1. Thu. 3 June 20041 An empirical study of the “healthy immigrant effect” with Canadian Community Health Survey Yimin (Gloria) Lou, M.A. Candidate University of Western Ontario Presentation at Canadian Population Society 2004 Annual Meetings, University of Manitoba, Winnipeg. Presentation at Canadian Population Society 2004 Annual Meetings, University of Manitoba, Winnipeg. Session 1, Determinants of Health: Socio-Economic Status, Immigration and Other Factors Session 1, Determinants of Health: Socio-Economic Status, Immigration and Other Factors

2. Thu. 3 June 20042 Introduction Observed phenomenon: the “healthy immigrant effect” in Canada, US and Australia Observed phenomenon: the “healthy immigrant effect” in Canada, US and Australia Brief features: Brief features: the health of immigrants is better than that of the host population the health of immigrants is better than that of the host population recent arrivals are more healthy than long-term arrivals recent arrivals are more healthy than long-term arrivals the health of immigrants is getting worse over time the health of immigrants is getting worse over time

3. Thu. 3 June 20043 Previous Research the “healthy immigrant effect” has been examined in terms of: the “healthy immigrant effect” has been examined in terms of: – Physical health:  Chen, Ng, and Wilkins 1996 (1994/95 NPHS)  Pérez 2002 (2000/01 CCHS) – Mental health:  Ali 2002 (2000/01 CCHS)

4. Thu. 3 June 20044 Why “Healthy Immigrant Effect”? Selectivity? Selectivity? Demographic and SES factors? Demographic and SES factors? Proficiency in official language? Proficiency in official language? Employment status? Employment status? Sense of belonging? Sense of belonging? Health behaviours? Health behaviours?

5. Thu. 3 June 20045 Objectives of the Study To verify the existence of the “healthy immigrant effect” with a general health index: self-perceived health. To verify the existence of the “healthy immigrant effect” with a general health index: self-perceived health. To explore the explanatory power of lifestyle to the “healthy immigrant effect”. To explore the explanatory power of lifestyle to the “healthy immigrant effect”. Operationalization of lifestyle obesity diet smoking habits drinking habits exercise

6. Thu. 3 June 20046 Methodology Data: cycle 1.1 of 2000/01 CCHS Data: cycle 1.1 of 2000/01 CCHS The sample size is about 130,000. The Canadian-born population accounts for 86.4%, new immigrants 2.8%, old immigrants 10.1%. The sample size is about 130,000. The Canadian-born population accounts for 86.4%, new immigrants 2.8%, old immigrants 10.1%. Techniques: Techniques: – Prevalence of self-perceived poor health by immigration status, sex or age is charted – Two logistic regression models are fitted (baseline model and lifestyle model) – All analyses are weighted

7. Thu. 3 June 20047 IVs in the Baseline Model Immigration Status: Canadian-born (reference), new immigrants, old immigrants Age: 5 year groups, between 20-64 Sex: male (reference), female Marital Status: married (reference), previously married, single Highest Education: less than secondary, secondary, some post-secondary, post- secondary graduation (reference) Household Income Adjusted by Family Size: lowest, lower-middle, middle, upper- middle, highest (reference)

8. Thu. 3 June 20048 Explanatory Variables in the Lifestyle Model Variables in the Baseline Model Body Mass Index: min=14, max=57.6 mean=25.9, Std.D.=4.8 Daily Consumption of Fruits and Vegetables: min=0, max=80, mean=4.6, Std.D.=2.6 Type of Smoker: daily smoker (reference), non-daily smoker Type of Drinker: regular drinker (reference), non-regular drinker Physical Activity Index: active, moderate, inactive (reference)

9. Thu. 3 June 20049 RESULTS

10. 10 Data Source: 2000/01 CCHS. 130821 cases, excluding 59 (0.05%) missing response to self- perceived health * Significantly different from the reference group, Canadian-born population (p<0.001)

11. Thu. 3 June 200411 Immigrants as a whole were less healthy than the Canadian-born population, for all respondents and for women. Immigrants as a whole were less healthy than the Canadian-born population, for all respondents and for women. New immigrants were healthier, while old immigrants were less healthy, than their Canadian-born counterparts, for all respondents and for both sexes respectively. New immigrants were healthier, while old immigrants were less healthy, than their Canadian-born counterparts, for all respondents and for both sexes respectively. Lower prevalence of poor self-perceived health of men compared to women was true for the Canadian-born population as well as for immigrants, no matter length of residence in Canada. Lower prevalence of poor self-perceived health of men compared to women was true for the Canadian-born population as well as for immigrants, no matter length of residence in Canada.

