This presentation offers critical insight on immigrant youth and the living conditions, settlement, and acculturation issues that play a role in determining their health and well-being. Drawing largely from the Wellesley Institute's Youth Photovoice research findings, this presentation provides background knowledge on the social determinants of health and a glimpse into the lives of immigrant youth. The presentation was part of SickKids’ Adolescent Medicine Rounds, and was attended by physicians, residents, fellows, medical students, nurses, social workers, psychologists and therapists working in the adolescent health field. Nasim Haque, MD, DrPH Director of Community Health www.wellesleyinstitute.com Follow us on twitter @wellesleyWI

1. Adolescent Medicine Rounds
Hospital for Sick Children
November 30, 2011
Social Determinants of Health
for Immigrant Youth:
Experiences from St. James Town Initiative
Nasim Haque, MD, DrPH
Director, Community Health
Wellesley Institute
November-30-11 |
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2. Overview: Immigrant Youth
Children and youth make up a significant portion of immigrants into Canada

3. Status of Immigrant Youth:
Where are they settling?
• 17% refugees, 32% independent category, and 40% family-class
immigrant
• ~ 200,000 non-status in Canada of which 50% reside in Toronto
& their age demographics are not known
• Among all immigrant youth in Canada in 2006, over 2/3rd live in
Toronto, Vancouver or Montreal
Salehi, R. 2010. Intersection of Health, Immigration, and Youth: A Systematic Literature Review. J. Immigrant Minority
Health 12:788-797.
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4. About St. James Town Initiative
SJT Initiative is a 5 year CBPR Initiative of WI
Research Question:
What implications do neighbourhoods have on
the health & well-being of immigrants?
Results:
Inform policy & support social change at
neighbourhood level
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5. Strategies & Activities
Multi-pronged Approach
COMMUNITY ENGAGEMENT
Participatory Skill enhancing Student Work with SJT Initiative
Action opportunities internships multiple website
Research stakeholders
Community Action SJT Residents Action Group
1) Adult Photovoice 4) Youth Photovoice
2) Community Mapping 5) Focus groups/interviews (CAC)
3) Concept Mapping 6) Sample Survey (CIHR funded)

6. 14,666 Residents
64,636 People / km2
(Unofficial Estimate: 25,000)
64% Immigrants
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6
18 Aging High-Rise Buildings
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7. Production of Health
Immigrant Youth have Added
Burden of Migration Experience
The social &
economic
environment
HEALTH Person’s
The physical individual /
environment biological
characteristics
& behaviours
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8. Migration Experiences
• Complex, dynamic and context bound process that take place
over time
• Psychosocial integration:
• Acculturation, assimilation, settlement, adaptation
• Important to understand pre and post-migration experiences
of youth to address their health issues
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9. What factors influence adolescent health
and wellbeing?
Risks factors include, but are not limited to:
• Poverty, social exclusion, peer rejection, isolation, and lack of
family support
• Growing up in disadvantaged circumstances
• The migration process in countries of destination & origin
• Lack of positive social and community networks and
environments
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10. Research Example
Voices of Multicultural Youth:
Impact of urban neighbourhood on
health and wellbeing (2010)
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11. Photovoice participants – SJT youth residents
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12. Photovoice to understand youth perception on
neighbourhood and health & wellbeing?
Photovoice asks you to take photographs
© Wellesley Institute
of things that are important to you - and
to tell the story of why these things are
important. The visual images and
accompanying stories are the tools used
to reach policy- and decision-makers.
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13. PHYSICAL ENVIRONMENT
Parks and Green Space
© Wellesley Institute
In a community school field, this picture shows a number of children playing soccer on a
summer day. It reflects back to my life as it was a school I use to attend and school field I use
to play on as well. These activities are strengths in our community as children are kept away
from trouble. It should be part of any child’s childhood memory as they spend their summer
days having fun, rather than getting into trouble.
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© Wellesley Institute (SJT Youth, 2010)

