Health Promotion and Chronic Disease Prevention in Canada-Research Policy and Practice最新文献

Introduction: Traditional approaches to supporting older adults in adopting and maintaining an active lifestyle have largely failed. The previously proposed "Staircase Approach" offers a new foundation for developing interventions and public health strategies; this approach includes Step 1 (changing sedentary behaviour) and Steps 2 to 4 (incorporating more physical activity of increasing levels of intensity). In this systematic search and review, we aimed to inform the co-creation of a novel Staircase Approach intervention for community-dwelling, inactive older adults, primarily focussed on Step 1.

Methods: A systematic search was performed across six databases (MEDLINE, PsycInfo, CINAHL, Cochrane CENTRAL, SPORTDiscus and Scopus).

Results: After duplicates were removed, 3427 titles and abstracts were screened. Fourteen articles (including 17 intervention groups) were included after full-text review. Five were randomized controlled trials, three compared two interventions and six were single-arm studies. Sample sizes ranged from 9 to 176 participants, and included 617 older adults at baseline. Mean age of samples ranged from 64.3 (standard deviation [SD] 3.8) to 85.1 (SD 6.2) years, while the intervention length ranged from less than one day to 6 months. Sedentary time interventions are well accepted; most studies had completion rates above 80%. Based on findings from within-group comparisons, half of the studies showed a reduction in sedentary time (6/12 groups) and half showed an increase in physical activity (6/12 groups). Based on findings from between-group comparisons, 2 out of 5 intervention groups showed improvements in sitting time and physical activity outcomes compared to controls. Satisfaction and adherence to interventions were generally high.

Conclusion: Sedentary time interventions for older adults show promise and point to several components that may be included in an intervention focussed on Step 1 of the Staircase Approach.

Introduction: The 2023 Canadian Centre on Substance Use and Addiction drinking guidelines specify a universal low-risk threshold of 2 or fewer drinks per week, lower than previous guidelines that recommended no more than 10 drinks per week or 2 per occasion for females, and 15 per week or 3 per occasion for males. This study examined the increases in risk classification and perceptions of these new guideline thresholds.

Methods: Prevalence of those exceeding the new low-risk threshold was compared with that of previous and other international guidelines in an observational cohort of community adults (N = 1502) from southern Ontario who had been followed since 2018 (11 waves of data collection). To examine awareness of the new guidelines and perceived risk of drinking beyond them, a follow-up was conducted with a subset of the cohort, three months after the release of the guidelines (April 2023).

Results: Across waves, on average, 52% exceeded the new low-risk threshold compared to 11% who exceeded previous guidelines. Other international guidelines classified, on average, 16% (US), 20% (UK) and 29% (WHO) of the sample as exceeding low-risk guidelines. Approximately half of study participants (51%) were aware of Canada's new guidelines, but 77% perceived exceeding 2 drinks per week as having little to no risk.

Conclusion: Over four times more adults exceeded the new low-risk drinking threshold compared to that of the previous Canadian guidelines. Additionally, more were classified as exceeding the new low-risk threshold compared to other international drinking thresholds. These results, combined with low perceptions of risk associated with consuming more than 2 drinks per week, suggest that many Canadians are at risk of exceeding the new guidelines.

Executive summary: The drug toxicity crisis in Canada and elsewhere has increased the need for timely and relevant data to inform policies and programs aimed at mitigating substance-related harms. While a number of monitoring systems addressing specific components of substance use and related harms in Canada exist, they are not guided by an overarching conceptual framework. This evidence-informed policy brief describes the development of a conceptual framework for the public health monitoring of substance-related harms. The resulting framework includes four primary topic areas (risk and protective factors, substance use, health supporting systems and substance-related harms and benefits) four cross-cutting topic areas (life course, equity, substance use stigma and mental and physical health and illness) and two overarching considerations (respectful use of data and engagement). This framework can be used to organize existing activities and to identify data and monitoring gaps for further development.

Introduction: Healthcare workers (HCWs) have reported COVID-19 pandemic-related adverse mental health impacts. We examined the demographic profile of HCWs who self-referred for mental health treatment, how referrals changed over time in relation to waves of COVID-19, what the main problem was for which HCWs sought treatment, and how this changed during the pandemic.

