Nazilla Khanlou

Intersection of Canadian Policy Parameters Affecting Women with Precarious Immigration Status: A Baseline for Understanding Barriers to Health

Canadian federal policy provides a framework for the immigration and health experiences of immigrant women. The official immigration category under which a migrant is admitted determines to what degree her right to remain in the country (immigration status) is precarious. Women immigrants fall primarily into the more dependent categories and they experience barriers to access to health services arising from this precarious status. Federal immigration and health policies create direct barriers to health through regulation of immigrants’ access to services as well as unintended secondary barriers. These direct and secondary policy barriers intersect with each other and with socio-cultural barriers arising from the migrant’s socio-economic and ethno-cultural background to undermine equitable access to health for immigrant women living in Canada.

Therapeutic landscapes of the mind: theorizing some intersections between health geography, health promotion and immigration studies

For over a decade, the concept of therapeutic landscapes has provided health geographers with a useful framework for investigating the dynamics between place and well-being. However, its application has been largely restricted to physical places in which human co-presence is a necessary condition. Through both a review of the literature on therapeutic landscapes and four personal narratives from immigrants to Canada, the concept is extended to interpret experiences of migration and to explore, in particular, the personalized mental strategies that individuals enact to enhance their mental health and promote their well-being in times of change. These involve memories of home and a range of practical methods that are employed to strengthen them. Given these findings, it is argued that the therapeutic landscape concept should be extended beyond physical sites to include everyday and personalized place-related memories. The authors term this expanded concept ‘therapeutic landscapes of the mind’. Given this proposed broader definition, the concept may usefully be applied beyond health geography as a theoretical framework by other health-focused academic disciplines.

Cultural Identity and Experiences of Prejudice and Discrimination of Afghan and Iranian Immigrant Youth.

In culturally diverse and immigrant receiving societies, immigrant youth can be subject to prejudice and discrimination. Such experiences can impact on immigrant youth’s cultural identity and influence their psychosocial outcomes. This paper presents findings of a study that examined cultural identity and experiences of prejudice and discrimination among Afghan (N = 9) and Iranian (N = 17) immigrant youth in Canada. The study had a prospective, comparative, longitudinal qualitative design. Data was gathered through focus groups, interviews, journals and field logs. Four main themes emerged on participants’ experiences of prejudice and discrimination: (a) societal factors influencing prejudice; (b) personal experiences of discrimination; (c) fear of disclosure and silenced cultural identity; and (d) resiliency and strength of cultural identity. Drawing from Rosenberg’s (Conceiving the self, Basic Books, New York, 1979) self-concept framework and Romero and Roberts (J. Adolesc., 21:641–656, 1998) distinction between prejudice and discrimination, results indicated that youth’s extant and presenting cultural identity were affected. Inclusive policies and practices are needed to promote youth integration in multicultural and immigrant receiving settings.

Post-Migratory Experiences of Newcomer Female Youth: Self-Esteem and Identity Development

This study explored the post-migratory experiences of newcomer female youth attending secondary school within a multi-cultural context. Focus groups were held with 10 newcomer female youth, in Toronto, Canada. Data were also collected through focus groups or in-depth interviews with school educators, parents, and school and community health center workers. In addition, the Current Self-Esteem (CSE) instrument was utilized to examine the global self-esteem of youth and the influences on their self-esteem. The average age of youth participants was 17 years old and their averageage of immigration to Canada was 13.9 years old. The average score for the CSE was 7.9, which indicated that respondents felt, in general, good about themselves. Among the influences on youths self-esteem were those related to Self, School, Relationships, Achievements and Lifestyle. The emerging sub-themes of the Self-Concept theme, arising from the qualitative data, consisted of Dynamic Self, Silenced Self, Cultural Identity, Female Role Models, Future Aspirations. The impact of the resettlement process on the self-esteem and identity of newcomer females is considered. It is concluded that in multi-cultural and post-migration societies multi-sectoral and context-specific mental health promotion strategies and policies are needed for youth.

