Gender Differences in Alcohol Use and Risk Drinking in Ontario Ethnic Groups.

This article examines prevalence and gender differences of alcohol use and risk drinking in a representative sample of Ontario adults. Data were drawn from the Centre for Addiction and Mental Health (CAMH) Monitor survey of Ontario adults aged 18 and older collected between January 2005 and December 2010. The prevalence of self-reported lifetime, current, and high-risk drinking were all higher among the Canadian and the European-origin groups compared with other ethnic groups. Within-group gender differences were evident for all ethnic groups. The narrowest gender gap was observed within the North European group and the widest in the South Asian group. The non-European ethnic groups had higher rates of abstinence and lower alcohol consumption rates; nevertheless, a considerable proportion of people from these groups may be at risk of alcohol-related harm due to risky and harmful alcohol consumption patterns. Future research should continue to investigate alcohol use in these groups and identify subgroups at risk and factors that increase or decrease their vulnerability to risky and problem drinking.

Stresses of passage, balms of resettlement, and posttraumatic stress disorder among Sri Lankan Tamils in Canada.

OBJECTIVES: To explore the salience of pre- and postmigration stresses as risk factors for posttraumatic stress disorder (PTSD) and to identify resilience factors and explore their mental health salience. METHODS: We conducted a mental health survey of 1603 Sri Lankan Tamils in Toronto, incorporating the World Health Organization Composite International Diagnostic Interview for PTSD. RESULTS: According to the International Classification of Diseases, 10th Revision, criteria, lifetime prevalence for PTSD was 12%; according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria it was 5.8%. Female sex and the number of stresses of passage increased the probability of PTSD, whereas satisfaction with life and the availability of nonfamily social relations reduced it. CONCLUSIONS: Consideration of pre- and postmigration stresses of passage and of the nature of resilience contributes to an improved understanding of PTSD among refugees.

Meanings of home and mental well-being among Sudanese refugees in Canada.

OBJECTIVES: This article examines family and social factors that affect refugee mental health during resettlement by presenting qualitative analysis of the concept of home and its functional and psychological meanings based on findings from research with Sudanese refugees in Canada. DESIGN: Data were collected in two successive multi-method, community-based studies between 2003 and 2007 with Sudanese refugee participants in Ontario and Alberta, Canada. The first study used survey methods with 220 participants in seven sites and the second, in-depth qualitative interviews with 30 community members in three sites. RESULTS: In the first study, economic hardship and family adaptation challenges were reported to affect Sudanese mental well-being. The second study explored cultural aspects of Sudanese family and community well-being in greater depth. Meanings of home emerged from data as a key concept linking social support, resettlement, and mental health. Findings highlight how the presence or absence of the social supports associated with home affect refugees' mental health during resettlement. The analysis focuses on four themes: emotional support; fulfilling social roles and expectations; problem solving and conflict resolution; and dignity and growth, as well as perceived impact on community mental health. CONCLUSION: Qualities of home that Sudanese lack during resettlement points to critical gaps that must be filled by mental health and other service providers to promote positive refugee mental health in countries of resettlement.

Taking culture seriously: ethnolinguistic community perspectives on mental health.

OBJECTIVE: Ethnolinguistic communities are underserved by mental health systems in immigrant-receiving, multicultural societies, but their perspectives are seldom elicited in mental health research or reform planning. This article helps fill this gap by presenting community perspectives on concepts of mental health, mental illness and mental health experiences with five ethnocultural communities (Latin American, Mandarin-speaking Chinese, Polish, Punjabi Sikh and Somali) in Ontario, Canada. METHODS: Data were collected from 21 focus groups as part of a large-scale, participatory action research project called Taking Culture Seriously in Community Mental Health. RESULTS: The analysis focuses on how mental health and mental illnesses are described, how mental health care is experienced and what recommendations community members provide to improve the mental health system. CONCLUSIONS: Study findings illustrate the importance of the social context of immigration and settlement in conceptualizing mental health and mental distress. We conclude that systemic changes are needed to formulate collaborative, community-based strategies for mental health promotion and interventions.

