Family-based Interventions of Preventing Substance Use Among Immigrant Youth: A Scoping Review.

Introduction: Immigrant youth face heightened risks of substance use due to the stress associated with immigration and acculturation. While parental intervention can have a preventative impact on substance use, parents need to be well-informed about substance use and effective interventions that can prevent substance use among immigrant youth. Such interventions ought to be culturally sensitive, family-based, and targeted at the specific substances that are prevalent in a given context. Identifying and curating interventions that can empower parents in addressing substance use can help mitigate the risks that immigrant youth may face. Methods: This scoping review aimed to identify the types, characteristics, and effectiveness of family-based substance use intervention programs. Based on Arksay and O'Malley's guidelines, interventions included in the review must have met the following criteria: (a) was a family-based intervention aiming to prevent substance use; (b) targeted immigrant teens aged 12 to 17 years old; (c) was published in English; (d) originated from Australia, Canada, New Zealand, or the United States. The pinch table was used to synthesize included articles, after which studies were compared and categorized, and cross-cutting categories were identified. Results: After screening 4551 searched literature, 13 studies that utilized family-based interventions were included in the review. All interventions were face-to-face programs, and most interventions involved parents and youth as participants. Eco-developmental theory and active learning strategies were used by multiple interventions. Given immigrant families were target stakeholders, both deep structure and surface structure cultural adaptations were utilized. Interventions increased parents' knowledge and skills regarding substance use prevention and delayed substance use initiation among youth. Conclusion: From the review, it was evident that parents are an essential element in any program aiming to prevent or reduce children's substance use. Besides information about substance use prevention, the curriculum also involves parenting and communication skills for parents to understand the protective effects of family. Effective family-based interventions for immigrant youth require attention to parenting and immigration stress, while also considering cultural adaptation. Future directions and limitations are also discussed.

Exploring arts-based interventions for youth substance use prevention: a scoping review of literature.

INTRODUCTION: There is a rise in problematic substance use among Canadian youth, which is precipitating a public health crisis. Interventions are needed to empower youth to mitigate substance use risks. Active youth involvement in substance use prevention is urgently needed to increase uptake and ownership of the process and outcome of the intervention. Arts-based interventions are ideal participatory action approaches that can empower young people to be active agents in substance use prevention. These approaches can help promote health, reduce harm, and change behaviours. Scoping reviews are a vital tool that can help the research team identify relevant interventions that can be adapted to a community. METHODS: This scoping review explores various arts-based substance use prevention interventions for youth. The scoping review used the iterative stages of Arksey and O'Malley to search Portal ERIC, Ovid MEDLINE, C.I.N.A.H.L., E.M.B.A.S.E., Web of Science, and A.P.A. PsycInfo and grey literature from Canadian Centre on Substance Use and Addiction and websites suggested by the Canadian Agency for Drugs and Technologies in Health. Inclusion criteria are a) articles utilizing arts-based intervention on substance use prevention; b) studies with a clearly defined intervention; c) intervention targeting the youth (age 12-17) and d) publications written in English. Thematic analysis was used to identify the main themes from the included articles. RESULTS AND DISCUSSION: Themes identified in a thematic synthesis of these studies included a) the intent of the intervention; b) intervention characteristics; and c) the perceived effectiveness of interventions. Art-based interventions increased knowledge and changed attitudes and practices on substance use among youth. Making the interventions aesthetically appealing and engaging, active youth involvement in the development of the intervention and developing youth-centred interventions which attended to the realities they faced were central to the success of these interventions.

Food insecurity among postsecondary international students: a scoping review protocol.

INTRODUCTION: International students make significant contributions to their host institutions and countries. Yet research shows that not all international students have the financial means to fend for themselves and meet their financial obligations for the entire study programme. Such students are at significant risk of food insecurity. The objective of this scoping review is to synthesise available information on the factors related to food insecurity among international students studying at postsecondary educational institutions and identify the types of food insecurity interventions that have been implemented to address this issue. METHODS AND ANALYSIS: The Joanna Briggs Institute scoping review methodology will be used to guide this scoping review, and we will search the following databases: MEDLINE (through Ovid), CINAHL (EBSCO), PubMed, ERIC (via Ovid), PROSPERO and ProQuest. The titles, abstracts, and subsequently full texts of the selected papers will then be screened against the inclusion criteria. Data from articles included in the review will be extracted using a data charting form and will be summarised in a tabular form. Thematic analysis will be used to identify common themes that thread through the selected studies and will be guided by the steps developed by Terry et al. ETHICS AND DISSEMINATION: Since this project entails a review of available literature, ethical approval is not required. The findings will be presented at academic conferences and published in a peer-reviewed journal. To make the findings more accessible, they will also be distributed via digital communication platforms.

