The health of children and immigrants has been paramount to the economics literature in recent years. A strong relationship between parents’ socioeconomic status and children’s health has been well established. The vast short- and long-term consequences of children’s health outcomes, like low birth weight, have been emphasized. Similarly, empirical studies have attributed considerable importance to immigrants’ health. The healthy immigrant effect (HIE), a phenomenon where immigrants are healthier upon arrival but their health diminishes through time, has been evidenced in Canada. However, the link between children’s health and the HIE has not been made. Using birth weight as a health measure, the intergenerational transmission of the HIE through social capital is examined. With the National Longitudinal Survey of Children and Youth this study provides robust evidence of the perpetuation of the HIE. However, social capital does not appear to be a determinant of birth weight for immigrants’ children in Canada.

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I present a qualitative study investigating the self-perceived health of recently arrived Canadian immigrants. The study develops health promotion’s understanding of culture as a social determinant of health, and conceptually locates it within a broader context of psychosocial factors. The study involves semi-structured individual interviews focusing on self-perceived health and well-being. The sample group consists of recently arrived (within the last 10 years) adult immigrants between 23 and 46 years of age, from a variety of cultural backgrounds, who participate with the YMCA Cross Cultural & Community Services’ Host program in Kitchener-Waterloo, Ontario. I also interview two YMCA settlement program supervisors who discuss health care issues facing Canadian newcomers. Newcomer self-expression contributes to a better understanding of the social and cultural determinants of the Healthy Immigrant Effect. This study represents a theoretically and empirically informed personal examination of Canadian multiculturalism from a public health research perspective.

In order to better tailor treatment to specific populations, factors which contribute to health disparities among different racial/ethnic groups must be examined. Among Mexican American individuals, the high rate of diabetes represents a significant contributor to overall health. The present study focuses on factors affecting diabetes status among Mexican Americans born in either Mexico or the United States using the 2007 – 2008 NHANES data set. Comparisons were made between diabetes status based on self-report and clinical classification using HbA1c. Results indicated that within the diabetic subsample, Mexican Americans born in Mexico were twice as likely to be incorrectly classified as non-diabetic, when they actually were diabetic, when using a self-report method. In contrast, nativity did not result in differences in diabetes incidence using the HbA1c clinical cut-score diagnostic classification. Age, BMI, gender, nativity, and health insurance coverage were found to have varying relationships to diabetes prevalence and HbA1c levels, but time in the U.S. for Mexico-born individuals was not found to uniquely predict diabetes incidence. Analyses also demonstrated that Mexico-born males, as compared to the other groups, had significantly higher HbA1c levels. Further research is necessary to better understand the relationships among these factors. However, findings do demonstrate a need for more objective disease classification, particularly when examining immigration status and diabetes. Additionally, the complexity of these interactions establishes a need for specific health intervention for foreign-born populations which might be missed by self-report screening asking about presence of disease and exacerbated by an oversimplification of the “healthy immigrant effect”.

Nutritional communication research helps with public health promotion, government dietary intervention and future outlooks for the dietetics profession. This research explores the way health professionals target niche population groups to educate on nutrition. The phenomenological methodology and the Communication Accommodation theory framework guided interviews with 10 Arab-speaking females diagnosed with type II diabetes or prediabetes. The findings reveal eight major underlying themes: language, socio-economic impact, level of integration/adaption to new environment, role of religion in life, health is a personal responsibility, role of family/specific family members, role of health professional and views on the Canadian food/culture. Ultimately, dietary acculturation of the sample group is influenced by level of English language proficiency, health literacy, exposure to health information and cultural values.

