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The Peel Region of Toronto, Canada is home to over a third of the province's South Asian population. Youth are at a vulnerable time period in terms of their mental health. South Asian youth populations may face additional challenges to their mental health such as acculturative stress, intergenerational conflict, and racism and discrimination. This qualitative study set out to understand the mental health concerns and service access barriers experienced by South Asian youth populations in the Peel Region of Toronto, Canada from the perspective of mental health service providers. In-depth semi-structured interviews were carried out with mental health service providers (n = 22) who work with South Asian youth living in Peel Region. Thematic analysis was used to elucidate themes related to mental health stressors and service access barriers experienced by youth. According to mental health service providers, South Asian youth navigate a number of unique stressors related to the domains of culture, religion, and family dynamics, experiences of discrimination, the impact of migration, beliefs around mental illness and help-seeking, help-seeking trajectories and therapy recommendations, and lastly, sex differences. Mental health service providers outlined steps needed to effectively address the unique mental health challenges, best practice guidelines, and recommendations for working with South Asian youth, families, and communities to provide a practical and nuanced overview on how a multi-level strategy for mental health care can effectively meet the needs of South Asian youth populations.

Mental illness stigma has detrimental effects on health and wellbeing. Approaches to address stigma in racialized populations in Western nations need to emphasize inclusivity, social justice, and sociocultural intersectionality of determinants of health. The current paper evaluates three intervention approaches to reduce stigma of mental illness among Asian men in Toronto, Canada. Participants received one of four group interventions: psychoeducation, Acceptance and Commitment Therapy (ACT), Contact-based Empowerment Education (CEE), and a combination of ACT+CEE. Self-report measures on stigma (CAMI, ISMI) and social change (SJS) were administered before and after the intervention. A total of 535 Asian men completed the interventions. Overall analyses found that all intervention approaches were successful in reducing stigma and promoting social change. Subscale differences suggest that CEE may be more broadly effective in reducing mental illness stigmatizing attitudes while ACT may be more specifically effective in reducing internalized stigma. More work needs to be done to elucidate mechanisms that contribute to socioculturally-informed mental illness stigma interventions for racialized communities and traditionally marginalized populations.

There is little longitudinal research that directly compares the effectiveness of Canada’s Government-Assisted Refugee (GAR) and Privately Sponsored Refugee (PSR) Programs that takes into account possible socio-demographic differences between them. This article reports findings from 1,921 newly arrived adult Syrian refugees in British Columbia, Ontario, and Quebec. GARs and PSRs differed widely on several demographic characteristics, including length of time displaced. Furthermore, PSRs sponsored by Groups of 5 resembled GARs more than other PSR sponsorship types on many of these characteristics. PSRs also had broader social networks than GARs. Sociodemographic differences and city of residence influenced integration outcomes, emphasizing the importance of considering differences between refugee groups when comparing the impact of these programs., Il existe peu de recherches longitudinales comparant directement l’efficacité des programmes gouvernemental (RPG) et privé (PPR) de parrainage des réfugiés au Canada qui tiennent compte de possibles différences socio-démographique entre eux. Cet article rend compte des résultats de 1921 nouveaux arrivants syriens adultes en Colombie-Britannique, en Ontario et au Québec. Les RPG et PPR diffèrent largement sur plusieurs caractéristiques démographiques, dont le temps du déplacement. De plus, les PPR parrainés par groupes de cinq ressemblaient davantage aux RPG que les autres types de parrainage PPR sur plusieurs de ces caractéristiques. Les PPR avaient aussi des réseaux sociaux plus larges que les RPG. Les différences sociodémographiques et la ville de résidence influent sur l’intégration, ce qui fait ressortir l’importance de tenir compte des différences entre les groupes de réfugiés dans la comparaison de l’impact de ces programmes.

