Bruce Newbold

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 Canadas 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.

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 Canadas 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

Abstract 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 intra-urban scale in an industrial setting. Models predicting exposure within smaller areas may lead to improved detection of health effects in epidemiologic studies.

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

BackgroundWater 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?MethodsData 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).ResultsUnder-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.ConclusionsOur 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.

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.

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.

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.

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

BackgroundVariations 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.MethodsA standardized asthma survey was administered to children in grades one and eight in Hamilton, Canada, in 1994–95 (N ~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.ResultsThere 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.ConclusionOur 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.

IMPACT: An integrated GIS-based model for simulating the consequences of demographic changes and population ageing on transportation

Recent advancements in computing and geographic information systems (GIS) have revolutionized the development of planning support systems (PSSs) to study and simulate the future of travel demand in urban areas. While travel demand models have been widely developed and used to inform the urban planning process, very little has been done to explicitly account for demographic changes and the ageing of population within such models. The work in this paper bridges this gap by describing the development and application of IMPACT (integrated model for population ageing consequences on transportation), a GIS-based PSS capable of assessing the ramifications of demographic changes, including population ageing, on the performance and usage of urban transportation systems. Unlike existing operational PSSs, IMPACT possesses unique and novel features that enable it to model demographic changes and urban travel demand for various age cohorts. Through the simulation of scenarios for varying fertility rates, the paper explores and quantifies the impacts of ageing and population age-structure changes on travel patterns in the census metropolitan area (CMA) of Hamilton in Ontario, Canada. The analysis suggests a consistent increase in the number of trips and mobility levels of elderly drivers, as a result of population ageing over time. Furthermore, increases in fertility rates could significantly impact the usage and performance of the transportation system for certain periods of the day, by the year 2031. Results such as these are important to consider when planning the future of cities. The findings in this paper provide new insights into the future of urban travel in the Canadian context.

Sense of Place in Hamilton, Ontario: Empirical Results of a Neighborhood-Based Survey

Although the concept of sense of place has a long history in the social sciences, relatively few studies have attempted a quantitative analysis of sense of place at the neighborhood level. This study reports on the empirical findings of a sense of place survey developed and tested in two contrasting neighborhoods in Hamilton, Ontario, Canada: Southwest Mountain, an upper-middle-class suburban neighborhood and Northeast Industrial, a lower-income, working-class neighborhood located in the heart of the citys industrial district. The principal objective is to assess the relationship between sense of place and the socio-demographic characteristics of residents living in neighborhoods of very different socioeconomic status. This study also introduces a method for calculating a neighborhood sense of place score derived from a fully tested, validated survey instrument. It was found that sense of place was strongest in Southwest Mountain, and among seniors, long-term residents, unmarried people, and immigrants. In addition, residents with a lower level of education and those in the unpaid labor force had a stronger sense of place.