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Newcomers are often healthy when they arrive in Canada, yet experience health declines shortly thereafter, possibly due to lifestyle changes. As part of the Healthy Immigrant Children study, this mixed-methods study aims to analyze possible predictors of physical activity among 300 newcomer children, and explore their lived experiences using a sub-sample of 19 parents and 24 service providers. Data collection involved questionnaires concerning socioeconomic status and physical activity, anthropometric measurements, and in-depth interviews. Participants aged 5 years and older largely met physical activity recommendations (82.9%), while none of the 3-4-year-olds did. Males were more active than females, especially among older ages. Many participants engaged in too much screen time (53.4-90.0%). Age and income predicted physical activity among males, while parents' education level was the only significant predictor among females. Barriers to physical activity included: recreational physical activity being an unfamiliar concept, gender limitations, financial resources, safety concerns, and children's preference for screen time. Schools played a central role in newcomer children's health by providing accessible opportunities for physical activity. Newcomer families preferred to have their children involved in culturally relevant physical activities. Given the growing newcomer population, it is important to support active lifestyle practices among them. Novelty: About 83% of newcomer children aged 5 years and older met physical activity recommendations, while none of the 3-4-year-olds did. Age and income predicted males' physical activity, while parents' education level predicted females' physical activity. Schools provide accessible opportunities for newcomer children to engage in physical activity.

Objective: To explore the dietary habits, nutrient adequacies and dietary change experiences of immigrant and refugee children., Design: Mixed-methods cross-sectional design. Children completed three 24 h dietary recalls to determine nutrient inadequacies. Parents and service providers were interviewed to capture dietary practices., Setting: Healthy Immigrant Children study, Saskatchewan, Canada., Participants: Three hundred immigrant and refugee children aged 3-13 years and twenty-two parents who lived in Regina or Saskatoon for less than 5 years; twenty-four newcomer services providers., Results: Immigrant children had higher mean intakes of meat and alternatives, milk and alternatives, and whole grains; and consumed more vitamin B12, folate, Ca, vitamin D, Fe and Zn compared with refugee children. Refugee children were at higher risk of having inadequate intakes of folate (37 %) and Fe (18 %). Both immigrant and refugee children were at high risk of inadequate vitamin D (87 and 93 %, respectively) and Ca intakes (79 and 80 %), and a substantial portion were at risk for inadequate Zn intake (21 and 31 %). Participants mentioned challenges with maintaining a healthy traditional diet in the midst of a busy schedule, while responding to their children's demands for foods high in fat and sugar., Conclusions: Newcomer children are at risk for inadequate intakes of vitamin D, Ca and Zn, while refugee children are at additional risk for inadequate folate and Fe intakes. Newcomers to Canada may experience subtle or drastic changes in their food environment leading to dietary acculturation that includes increased consumption of foods high in sugar, salt and fat.

Food insecurity continues to persist among vulnerable groups in Canada, including newcomer families. This mixed-methods study uses an exploratory sequential design to characterize the food security status of newcomer families with children aged 3-13 years. Parents completed food security and 24-hour dietary recall questionnaires, and parents and service providers were interviewed to explore their food insecurity experiences. Fifty percent of participant households experienced food insecurity, while 41% of children were food insecure. More recent newcomer families, and families with parents that had completed high school or some years of postsecondary training, more commonly experienced household food insecurity, compared to families with parents without high school diplomas or those with university degrees. Food-insecure children aged 4-8 years were at higher risk of consuming a lower proportion of energy from protein, lower servings of milk products, and inadequate intakes of vitamin B 12 and calcium. Participants identified changes in food buying habits due to low income, using food budgets to purchase prescription drugs and to repay transportation loans, while the school food environment impacted children's food security. Food security initiatives targeting newcomers may benefit from building on the strengths of newcomers, including traditional dietary practices and willingness to engage in capacity-building programming.