Methods: Five major healthcare institutions provided mental health supports to HCWs across Ontario during the pandemic. Data from May 2020 to March 2022 were collected from 2725 HCW self-referrals regarding referral frequency, main presenting mental health problem and demographic information including ethnicity, gender, age, healthcare setting, profession and whether the HCW had a prior mental health diagnosis or had received prior mental health treatment.

Results: Treatment-seeking HCWs who self-referred predominantly self-identified as female and White. Almost half were nurses, and almost half had received previous mental health treatment; a slightly higher percentage reported a prior mental health diagnosis. Over 60% of the overall sample of HCWs worked in hospitals. The timing of increases and decreases in monthly new referrals roughly aligned with the onset and ending, respectively, of COVID-19 waves. The top five most common presenting problems for treatment-seeking were generalized anxiety/worry symptoms, depression, situational crisis/acute stress response, difficulty with stress/occupational or financial, and posttraumatic stress symptoms.

Conclusion: Ontario HCWs self-referred to access mental health supports during the COVID-19 pandemic. The majority sought treatment for generalized anxiety/worry or depression symptoms. Results of this study may inform system planning for future pandemics, as well as for HCW wellness programs for continued workplace stress in the postpandemic period.

Introduction: This study provides a descriptive overview of the prevalence of posttraumatic stress disorder (PTSD) in Canada, across sociodemographic characteristics, mental health-related variables and negative impacts of the COVID-19 pandemic.

Methods: Data were obtained from cycles 1 and 2 of the Survey on COVID-19 and Mental Health (SCMH), collected in fall 2020 (N = 14 689) and spring 2021 (N = 8032). The prevalence of PTSD was measured using the PTSD Checklist for DSM-5 (PCL-5) Cross-sectional associations were quantified using logistic regression, while controlling for sociodemographic characteristics.

Results: The overall prevalence of PTSD was 6.9%. Factors associated with higher PTSD prevalence were female gender; younger age; lower income (females only); living in an urban area; frontline worker status or not being at work in the past week (males only); fair or poor mental health; a weak sense of community belonging; symptoms of generalized anxiety disorder and major depressive disorder; suicidal ideation; heavy alcohol use; daily cannabis use; increased alcohol and cannabis use since the start of the pandemic; decreased alcohol consumption since the start of the pandemic (males only); concerns about violence in the home; and negative impacts of the pandemic.

Conclusion: PTSD prevalence in Canada varies significantly across sociodemographic groups and is more common among those with indicators of lower mental health and well-being, as well as those more adversely affected by the COVID-19 pandemic. Ongoing and enhanced surveillance of PTSD in Canada is important to better understand and address the burden and impacts of this condition.

Introduction: Strategic knowledge mobilization efforts are needed to enhance uptake and use of the Canadian 24-Hour Movement Guidelines (24HMG), which describe optimal amounts of physical activity, sedentary behaviour and sleep each day for overall health. The Whole Day Matters Toolkit for Primary Care is an evidence-informed resource to help primary care providers (PCPs) disseminate the 24HMGs. The purpose of this study was to describe gaining consensus on toolkit components through iterative revisions to improve its utility in preparation for the September 2022 launch, and to summarize early dissemination efforts.

Methods: A multidisciplinary expert working group planned three modified Delphi surveys to assess PCPs' level of agreement with toolkit components on 7-point Likert scales with follow-up prompts for ratings of 4 or less. Consensus was defined a priori as a mean of 6 or higher out of 7 and 60% or more of PCPs selecting at least "somewhat agree." Items on which consensus was reached were removed from subsequent surveys unless they were revised.

Results: Twenty PCPs completed surveys 1 and 2; 15 completed survey 3. Consensus was reached on 5% (4/83), 17% (14/83) and 55% (38/69) of the items in surveys 1, 2 and 3, respectively. The number of qualitative comments decreased from 26 to 19 to 12, further indicating increasing consensus.

Conclusion: Items on which consensus was not gained may reflect differences in provider characteristics or settings. A coproduced dissemination strategy was enacted. Toolkit reach was evaluated at launch and 4 months later.

Introduction: The aim of this study was to assess the potential impacts of the introduction of a smoke-free generation (SFG) policy in Canada with a perpetual ban on cigarette sales to anyone born after 2009 instigated on 1 January 2025.

Methods: An existing Canadian model relating to smoking cessation was adapted and augmented to assess the impact of an SFG policy on quality-adjusted life years (QALYs), life expectancy, health care costs, smoking-related taxes, and Canadian tobacco industry gross domestic product (GDP). The cumulative impact of the policy for the entire Canadian population was assessed for time horizons up to 90 years with an annual discount rate of 1.5%.