BACKGROUND Stigma of mental illness contributes to silence, denial and delayed help seeking. Existing stigma reduction strategies seldom consider gender and cultural contexts. PURPOSE The Strengths in Unity study was a multi-site Canadian study that engaged Asian men in three stigma reduction interventions (ACT, CEE, psychoeducation) and mobilized them as Community Mental Health Ambassadors. Our participants included both men living with or affected by mental illness (LWA) as well as community leaders (CL). This paper will: (1) describe the baseline characteristics of the Toronto participants including their sociodemographic information, mental illness stigma (CAMI and ISMI), attitudes towards social change (SJS), and intervention-related process variables (AAQ-II, VLQ, FMI, Empowerment); (2) compare the differences among these variables between LWA and CL; and (3) explore factors that may correlate with socio-economic status and mental health stigma. RESULTS A total of 609 Asian men were recruited in Toronto, Canada. Both CL and LWA had similar scores on measures of external and internalized stigma and social change attitudes, except that LWA had more positive views about the acceptance and integration of those with mental illness into the community on the CAMI, while CL had a higher level of perceived behavioral control on the SJS. Group differences were also observed between LWA and CL in some process-related variables. Exploratory analysis suggests that younger and more educated participants had lower stigma. CONCLUSION Our findings underscore the importance of engaging both community leaders and people with lived experience as mental health advocates to address stigma.

Forced migration and extended time spent migrating may lead to prolonged marginalization and increased risk of HIV. We conducted a population-based cohort study to examine whether secondary migration status, where secondary migrants resided in a transition country prior to arrival in Ontario, Canada and primary migrants arrived directly from their country of birth, modified the relationship between refugee status and HIV. Unadjusted and adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated using log-binomial regression. In sensitivity analysis, refugees with secondary migration were matched to the other three groups on country of birth, age and year of arrival (+/- 5 years) and analyzed using conditional logistic regression. Unmatched and matched models were adjusted for age and education. HIV prevalence among secondary and primary refugees and non-refugees was 1.47% (24/1629), 0.82% (112/13,640), 0.06% (7/11,571) and 0.04% (49/114,935), respectively. Secondary migration was a significant effect modifier (

Mammography and fecal occult blood testing (FOBT) improve the detection, management, and prognosis of breast and colorectal cancer, respectively, but are underperformed in the recent immigrant and refugee population. We aimed to identify barriers to screening and potential solutions in this population. A mixed-methods study involving a retrospective chart review and focus group interviews was conducted, with data analyzed using univariate logistic regression and thematic analysis, respectively. Mammography completion was associated with greater time in Canada (p = 0.01) and region of origin (p = 0.04), while FOBT completion was associated with region of origin (p = 0.03). Barriers included time constraints, language and cultural differences, and poor interprofessional communication. This study of recent immigrants and refugees identifies barriers to screening and supports potential solutions including culturally-congruent peer workers, targeted screening workshops, and visual screening aids. Further work is needed to address the unique healthcare needs of this diverse and growing population.

Background Access disparities for mental health care exist for vulnerable ethnocultural and immigrant groups. Community health centres that serve these groups could be supported further by interactive, computer-based, self-assessments. Methods An interactive computer-assisted client assessment survey (iCCAS) tool was developed for preconsult assessment of common mental disorders (using the Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder 7-item [GAD-7] scale, Primary Care Post-traumatic Stress Disorder [PTSD-PC] screen and CAGE [concern/cut-down, anger, guilt and eye-opener] questionnaire), with point-of-care reports. The pilot randomized controlled trial recruited adult patients, fluent in English or Spanish, who were seeing a physician or nurse practitioner at the partnering community health centre in Toronto. Randomization into iCCAS or usual care was computer generated, and allocation was concealed in sequentially numbered, opaque envelopes that were opened after consent. The objectives were to examine the interventions' efficacy in improving mental health discussion (primary) and symptom detection (secondary). Data were collected by exit survey and chart review. Results Of the 1248 patients assessed, 190 were eligible for participation. Of these, 148 were randomly assigned (response rate 78%). The iCCAS (n = 75) and usual care (n = 72) groups were similar in sociodemographics; 98% were immigrants, and 68% were women. Mental health discussion occurred for 58.7% of patients in the iCCAS group and 40.3% in the usual care group (p ≤ 0.05). The effect remained significant while controlling for potential covariates (language, sex, education, employment) in generalized linear mixed model (GLMM; adjusted odds ratio [OR] 2.2; 95% confidence interval [CI] 1.1-4.5). Mental health symptom detection occurred for 38.7% of patients in the iCCAS group and 27.8% in the usual care group (p > 0.05). The effect was not significant beyond potential covariates in GLMM (adjusted OR 1.9; 95% CI 0.9-4.1). Interpretation The studied intervention holds potential for community health centres to improve mental health discussion. Further research with larger samples should examine the impact on detection and enhance generalizability. Trial registration: ClinicalTrials.gov, no: NCT02023957, registered on Dec. 12, 2013.

