Revisiting the healthy immigrant effect with diabetes risk in Canada: why race/ethnicity matters.

Objective: Evidence shows that recent immigrants are healthier than the native-born population, a phenomenon known as the healthy immigrant effect. With increasing duration of stay, this health gap significantly narrows as immigrants' health deteriorates to either resemble or become worse than the host population. However, little is known about the category of immigrants for whom this decline is most pronounced since the extant research largely considers immigrants as a homogeneous group, thus overlooking important racial/ethnic differences.Design: Using data from the 2014 Canadian Community Health Survey (CCHS), we categorised immigrants by race/ethnicity and duration of stay in Canada and compared them to their native-born white Canadian counterparts on the likelihood of having a chronic health condition, using type 2 diabetes (T2D) as a case.Results: In the base model, recent visible minority (i.e. non-white or non-Caucasian) immigrants and recent white immigrants were less likely than the native-born white Canadian population to have T2D (recent visible minority immigrants OR = 0.46, CI = 0.27-0.79, p = 0.005; recent white immigrants OR = 0.26, CI = 0.11-0.64, p = 0.003). The odds of having T2D were significantly higher for long-term immigrants than the native-born white Canadian population (long-term visible minority immigrants OR = 1.59, CI = 1.27-2.00, p = 0.000; long-term white immigrants OR = 1.74, CI = 1.44-2.10, p = 0.000). In the multivariate model, long-term visible minority immigrants were about 2.3 times more likely than their white Canadian born counterparts to have T2D (CI = 1.86-2.96, p = 0.000). Long-term visible minority immigrants were about 2.1 times more likely than long-term white immigrants to have T2D (CI = 1.49-2.94, p = 0.000)Conclusion: Immigrants' health deterioration varies significantly across ethnic categories in Canada. Interventions for facilitating the integration of visible minority immigrants may help reduce these health inequities.

Local knowledge and practices towards malaria in an irrigated farming community in Ghana.

BACKGROUND: Although malaria is endemic across Ghana, the risk is generally elevated for residents living in and around stagnant water bodies such as dams and irrigated farming projects. What knowledge do these at-risk populations have about the aetiology and symptoms of malaria? What are their coping strategies? And what interventions are needed to help improve the health outcomes of people living in high-risk malaria communities? METHODS: This study addressed these research questions with primary data, comprising both qualitative interviews and quantitative surveys, collected in Asutsuare-a rural irrigated farming community located in the Greater Accra Region of Ghana. RESULTS: Results from the fieldwork showed that awareness of malaria as a major health concern in the community was universal. Respondents also displayed a high knowledge of some common clinical symptoms of malaria. Yet, only 3% out of the total survey respondents of 337 indicated they immediately visit a health facility for treatment whenever they suspected malaria. The overwhelming majority (about 97%) indicated they only visit a healthcare facility for treatment if they felt the suspected malaria illness was severe and/or other treatment options had failed. CONCLUSION: Malaria testing training for drug dispensing personnel as well as the provision of malaria testing kits in drug dispensing stores are necessary to facilitate early malaria screening and timely diagnosis particularly in rural endemic areas.

Religion, contraception, and method choice of married women in Ghana.

Using pooled data from the 1998 and 2003 Demographic and Health Surveys, this paper investigates the association between religion and contraceptive behavior of married women in Ghana. Guided by the particularized theology and characteristics hypotheses, multinomial logit and complementary log-log models are used to explore denominational differences in contraceptive adoption among currently married women and assess whether the differences could be explained through other characteristics. We found that while there were no differences between women of different Christian faiths, non-Christian women (Muslim and Traditional) were significantly more likely to have never used contraception compared with Christian women. Similar observations were made on current use of contraception, although the differences were greatly reduced in the multivariate models.

Investigating site-level longitudinal effects of population health interventions: Gay-Straight Alliances and school safety.

There is limited research on evaluating nonrandomized population health interventions. We aimed to introduce a new approach for assessing site-level longitudinal effects of population health interventions (SLEPHI) by innovatively applying multiple group multilevel (MG-ML) modeling to repeated cycles of cross-sectional data collected from different individuals of the same sites at different times, a design commonly employed in public health research. For illustration, we used this SLEPHI method to examine the influence of Gay-Straight Alliances (GSAs) on school-level perceived safety among lesbian, gay, and bisexual (LGB) and heterosexual (HET) adolescents. Individual-level data of perceived school safety came from 1625 LGB students (67.4% female; mean age, 15.7 years) and 37,597 HET students (50.2% female; mean age, 15.4 years) attending Grades 7-12 in 135 schools, which participated in 3 British Columbia Adolescent Health Surveys (BCAHS: 2003, 2008, 2013) in Canada. School-level data of GSA length since established were collected by telephone in 2008 and 2014. Nested MG-ML models suggested that after accounting for secular trend, cohort effects, measurement error, measurement equivalence, and student age, GSA length linearly related to increased school-level perceived safety among LGB students (b = 1.57, SE = 0.21, p < .001, ß = 0.32) and also among HET students (ß = 0.34 in 2003 & 2013, ß = 0.32 in 2008) although statistical differences between years for HET youth were likely due to the large sample size. By conducting MG-ML analysis on repeated cross-sectional surveys, this SLEPHI method accounted for many confounding factors and followed schools for a longer period than most longitudinal designs can follow individuals. Therefore, we drew a stronger conclusion than previous observational research about GSAs and LGB students' well-being. The SLEPHI method can be widely applied to other repeated cycles of cross-sectional data in public health research.

Boys are not exempt: Sexual exploitation of adolescents in sub-Saharan Africa.

Research on youth sexual exploitation in Africa has largely neglected the experiences of exploited boys. To date, much of the research in sub-Saharan Africa continues to consider boys mainly as exploiters but not as exploited. Using the only publicly available population-based surveys from the National Survey of Adolescents, conducted in four sub-Saharan African countries - Burkina Faso, Ghana, Malawi, and Uganda-we assessed factors associated with transactional sexual behaviour among never-married adolescent boys and girls. We also examined whether boys' reported sexual exploitation was linked to similar risky sexual behaviours as has been noted among girls in sub-Saharan Africa. Results from our analyses indicated that even though adolescent girls have a somewhat higher likelihood of reporting sexual abuse and exploitation, the odds of trading sex were significantly elevated for previously traumatized boys (that is those with a history of sexual and physical abuse) but not for their female counterparts. Just like adolescent girls, transactional sexual behaviour was associated with the risk of having concurrent multiple sexual partners for boys. These findings support the reality of boys' sexual exploitation within the African context, and further highlight the importance of including males in general and boys in particular in population-based studies on sexual health, risk, and protective factors in the sub-Saharan African region. Understanding the factors linked to sexual exploitation for both boys and girls will help in developing policies and programs that could improve the overall sexual and reproductive health outcomes among adolescents and youth in sub-Saharan Africa.