Adherence to guideline-recommended secondary cardiovascular prevention therapy (statins and cardiac rehabilitation) has been demonstrated to reduce the risk of all-cause mortality (Statins RRR 0.25, 95% CI 0.19-0.30; Cardiac Rehabilitation RRR 0.26, 95% CI 0.14-0.36) and secondary events.1,2 Yet, ≥50% of patients discontinue statin use within 12-month after an initial prescription and completion of cardiac rehabilitation is ≤20% in Ontario.3,4 Low statin adherence and cardiac rehab completion limits patients from realizing the full benefits of therapy. A meta-analysis of randomized controlled trials of adherence to statins for secondary prevention reported that nonadherence to statins was greater in non-white ethnicities compared to white ethnicities (OR 1.28, 95% CI 1.04-1.59) with geographical variation in outcomes.5 In respect to cardiac rehabilitation, the literature suggests that non-white ethnicities are less likely to complete cardiac rehabilitation compared to white participants.6,7 However, a gap remains in our knowledge of cardiac rehabilitation completion among immigrants due to lack of outcome reporting across clinical trials. The literature suggests that immigrants have improved health profiles relative to Canadian-born patients. Specifically, immigrants with ≤10 years of Canadian residency have greater medication adherence than immigrants with >10 of Canadian residency when compared to Canadian-born participants.6-9 This thesis was a planned sub-study of the Interventions Supporting Long-Term Adherence and Decreasing Cardiovascular Events (ISLAND) randomized control trial. The ISLAND study was a pragmatic, randomized controlled trial investigating the effect of educational reminders on adherence to guideline-recommended therapy post-myocardial infarction. Study participants were allocated in a 1:1:1 ratio to one of three groups: i) usual care, ii) educational reminders sent via post, or iii) combination post and interactive voice response educational reminders. Investigators were blinded to the allocation sequence, participant allocation, and outcome assessment. Medication adherence and completion of cardiac rehabilitation were assessed 12-months from baseline. This sub-study of ISLAND focused on participants who completed a 12-month outcome assessment with a recorded response to the following question, “Were you born a Canadian citizen?”. Immigrants experienced greater odds of statin adherence at 7-days (OR 1.36, 95% CI 1.00-1.85) and 30 days (OR 1.36, 95% CI 0.96-1.94) at one-year post-myocardial infarction, after adjusting for age, diabetes, sex, and smoking status. We found no evidence that immigration status was associated with cardiac rehabilitation completion (OR 0.91, 95% CI 0.72-1.14) after adjusting for age, diabetes, sex, smoking status, average neighborhood income quintile, education, and marital status. The odds of statin adherence at 7-days (OR 1.33, 95% CI 0.89-2.18) and 30-days (OR 1.39, 95% CI 0.89-2.18) was greater in visual minorities than white patients, however the difference was not statistically significant. We found no evidence of an association between ethnicity and cardiac rehabilitation completion (OR 0.98, 95% CI 0.75-1.29). Our analysis could not fully evaluate the healthy immigrant effect due to an insufficient sample size of immigrants with <10 years of Canadian residency exposure (n=29). In conclusion, we report a statistically significant 36% increase in the odds of 7-day and 30-day statin adherence in immigrants compared to Canadian-born patients. We also report that the odds of cardiac rehabilitation decreased by 9% in immigrants compared to Canadian-born patients at 12-months post-myocardial infarction but this was not statistically significant. Our findings offer support for the “healthy immigrant effect” continuing in immigrants with >10 years of Canadian residency exposure. We were unable to evaluate outcomes in immigrants with <10 years Canadian residency exposure due to a lack of sample size (n=29). / Thesis / Master of Science (MSc) / The primary purpose of this research project was to assess whether immigrants, individuals who reside in Canada but were born outside of the country, who have experienced a previous heart attack were adhere to heart health therapies better than Canadian-born patients. The heart health therapies of interest to our investigation are two guideline-recommended heart attack prevention therapies, statins and cardiac rehabilitation. The study design of our research project was a cohort sub-study of the ISLAND randomized control trial which investigated adherence to heart health therapies in patients residing in Ontario, Canada. Our major finding was that immigrants who lived in Canada for >10 years were more adherent to statin therapy for a previous heart attack compared to Canadian-born participants. Our findings support the hypothesis that immigrants tend to demonstrate behaviours associated with improved outcomes compared to their Canadian-born counterparts.

While the healthy immigrant effect (HIE) has been seen throughout the western world in the adult population; research on the older population shows an inverse relationship between self-reported health and immigration status – i.e., in many instances, a health disadvantage for older immigrants. Explanations for this vary from a lack of selection into population, among older immigrants, to a duration effect; such that perceived health advantages seen in early life dissipate upon reaching older age. While these are the widely accepted reasons for the disappearance of the HIE among older people, not all mitigating factors have been examined in detail. This study aims to identify if there is an association between retirement and the healthy immigrant effect seen in Europe. It uses SHARE data for 27 European countries to examine self reported health (SRH) outcomes &amp; presence of longterm illness’ (LTI) for population groups aged 55-74. The findings indicate the presence of a greater health disadvantage for retired immigrants (versus native-born retirees) as compared with those who are not retired. Additionally, better health outcomes (compared to native-born individuals) were seen for immigrants who retired late (after the age of 65) versus those who retired early. Retirement due to poor health was examined as an explanation for these findings, but it did not appear to affect the results, suggesting the observed patterns are most likely caused by an alternative factor relating to retirement. Further research is recommended to identify these factors.