Background Despite being considered high risk, little is known about the perinatal health of refugees in developed countries. Our objectives were to examine whether: (1) the healthy migrant effect applies to infants born to refugee women with respect to severe neonatal morbidity (SNM); (2) refugee status was a risk factor for SNM among immigrants; (3) refugee sponsorship status was a risk factor for SNM by comparing asylum-seekers to sponsored refugees; and (4) refugees were at greater risk of specific SNM subtypes. Methods Immigration records (1985-2010) linked to Ontario hospital data (2002-2010) were used to examine SNM. We calculated adjusted risk ratios (ARR) with 95 % confidence intervals (95 % CI) for SNM and unadjusted risk ratios with 99 % CI for SNM subtypes using log-binomial regression. Results There were borderline differences in SNM among refugees (N = 29,755) compared to both non-immigrants (N = 860,314) (ARR = 0.94, 95 % CI 0.89, 0.99) and other immigrants (N = 230,847) (ARR = 1.10, 95 % CI 1.04, 1.18) with a larger difference comparing other immigrants to non-immigrants (ARR = 0.83, 95 % CI 0.81, 0.85). Asylum-seekers did not differ from sponsored refugees (ARR = 1.07, 95 % CI 0.90, 1.27). Though rare, several SNM subtypes were significant with large effect sizes. Conclusion With respect to SNM risk, the healthy migrant effect clearly applies to non-refugee immigrants, but is weaker for refugees and may not apply. Among immigrants, refugee status was a weak risk factor for SNM and may not be clinically important. Sponsorship status was not associated with greater risk of SNM. Further investigation of several SNM subtypes is warranted.

Knowledge translation is a dynamic and iterative process that includes the synthesis, dissemination, exchange, and application of knowledge. It is considered the bridge that closes the gap between research and practice. Yet it appears that in all areas of practice, a significant gap remains in translating research knowledge into practical application. Recently, researchers and practitioners in the field of health care have begun to recognize reflection and reflexive exercises as a fundamental component to the knowledge translation process. As a practical tool, reflexivity can go beyond simply looking at what practitioners are doing; when approached in a systematic manner, it has the potential to enable practitioners from a wide variety of backgrounds to identify, understand, and act in relation to the personal, professional, and political challenges they face in practice. This article focuses on how reflexive practice as a methodological tool can provide researchers and practitioners with new insights and increased self-awareness, as they are able to critically examine the nature of their work and acknowledge biases, which may affect the knowledge translation process. Through the use of structured journal entries, the nature of the relationship between reflexivity and knowledge translation was examined, specifically exploring if reflexivity can improve the knowledge translation process, leading to increased utilization and application of research findings into everyday practice.

