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Abstract: The paper addresses a critically important area in Canadian immigration and health from both a social and a spatial perspective. It employs multilevel and contextual approaches to examine the social determinants of immigrant health as well as the place effects on self-reported health at a regional and neighborhood scale. The data come from the raw microdata file of the 2005–10 Canadian Community Health Survey (a random national health survey) and the publicly available Canadian Marginalization index based on the 2006 Census. Three populations are compared: Canadian-born, overall foreign-born, and Chinese immigrants. The results suggest various degrees of association between self-reported health, individual and lifestyle behavioral characteristics, and neighborhood material deprivation and ethnic concentration in census tracts. These factors contribute differently to the reported health of Chinese immigrants, Canada's largest recent immigrant group. A healthy immigrant effect is partially evident in the overall foreign-born population, but appears to be relatively weak in Chinese immigrants. For all groups, neighborhood deprivation moderately increases the likelihood of reporting poor health. Ethnic concentration negatively affects self-rated health, with the exception of the slight protective effect of Chinese-specific ethnic density in census tracts. The multilevel models reveal significant area inequalities across Census Metropolitan Areas/Census Agglomerations in risk of reporting unhealthy status, with greater magnitude in the foreign-born population. The vast regional variations in health among Chinese immigrants should be interpreted carefully due to the group's heavy concentration in large cities. The study contributes to the literature on ethnicity and health by systematically incorporating neighborhood contextual effects in modeling the social determinants of immigrant health status. It fills a gap in the literature on neighborhoods and health by focusing on ethnically disparate groups rather than on the general population. By revealing regional disparities in health, the paper adds a spatial perspective to the work on immigrant health. [Copyright &y& Elsevier]

Abstract: Immigrants in Canada constitute approximately 20% of the total population and will continue to account for a significant portion of the country''s population in the future. Accordingly, a growing body of research has focused on examining the disparity in health status between the increasing foreign-born and the Canadian-born populations. The healthy immigrant effect, in particular, acknowledges that immigrants have better health status than their Canadian-born counterparts upon arrival in the country. However, studies have shown that over time the health of immigrants declines to a level on par with the Canadian-born population. There is much speculation as to the reasons for this decline including acculturation (i.e., uptake of unhealthy lifestyles) and a lack of access to health care. Yet, there have been few studies to examine possible reasons for potential declines in health, especially from the perspective of immigrants themselves. This study is one of the first to qualitatively examine perceived changes in health status and reasons for health status change among immigrants. The paper presents the results of 23 in-depth interviews with adults with recent (less than 3 years of residency), mid-term (3–10 years), and long-term (more than 10 years) immigrants living in the Greater Toronto Area. The results reveal that the majority of the participants believed their health had remained stable or even improved over time due to improved living standards and lifestyle behaviours in Canada. Those who perceived their health to have worsened over time attributed the change to the stress associated with migration, and the aging process rather than the adoption of an unhealthy lifestyle. Additionally, while the vast majority of participants reported improved access to resources upon migration, there were mixed reviews in terms of how beneficial these resources were or could be for health. The findings highlight the need for research to incorporate mental health into studies on changing immigrant health status and to focus on those factors contributing to high levels of stress among more recent immigrants. [Copyright &y& Elsevier]