Impact of immigration status on health behaviors and perceptions in cancer survivors.

BACKGROUND: Health behaviors including smoking cessation, physical activity (PA), and alcohol moderation are key aspects of cancer survivorship. Immigrants may have unique survivorship needs. We evaluated whether immigrant cancer survivors had health behaviors and perceptions that were distinct from native-born cancer survivors. METHODS: Adult cancer patients from Princess Margaret Cancer Centre were surveyed on their smoking, PA, and alcohol habits and perceptions of the effects of these behaviors on quality of life (QoL), 5-year survival, and fatigue. Multivariable models evaluated the association of immigration status and region-of-origin on behaviors and perceptions. RESULTS: Of the 784 patients, 39% self-identified as immigrants. Median time of survey was 24 months after histological diagnosis. At baseline, immigrants had trends toward not meeting Canadian PA guidelines or being ever-drinkers; patients from non-Western countries were less likely to smoke (aORcurrent  = 0.46, aORex-smoker  = 0.47, P = 0.02), drink alcohol (aORcurrent  = 0.22, aORex-drinker  = 0.52, P < 0.001), or meet PA guidelines (aOR = 0.44, P = 0.006). Among immigrants, remote immigrants (migrated ≥40 years ago) were more likely to be consuming alcohol at diagnosis (aOR = 5.70, P < 0.001) compared to recent immigrants. Compared to nonimmigrants, immigrants were less likely to perceive smoking as harmful on QoL (aOR = 0.58, P = 0.008) and survival (aOR = 0.56, P = 0.002), and less likely to perceive that PA improved fatigue (aOR = 0.62, P = 0.04) and survival (aOR = 0.64, P = 0.08). CONCLUSIONS: Immigrants had different patterns of health behaviors than nonimmigrants. Immigrants were less likely to perceive continued smoking as harmful and were less likely to be aware of PA benefits. Culturally tailored counselling may be required for immigrants who smoke or are physically sedentary at diagnosis.

Age, gender, and current living status were associated with perceived access to treatment among Canadians using a cross sectional survey.

BACKGROUND: Access, particularly timely access, to care is the Canadian public's most important healthcare concern. The drivers of perceived appropriateness of access to care among patients with at least one chronic health condition (CHC) are not, however, well defined. This study evaluated whether personal characteristics, self-reported health status and care received were associated with patients' perception of effective access in managing a chronic illness. METHODS: The study population (n = 619) was drawn from a representative sample of the adult Canadian population who reported having ≥1 CHC in the 2013-2014 Health Care in Canada survey. Ordinal regression, with the continuation ratio model, was used to evaluate association of perceived level of access to treatment with socio-demographic factors, perceived health status and care utilization experience. RESULTS: Factors most closely associated with patients' satisfaction with care access were: age, sex, current cohabitation, care affordability, and availability of support and information to help manage their CHCs. Individuals, particularly females, < 35 years, currently living alone, with poor access to professional support or information and who feel affordability of care has worsened over the past five years were more likely to report a poorer level of treatment access. CONCLUSIONS: Individuals living alone, who are younger, and women may be especially susceptible to lower perceived access to care of CHCs and a sense of pessimism about things not getting better. Further evaluation of the reasons behind these findings may help develop effective strategies to assist these populations to access the care they need.

Effects of Outpatient Aftercare on Psychiatric Rehospitalization Among Children and Emerging Adults in Alberta, Canada.

OBJECTIVE: The one-year readmission rates for children and youths hospitalized for a psychiatric condition is estimated at 38%. Studies suggest that these high readmission rates result from a lack of aftercare, but evidence is mixed. This study further explored the relationship between aftercare and readmission among children and youths ages five to 24 in Alberta, Canada, by using the same study sample to identify predictors of both outcomes. METHODS: A retrospective analysis using linked administrative data was performed. Records of the index inpatient stay and any subsequent readmissions for a mental health reason between July 1, 2007, and December 31, 2012, were obtained from the Discharge Abstract Database. Data on outpatient aftercare for this sample were obtained from ambulatory care records and a patient-level physician billing database. Rates of aftercare and readmission were calculated. A Cox proportional hazards regression model was used to identify predictors of both outcomes. RESULTS: Overall, 15,628 hospitalizations were identified for 12,728 unique individuals. For these hospitalizations, aftercare services were recorded for 29.4% within one week of discharge and for 54.5% within 30 days. Fourteen percent of hospitalizations resulted in readmission within 90 days. Aftercare was associated with a 32% reduction in readmission. Prior service use, longer hospital stays, higher income, specific diagnoses, female sex, and comorbid mental health conditions were associated with a greater likelihood of aftercare receipt. CONCLUSIONS: Access to community mental health services for children and youths remains a priority. The significant role of aftercare in reducing readmission risk demonstrates the need to improve these services.