“It is an Issue of not Knowing Where to Go”: Service Providers’ Perspectives on Challenges in Accessing Social Support and Services by Immigrant Mothers of Children with Disabilities

In Canada little is known about the challenges immigrant mothers of children with disabilities encounter in accessing formal and informal social support. This paper presents the perspectives of service providers on the mothers’ challenges. Data was collected from 27 service providers in Toronto, Canada in 2012 through in-depth interviews. The interview guide was informed by published literature on families of children with special needs. Level one analyses entailed descriptive analyses; and level two consisted of applying House’s 4 domains of social support to organize the themes. Following House’s domains, challenges to (1) Structural support, (2) Instrumental support, (3) Emotional support, and (4) Perception of support were identified. Among providers who work with families of children with disabilities there is recognition of the mothers’ particular challenges in light of their immigration status. Language and communication are significant barriers for immigrant mothers in accessing social support.

A descriptive phenomenology study of newcomers' experience of maternity care services: Chinese women's perspectives

BackgroundMaternity health care available in Canada is based on the needs of women born in Canada and often lacks the flexibility to meet the needs of immigrant women. The purpose of this study was to explore immigrant Chinese women’s experiences in accessing maternity care, the utilization of maternity health services, and the obstacles they perceived in Canada.MethodsThis descriptive phenomenology study used in-depth semi-structured interviews to examine immigrant Chinese women’s experiences. Fifteen participants were recruited from the Chinese community in Toronto, Canada by using purposive sampling. The interviews were digitally recorded and transcribed verbatim into written Chinese. The transcripts were analyzed using Colaizzi’s (1978) phenomenological method.ResultsSix themes were extracted from the interviews: (1) preference for linguistically and culturally competent healthcare providers, with obstetricians over midwives, (2) strategies to deal with the inconvenience of the Canadian healthcare system (3) multiple resources to obtain pregnancy information, (4) the merits of the Canadian healthcare system, (5) the need for culturally sensitive care, and (6) the emergence of alternative supports and the use of private services.ConclusionsThe findings provide new knowledge and understanding of immigrant Chinese women’s experiences in accessing maternity health services within a large metropolitan Canadian city. Participants described two unique experiences within the themes: preference for linguistically and culturally competent healthcare providers, with obstetricians over midwives, and the emergence of alternative supports and the use of private services. Few studies of immigrant maternity service access have identified these experiences which may be linked to cultural difference. Further investigation with women from different cultural backgrounds is needed to develop a comprehensive understanding of immigrant women’s experiences with maternity care.

Young and New to Canada: Promoting the Mental Wellbeing of Immigrant and Refugee Female Youth

Each year newcomers enter Canada as their destination country of resettlement. Among these, female immigrant and refugee children and youth comprise a significant portion of newcomers. For example, in 2002 over 36% of female immigrants to Canada were children and youth between 0 and 24 years of age (Citizenship and Immigration Canada 2003). Among refugees this proportion increases. During the same year, close to 48% of female refugees to Canada were children and youth (Citizenship and Immigration Canada 2003). The significant size of female immigrant and refugee youth demands research, practice, and policy that specifically address this sub-group of newcomers. While youth bring many resiliences and positive hopes for their future in their new country of residence, they, along with their families, can face significant resettlement barriers within the first few years of their arrival. Newcomer female youth can be immigrants or refugees. However, it is important to distinguish between the two groups of youth as they differ significantly in their premigration experiences, which can affect their post-migration mental health needs. For example both groups face, and often over time accommodate to, changes inherent to migrating from one place to another (such as changes in family structure, social networks, cultural, and economic circumstances). However, refugee youths’ pre-migration experiInt J Ment Health Addiction (2008) 6:514–516 DOI 10.1007/s11469-007-9071-y

School-age children’s safety attitudes, cognitions, knowledge, and injury experiences: how do these relate to their safety practices?