Despite growing concerns about common mental disorders (CMDs), challenges persist in accessing timely and appropriate care, especially for immigrant, refugee, racialized and low-income groups. Partnering with a community health centre serving these populations in Toronto, we examined the Interactive Computer-assisted Client Assessment Survey (iCCAS) that screens for CMDs (depression, generalized anxiety, post-traumatic stress, and alcohol overuse) and related social factors. In this case study design with embedded units, we explored the mental health care journeys of patients who screened positive for a CMD. The analysis identified three major pathways of care: (1) early detection of previously unidentified CMDs; (2) detection of comorbid mental health conditions; and (3) prevention of possible relapse and/or management of existing previously recognized mental health condition. These cases indicate iCCAS holds potential to facilitate more open, tailored, and informed collaborations between patients and clinicians regarding mental health care plans.

Objective The objective of this research was to explore self-management practices and the use of diabetes information and care among Black-Caribbean immigrants with type 2 diabetes. Method The study population included Black-Caribbean immigrants and Canadian-born participants between the ages of 35 to 64 years with type 2 diabetes. Study participants were recruited from community health centres (CHCs), diabetes education centres, hospital-based diabetes clinics, the Canadian Diabetes Association and immigrant-serving organizations. A structured questionnaire was used to collect demographics and information related to diabetes status, self-management practices and the use of diabetes information and care. Results Interviews were conducted with 48 Black-Caribbean immigrants and 54 Canadian-born participants with type 2 diabetes. Black-Caribbean immigrants were significantly more likely than the Canadian-born group to engage in recommended diabetes self-management practices (i.e. reduced fat diet, reduced carbohydrate diet, non-smoking and regular physical activity) and receive regular A1C and eye screening by a health professional. Black-Caribbean immigrant participants were significantly more likely to report receiving diabetes information and care through a community health centre (CHC) and nurses and dieticians than their Canadian-born counterparts. Conclusions CHCs and allied health professionals play an important role in the management of diabetes in the Black-Caribbean immigrant community and may contribute to this group's favourable diabetes self-management profile and access to information and care. Additional research is necessary to confirm whether these findings are generalizable to the Black-Caribbean community in general (i.e. immigrant and non-immigrant) and to determine whether the use of CHCs and/or allied health professionals is associated with favourable outcomes in the Black-Caribbean immigrant community as well as others.

Research with immigrant and refugee families consistently documents acculturation gaps and role reversals between migrant youth and their parents. However, debate exists over whether these necessarily lead to family conflict and distress. This question was explored in this community-based qualitative study through focus groups and interviews with 70 newcomer refugee youth aged 16 to 24 from the Afghan, Karen and Sudanese communities in Toronto. Thematic analysis revealed that youths’ responsibilities increased following migration, often involving service navigation, language interpretation, and providing financial and emotional support, in addition to household chores and pursuing education and employment. Several youth explicitly took on parental roles in the absence of a parent. These changes did not necessarily lead to conflict, and where family conflict and distancing occurred, other factors such as lack of time together or low levels of family support seemed to be the contributing factors. Youth were clearly “resettlement champions” for their families, which increased family-level well-being, often at the cost of individual-level well-being. Policy implications are discussed. Resume: Une recherche documentee sur les familles d’immigres et de refugies montre de maniere consistante des ecarts dus a l’acculturation ainsi que des renversements de role entre les jeunes immigres et leurs parents. Il y a cependant un debat sur la question de savoir si ceci doit forcement mener a des conflits familiaux et a une certaine detresse. Cette question a fait l’objet d’une etude qualitative realisee dans les communautes afghanes, karenes et soudanaises de Toronto a partir de groupes cibles et d’entrevues menees avec 70 jeunes refugies nouvellement arrives et âges de 16 a 24 ans. Une analyse thematique a revele que les responsabilites de ces jeunes augmentaient suite a l’immigration, souvent afin d’aider les leurs a s’orienter dans les services, a leur servir d’interprete et a leur apporter un soutien financier et emotionnel, et ce en plus de tenir la maison, de continuer des etudes et de gagner leur vie. Plusieurs d’entre eux ont pris explicitement le role de parents en l’absence de l’un d’entre eux. Ces changements n’ont pas automatiquement provoque de conflits sauf que, la ou il y en a eu dans la famille ou qu’elle a souffert de distanciation, d’autres facteurs tels que le manque de temps en commun ou un bas niveau de support familial semblent y avoir contribue. Les jeunes sont clairement les «champions du reetablissement» pour les leurs, ameliorant le bien-etre familial, souvent au prix d’un mieux-vivre individuel. Il s’agit donc de voir ce que cette situation implique au niveau des politiques a leur egard.

