relationships tend to have an elevated prevalence of intimate partner violence (IPV). Among seven extant studies, only one empirically examined speculations in the literature for this relationship. Based on analyses of data from Statistics Canada's 2009 General Social Survey (GSS), Brownridge was not able to fully account for the elevated odds of IPV in interracial relationships. The current study used data on 16,706 Canadians (731 in interracial relationships and 15,975 in noninterracial relationships) from the 2014 iteration of Statistics Canada's GSS to determine whether the risk of IPV in interracial relationships had changed since 2009 and to explore risk factors that may account for the elevated odds of IPV in interracial relationships. Results showed that individuals in interracial relationships faced elevated odds of IPV victimization relative to monoracial relationships in the 5-year reporting period prior to the study (odds ratio [OR] = 2.37; 95% confidence interval [CI] = [1.40, 4.02]; p < .001). This was similar to what Brownridge found in the 2009 GSS data, indicating that the elevated risk of IPV in interracial relationships had remained stable in Canada over a 10-year reporting period. Risk factors from three levels of an ecological model were explored, and logistic multiple regression analyses showed that characteristics of the partner (young age, drug use, and jealous behavior) fully accounted for the significantly elevated odds of IPV victimization in interracial unions. Although the leading speculation for this relationship implicates stressors that are unique to these relationships, the current study suggested that this phenomenon is mostly due to characteristics of individuals with whom those in interracial relationships are more likely to be coupled.

Does Being a Visible Minority Matter? Predictors of Internationally Educated Nurses' Workplace Integration.

STUDY BACKGROUND: Nurses continue to migrate to Canada. Majority are visible minorities. Once employed, internationally educated nurses can struggle to integrate into their workplaces. A comprehensive understanding of factors that support internationally educated nurses' workplace integration is lacking, limiting our ability to design appropriate policies and practices. PURPOSE: The aim is to (1) examine internationally educated nurses' perceptions of the extent to which they have integrated in their workplaces and the individual and contextual factors that supported their workplace integration, (2) explore whether internationally educated nurses' perceptions differed by visible minority status, and (3) identify the key factors that predict internationally educated nurses' workplace integration. METHODS: Cross-sectional survey of 1215 internationally educated nurses. All were immigrants, permanent residents, and employed as regulated nurses. Multiple linear regression was used to examine the influence of individual and contextual factors on perceived degree of workplace integration. RESULTS: Visible minority status had a large, statistically significant negative association with workplace integration (ß = -0.236, p < .001). Good relationships with coworkers (ß =0.043, p < .005), and continuing to develop nursing knowledge and skills (ß =0.178, p < .003), had statistically significant, positive associations with workplace integration. CONCLUSIONS: Internationally educated nurses' visible minority status can influence their workplaces. Providing education, managerial support, and mentorship fosters internationally educated nurses' workplace integration.

COVID-19: A case for the collection of race data in Canada and abroad.

Racialized populations have consistently been shown to have poorer health outcomes worldwide. This pattern has become even more prominent in the wake of the coronavirus disease 2019 (COVID-19) pandemic. In countries where race disaggregated data are routinely collected, such as the United States and the United Kingdom, preliminary reports have identified that racialized populations are at a heightened risk of COVID-19 infection and mortality. Similar patterns are emerging in Canada but rely on proxy measures such as neighbourhood diversity to account for race, in the absence of person-level data. It follows that the collection of race disaggregated data in Canada is a crucial element in identifying individuals at risk of poorer COVID-19 outcomes and developing targeted public health interventions to mitigate risk among Canada's racialized populations. Given this continuing gap, advocating for timely access to this data is of great importance owing to the challenges that the COVID-19 pandemic has highlighted amongst racialized populations in Canada and worldwide.

Should I Stay or Should I Go? Employment Discrimination and Workplace Harassment against Transgender and Other Minority Employees in Canada's Federal Public Service.

There is a growing literature interested in the workplace experiences of transgender individuals. The biggest limitation for researchers in this field continues to be the dearth of population-level data that captures information on gender identity and employment characteristics. Using the 2017 Public Service Employee Survey, this paper explores employment discrimination and workplace harassment against gender diverse (transgender, non-binary, genderqueer) and other minority employees working in Canada's federal public service. This study finds that gender diverse employees are between 2.2 and 2.5 times more likely to experience discrimination and workplace harassment than their cisgender male coworkers. Cisgender women, visible minorities, Indigenous, and those with disabilities are also more likely to report discrimination and workplace harassment. Cisgender women and gender diverse employees who occupy multiple minority statuses may experience an additive likelihood of discrimination and harassment. This study also finds that employee retention can be improved by providing more inclusive and tolerant workplaces.