Results: After 50 years, this SFG policy would lead to 476 814 more QALYs, $2.3 billion less in health care costs, $7.4 billion less in smoking-related taxes and a $3.1 billion reduction in tobacco industry GDP. The combined value of health benefits gained and health care costs averted would exceed the sum of tax revenues foregone and reduced GDP, if the value of a QALY was at least $17 147. Use of higher discount rates and inclusion of unrelated health care costs had little impact on the interpretation of the results.

Conclusion: The implementation of an SFG policy will bring substantive health benefits to the population in Canada. Although health care cost savings are lower than the combination of lost tax revenues and the decline in the GDP from the Canadian tobacco industry, the value of the health benefits realized outweigh the negative offsets.

An analysis of 1771 Canadian adults who smoke or used to smoke cigarettes was conducted using data from the 2022 International Tobacco Control Four Country Smoking and Vaping Survey. Using weighted data, we estimated the prevalence of Canadian adults who tried to quit smoking between 2020 and 2022, and the use of a nicotine vaping product (NVP) and the flavours and devices used most often at their most recent quit attempt. Overall, 36.5% made a quit attempt; of those, 19.4% used an NVP. Those who were younger and quit smoking were more likely to have used an NVP. Prefilled cartridges or pods (36.3%) and fruit flavours (39.5%) were used most frequently.

Falls among older adults (aged 65 years and older) are a public health concern in Canada. Fall-related injuries can cause a reduction in quality of life among older adults, and death. They also entail substantial health care costs. It is essential to monitor fallrelated injuries and deaths among older adults to better understand temporal trends and characteristics and to evaluate fall prevention strategies. We used the most up-to-date data from the Canadian Vital Statistics-Death database, Discharge Abstract Database and National Ambulatory Care Reporting System to analyze the temporal trends of fallrelated mortality, hospitalizations and emergency department (ED) visits among older adults in Canada over more than a decade. Age and sex characteristics were also examined. In 2022, 7189 older adults died due to a fall in Canada (excluding Yukon). From 2010 to 2022, deaths due to falls generally increased in both number and rates. In fiscal year 2023/24, there were 81 599 fall-related hospitalizations in Canada (excluding Quebec) and 212 570 fall-related ED visits in Ontario and Alberta. From fiscal year 2010/11 to 2023/24, even though the overall trend of the rates of fall-related hospitalizations and ED visits did not increase, the numbers generally rose year by year except in 2020/21, the early stage of the COVID-19 pandemic. As for the age and sex characteristics, the rates for deaths, hospitalizations and ED visits rose with advancing age for both men and women. With the aging population, continuous monitoring of the trends is crucial for fall prevention.

Introduction: To date, surveillance of vaping among Canadians (using vaping products with or without nicotine) has largely been examined with respect to age and smoking status. However, a nationally representative examination of a broad set of characteristics is lacking. This study characterized Canadians aged 15 years and older who vape, stratified by smoking status.

Methods: Data from the 2020 Canadian Community Health Survey (unweighted analytical sample size: 28 413 respondents) were used to examine past-30-day vaping stratified by smoking status (current smoking, former smoking, and never/nonsmoking). A Sexand Gender-Based Analysis Plus approach was used to select individual-level characteristics for analysis. Descriptive statistics were used to examine outcomes by each characteristic and multivariable logistic regression models were constructed to identify significant factors associated with each past-30-day vaping by smoking status category, using weighted data.

Results: In 2020, 2.0% (605 000) of Canadians aged 15 years and older reported vaping and current smoking (dual use), 1.2% (372 000) reported vaping and former smoking and 1.1% (352 000) reported vaping and never/nonsmoking. Within each past-30-day vaping by smoking status category, certain subgroups presented higher risks: youth and young adults, men, and those having a mood and/or anxiety disorder had higher odds of dual use. Vaping and former smoking was associated with self-identification as a man, having a mood and/or anxiety disorder and provincial region. Youth and young adults, men and those identifying as not a visible minority had higher odds of vaping and never/nonsmoking.

Conclusion: This analysis of Canadians who vape, stratified by smoking status, identifies high-prevalence subpopulations and informs us of the composition of vaping populations by select characteristics, deepening our understanding of Canadians who engage in vaping behaviours.