LAUSR

Immigrant youth are at high risk of experiencing discrimination, harassment, aggression, physical violence, and sexual violence in their destination country.1 These risks affect youth who are refugees or asylum seekers as well as those who experience voluntary or planned migration. The potential risk for harm after immigration demonstrates a clear need for research to inform prevention and intervention efforts to protect the safety and security of immigrant youth. In this context, the study by Saunders and colleagues2 on the risk of experiencing violent injury among immigrant and refugee youth in Canada is timely and important. Canada is a leader in the Americas in accepting immigrant families, and immigrants to Canada constitute nearly one-quarter of the population.3 The study by Saunders et al2 included nearly 23 million person-years for youth aged 10 to 24 years between 2008 and 2016 and found that rates of violent injuries—those requiring acute care (ie, an emergency department visit or hospitalization) or resulting in death—to be 51% lower among immigrant youth compared with Canadian-born youth after adjusting for age, sex, neighborhood income, and rurality.2 Rates of injuries were particularly low among immigrants from South and East Asia, Canada’s largest intake countries. Saunders et al2 explain that Canada accepts a relatively high proportion of immigrants in socioeconomic classes that place them at lower risk of experiencing violence. Additionally, Saunders et al2 posit that other factors, such as the type of social support, family cohesion, and living in communities with other immigrants, may be protective against experiencing violence among immigrant youth.4 However, this study found that refugee status was associated with higher risk of experiencing violent injuries compared with nonrefugee status, while both groups had lower rates of assault than nonimmigrants. This difference in risk may reflect a difference between the experience of arriving in Canada following forced displacement compared with voluntary and planned migration. In addition, refugee and immigrant groups may experience differential rates of xenophobia, discrimination, and harassment. Somali youth were the only immigrant youth who experienced higher rates of violent injuries compared with nonimmigrants. This finding amplifies recent efforts by community-led organizations, such as Youth LEAPS5 in Toronto, Ontario, to raise awareness and address the large burden of violence and homicide—often associated with racism and Islamophobia— that Somali youth face. For example, although Somali people constitute 1% of the population, in 2014, 16% of homicide victims in Toronto were Somali. The ability of Saunders et al2 to link health and administrative data sets (ie, health insurance registry, emergency department visits, hospitalizations, deaths, residence information, and immigration status) fills an important gap in scholarship on violence against immigrant youth. The size of the study sample allowed the authors to evaluate the risk of experiencing violent injury at the level of country of origin. This level of granularity beyond the regional level is unique in population health and critical in understanding health disparities. In a context in which data on immigration status are often scarce, the study by Saunders et al2 provides a blueprint for other researchers on how to use health and administrative data to examine the associations of immigrant and refugee status with a variety of health outcomes. This study also draws attention to several important themes researchers of violence and immigration are grappling with: first, the importance of examining discrimination; second, who may be missing in data; and third, how sociopolitical context is associated with health outcomes. First, + Related article