14. PHYSICAL ENVIRONMENT
Recreational Facilities
© Wellesley Institute
As a child, one way I kept myself occupied with my time was through playing basketball. It not
only kept me off the streets, but also wasted the majority of my time, keeping me active. If more
community programs ran such activities, it would bring the community closer and keep children
off the streets away from any type of violence. These activities are strengths in our community
as children are kept away from trouble.
(SJT Youth, 2010)

15. PHYSICAL ENVIRONMENT
Recreational Facilities
In a community where 73 percent of the population is immigrants, parents have to work to
put food on the table and so the kids are home alone. They will eventually go out in the
summer when it is extremely hot and if the swimming pool is packed, it is likely the child will
leave and play somewhere in the street. When they are in the street, they are exposed to
bits and pieces of bad things. Eventually they will get curious and see why they are so bad
themselves and they become criminals, drug dealers or even drug addicts...... Also
swimming is way to prevent child obesity (SJT Youth, 2010)
© Wellesley Institute
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16. PHYSICAL ENVIRONMENT
Plants and Gardens
© Wellesley Institute
This image gives the neighbourhood a vibrant, peaceful and beautiful effect. It also relates to
our lives because it is said flowers can help ease tension and mellow the mind. A reason that
these flowers are related to health apart from the calming aspect is that it also increases plant
life, breeds new ecosystems, and reduces some of the harmful gasses in our atmosphere. 16
(SJT Youth, 2010)

17. PHYSICAL ENVIRONMENT
Plants and Gardens
© Wellesley Institute
This flower may look like an ordinary flower, however it represents so much more. It is
unfortunate that we don’t see many gardens around or plants being planted around the
neighbourhood. This also relates to our health in a bad way because our neighbourhood is filled
with only buildings making it look depressing to walk through.
Flowers give humans a chance of breathing fresh air, thus, it’s useful for health. By seeing
different flowers our mind get energized
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www.wellesleyinstitute.com/sjtinitiative.com (SJT Youth, 2010)

18. PHYSICAL ENVIRONMENT
Overcrowding
... In a neighbourhood such as St. James
Town where most people live in high rise
buildings and come from low income
families it may not seem like the best
idea to build more buildings when we
don’t already have that much green
space around. This issue relates to your
lives because we need more things than
buildings around our community, such as
more parks, centres for youth but
instead we invest in building and more
buildings.
(SJT Youth, 2010)
© Wellesley Institute
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19. SOCIAL ENVIRONMENT
Safety, Crime, Drugs, Fear
© Wellesley Institute
The picture shows a memorial of a residence of St. James Town whose life was robbed off him
last year due to gun violence. The person who murdered “Juice” is yet to be found. It just comes
to show that more security is needed in the area. A lot of undercover police are the area
dressing up as drug dealers or buyers but they are usually easily spotted and pin pointed. 19
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(SJT Youth, 2010)

20. VIOLENCE AND CRIME
“It is a problem that after 12 a.m. going out alone is kind of suicide to residence. I
have been in trouble many times that now I try not to go or if I want to go I go
with my friends which is more safe for me.”
“During night time this area is not really safe, because in a neighborhood where a
lot of gang plays, bad crime and other bad things happened and a lot of young
boys and girls are coming at night time to smoke and sometime when they got
drank they start fighting with people and with themselves. In my opinion that
area is not safe at the middle of the night and we need more security there.”
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21. SOCIAL ATTRIBUTES
Places of Worship
© Wellesley Institute
In a way this can relate to our health because there are many other things that have to do with
health and not just physicalness but also emotionally. People pray and worship what they do to
make themselves feel better and that has to do with our health.
(SJT Youth, 2010)
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22. SOCIAL ATTRIBUTES
School
This is good for our health because children are getting an education they deserve and will get
so the future could be better. This strength exists because of the strong community involvement
with he school. All the parents are all in the parent council meetings and voice their opinions
which benefit the school.
(SJT Youth, 2010)
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23. RESIDENT BEHAVIOUR
© Wellesley Institute
This is related to our lives because every day we are witness to some type of harmful
carcinogens produced by these cigarettes. Whether second hand, or first hand smoke, living
in St. James Town means a high chance of encountering cigarettes. Because of this more
people are exposed to harmful chemicals.
(SJT Youth, 2010)