To examine the rates of common mental disorders (CMDs) such as depression, anxiety, posttraumatic stress disorder (PTSD), and alcohol use in an urban community health care centre (CHC) serving vulnerable immigrant and ethnoracial communities in order to improve knowledge on the rates of CMDs specific to these groups accessing primary care settings.English or Spanish, self-administered, tablet-based survey known as the Interactive Computer-Assisted Client Assessment Survey (iCCAS).Access Alliance Multicultural Health and Community Services CHC in Toronto, Ont.Adult patients waiting to see a clinician.The iCCAS screened for depression (using the PHQ-9 [Patient Health Questionnaire]), anxiety (using the GAD-7 [Generalized Anxiety Disorder 7-item scale]), PTSD (using the PC-PTSD [Primary Care PTSD Screen]), and alcohol dependency (using the CAGE questionnaire); those with an existing diagnosis and active treatment for one of these conditions were not asked to complete that condition-specific screening scale. An exit survey measured demographic characteristics and relevant indicators.A response rate of 78.6% was achieved. The iCCAS survey was completed by 75 patients (26 men and 49 women) with a mean age of 36.5 years. Almost all were first-generation immigrants: 32.0% originated from Latin America, 28.0% from South Asia, and 17.3% from Africa or the Middle East. Major depression was found among 44.0% of participants (11 with diagnosis and treatment, 22 with a score of 10 or greater on the PHQ-9). Generalized anxiety disorder was present in 26.7% of participants (7 with diagnosis and treatment, 13 with a score of 10 or greater on the GAD-7 scale). Posttraumatic stress disorder was detected in 37.3% of participants (7 with diagnosis and treatment, 21 with a score of 3 or greater on the PC-PTSD tool). Alcohol dependency was found among 10.7% of participants (1 with diagnosis and treatment, 7 with a score of 2 or greater on the CAGE questionnaire).The high rates of probable depression, generalized anxiety, and PTSD that were found in the studied population suggest a need for systematic assessment of CMDs in CHCs, as well as training and resources to increase readiness to handle identified cases.

We sought to document pathways between under/unemployment and health among racialized immigrant women in Toronto while exploring the ways in which gender, class, migration and racialization, as interlocking systems of social relations, structure these relationships.We conducted 30 interviews with racialized immigrant women who were struggling to get stable employment that matched their education and/or experience. Participants were recruited through flyers, partner agencies and peer researcher networks. Most interviews (21) were conducted in a language other than English. Interviews were transcribed, translated as appropriate and analyzed using NVivo software. The project followed a community-based participatory action research model.Under/unemployment negatively impacted the physical and mental health of participants and their families. It did so directly, for example through social isolation, as well as indirectly through representation in poor quality jobs. Under/unemployment additionally led to the intensification of job search strategies and of the household/caregiving workload which also negatively impacted health. Health problems, in turn, contributed to pushing participants into long-term substandard employment trajectories. Participants' experiences were heavily structured by their social location as low income racialized immigrant women.Our study provides needed qualitative evidence on the gendered and racialized dimensions of under/unemployment, and adverse health impacts resulting from this. Drawing on intersectional analysis, we unpack the role that social location plays in creating highly uneven patterns of under/unemployment and negative health pathways for racialized immigrant women. We discuss equity informed strategies to help racialized immigrant women overcome barriers to stable work that match their education and/or experience.