[Use of illicit drugs and critical perspectives of drug users' relatives and acquaintances in Northern Rio de Janeiro City, Brazil]. / Uso de drogas ilícitas e perspectivas críticas de familiares e pessoas próximas, na cidade do Rio de Janeiro, Zona Norte, Brasil.

This article presents the partial results of a multicenter, qualitative study, which involved seven Latin-American countries and Canada. The results presented refer to Northern Rio de Janeiro (city), Brazil. The objective of the study was to describe the perspective of relatives/acquaintances of illicit drug users about protective and risk factors, prevention initiatives, treatment services, and legal aspects regarding illicit drugs. Interviews were performed with 99 individuals, who reported being affected by their relationship with an illicit drug user (relative or acquaintance), approaching their perspectives regarding the key-domains. Most participants were women (73.7%); relatives who used drugs were mostly men (78.2%); the most consumed drug was marijuana (77.8%). The highlighted protective factor was having recreational-sports activities in the community (88.9%), and the risk factor was curiosity for trying something new (94.4%). The main treatment services were Church Groups (51.5%), and participants stated that laws should be more punitive (82.8%). In conclusion, this information is essential to fight against drug use/abuse, showing that there is a need for actions that consider different perspectives at different levels.

[Family and acquaintances of illicit drug users: community perspectives on laws and public policies in Western Rio de Janeiro, Brazil]. / Familiares e pessoas conhecidas de usuários de drogas ilícitas: recorte de opiniões sobre leis e políticas públicas de uma comunidade da Zona Oeste do Rio de Janeiro, Brasil.

This article is part of the study 'Illicit Drug Use in Seven Latin American Countries and Canada: Critical Perspectives of Family and Familiars' (7LACC), which investigated four domains: protective and risk factors; preventive initiatives; treatment facilities; and laws and policies. The article presents a section of the results based on four items of the laws and policies domain--as perceived by the family and acquaintances of illicit drug users living in the community. Participants were recruited in urban primary health care units located in Western Rio de Janeiro (city), Brazil. This multi-method, cross-temporal study performed interviews with 100 adults (18 years of age or older), all cognitively healthy. Results and key conclusions included non-compliance with the fundamental principles of the Unique Health System Legislation / Law 8.080/90 and the erroneous implementation of laws and public policies on illicit drug.

[Illegal aspects of illicit drugs use in Mexico]. / Aspectos legales del uso de drogas ilícitas en México.

The objective of this cross-sectional, descriptive study was to obtain the opinions of a group of people about legal issues regarding addiction. Data collection was performed using a structured questionnaire with four themes. In order to participate, the individual could not use any drugs but should have a close relationship with a drug user. The data was processed using SPSS V. 14. There were 100 participants, 75% of whom were women, and 38% had a drug user as a friend, mainly cocaine and marijuana users. The participants had one opinion in common: laws should be more severe for people who use, sell, or transport drugs. The current laws do not improve consumers' criminal behavior. There is a need for further studies addressing people's opinion about this phenomenon in order to obtain a more realistic view of this drug issue.

[Critical perspective of the family and acquaintances on family and community risk factors in illicit drug use in São Jose, Costa Rica]. / Perspectiva crítica de la familia y de personas cercanas sobre factores de riesgo familiares y comunitarios en el uso de drogas ilícitas en San José, Costa Rica.

This article presents the results of a quantitative study. The purpose was to describe the perspective of family members and acquaintances of illicit drug users about family and community risk factors that can contribute to addiction to illicit drugs. A questionnaire was used for data collection. The population consisted of 100 individuals, 18 years of age or older, who reported being affected by their relationship with an illicit drug user (relative or acquaintance). Most users (82%) were men, with an average age of 27.3 years. Family risk factors included: family rejection (99%), not feeling loved (98%), lack of communication (95%), family conflicts and violence (95%). Social or community factors included: 99% having friends who use drugs, 99% peer pressure, 93% living in an unsafe area, and 99% experienced a stressful event. The critical perspective proposes to use more prevention strategies to avoid risk factors in the family and community.