Adequate calcium intake and supply of vitamin D during childhood play important roles in ensuring adequate bone mass gain to achieve optimal peak bone mass. The Healthy Immigrant Children study employed a mixed-method cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3-13 years who had been in Canada for less than 5 years. This paper presents bone mineral content and vitamin D status data along with qualitative data that deepen the understanding of newcomer bone health status. A significantly higher percentage of refugee children (72.3%) had insufficient (<50 nmol/L) or deficient (<30 nmol/L) serum vitamin D compared with immigrants (53.2%). Vitamin D deficiency was most common among ethnic minority girls. Newcomer children with higher intakes of vitamin D, younger newcomer children, and those from western Europe or the United States had higher serum vitamin D levels. Immigrants had significantly higher mean total body bone mineral content compared with refugees. Total body fat, serum vitamin D, calcium intake, height, height by calcium intake, total body fat by calcium intake, and total body fat by height predicted total body bone mineral content levels. Vitamin D deficiency among newcomer children may be related to lack of knowledge regarding children's vitamin D requirements in the Canadian environment, dietary habits established in country of origin, low income that limits healthy dietary choices, and lifestyle habits that limit exposure to sunlight. Results suggest a need to screen newcomer children and pregnant women for vitamin D deficiency and support early intervention.

There are knowledge gaps in our understanding of the development of chronic disease risks in children, especially with regard to the risk differentials experienced by immigrants and refugees. The Healthy Immigrant Children study employed a mixed-methods cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3-13 years who had been in Canada for less than 5 years. Quantitative data regarding socioeconomic status, food security, physical activity, diet, and bone and body composition and anthropometric measurements were collected. Qualitative data regarding their experiences with accessing health care and their family lifestyle habits were gathered through in-depth interviews with the parents of newcomer children. Many newcomers spoke about their struggles to attain their desired standard of living. Regarding health outcomes, significantly more refugees (23%) had stunted growth when compared with immigrants (5%). Older children, those with better-educated parents, and those who consumed a poorer-quality diet were at a higher risk of being overweight or obese. Sixty percent of refugees and 42% of immigrants had high blood cholesterol. Significant health concerns for refugee children include stunting and high blood cholesterol levels, and emerging trends indicate that older immigrant children from privileged backgrounds in low-income countries may be more at risk of overweight and obesity. A variety of pathways related to their families' conceptualization of life in Canada and the social structures that limit progress to meeting their goals likely influence the development of health inequity among refugee and immigrant children. Public health initiatives should address these health inequities among newcomer families.

Background: Low levels of circulating vitamin D are more likely to be found in those with darker skin pigmentation, who live in areas of high latitude, and who wear more clothing. We examined the prevalence of vitamin D deficiency and inadequacy in newcomer immigrant and refugee children., Methods: We evaluated circulating vitamin D status of immigrant children at the national level. Subsequently, we investigated vitamin D intake, circulating vitamin D status, and total body bone mineral content (TBBMC) in newcomer children living in Saskatchewan., Results: In the sample of newcomer children in Saskatchewan, the prevalence of inadequacy in calcium and vitamin D intakes was 76% and 89.4%, respectively. Vitamin D intake from food/supplement was significantly higher in immigrants compared to refugees, which accords with the significant difference in serum status. Circulating vitamin D status indicated that 29% of participants were deficient and another 44% had inadequate levels of serum 25(OH)D for bone health. Dietary vitamin D intake, sex, region of origin, and length of stay in Canada were significant predictors of serum vitamin D status. RESULTS for TBBMC revealed that 38.6% were found to have low TBBMC compared to estimated values for age, sex, and ethnicity. In the regression model, after controlling for possible confounders, children who were taller and had greater circulating vitamin D also had greater TBBMC. Nationally, immigrant children, particularly girls, have significantly lower plasma 25(OH)D than non-immigrant children., Interpretation: Newcomer immigrant and refugee children are at a high risk of vitamin D deficiency and inadequacy, which may have serious negative consequences for their health.