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

Introduction: The overdose crisis is one of the most serious public health challenges in North America. Supervised consumption sites (SCSs) effectively prevent onsite overdose deaths and connect people to health services, but their association with populationlevel overdose mortality remains unclear.

Methods: We searched Embase, Global Health and MEDLINE databases for studies examining associations between SCSs and population-level overdose mortality during the post-2016 overdose crisis (January 2016 to November 2024). Two reviewers, working independently, screened studies, extracted data and assessed study quality using standardized tools (PROSPERO CRD42023406080).

Results: Six studies, all from Canada, met the inclusion criteria. In the four quasiexperimental studies, two large-scale analyses of local health areas or public health units found no significant associations between SCS measures and overdose mortality within provinces. Some analyses of smaller urban areas showed protective associations, although this finding was not consistent across studies. Two observational studies suggested associations between SCS and lower mortality rates, though with methodological limitations.

Conclusion: Province-wide analyses generally did not detect significant associations between areas with and without SCSs and population-level overdose mortality. Analyses suggest that SCSs in some smaller urban contexts were associated with less overdose mortality, though findings were inconsistent. Further research is needed to understand how geographic scale, implementation context and limited service coverage may influence the detection and magnitude of potential effects of SCSs on overdose mortality.

As the problem of household food insecurity perseveres, effective evidence-informed responses are badly needed. The systematic reviews of evidence compiled by the Public Health Agency of Canada provide an important foundation for such action, but they also indicate the need for accountability, so that precious public funds do not continue to be spent on initiatives with no evidence of impact. We need targets for food insecurity reduction and some accountability for policy interventions that come with significant public investments. Household food insecurity rates and the related adverse consequences are only going to get worse unless we address the inadequate, insecure incomes that are the primary driver of this population health problem.

Background: The COVID-19 pandemic disrupted public health efforts for chronic disease prevention (CDP) in Canada and elsewhere. We describe COVID-19-related disruptions in CDP resources and activities among Canadian public health organizations.

Methods: We surveyed all organizations in Canada with mandates for primary CDP, including "resource organizations" that develop or transfer CDP initiatives and "user organizations" that deliver these CDP initiatives to target populations. Key informants most knowledgeable about CDP activities and resources within each organization reported pandemic-related changes in CDP resources and activities. User organizations also reported on the status of 18 specific CDP activities and rated whether pandemic containment measures were barriers to or facilitators of CDP activities.

Results: Of the 298 participating organizations (88% response), 129 were resource organizations (37% formally mandated organizations [FMOs]; 63% non-governmental organizations [NGOs]) and 169 were user organizations (48% FMOs; 52% NGOs). Overall, 36% reported decreases in CDP funding (24% major, 12% minor), 30%-41% reported decreases in full-time, volunteer and managerial staff (19%-27% major, 11%-14% minor) and 32% reported decreases in CDP activities (23% major, 9% minor). User FMOs were most affected by decreases. Among user organizations, 16%-39% decreased, suspended or discontinued specific CDP activities. Still, 8%-39% increased their activities, particularly those targeting mental health, marginalized populations, racialized communities and specific gender groups. Half (53%) of user organizations perceived COVID-19 contagion restrictions as barriers to CDP activities.

Conclusion: Continued monitoring of CDP resources and activities can inform emergency preparedness and ensure that CDP remains a priority during public health crises.

Background: Higher amounts of recreational screen time have been associated with mental ill-health among children and youth. We examined the association between meeting the 24-Hour Movement Guideline's recreational screen time recommendation of ≤ 2 hours/day and indicators of mental health among children and youth.

Methods: Using the 2019 Canadian Health Survey on Children and Youth (N = 26 986), associations were assessed using age- and sex-stratified multivariate logistic regression. A secondary analysis used incremental amounts of screen time to explore dose-response relationships.

