The Effect of Acculturation on the Health of New Immigrants to Canada between 2001 and 2005 ASTRID FLÉNON* ALAIN GAGNON* JENNIFER SIGOUIN ** ZOUA VANG** *UNIVERSITÉ DE MONTREAL **MCGILL UNIVERSITY 2014 National Conference: Investing in our Futures Winnipeg, Manitoba, October 30th, 2014
PRESENTATION OVERVIEW Background Research Question And Objectives Data and Methods Results Discussion and further steps
1. BACKGROUND Immigrant s health: Area of concern in the development of policies for population health 60% of the Canadian s population growth is due to immigration Foreign-born health advantage, also known as the healthy migrant effect This has been found among immigrants in Europe, the USA and Canada Pattern of worsening health with increased length of residency and as immigrants adjust to their new homeland Acculturation of Western norms: potent explanation mechanism
I. BACKGROUND Acculturation measure in large sample surveys remains a challenge (Salant et Lauderdale, 2003) Use of scales measures for mental health studies Acculturation strategies (Berry, 1997) Effect of acculturation on immigrant s mental health study in Canada: Ballantyne and al. (2013) Effect of acculturation strategies on immigrant s mental health: Pan and Wong (2011) Results : assimilative acculturation is more stressful
II. RESEARCH QUESTION AND OBJECTIVES Do acculturation strategies predict mental health status of immigrants early after their arrival to Canada? Objective 1: Describe mental health changes of immigrants early after their arrival Objective 2: Analyze predictive effect of acculturation strategies on mental health of immigrants
III. DATA AND METHODS Data source : Longitudinal Survey of Immigration to Canada (LSIC, Statistics Canada) Longitudinally designed: One arrival cohort of 20322 immigrants who had landed in Canada October 1, 2000 and September 30, 2001, Aged 15 years or more Come from outside Canada. Three waves of data collection: 2001, 2003 and 2005 First wave surveyed 12128 immigrants, sample attrition rate over three waves: 37% LSIC dataset used contains cohort of 7716 landed immigrants: 3819 men and 3897 women
III. DATA AND METHODS Acculturation variable : Four-scale variable based on Berry s 2X2 typology Acculturation strategies Is it considered to be of value to maintain one's identity and characteristics? Is it considered to be of value to maintain relationships with larger society? Yes No Yes Integration Assimilation No Separation Marginalization Testing effect modifiers with interaction variables between: Acculturation and education Acculturation and financial status
III. DATA AND METHODS Self-related mental health Binary outcome Having emotional or mental health problem since arrival (yes or no) Control variables Pre migration variables: sex, Post migration variables: marital status (with or without spouse), immigration status (economic class, family class, and refugees), age (decennial age groups from 25 to 64, with the oldest group 65+), place of birth (Europe and North America, Asia and Oceania, Middle East, Africa, Other Americas), visible minority status (yes or no), province of residence (Quebec, Ontario, British Columbia, Other), language spoken at home (English, French, Other), university level outside Canada (yes or no), having relatives/friends at arrival (yes or no financial situation (not enough, just enough, more than enough mon
Summary statistics LSIC-(wave 1, Canada, 2001) Variables Freq % Variables Freq % Variables Freq % Variables Freq % Acculturation strategy 7650 Place of birth 7710 Language spoken at home 7730 Age 7720 Integration 5980 78,17 North America and Europe 1260 16,34 English 1160 15,01 15-24 1260 16,32 Assimilation 1100 14,38 Asia and Oceania 4960 64,33 French 340 4,4 25-34 3060 39,64 Separation 380 4,97 Middle East 300 3,89 Other 6230 80,6 35-44 2040 26,42 Marginalization 190 2,48 Africa 720 9,34 Province of residency 7700 45-54 760 9,84 Female 3900 50,52 Other Americas 470 6,10 Quebec 1180 15,32 55-64 350 4,53 Immigration status Family Class Immigrants Economic Class Immigrants 7720 University 4170 54,09 Ontario 4290 55,71 65+ 250 3,24 2090 27,07 Had relative at arrival 4250 55,05 British Columbia 1340 17,40 Financial status 5110 66,19 Had friend at arrival 4420 57,25 Other 890 11,56 More than enough 7680 690 8,98 Refugees 520 6,74 Yes visible minority 6140 79,64 Married 5820 75,39 Just enough 4340 56,51 Not enough 2650 34,51