Diverses études s’accordent sur le fait que les immigrants, notamment dans les premiers moments succédant leur arrivée, sont en meilleure santé que les natifs, ce que l’on appelle l’« effet de sélection de l’immigrant en bonne santé » (ESIBS). Toutefois, cet effet tend à se dissiper avec la durée de résidence dans le pays d’accueil. Dans la perspective de vérifier si ce fait est toujours avéré au Canada, l’objectif principal de l’étude est de documenter l’évolution de l’ESIBS au cours des 20 dernières années. En outre, nous analysons l’évolution du rôle de la durée de résidence dans la dissipation de l’ESIBS, et en particulier nous cherchons à savoir si cette dissipation s’observe toujours et dans quelle mesure. Pour atteindre notre objectif, nous appuyons nos analyses sur les données issues de tous les passages de l’Enquête sur la santé dans les collectivités canadiennes (ESCC) de 2001 à 2018 (au nombre de 8), excepté celle de 2011-2012 pour laquelle les données sont indisponibles. Pour mesurer la santé des individus, nous nous en remettons principalement à la variable de la santé perçue ou auto-déclarée de l’ESCC. L’analyse descriptive, dans un premier temps, met en lumière le rôle de la durée de résidence sur la santé perçue en croisant cette variable avec une série de variables sociodémographiques, en particulier l’âge, le sexe, l’ethnicité et le revenu. Une analyse multivariée, basée sur le modèle complémentaire log-log (ou cloglog), permet d’étudier de manière plus approfondie les relations entre la variable (dépendante) de santé perçue et ces variables indépendantes. Comme résultats principaux, nous observons que l’ESIBS s’est maintenu tout au long de la période étudiée, de même que l’effet négatif sur la santé de la durée de résidence écoulée. Il semble même que l’ESIBS se soit accentué avec le temps, particulièrement pour les immigrants récents (i.e., durée de résidence < 10 ans). Cette amélioration s’observe plus particulièrement chez les femmes immigrantes récentes en 2018, probablement à cause d’un effet de sélection accru dans ces cohortes d’immigrantes. L’amélioration de la santé perçue des immigrants est également statistiquement significative, mais n’est pas aussi prononcée que pour les immigrantes. Hormis l’état matrimonial et la province de résidence pour lesquels l’effet n’était pas très important dans nos modèles, les autres variables conjuguées avec la durée de résidence permettent d’approfondir notre compréhension de l’ESIBS et de ses relations multivariées avec ses principaux déterminants mesurables. Fait notoire, l’ESIBS se manifeste presqu’exclusivement dans les groupes socioéconomiques les moins avantagés, et pratiquement pas dans les groupes avantagés, indiquant qu’un revenu élevé peut avoir le rôle d’un effet protecteur de la santé, chez les natifs comme chez les immigrants. / Various studies agree that immigrants, especially in the first moments after arrival, are healthier than the native-born, the so-called “healthy immigrant effect” (HIE). However, this effect tends to dissipate with the length of residence in the host country. In order to verify whether this fact is still true in Canada, the main objective of the study is to document the evolution of the HIE over the last 20 years. In addition, we analyze the changing role of residence time in the dissipation of HIE, and in particular whether and to what extent this dissipation is still observed. To achieve our objective, we base our analyses on data from all the Canadian Community Health Survey (CCHS) rounds from 2001 to 2018 (8 in number), except for 2011-2012 for which data are unavailable. To measure the health of individuals, we rely primarily on the perceived or self-reported health variable of the CCHS. The descriptive analysis first highlights the role of length of residence on perceived health by cross-tabulating this variable with a series of socio-demographic variables, in particular age, gender, ethnicity and income. A multivariate analysis based on the complementary log-log (or cloglog) model, allows us to further investigate the relationships between the (dependent self-reported health variable and these independent variables. As main results we observe that the HIE has been maintained throughout the study period, as well as the negative effect of the length of residence on health. It even seems that the HIE has increased over time, especially for recent immigrants (i.e., length of residence <10 years). This improvement is particularly observed among recent immigrant women in 2018, probably due to an increased selection effect in these immigrant cohorts. The improvement in the self-reported health of immigrants is also statistically significant but is not as pronounced as for female immigrants. Apart from marital status and province of residence, for which the effect was not very significant in our models, the other variables combined with length of residence provide further insight into the HIE and its multivariate relationships with its main measurable determinants. Notably, HIE occurs almost exclusively in the lowest socio-economic groups, and almost not in the highest, indicating that high income may act as a protective effect on health, both for natives and immigrants.