24. ECONOMIC ENVIRONMENT
© Wellesley Institute
Money also leads to better access to health most people living in St. James Town do not have
money to go to the doctor and most of them do not have money to pay their rent. The
money earned by some people is not even enough to properly feed them. The big issues
around in this area are about money including the cost of living income and employment.
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(SJT Youth, 2010)

25. Neighbourhood Quality & Depression
(preliminary findings from SJT survey, 2011)
Perceived Neighbourhood Problems Effects on Depression
4
3.5
3
2.5
Odds Ratio
Non-Immigrant
2 Chinese
Filipino
1.5
Tamil
1
0.5
0
Not or A Few Problem Some Problems Severe Problems

26. Broad Determinants of Health
a CBPR project on Neighbourhood & Health and Wellbeing
Results from Concept Mapping Project
Concept
Mapping results
show that
residents’ health
is affected by a
broad range of
issues, most of
which are
outside of the
health-care
system
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27. Importance of Neighbourhood Factors on
Health and Well-Being
Results from Concept Mapping Project
Importance Action Potential
4.12 3.51
Improvement for Health Society
Residents rated Safety
Improvement for Health
the importance of Environment
various Need Social & Protection
Sense of Pride
Environment
neighbourhood
factors that had Attractions
Safety
been identified as Education Green Space
influencing their Green Space Lack of Maintenance &Improvement
health and well-
Sense of Pride Attractions
being.
Lack of Maintenance Need Social and Protection
Society Education
3.08
3.56
r = .12
* Absolute values for ratings range from 1-5
November 30, 2011 |
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28. Training Workshop 1
© Wellesley Institute
September 23, 2011 |
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29. Important Stakeholders: Training Workshop 2
© Wellesley Institute
September 23, 2011 |
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30. Community Forum & Expo: August 17, 2010
© The Wellesley Institute
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© Wellesley Institute

31. What are the Issues?
Immigrant youth tend to:
• Live in low-income households and low-cost neighbourhoods which often
have higher poverty and crime rates and offer poor living conditions
• Lack social support – a contributing factor to the higher rates of depression
and social exclusion
• Language barriers – remaining silent, appearing withdrawn, moody, and
fearful
• Internalize a new set of cultural norms, and a new value system more quickly
than their parents – confrontation with parents
• More likely to have less parental support to avoid risk behaviour and may be
more susceptible to peer pressures to engage in risk behaviour
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32. Addressing the issue
1. Address health inequities: Are services “missing” for young
people who, due to low socio-economic status, gender,
migrant status, or family structure are at increased risk ?
What mechanisms can help reach disadvantaged young
people?
2. Involve immigrant youth: Are immigrant youth adequately
involved in the design of service delivery? What can be done
to further involve them?
3. Engage in inter-sectoral action: Given the importance of the
school setting for most adolescents, what is the role of the
health system in this regard?
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33. Acknowledgement
Estelle Sun: Project Coordinator, Wellesley Institute
Sami, Sarah & Dina: Youth Interns , summer 2009-2010
Ali Moallim : Community Leader, SJT
Sean McIntyre: Constituency Assistant to Area Councillor
St. James Town Youth project participants
November 16, 2011
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34. Following - Up
These speaking notes, and reports are available on our
website at www.sjtinitiative.com
My email: nasim@wellesleyinstitute.com
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35. ST. JAMES TOWN INITIATIVE
www.sjtinitiative.com
THANK YOU
© The Wellesley Institute
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