Measuring the Overall Burden of Early Childhood Malnutrition in Ghana: A Comparison of Estimates From Multiple Data Sources.

BACKGROUND: Childhood malnutrition contributes to nearly half (45%) of all deaths among children under 5 globally. The United Nations' Sustainable Development Goals (SDGs) aims to end all forms of malnutrition by 2030; however, measuring progress towards these goals is challenging, particularly in countries with emerging economies where nationally-representative data are limited. The primary objective of this study was to estimate the overall burden of childhood malnutrition in Ghana at national and regional levels using 3 data sources. METHODS: Using data from the long-standing Ghana Demographic and Health Surveys (GDHS), Ghana Multiple Indicator Cluster Survey (GMICS), and the emerging Ghana Socioeconomic Panel Survey (GSPS), we compared the prevalence of malnutrition using the extended composite index of anthropometric failure (eCIAF) for the period 2008- 2011. This study included data for children aged 6-59 months and calculated all anthropometric z-scores based on the World Health Organization (WHO) Growth Standards. We tested for differences in malnutrition subtypes using two-group configural frequency analysis (CFA). RESULTS: Of the 10 281 children (6532 from GMICS, 2141 from GDHS and 1608 from GSPS) included in the study, the only demographic difference observed was the children included in the GSPS were slightly older than those included in the GDHS and GMICS (median age of 36 vs 30 vs 33 months, P<.001). Based on the eCIAF, the overall prevalence of malnutrition at the national level was higher among children in the GSPS (57.3%, 95% CI: 53.9%-60.6%), followed by the GDHS (39.7%, 95% CI: 37.0%-42.5%), and then those in the GMICS (31.2%, 95% CI: 29.3%-33.1%). The two-group CFA showed that the 3 data sources also estimated different prevalence rates for most of the malnutrition subtypes included in the eCIAF. CONCLUSION: Depending on the data source adopted, our estimates of eCIAF showed that between one-third and half of all Ghanaian children aged 6-59 months had at least one form of malnutrition over the period 2008-2011. These eCIAF estimates should complement the commonly reported measures such as stunting and wasting when interpreting the severity of malnutrition in the country to inform policy decisions.

Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study.

BACKGROUND: Immigrants from culturally, ethnically, and linguistically diverse countries face many challenges during the resettlement phase, which influence their access to healthcare services and health outcomes. The "Healthy Immigrant Effect" or the health advantage that immigrants arrive with is observed to deteriorate with increased length of stay in the host country. METHODS: An exploratory qualitative design, following a community-based research approach, was employed. The research team consisted of health researchers, clinicians, and community members. The objective was to explore the barriers to healthcare access among immigrants with limited English language proficiency. Three focus groups were carried out with 29 women and nine men attending English language classes at a settlement agency in a mid-sized city. Additionally, 17 individual interviews were carried out with healthcare providers and administrative staff caring for immigrants and refugees. RESULTS: A thematic analysis was carried out with transcribed focus groups and healthcare provider interview data. Both the healthcare providers and immigrants indicated that limited language proficiency often delayed access to available healthcare services and interfered with the development of a therapeutic relationship between the client and the healthcare provider. Language barriers also impeded effective communication between healthcare providers and clients, leading to suboptimal care and dissatisfaction with the care received. Language barriers interfered with treatment adherence and the use of preventative and screening services, further delaying access to timely care, causing poor chronic disease management, and ultimately resulting in poor health outcomes. Involving untrained interpreters, family members, or others from the ethnic community was problematic due to misinterpretation and confidentiality issues. CONCLUSIONS: The study emphasises the need to provide language assistance during medical consultations to address language barriers among immigrants. The development of guidelines for recruitment, training, and effective engagement of language interpreters during medical consultation is recommended to ensure high quality, equitable and client-centered care.