[Risk factors related to the use of illegal drugs: the critical perspective of drug users' relatives and acquaintances at a public health center in San Pedro Sula, Honduras]. / Factores de riesgo relacionados al uso de drogas ilegales: perspectiva crítica de familiares y personas cercanas en un centro de salud público en San Pedro Sula, Honduras.

This article presents quantitative data from a multicenter, cross-sectional study, which was performed at a public health center in San Pedro Sula, Honduras, using multiple methods. The objective of the study was to describe the critical perspective of people who reported being affected by their relationship with an illicit drug user (relative or acquaintance) in terms of risk factors. Data collection was performed using 100 questionnaires. Most participants were women with low education levels. Drug users were mostly men, with an average age of 23.3 years. The most consumed drug was marijuana (78%), followed by crack/cocaine (72%), glue/inhalants (27%), hallucinogens (ecstasy/LSD) (3%), amphetamines/stimulants (1%), and heroin (1%). The identified risk factors include: previous experience with alcohol/tobacco, having friends who use drugs, lack of information, low self-esteem, age, and other personal, family and social factors. In conclusion, prevention and protection should be reinforced.

[Drug consumption and treatment from a family and friends perspectives: Guatemala]. / El consumo de drogas y su tratamiento desde la perspectiva de familiares y amigos de consumidores: Guatemala.

This quantitative and qualitative research describes the perspective of families and relatives of drug abusers in seven Latin American countries. In Guatemala, most of the people affected by the drug problem is multidrug abusers. Marijuana, followed by cocaine and benzodiazepines are the most used drugs. Of the respondents, 46% think drug use is a personal choice. They also recognize family as the most important protective factor, friends who use drugs and peer pressure are the major risk factors. The study reveals that the population believes that the response of the health services is insufficient, and that the preventive initiatives are not available or not properly addressed. The results show the need of more studies to update the knowledge of the drug problem in Guatemala. Future qualitative and quantitative research is needed to address the theme.

[Drug use and treatment from the perspective of the users' family and friends in Bogota, Colombia]. / El consumo de drogas y su tratamiento desde la perspectiva de familiares y amigos de consumidores en Bogotá, Colombia.

This article presents an analysis of the partial results from a quantitative study that addresses the perspective of drug users' family and friends regarding the treatment of problems resulting from the use of illicit drugs. Participants were 104 health service users in Bogotá. Of the participants, 58% consider that drug use is a disease that needs treatment; 56% stated the general hospital as the main alternative for treatment; 95% reported that the state accounted for this situation. Participants were more acquainted with private institutions, with therapeutic communities and religious groups being reported as the ones with the strongest commitment to the problem. For 73% of participants, the existing services are inappropriate and of difficult use and access. Stigma is the main barrier for a person to seek health care, and only 50% believe there is any use in treatments. There is a need for broader dissemination of the existing resources so as to increase their implementation and use.

[Critical perspective of relatives and acquaintances regarding protective factors and the use of illicit drugs in Guayaquil, Equador]. / Factores de protección relacionado al uso de drogas ilícitas: perspectiva crítica de familiares y personas cercanas a los usuarios de drogas, en la Ciudad de Guayaquil, Ecuador.

The objective of this study was to determine the perspectives of drug users' relatives and acquaintances about protective factors for illicit drug use at a health center in Guayaquil. This is a descriptive, cross-sectional study. Data collection was performed through interviews using a questionnaire. Interviews were performed with 100 people who knew a drug user (relative or friend). The results showed that the following personal and family factors could be protective: 97% having solid moral principles, 96% express their feelings, 98% dedicate time for the family, and 95 % have a supportive relationship with one of the parents. Regarding the community, all participants (100%) agree there is a need for a government that understands this issue, 99% refer there should be honest policemen, and 99% state the need for programs that protect people from drug use and institutions that work with prevention. Family, community and personal decisions have effects on becoming involved, hence the need to reinforce protective factors and thus reduce the number of addicted individuals.

[Laws and policies on illicit drugs in Brazil and the perspective of drug users' family members and acquaintances: a study in the City of Ribeirão Preto, São Paulo, Brazil]. / Políticas e leis sobre drogas ilícitas no Brasil e a perspectiva de familiares e pessoas próximas a usuários de drogas: estudo na Cidade de Ribeirão Preto, São Paulo, Brasil.