Factors Associated with COVID-19 Vaccine Hesitancy among Visible Minority Groups from a Global Context: A Scoping Review.

Vaccine hesitancy is one of the top ten greatest threats to global health. During the COVID-19 era, vaccine hesitancy poses substantial risks, especially in visible minorities, who are disproportionately affected by the pandemic. Although evidence of vaccine hesitancy exists, there is minimal focus on visible minorities and the reasons for hesitancy in this group are unclear. Identifying these populations and their reasons for vaccine hesitancy is crucial in improving vaccine uptake and curbing the spread of COVID-19. This scoping review follows a modified version of the Arksey and O'Malley strategy. Using comprehensive search strategies, advanced searches were conducted on Medline, CINAHL, and PubMed databases to acquire relevant articles. Full-text reviews using inclusion and exclusion criteria were performed to extract themes of vaccine hesitancy. Themes were grouped into factors using thematic qualitative analysis and were objectively confirmed by principal component analysis (PCA). To complement both analyses, a word cloud of titles and abstracts for the final articles was generated. This study included 71 articles. Themes were grouped into 8 factors and the top 3 recurring factors were safety and effectiveness of the vaccine, mistrust, and socioeconomic characteristics. Shedding light on these factors could help mitigate health inequities and increase overall vaccine uptake worldwide through interventions and policies targeted at these factors. Ultimately, this would help achieve global herd immunity.

Les traits d'identité culturelle en lien avec le statut d'immigrant et l'ethnicité : quel lien avec les symptômes de détresse psychologique et les symptômes dépressifs dans la main-d'œuvre canadienne? Résultats des neuf cycles de l'ENSP.

PURPOSE: This study investigated variations over time of psychological distress and depressive symptoms among working Canadians according to two cultural identity traits: ethnicity and immigration status. METHOD: Data came from the nine cycles of the National Population Health Survey (NPHS) conducted by Statistics Canada. Based on a sample of 7069 workers, multiple regressions analyses and multilevel regressions models were carried out. Analyses were adjusted for confounders such as age, gender, marital status, household income, social support outside the workplace, level of education, presence of children between 0 and 5 years of age and presence of children from 6 to 11 years of age. RESULTS: Over time, and after accounting for potential confounders, immigration status is not associated with psychological distress or depressive symptoms. Ethnicity is associated with depressive symptoms, but not with psychological distress symptoms. Visible minorities have less depressive symptoms compared to Caucasians. CONCLUSION: Unlike immigration status, ethnicity seems to explain a portion of mental health inequities among workers. One area to be explored in future researches is whether in the Canadian workforce, work conditions could explain ethnic inequalities in mental health.

Health Experiences of Immigrant Visible Minority Women: A Literature Review.

This literature review on the health experiences of visible minority women is based on a critical review of the international English language peer-reviewed publications from 1980 to 2011. The overall goal was to gather understanding of immigrant women's employment and health experiences. The key findings from the review specific to health are: (a) There is variation in definition and meaning of health across cultures; (b) Immigrant visible minority women experience several barriers to accessing healthcare services including discrimination; (c) There is a paradigm clash between Western bio-medical principles and Eastern holistic approach to health. Social work practice implications are discussed.

"Drop dead I need your job": An exploratory study of intra-professional conflict amongst nurses in two Ontario cities.

Past studies have focused on inter-professional conflict and its implication for professional status and work. However, there is a dearth of research on intra-professional conflict and its implications for professions. This study explores intra-professional conflicts among nurses in Ontario, using a qualitative research design, drawing on in-depth interviews with 66 nurses. The study identifies conflicts along race and age: Visible minority and younger nurses report more conflict, with visible minority nurses particularly vulnerable and racially marginalized. Members of Visible minorities and young nurses responded to workplace conflict by demonstrating competence, seeking support from colleagues, and either ignoring the abuse or standing up for themselves. These strategies do nothing to challenge professional unity. Nonetheless, intra-professional conflict has negative consequences for professionals and their work.