Introduction Notre objectif était d'explorer les pratiques d'auto-traitement, l'utilisation des services de santé et la recherche d'information sur le diabète de type 2 chez les adultes des deux sexes issus de quatre communautés d'immigrants récents de Toronto. Méthodologie Un questionnaire structuré a été adapté au contexte canadien et traduit en 4 langues. En tout, 184 participants atteints du diabète de type 2 (130 immigrants récents et 54 sujets nés au Canada) ont été recrutés tant en milieu communautaire qu'en milieu hospitalier. Résultats Les immigrants récents étaient significativement moins nombreux que les sujets nés au Canada àvérifier régulièrement leur glycémie et l'état de leurs pieds et significativement plus nombreux que les sujets nés au Canada à être non-fumeurs, à faire régulièrement de l'activité physique et à réduire leur apport alimentaire en graisses. Les immigrants récents avaient significativement moins souvent recours à un spécialiste, à un autre dispensateur de soins et à un diététiste et déclaraient en moins grand nombre consulter des diététistes, des infirmières et des organisations pour diabétiques comme sources d'information sur le diabète. Des différences importantes ont été observées selon le sexe et le pays d'origine. Conclusion Les observations semblent indiquer que les stratégies de prévention et de prise en charge du diabète destinées aux immigrants récents doivent tenir compte des barrières linguistiques, financières, informationnelles et systémiques qui nuisent à l'accès à l'information et aux soins.

Introduction Our objective was to explore self-management practices, health services use and information-seeking for type 2 diabetes care among adult men and women from four recent immigrant communities in Toronto. Methods A structured questionnaire was adapted for the Canadian context and translated into 4 languages. A total of 184 participants with type 2 diabetes—130 recent immigrants and 54 Canadian-born—were recruited in both community and hospital settings. Results Recent immigrants were significantly less likely than the Canadian-born group to perform regular blood glucose and foot checks and significantly more likely than the Canadian-born group to be non-smokers, participate in regular physical activity and reduce dietary fat. Recent immigrants were significantly less likely than the Canadian-born group to use a specialist, alternative provider and dietician and less likely to report using dieticians, nurses and diabetes organizations as sources of diabetes-related information. Important differences were observed by sex and country of origin. Conclusion Findings suggest that diabetes prevention and management strategies for recent immigrants must address linguistic, financial, informational and systemic barriers to information and care.

Objectives Immigrants are thought to be healthier than their native-born counterparts, but less is known about the health of refugees or forced migrants. Previous studies often equate refugee status with immigration status or country of birth (COB) and none have compared refugee to non-refugee immigrants from the same COB. Herein, we examined whether: (1) a refugee mother experiences greater odds of adverse maternal and perinatal health outcomes compared with a similar non-refugee mother from the same COB and (2) refugee and non-refugee immigrants differ from Canadian-born mothers for maternal and perinatal outcomes. Design This is a retrospective population-based database study. We implemented two cohort designs: (1) 1:1 matching of refugees to non-refugee immigrants on COB, year and age at arrival (±5 years) and (2) an unmatched design using all data. Setting and participants Refugee immigrant mothers (n=34 233), non-refugee immigrant mothers (n=243 439) and Canadian-born mothers (n=615 394) eligible for universal healthcare insurance who had a hospital birth in Ontario, Canada, between 2002 and 2014. Primary outcomes Numerous adverse maternal and perinatal health outcomes. Results Refugees differed from non-refugee immigrants most notably for HIV, with respective rates of 0.39% and 0.20% and an adjusted OR (AOR) of 1.82 (95% CI 1.19 to 2.79). Other elevated outcomes included caesarean section (AOR 1.04, 95% CI 1.00 to 1.08) and moderate preterm birth (AOR 1.08, 95% CI 0.99 to 1.17). For the majority of outcomes, refugee and non-refugee immigrants experienced similar AORs when compared with Canadian-born mothers. Conclusions Refugee status was associated with a few adverse maternal and perinatal health outcomes, but the associations were not strong except for HIV. The definition of refugee status used herein may not sensitively identify refugees at highest risk. Future research would benefit from further refining refugee status based on migration experiences.

