Branka Agic

Alcohol use in seven ethnic communities in Ontario: A qualitative investigation

Populations in Canada represent a diverse range of cultures with different beliefs and norms regarding alcohol use and related problems. While there is very little published research on the cultural aspects of alcohol and other substance uses in Canada, in spite of the cultural diversity of the country, there are important indications that alcohol is a serious problem in many ethnic communities. In order to arrive at a more complete understanding of the issues related to providing culturally sensitive approaches that would meet the alcohol-related health promotion needs of diverse communities, focus group discussions were conducted with the key informants and community members from seven Ontario communities: the Polish, Portuguese, Russian, Tamil, Punjabi, Serbian and Somali. The results revealed that the types and sizes of alcoholic beverages consumed in each community, drinking levels that are considered ‘normal’ or ‘excessive’, as well as the perception of alcohol-related problems are largely shaped by their cultural norms and beliefs, which often differ from those of the dominant culture. Health messages that reflect the dominant culture are often not relevant to people from different cultural backgrounds. Socioeconomic disadvantages and barriers to service utilization heighten their vulnerability to alcohol problems. These findings have important implications for prevention and service provision, particularly to ethnic communities that may be unlikely to access services through more standard channels.

Mental Healthcare Policy for Refugees in Canada

Existing services do not meet the needs of refugees with physical or psychological difficulties. To promote health and to prevent the development of mental and physical illness in the refugee population there is a need for three areas of policy action: (1) Public policy that minimizes the impact of social risk factors for physical and mental illness; (2) Equitable access to a full range of health, social care and legal services that are capable of delivering appropriate and high quality care; and (3) Public bodies that organize to fulfill their duties under national and international law.

Protocol: a cluster randomised control trial study exploring stigmatisation and recovery-based perspectives regarding mental illness and substance use problems among primary healthcare providers across Toronto, Ontario

Introduction Primary care settings are often the first and only point of contact for persons with mental health and/or substance use problems. However, staff experience and training in this area are often limited. These factors as well as a multitude of other components such as structural and systemic stigma experienced by staff can lead to clients being stigmatised, leading to poorer outcomes. By developing a comprehensive intervention for primary care staff working at community health centres (CHCs) aimed at reducing stigma towards people with mental health and substance use problems (MHSUP), we sought to test an innovative and contact-based intervention consisting of staff training, raising awareness, a recovery-focused art programme and an analysis of internal policies and procedures. All of these components can inform and support staff so they can provide better care for people who are experiencing MHSUP. CHC staff members and clients will be included in this project as active participants. Methods and analysis This mixed-methods project will consist of repeated surveys of staff and clients, as well as in-depth, semistructured interviews with a sample of clients and staff. A cluster randomised control trial design will test the effectiveness of an antistigma intervention for CHCs in Toronto, Canada. Six CHCs—three receiving the intervention and three controls—will be included in the study. Using a variety of measures, including the Opening Minds Scale for Health Care Providers (OMS-HC), Mental Illness: Clinicians Attitudes (MICA) Scale, Modified Bogardus Social Distance Scale, Perceived Devaluation-Discrimination Scale, Discrimination Experience subscale of the Internalized Stigma of Mental Illness (ISMI) Scale and the Recovery Assessment Scale (RAS), we hope to gain a thorough understanding of staff members’ attitudes and beliefs and clients’ perceptions of staff beliefs and behaviours. In-depth interviews will reveal important themes related to clients’ experiences of stigma both within and outside the healthcare setting. Ethics and dissemination If demonstrated to be successful, this intervention can be used as a model for future initiatives aimed at reducing MHSUP-related stigma among healthcare providers in an organisational context. Adapting this work in other settings is a key strategic goal of this project. The project will also advance knowledge about stigma reduction and the experience of encountering stigma within a healthcare setting. Trial registration NCT03043417; Post-results.

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.