Exploring family based immigrant youth substance use prevention programmes: a scoping review protocol.

INTRODUCTION: Canada has one of the highest rates of problematic opiate and alcohol use in the world. Globally, Canada was the second country that legalized marijuana for non-medical use. As Canada is an immigrant-receiving country, newcomers and immigrants contend with a substance use landscape that was likely absent in their countries of origin. Although immigrants have lower rates of substance use than the host population, the risk of substance use, especially among youth, increases with acculturation and peer pressure. While parents are best placed to mitigate the risks for substance use among their youth, immigrant parents often do not have the knowledge and skills to do so. Therefore, culturally adaptable family based interventions need be explored to build immigrant parents' capacities to mitigate substance use risks. AIM AND PURPOSE: The aim of this scoping review is to explore family based substance use prevention interventions for immigrant youth, which will be guided by two questions:What is known about family based interventions for preventing immigrant adolescents' substance use?What are the features and study results of these intervention protocols? METHODS AND ANALYSIS: We will apply Arksey and O'Malley's procedure for reporting scoping review and report study findings based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews. DISCUSSION: We hope that the knowledge translation emanating from this review will increase immigrant parents' knowledge of substance use and enable them to effectively intervene to prevent substance use among their youth. We also hope that this work can inform policy development on best practices for substance use prevention and for the creation of culturally sensitive programmes and services for immigrant youth.

Immigration as a social determinant of troubled sleep in Canada: some evidence from the Canadian Community Health Survey-Mental Health.

BACKGROUND: The literature pays very little attention to immigrants' sleep in Canada, although sleep is essential to individual health and well-being. ANALYSIS: Drawing data from the Canadian Community Health Survey-Mental Health, we aim to address this void by comparing troubled sleep among recent immigrants, established immigrants, and the native-born Canadians. RESULTS: Despite immigrants' declining health over time in Canada, our findings reveal that both recent and established immigrants report fewer cases of troubled sleep than their native-born counterparts. Recent (odds ratio [OR] = 0.70, 95% confidence intervals [CIs] = 0.62-0.79) and established immigrants (OR = 0.86, 95% CIs = 0.79-0.92) were less likely to report troubled sleep than the native-born at the bivariate level, although its significant impact for recent immigrants was completely attenuated when health status was controlled for (OR = 0.88, 95% CIs = 0.76-1.02). Established immigrants were still less likely to report fewer cases of troubled sleep than the native-born even after controlling for all control variables (OR = 0.88, 95% CIs = 0.81-0.96). CONCLUSION: Based on these findings, we discuss that fewer troubled sleep cases reported by immigrants may be explained by their initial health advantage, resilience trajectory, and cultural interpretation of sleep. We also provide several suggestions for future research.

Timing and utilisation of antenatal care service in Nigeria and Malawi.

As the world draws curtains on the implementation of Millennium Development Goals (MDGs), there is increasing interest in evaluating the performance of countries on the goals and assessing related challenges and opportunities to inform the upcoming Sustainable Development Goals (SDGs). This study examined changes in the timing and utilisation of maternal health care services in Nigeria and Malawi; using multivariate negative log-log and logistic regression models fitted to demographic and health survey data sets. Predicted probabilities were also computed to observe the net differences in the likelihood of both the first and the required number of antenatal care (ANC) visits for each of the three analysis years. Women in Nigeria were 7% less likely in 2008 compared to 2003, and in Malawi, 32% more likely in 2013 compared to 2000, to utilise ANC in the first trimester of pregnancy. Timing of first ANC visit was strongly influenced by wealth in Nigeria but not in Malawi. The findings in our case studies show how various contextual factors may enable or inhibit policy performance. Maternal and child health, SDGs should incorporate both wealth and degrees of urbanicity into country level implementation strategies.

Utilisation of skilled birth attendants over time in Nigeria and Malawi.