ObjectivesThis qualitative study set out to understand the mental health challenges and service access barriers experienced by South Asian youth populations in the Peel Region of Toronto, Canada.SettingIn-depth semistructured interviews were carried out with South Asian youth living in Peel Region (Mississauga, Brampton and Caledon), a suburb of Toronto, Canada, home to over 50% of Ontario’s South Asian population.ParticipantsSouth Asian youth (n=10) engaged in thoughtful, candid dialogue about their mental health and service access barriers.Primary and secondary outcome measuresQualitative interview themes related to mental health stressors and mental health service access barriers experienced by youth living in Peel Region were assessed using thematic analysis.ResultsSouth Asian youth face many mental health stressors, from intergenerational and cultural conflict, academic pressure, relationship stress, financial stress and family difficulties. These stressors can contribute to mental health challenges, such as depression and anxiety and drug use, with marijuana, alcohol and cigarettes cited as the most popular substances. South Asian youth were only able to identify about a third (36%) of the mental health resources presented to them and did not feel well informed about mental health resources available in their neighbourhood.ConclusionsThey offered recommendations for improved youth support directed at parents, education system, South Asian community and mental health system. Institutions and bodies at all levels of the society have a role to play in ensuring the mental health of South Asian youth.

Despite their high levels of education, racialized immigrant women in Canada are over-represented in low-paid, low-skill jobs characterized by high risk and precarity. Our project documents the exper iences with precarious employment of racialized immigrant women in Toronto . We conducted 30 semi- structured interviews with racialized immigrant wom en. Participants were recruited through posted flyers, partner agencies, peer researcher networks and snowball sampling. Interviews were transcribed and analyzed using NVivo software. The project followed a community-based pa rticipatory action research model. Participants faced powerful structural barriers to decent employment and additionally faced barriers associated with househo ld gender relations. Their labour market experiences negatively impacted their physical and mental health as well as that of their families. These problems f urther constrained women’s ability to secure decent employment. Our study make s important contributions in filling the gap on the gendered barriers raciali zed immigrant women face in the labour market and the gendered impacts of deski lling and precarity on women and their families. We propose labour market reforms and changes in immigration and social policies to enable racialize d immigrant women to overcome barriers to decent work.

INTRODUCTION: Community health is very much important in nursing education. It is essential because it maximizes the health status of individuals, families, groups and the community through direct approach with them. The main purpose of the study was to identify the gap in Community Health Nursing I course in Proficiency Certificate Level first year nursing program in Nepal. METHODS: Mix methods of research having qualitative and quantitative method were used in the study. Data were collected from 12 subject teachers, 35 nursing graduates and 61 Proficiency Certificate Level first year nursing students. The study used structured, five-point rating scale and open ended questions according to Strengths, Weaknesses, Opportunities and Threats analysis for the self-administered questionnaire. FINDINGS: Common view points of the three sector's respondents (student, nursing graduate and teachers) regarding the strengths of curriculum are: curriculum is based on Primary Health Care approach and covers preventive and promotive aspects of health. Regarding weaknesses, they said that there is inadequate time for practice, there is lack of innovative methods and materials, the course didn't cover new trends of environmental pollution and changes, global warming, greenhouse effect, climate change and deforestation etc. Similarly, they added that curriculum is not revised regularly and there is insufficient supervision in field. Likewise, regarding opportunities, they said that there is job opportunity in social organization as Community Health Nursing/Public Health Nurse. Moreover, they said that there is lack of employment scope as threats point. CONCLUSION: The paper concludes that new issues and trends of community health nursing should be added, and curriculum should be revised regularly.