III. DATA AND METHODS Logistic regressions : analyze the effect of acculturation strategies on immigrant's health. the probability of having mental/emotional problem at wave 3 from a vector of independent variables (listed above) Advantage of longitudinal design of LSIC, characteristics at wave 1 on mental health status at wave 3 Several models estimated
III. DATA AND METHODS Models 0: Unadjusted estimates Models 1-5: Nested models with controls Allowing log-likelihood ratio test Model 1 is compared to unadjusted model containing only acculturation variable Models 3-5: include interactions compared to model 2
% mental/emotional problem IV. RESULTS Mental or emotional problem across the three waves, LSIC, by sex (2001-2005) 40 35 30 25 20 15 10 5 Mental or emotional problem_men (n=3820) Mental or emotional problem_women (n=3890) Mental or emotional problem_all (n=7710) 0 Wave 1_2001 Wave 2_2003 Wave 3_2005 4,45 26,44 24,08 5,66 33,42 32,9 5,06 29,96 28,53 The most important change occurs between the first and the second waves. Until six months after arrival, the proportion of respondents declaring emotional problems is still low, and between the second and the fourth year, the proportion is stalling and almost declining.
Highlights No significantly effect of acculturation strategies after adjusting for all control Compared to their reference group statistically significant effect is found for: * female, * refugees, * all places of birth, * residents of other provinces (except British Columbia) *adults group of 25-34 years old *45-54 years old *Just or not enough money *p<0.05 **p<0.01 ***p<0.001; Standard errors in brackets ; All estimated OR in models are adjusted for immigration class, place of birth, visible minority status, language spoken at home, province, sex, age, marital status, family/friends in Canada)
*p<0.05 **p<0.01 ***p<0.001; Standard errors in brackets ; All estimated OR in models are adjusted for immigration class, place of birth, visible minority status, language spoken at home, province, sex, age, marital status, family/friends in Canada) Highlights Assimilation*University level Interaction significant level Both main effects still not significant. Marginalization*Just enough money and Marginalization*Not enough money Reduced odds of mental health problems Changes of main coefficient of marginalization from 1.192 to 3.729 Slightly higher coefficients for main effects of financial status Similar results in Model 3, 4 and 5
V. DISCUSSION AND FURTHER STEPS Effect of acculturation on mental health : only within separate group of SES. Protective effect of marginalization strategy: among those just enough and not enough group of financial status Detrimental effect assimilation strategies : among high educated immigrants (university level) Similar effect modification of SES on the relationship between acculturation ad health of immigrants was underlined by Salant and Lauderdale (2003) Further research : on other immigrants variables possible effect modifiers
VI. SELECTED REFERENCES Ballantyne, M, KM Benzies, et B Trute. 2013. «Depressive symptoms among immigrant and Canadian born mothers of preterm infants at neonatal intensive care discharge: a cross sectional study». BMC Pregnancy & Childbirth. doi:http://dx.doi.org/10.1186/1471-2393-13-s1-s11. Pan, JY, et DF Wong. 2011. «Acculturative stressors and acculturative strategies as predictors of negative affect among Chinese international students in Australia and Hong Kong: a cross-cultural comparative study.» Academic Psychiatry 35 (6): 376-81. doi:http://dx.doi.org/10.1176/appi.ap.35.6.376. Salant, Talya, et Diane S Lauderdale. 2003. «Measuring culture: a critical review of acculturation and health in Asian immigrant populations». Social Science & Medicine 57 (1): 71-90. doi:10.1016/s0277-9536(02)00300-3.
Thank you for your attention! Astrid Flénon Department of Demography C-5033 Université de Montréal C. P. 6128, succursale Centre-ville Montréal (Québec) H3C 3J7 Canada Office phone: (514) 343-6111 Ext: 1951 Fax: (514) 343-2309 ASTRID.FLENON@UMONTREAL