Despite recent modest progress in reducing maternal and infant mortality rates in sub-Saharan Africa, Nigeria and Malawi were still in the top 20 countries with highest rates of mortalities globally in 2015. Utilisation of professional services at delivery - one of the indictors of MDG 5 - has been suggested to reduce maternal mortality by 50%. Yet, contextual, socio-cultural and economic factors have served as barriers to uptake of such critical service. In this paper, we examined the impact of residential wealth index on utilisation of Skilled Birth Attendant in Nigeria (2003, 2008 and 2013), and Malawi (2000, 2004 and 2010) using Demographic and Health Survey data sets. The findings from multivariate logistic regressions show that women in Nigeria were 23% less likely to utilise skilled delivery services in 2013 compared to 2003. In Malawi, women were 75% more likely to utilise skilled delivery services in 2010 than in 2000. Residential wealth index was a significant predictor of utilisation of skilled delivery services over time in both Nigeria and Malawi. These findings illuminate progress made - based on which we make recommendations for achievement of SDG-3: ensure healthy lives and promote well-being for all at all ages in Nigeria and Malawi, and similar context.

Residential Spaces and Timing of First Sexual Intercourse Among Never-Married Youths in Nigeria.

Youths in sub-Saharan Africa who initiate sex at an early age tend to be more vulnerable to HIV/AIDS and other sexually transmitted diseases because of the lack of accurate knowledge of preventive behaviors. Although sociocultural and economic factors associated with sexual initiation among youths have been studied extensively in Nigeria, little is known about the effect of place-based factors. Rural and urban disparities remain high in Nigeria, and these disparities are reinforced by stark regional inequalities between the north and south. Considering these underlying inequalities, we examined the extent to which rural and urban youths in northern and southern Nigeria differ with regard to the timing of sexual initiation using the 2013 Nigerian Demographic and Health Survey. Results from our event history analyses suggest that never-married male and female youths who lived in the urban north delayed their first sexual intercourse compared with their counterparts in the rural north, but those who lived in the rural south had their first sex earlier. Young males who lived in the urban south also experienced their first sex earlier than their counterparts in the rural north. Surprisingly, educated youths and those who had accurate knowledge about HIV/AIDS transmission experienced their first sex early. Clearly, the timing of sexual initiation among youths varies across different spatial and cultural contexts. Therefore, interventions aimed at discouraging early sexual initiation among young people in Nigeria may need to go beyond merely providing health information and services to addressing the livelihood needs of youths, especially those in rural settings.

Does helping them benefit me? Examining the emotional cost and benefit of immigrants' pecuniary remittance behaviour in Canada.

The existing literature has largely focused on how immigrants' pre/post-migration experiences affect their health in destination societies. Hence, little is known about the extent to which immigrants' choice to maintain transnational ties to their family and friends abroad influences their health. This study makes a theoretical and empirical contribution to the sociology of health literature by examining how immigrants' pecuniary remittance behaviour affects their emotional health using data from the Longitudinal Survey of Immigrants to Canada (LSIC, 2001-2005). Our weighted logistic regression analyses demonstrate that sending remittances within the first six months of arrival predisposes immigrants to emotional health problems. However, remitting after six months of arrival provides an "emotional advantage" for immigrants, but this advantage is greater for female immigrants compared to their male counterparts. The study clearly shows that immigrants' remittance behaviour has far reaching gendered implications on their emotional health, which underscores the importance of including transnational theory and gender in the conceptual toolbox for explaining immigrants' health transitions. Admittedly, insights from this study can help professional healthcare staff, and immigrant settlement and integration agency workers better understand and address the mental health needs of immigrants in order to enhance their contribution to the Canadian economy.

Exploring the linkage between exposure to mass media and HIV testing among married women and men in Ghana.

Although HIV testing is critical to the treatment and prevention of HIV/AIDS, utilization rate of HIV testing services among married women and men remains low in Ghana. Mass media, as a tool to increase overall HIV testing turnouts, has been considered one of the important strategies in promoting and enhancing behavioural changes related to HIV/AIDS prevention. Using the 2014 Ghana Demographic and Health Survey, the current study examines the relationship between levels of exposure to print media, radio, and television and the uptake of HIV testing among married women and men in Ghana. Results show that HIV testing is more prevalent among married women than their male counterparts. We also find that higher levels of exposure to radio is associated with HIV testing among women, while higher levels of exposure to print media and television are associated with HIV testing among men. Implications of these findings are discussed for Ghana's HIV/AIDS strategic framework, which aims to expanding efforts at dealing with the HIV/AIDS epidemic. Specifically, it is important for health educators and programme planners to deliver HIV-related messages through television, radio, and print media to increase the uptake of HIV testing particularly among married women and men in Ghana.