The mental health of Korean transnational mothers: A scoping review

Background: A recent migration trend from Korea is transnational family arrangement where mothers migrate with children to English-speaking countries, while the fathers stay in the home country. Mothers in these families may experience more challenges than other family members because they have to adjust to a new country, new parenting role and family separation. But little is known about their mental health. Aims: This article scopes the evidences in the literature on impact of transnational family arrangement and migration on the mental health of Korean transnational mothers. Method: A comprehensive search was undertaken in 16 databases and 17 studies were identified. Results: The evidence on the mental health of Korean transnational mothers was analyzed into two themes: (1) challenges and life difficulties, (2) psychological and emotional states. In relation to the life difficulties such as role changes, adaptation in the host country and lack of social support, the mothers reported anxiety, depression, increased psychological distress and feeling of isolation. Positive perceptions such as sense of empowerment and increased self-confidence were also reported. Conclusion: The evidence suggests that there may be a potential for vulnerability to mental health problems in Korean transnational mothers. More research is needed to assess their mental health and to identify the risk factors.

Alone in Canada: A Case Study of Multi - Lingual Mental Health Promotion

This article describes the development of a popular, multilingual self-help booklet for single immigrants and refugees who may require psychological and social support during settlement and adaptation in Canada. First we explain the need for this type of mental health promotion, with reference to immigration patterns in Ontario, Canada, and social determinants of immigrant mental well-being. We then describe the collaborative process by which the booklet was developed, and some of the adaptation challenges addressed, offering practical tips for producing similar resources We conclude that the booklet has been successful because it portrays common psychosocial adaptation challenges in a relevant context, using accessible language and immigrant voices that affirm lived experiences and offer helpful advice for overcoming problems. We suggest that such health promotion resources are not only helpful for individuals, but may also help engage newcomer communities and others in understanding the complex factors affecting immigrant mental health.

Refugees in Host Countries: Psychosocial Aspects and Mental Health

In the last few years, the number of refugees worldwide has increased significantly, reaching the highest levels ever recorded. As described in the literature, the mental health of refugees is affected by their pre-migration, migration, and post-migration experiences. It is well documented that the circumstances that refugees go through can impact both their physical and mental health. While the pre-migration and migration factors cannot be altered, host countries can make the greatest impact on the mental health trajectories for refugees by addressing the post-migration psychosocial factors. This chapter discusses how certain social factors and policies can affect the psychological well-being and mental health of refugees and asylum seekers in Canada and other developed countries.

Differences in Self-Reported Health and Unmet Health Needs Between Government Assisted and Privately Sponsored Syrian Refugees: A Cross-Sectional Survey

Between November 2015 and January 2017, the Government of Canada resettled over 40,000 Syrian refugees through different sponsorship programs (GAR and PSR). Timely access to healthcare is essential for good health and successful integration. However, refugee support differs depending on sponsorship program, which may lead to differences in healthcare service access and needs. A cross-sectional study with a sample of Syrian refugees was conducted to assess healthcare access, and perceived physical and mental health status. Results indicate demographic and healthcare access differences between GARs and PSRs. GARs reported significantly lower perceived physical and mental health, as well as, higher unmet healthcare needs than PSRs. GARs are among the most vulnerable refugees; they report higher needs, more complex medical conditions and tend to have more difficulty re-settling. These factors likely combine to help explain lower self-reported health and higher health needs in our sample compared to PSRs.

Past year cannabis use and problematic cannabis use among adults by ethnicity in Ontario

BACKGROUND Rates of cannabis use differ around the world; in Ontario, the rate of use has been stable since about 2005. Understanding which population groups are at greater risk for problematic cannabis use can help reduce long-term health effects and service expenses. The aim of this study was to explore differences in cannabis use among Canadian adults of different ethnic origins living in Ontario. METHODS Data are based on telephone interviews with 11,560 respondents and are derived from multiple cycles (2005-2011) of the Centre for Addiction and Mental Healths (CAMH) Monitor survey, an ongoing cross-sectional survey of adults in Ontario, Canada, aged 18 years and older. Data were analyzed using bivariate cross-tabulations and logistic regression. Problematic cannabis use was determined with a score of 8+ on the ASSIST-CIS to identify moderate/high problematic users. RESULTS Lifetime, past year and problematic cannabis use (in the past 3 months) occurs among all ethnic groups: Canadian, East Asian, South East Asian, South Asian, Caribbean, African, East European, South European, North European, and Central West European. When compared to the Canadian group the odds of past year cannabis use was significantly lower for East Asians and South Asians, but higher for the Caribbean group. Significantly higher odds of problematic cannabis use were found for Caribbeans and Northern Europeans compared to Canadians. CONCLUSIONS These results of this study provide an important basis for considering the possible impact of the impending legalization of cannabis in Canada among different ethnic groups.