Brazilian drugs legislation has evolved from a prohibitionist system to a less repressive one in terms of drug users. The objective of this study was to identify the perception of relatives and acquaintances of drug users living in Ribeirão Preto, São Paulo, Brazil, about the country's laws and policies on drugs. Data collection was performed using a structured questionnaire. The sample consisted of 100 drug users' relatives or acquaintances, selected at a public health service. Respondents' relationships with the drug user were as follows: 31% friend, 23% sibling, 15% child and 7% spouse. Most users (78%) were men, with an average age of 26 years. Results confirm that national laws and policies have a direct effect on individuals' attitude and behaviors. There is a lack of trust in the police and a general perception that, despite recent chances that favor user rehabilitation, the laws on drugs do not respect users' human rights.

[Illicit drug use and the critical perspectives of drug users' relatives and acquaintances in Northern Rio de Janeiro City, Brazil]. / Uso de drogas ilícitas e perspectivas críticas de familiares e pessoas próximas na cidade do Rio de Janeiro-Zona Norte, Brasil.

This article presents the partial results of a multicenter, cross-temporal study, which was performed using multiple methods, and involved seven Latin-American countries and Canada. The results presented refer to the city center of Rio de Janeiro (n=108). The central question of the study was: 'How do illicit drug users' relatives and acquaintances describe protective and risk factors, prevention initiatives, treatment services, laws and policies regarding illicit drugs?' The quantitative data was collected using an instrument containing closed questions. In total, 108 young adults (18 years of age or older) were interviewed, who stated being affected by the drug although they were not users. For 104 interviewees (96%), negligence is the family dynamics that causes the greatest exposure to drugs, and 106 (98%) consider that parent support is what offers the greatest protection. Policies, the police and the criminal system have neither reduced drug use nor do they protect users.

Developing theory from complexity: reflections on a collaborative mixed method participatory action research study.

Research studies are increasingly complex: They draw on multiple methods to gather data, generate both qualitative and quantitative data, and frequently represent the perspectives of more than one stakeholder. The teams that generate them are increasingly multidisciplinary. A commitment to engaging community members in the research process often adds a further layer of complexity. How to approach a synthesizing analysis of these multiple and varied data sources with a large research team requires considerable reflection and dialogue. In this article, we outline the strategies used by one multidisciplinary team committed to a participatory action research (PAR) approach and engaged in a mixed method program of research to synthesize the findings from four subprojects into a conceptual framework that could guide practice in community mental health organizations. We also summarize factors that hold promise for increasing productivity when managing complex research projects.

Status and health security: an exploratory study of irregular immigrants in Toronto.

BACKGROUND: This qualitative study explores experiences of living without regular immigration status and implications for health security among irregular migrants in Toronto. Irregular migrants include those who lack secure status in Canada, including visitors who overstay visas; refugee claimants awaiting status determination; and failed claimants remaining in the country without authorization, awaiting deportation or following alternative procedures when judicial appeal is impossible. METHODS: In-depth, semi-structured interviews were conducted with irregular migrants recruited at a downtown community health centre. Interview transcripts were coded and analyzed using grounded theory and qualitative analytical techniques. The theoretical framework employed anthropological metaphors of liminality and examined psychosocial factors associated with stress. FINDINGS: Experiences of the study sample counter popular assumptions about irregular immigrants. The majority of study participants came to Canada to escape violence as well as lack of economic opportunity in home countries in Latin America, and most have tried to follow correct immigration procedures. Most are parents working in low-paying, exploitative jobs. They have attempted to lead productive and meaningful lives, but lack social support beyond the immediate family. They showed signs of suffering from trauma, depression, chronic stress, family separation and stress-related physical illnesses. Despite expressing self-esteem and using personal coping skills effectively, many reported unmet health needs and described barriers to help-seeking. Beyond the individual, the greatest impact of living without status appeared to be on the family, especially the children. CONCLUSIONS: More comprehensive information about this growing population is needed for health promotion, provision of mental health services and fair policy formulation.

Mental distress, economic hardship and expectations of life in Canada among Sudanese newcomers.