12. Thu. 3 June 200412 Data Source: 2000/01 CCHS. 130821 cases, excluding 59 (0.05%) missing response to self- perceived health * Significantly different from the reference group, Canadian-born population (p<0.001)

13. Thu. 3 June 200413 Immigrants as a whole were less healthy than the Canadian-born population, for all respondents and for women. Immigrants as a whole were less healthy than the Canadian-born population, for all respondents and for women. New immigrants were healthier, while old immigrants were less healthy, than their Canadian-born counterparts, for all respondents and for both sexes respectively. New immigrants were healthier, while old immigrants were less healthy, than their Canadian-born counterparts, for all respondents and for both sexes respectively. Lower prevalence of poor self-perceived health of men compared to women was true for the Canadian-born population as well as for immigrants, no matter length of residence in Canada. Lower prevalence of poor self-perceived health of men compared to women was true for the Canadian-born population as well as for immigrants, no matter length of residence in Canada.

14. Thu. 3 June 200414 Data Source: 2000/01 CCHS. 130821 cases, excluding 59 (0.05%) missing response to self- perceived health * Significantly different from the reference group, Canadian-born population (p<0.001)

15. Thu. 3 June 200415 Immigrants as a whole were less healthy than the Canadian-born population, for all respondents and for women. Immigrants as a whole were less healthy than the Canadian-born population, for all respondents and for women. New immigrants were healthier, while old immigrants were less healthy, than their Canadian-born counterparts, for all respondents and for both sexes respectively. New immigrants were healthier, while old immigrants were less healthy, than their Canadian-born counterparts, for all respondents and for both sexes respectively. Lower prevalence of poor self-perceived health of men compared to women was true for the Canadian-born population as well as for immigrants, no matter length of residence in Canada. Lower prevalence of poor self-perceived health of men compared to women was true for the Canadian-born population as well as for immigrants, no matter length of residence in Canada.

16. Thu. 3 June 200416 Data Source: 2000/01 CCHS, 130821 cases, excluding 59 (0.05%) missing response to self-perceived health

17. Thu. 3 June 200417 “ 50-Year-Old Effect ” Compared with the Canadian-born counterparts Compared with the Canadian-born counterparts –Before age 50, new immigrants were healthier and old immigrants were less healthy. The immigrants as a whole were less healthy. –After age 50, opposite results happened.

18. Thu. 3 June 200418 Table 1, Odds ratio for self-perceived poor health, by lifestyle logistic regression model, household population aged 20-64, excluding pregnant women.. Lifestyle Variables Odds ratio Body Mass Index 1.056* Daily consumption of fruits and vegetables 1.00 Type of smoker Daily smoker (reference) Daily smoker (reference)1.00 Not daily smoker Not daily smoker0.598* Type of Drinker Regular drinker (reference) Regular drinker (reference)1.00 Not regular drinker Not regular drinker1.724* Physical activity index Active Active0.533* Moderate Moderate0.714* Inactive (reference) Inactive (reference)1.00 Data source: 2000/01 CCHS

19. Thu. 3 June 200419 Table2, odds ratio for poor self-perceived health by sex and by immigration status, household population aged 20-64, excluding pregnant women. Data source: 2000/01 CCHS (Canadian Community Health Survey) † Odds ratios adjusted for age, sex, marital status, education, and household income. ‡ Odds ratios adjusted for age, sex (excluded for men group or women group), marital status, education, household income, body mass index, daily consumption of fruits and vegetables, type of smoker, type of drinker, and physical activity index. § Reference category. * Significantly different from reference category (p<0.05) * Significantly different from reference category (p<0.05)

20. Thu. 3 June 200420 Concluding Remarks The healthy immigrant effect did not hold for immigrant group as a whole. It applied to new immigrants over age 50 and old immigrants under age 50. The healthy immigrant effect did not hold for immigrant group as a whole. It applied to new immigrants over age 50 and old immigrants under age 50. There was significant difference in lifestyle between the Canadian-born population and immigrants. However, it was not associated with the difference in self-perceived health between the two population groups. There was significant difference in lifestyle between the Canadian-born population and immigrants. However, it was not associated with the difference in self-perceived health between the two population groups.

21. Thu. 3 June 200421 Contact Information Contact Information Yimin (Gloria) Lou Yimin (Gloria) Lou M.A. Candidate M.A. Candidate Department of Sociology Department of Sociology The University of Western Ontario The University of Western Ontario London, ON, N6A 5C2 London, ON, N6A 5C2 Telephone: (519) 661-2111 ext. 85109 Telephone: (519) 661-2111 ext. 85109 E-mail: ylou4@uwo.ca E-mail: ylou4@uwo.ca