EXPLAINING THE GAP IN ANTENATAL CARE SERVICE UTILIZATION BETWEEN YOUNGER AND OLDER MOTHERS IN GHANA.

Over two-thirds of pregnant women (69%) have at least one antenatal care (ANC) coverage contact in sub-Saharan Africa. However, to achieve the full life-saving potential that ANC promises for women and babies, a nuanced understanding of age-specific gaps in utilization of ANC services is required. Using the 2008 Ghana Demographic and Health Survey of 1456 individuals, this study examined the disparities in the use of ANC services between younger and older mothers by applying four counterfactual decomposition techniques. The results show that cross-group differences in the explanatory variables largely account for the differentials in ANC service utilization between younger and older mothers. Birth order (parity) accounts for the largest share of the contribution to the overall explained gap in ANC utilization between the younger and older mothers, suggesting that ANC differentials between the two groups are probably due to biosocial factors. To a lesser extent, wealth status of the two groups also contributes to the overall explained gap in ANC service utilization. The policy implications of these findings are that in order to bridge the ANC service utilization gap between the two groups, policymakers must systematically address gaps in cross-group differences in the explanatory variables in order to increase the utilization of ANC to attain the minimum recommendation of four visits as per World Health Organization guidelines.

Conundrum of Sexual Decision Making in Marital Relationships: Safer-Sex Knowledge, Behavior, and Attitudes of Married Women in Zambia.

Recent research suggests that Zambian women face an increasing risk of contracting human immunodeficiency virus (HIV) within marital relationships. Married women's perceived ability to negotiate safer sex or adopt self-efficacy practices is recognized as critical in preventing new infections within marriage. Yet women's self-efficacy practices, such as requesting condom use or refusing sex within marriage, are influenced by individual and context-specific factors. Using the 2007 Zambia Demographic and Health Survey data from 4,306 married women, this article examines the association between married women's perceived ability to negotiate safer sex and a range of attitudinal, knowledge, and sociodemographic variables. Results from complementary log-log regression models reveal that married women who have factual knowledge about HIV transmission and prevention, as well as those who have been tested for their HIV serostatus, were more likely to report they can request that their husbands use a condom. Rural married women were more likely to report they can refuse their husbands sex compared to woman in urban areas. Likewise, married women who agree that a wife is justified in refusing her husband sex if he sleeps with other women were more likely to report they can negotiate safer sex compared to women who disagree. These findings suggest that married women are able to negotiate safer sex if they have correct factual knowledge about HIV transmission and are aware of their rights within marital relations.

Negotiation for safer sex among married women in Cambodia: the role of women's autonomy.

Negotiating safer sex among married women has been identified as an important determinant of vulnerability or resilience to new HIV infections. Using the Cambodia Demographic and Health Survey data of 2010, this paper examined negotiation for safer sex among 11,218 married women in the context of Cambodia's highly touted reduction in HIV/AIDS prevalence. The results from a complementary log-log regression model indicate that wealthier and highly educated married women were more likely to report that they can refuse sexual intercourse and ask their husbands to use a condom. Interestingly, while women who were fully involved in decision-making on their own health care were 19% more likely to refuse sex, they were 14% less likely to be able to ask their husbands to use a condom, compared with their counterparts who were not involved in this decision-making. Women who were partially involved in decision-making on family visits were 17% less likely to be able to ask their husbands to use a condom compared with those who were not involved. In this context, involvement in decision-making may have translated into trust and risk compensation. Those who believed in HIV transmission myths were less likely to negotiate safer sex relative to their counterparts who did not hold such myths to be true. Women's ability to negotiate for safer sex is, therefore, a function of their autonomy in terms of their full participation in decision-making in health care, household expenditure and mobility. Policy implications of the capacity of women to negotiate for safer sex are delineated.