Self-esteem is recognized as an important correlate of youth mental wellbeing and, by extension, supportive of individual resilience. While an extensive body of literature exists on self-esteem of mainstream youth, less is known about self-esteem experiences of immigrant youth, and in particular newcomer and refugee youth. Applying a community-based participatory research approach, and using mixed methods, the aim of the study presented was to understand social determinants of newcomer youth’s mental wellbeing, and recognize both their challenges and resilience. The chapter focuses on the self-esteem of newcomer youth from four ethnic backgrounds (Afghan, Colombian, Sudanese, and Tamil).The study findings can contribute to mental health promotion strategies in multicultural and immigrant-receiving community settings.

Due to experiences of forced migration, a large proportion of resettled refugee families arrive in resettlement countries with low levels of education, limited official language fluency, fractured family relationships, and less than optimal physical and mental health. These pre-migration determinants intersect with systemic barriers in ways that make it extremely difficult for refugees to secure employment/income security, access health and settlement services, and pursue their educational and other goals. This chapter discusses the role that newcomer refugee youth play in helping their families resettle in response to systemic post-migration barriers.

A large percentage of refugees have low levels of education and official language fluency upon arrival in Canada. Thi spaper discusses educational goals of newcomer refugee youth from three communities in Toronto (Afghan, Karen, and Sudanese), and explores how these are linked to premigration and post-migration determinants. Guided by community-based research principles, we collaborated with eight refugee youth peer researchers and conducted ten focus groups and thirteen interviews with refugee youth. Results show that newcomer refugee youth develop strong aspirations for higher education in Canada as a proactive response to overcome pre-migration experiences of forced migration and educational disruptions. We then discuss how these youth negotiate educational goals in post-migration context in relation to shifts in family responsibilities and everyday encounter with multiple systemic barriers in Canada. In doing this, we examine the thin line between vulnerability and empowerment that refugee youth straddle and reveal policy gaps and contradictions in the depoliticized humanitarianism within refugee resettlement in Canada.

The worldwide rise in common mental disorders (CMDs) is posing challenges in the provision of and access to care, particularly for immigrant, refugee and racialized groups from low-income backgrounds. eHealth tools, such as the Interactive Computer-Assisted Client Assessment Survey (iCCAS) may reduce some barriers to access. iCCAS is a tablet-based, touch-screen self-assessment completed by clients while waiting to see their family physician (FP) or nurse practitioner (NP). In an academic-community initiative, iCCAS was made available in English and Spanish at a Community Health Centre in Toronto through a mixed-method trial. This paper reports the perspectives of clients in the iCCAS group (n = 74) collected through an exit survey, and the perspectives of 9 providers (four FP and five NP) gathered through qualitative interviews. Client acceptance of the tool was assessed for cognitive and technical dimensions of their experience. They rated twelve items for perceived Benefits and Barriers and four questions for the technical quality. Most clients reported that the iCCAS completion time was acceptable (94.5 %), the touch-screen was easy to use (97.3 %), and the instructions (93.2 %) and questions (94.6 %) were clear. Clients endorsed the tool’s Benefits, but were unsure about Barriers to information privacy and provider interaction (mean 4.1, 2.6 and 2.8, respectively on a five-point scale). Qualitative analysis of the provider interviews identified five themes: challenges in Assessing Mental Health Services, such as case complexity, time, language and stigma; the Tool’s Benefits, including non-intrusive prompting of clients to discuss mental health, and facilitation of providers’ assessment and care plans; the Tool’s Integration into everyday practice; Challenges for Use (e.g. time); and Promoting Integration Effectively, centered on the timing of screening, setting readiness, language diversity, and technological advances. Participant clients and providers perceived iCCAS as an easy and useful tool for mental health assessments at the Community Health Centre and similar settings. The findings are anticipated to inform further work in this area. ClinicalTrials.gov; NCT02023957 ; Registered retrospectively 12 Dec. 2013