Background: A variety of factors affect the safety and risk practices of school-age children, but rarely have multiple factors been considered simultaneously. Objective: To examine children’s safety attitudes and cognitions more thoroughly and assess how these factors, along with children’s safety knowledge and injury experiences, relate to children’s safety practices. Methods: Over several classroom sessions, boys and girls in two age groups (7–9, 10–12 years) completed a psychometrically sound questionnaire that indexes their behaviors, attitudes, cognitions, knowledge, and injury experiences. Results: Fewer safety practices were reported by older than younger children and boys than girls. Children’s attitudes, cognitions, knowledge, and injury experiences each correlated with safety practices, but only safety attitudes and injury experiences predicted practices in a multivariate model. Conclusion: Exploring the relative influence of numerous factors on safety practices highlights the important role that attitudes play in predicting children’s safety practices. Implications of these results for injury prevention programming are discussed.

South Asian populations in Canada: migration and mental health

BackgroundSouth Asian populations are the largest visible minority group in Canada; however, there is very little information on the mental health of these populations. The objective of this study was to determine the prevalence rates and characteristics of mental health outcomes for South Asian first-generation immigrant and second-generation Canadian-born populations.MethodsThe Canadian Community Health Survey (CCHS) 2011 was used to calculate the estimated prevalence rates of the following mental health outcomes: mood disorders, anxiety disorders, fair-poor self-perceived mental health status, and extremely stressful life stress. The characteristics associated with these four mental health outcomes were determined through multivariate logistic regression analysis of merged CCHS 2007–2011 data.ResultsSouth Asian Canadian-born (3.5%, 95% CI 3.4-3.6%) and South Asian immigrant populations (3.5%, 95% CI 3.5-3.5%) did not vary significantly in estimated prevalence rates of mood disorders. However, South Asian immigrants experienced higher estimated prevalence rates of diagnosed anxiety disorders (3.4%, 95% CI 3.4-3.5 vs. 1.1%, 95% CI 1.1-1.1%) and self-reported extremely stressful life stress (2.6%, 95% CI 2.6-2.7% vs. 2.4%, 95% CI 2.3-2.4%) compared to their Canadian-born counterparts. Lastly, South Asian Canadian-born populations had a higher estimated prevalence rate of poor-fair self-perceived mental health status (4.4%, 95% CI 4.3-4.5%) compared to their immigrant counterparts (3.4%, 95% CI 3.3-3.4%). Different profiles of mental health determinants emerged for South Asian Canadian-born and immigrant populations. Female gender, having no children under the age of 12 in the household, food insecurity, poor-fair self-rated health status, being a current smoker, immigrating to Canada before adulthood, and taking the CCHS survey in either English or French was associated with greater risk of negative mental health outcomes for South Asian immigrant populations, while not being currently employed, having a regular medical doctor, and inactive physical activity level were associated with greater risk for South Asian Canadian-born populations.ConclusionsMental health outreach programs need to be cognizant of the differences in prevalence rates and characteristics of mental health outcomes for South Asian immigrant and Canadian-born populations to better tailor mental health services to be responsive to the unique mental health needs of South Asian populations in Canada.

Public health policy and social support for immigrant mothers raising disabled children in Canada

A literature review regarding the social support of immigrant mothers of disabled children in Canada was undertaken with a focus on settings where supports need to be shored up. An integrative review of published papers and policy reports concerning key aspects of social supports for immigrant mothers and disabled children was undertaken. Immigrant mothers experience numerous barriers to social supports for themselves and their disabled children. Maternal immigrant populations experience unique challenges in the setting of childhood disability as well as the challenges of mothers in the dominant culture. There are negative impacts on maternal health as a result of inadequate policy offerings. Public health policy needs to be refashioned in light of weak systems and supports for both immigrant mothers and disabled children and to acknowledge that the current system poses concerning implications for the long-term health of both groups.