As part of a settlement needs assessment of 220 recently arrived Sudanese refugees and immigrants in seven cities, we examined overall health status, indicators of mental distress, economic hardship and expectations of life in Canada. Data were collected in a community-based study using qualitative and quantitative techniques. Results indicate that those Sudanese for whom life in Canada was not what they expected and those who experienced economic hardship as measured by worry over having enough money for food or medicine experienced poorer overall health and reported a greater number of symptoms of psychological distress. After controlling for demographic and related variables, we found that individuals who were experiencing economic hardship were between 2.6 and 3.9 times as likely to experience loss of sleep, constant strain, unhappiness and depression, and bad memories as individuals who do not experience hardship. Healthcare providers should be aware of how postmigration social disadvantages may increase the risk of mental distress particularly among refugees.

Alcohol use among immigrants in Ontario, Canada.

INTRODUCTION AND AIMS: This study examined prevalence of alcohol consumption among immigrants and the Canadian-born populations of Ontario by ethnic origin, and the association between ethnicity, country of birth, age at arrival, length of residence in Canada and drinking measures. DESIGN AND METHODS: Data were derived from the Centre for Addiction and Mental Health (CAMH) Monitor, a cross-sectional survey of Ontario adults, conducted between January 2005 and December 2010 (n = 13,557). RESULTS: The prevalence of alcohol consumption and risk drinking was generally lower among foreign-born than Canadian-born respondents, but significant variations across ethnic groups were found. In general, foreign-born respondents of European descent reported higher rates of alcohol use and risk drinking than foreign-born respondents from other ethnic groups. We also observed that ethnicity effects varied by whether or not respondents were born in Canada, and by the age at which they arrived in Canada. DISCUSSION AND CONCLUSIONS: While previous studies generally found an increase in immigrants' alcohol consumption with years in Canada, our data suggest that longer duration of residence may have either positive or negative effects on immigrants' alcohol use, depending on the country of origin/traditional drinking pattern. More research is needed to explore determinants of alcohol use and risk drinking among immigrants and to identify those groups at highest risk.

Social support and the significance of shared experience in refugee migration and resettlement.

This article examines the role of social support as a determinant of refugee well-being and migration patterns during early resettlement. Analysis is based on qualitative in-depth interviews with 47 government-assisted refugees in Canada and 38 key informants (settlement service providers and immigration officials) in Canada and overseas. The study describes refugees' decision making during stages of migration and resettlement, from whom they seek social support in particular situations, what sources are appraised as most important, and what is significant about the support. The authors suggest that a goal of refugees support-seeking strategies is affirmation through shared experience.

Supporting African refugees in Canada: insights from a support intervention.

Although evidence suggests the importance of social support for refugees, this knowledge has not been invoked to systematically develop culturally congruent support interventions that help refugees adapt to life in receiving countries. The objective of this study was to design and pilot test a culturally congruent intervention that meets the support needs and preferences of two ethno-culturally distinct refugee groups. Support was delivered to Somali and Sudanese refugees (n = 58), by trained peer and professional facilitators. Face-to-face groups comprised of refugees, matched by gender and ethnicity, were created to enhance the depleted social networks of Somali and Sudanese refugees. Each peer support group met bi-weekly for a face-to-face session for 12 weeks. Peer facilitators delivered supplementary one-to-one support via the telephone. The ingredients of the support intervention included: (i) peer facilitators and professionals; (ii) provision of information, affirmation and emotional support; and (iii) accessibility (e.g. childcare, transportation). The study employed a qualitative participatory research design. Data collected for the study included (i) in-depth pre-intervention interviews with potential support group participants in 2008-2009 to assess intervention preferences; (ii) fieldnotes by peer and professional facilitators during the intervention in 2009-10; (iii) post-intervention group interviews with support group participants in 2010; and (iv) in-depth interviews with peer and professional helpers in 2010. A major perceived benefit of the support programme was connecting with people from African refugee participants' cultural communities. Participants appreciated the gender and culture-specific groups. Following the social support intervention, refugees reported increased social integration, decreased loneliness and expanded coping repertoire.