Results: Female children (5-11 years) who met the recommendation were less likely to be diagnosed with an anxiety disorder (adjusted odds ratio = 0.49; 99% CI: 0.25-0.96) or appear sad/depressed (0.60; 0.37-0.99). Female youth (12-17 years) who met the recommendation were more likely to report excellent or very good mental health, high happiness and high life satisfaction and less likely to report feeling stressed, anxious or depressed or be diagnosed with an anxiety disorder. Male youth who met the recommendation were more likely to report high happiness (1.74; 1.40-2.15) and high life satisfaction (1.64; 1.34-2.01) and less likely to feel stressed (0.74; 0.56-0.99) or experience psychosocial difficulties (0.79; 0.64-0.97). Some dose-response relationships were present among youth.

Conclusion: Adherence to the screen time recommendation was associated with several mental health indicators. Understanding these associations can help inform future research and guide strategies to improve mental health.

Introduction: The objective of this article is to examine the association between outdoor physical activity (OPA) and mental health, life satisfaction, happiness and life stress among Canadian adolescents aged 12 to 17 years.

Methods: This cross-sectional and nationally representative study used self-reported data from the 2019 Canadian Health Survey on Children and Youth (n = 10 413). The survey categorized OPA into six groups (from 0 to ≥ 14 hours/week). Logistic regression analyses examined the associations between OPA levels and outcomes, with adjustments for relevant covariates.

Results: In adjusted models, OPA was not significantly associated with anxiety or depressive symptoms. Compared to adolescents with no OPA, those who engaged in ≥ 14 hours/week had higher odds of positive mental health (odds ratio [OR] = 1.64; 95% confidence interval [CI]: 1.13-2.38), high life satisfaction (OR = 1.75; 95% CI: 1.24-2.46) and high happiness (OR = 2.36; 95% CI: 1.59-3.50), independent of covariates including indoor physical activity. A positive dose-response relationship was observed between higher levels of OPA and life satisfaction and happiness.

Conclusion: Independent of indoor physical activity and other covariates, OPA was associated with positive mental health, high life satisfaction and high happiness, with levels of OPA of ≥ 14 hours/week (highest category) showing the strongest associations. Further studies are needed to elucidate the mechanisms linking OPA with higher life satisfaction and happiness.

Introduction: Firearm-related injuries (FRI) are an important public health issue in Canada. This study aims to determine the incidence of FRI in British Columbia (BC) and examine the distribution according to demographics, intent, urban-rural residence and neighbourhood deprivation.

Methods: De-identified data on deaths and hospitalizations (2010-2019) were retrieved from the BC Vital Statistics and the Discharge Abstract Database obtained from the BC Ministry of Health. We implemented the Canadian Index of Multiple Deprivation for the dissemination area-level marginalization.

Results: A total of 1868 fatal and nonfatal FRI were included in our study, of which 46.4% were due to self-harm. The annual injury rate was 3.93 per 100 000, with the highest rates among men aged 15 to 34 years. Rates were highest in rural and remote areas, in neighbourhoods with the least diverse ethno-cultural composition, and the greatest level of situational vulnerability and economic dependency. We did not observe significantly different rates across residential instability quintiles. The marginalization pattern for intentional self-harm was similar to the aggregated deprivation profile. While assaults were more common in neighbourhoods with higher levels of situational vulnerability and more diverse populations, unintentional injuries were more prevalent in neighbourhoods with higher levels of situational vulnerability.

Conclusion: This study revealed that the burden of FRI was not evenly distributed across demographic determinants, neighbourhood deprivation or urban-rural areas of residence throughout BC. We also observed different deprivation profiles across the various intents of injury and death. Findings highlight the need for addressing FRI at its root causes, by implementing system-level interventions focussed on suicide prevention, poverty reduction, and promoting employment and education.

Introduction: The prevalence of cannabis use continues to increase among certain populations in Canada. This study focussed on the increase in cannabis-attributable hospitalizations and emergency department (ED) visits from 2007 to 2020.

Methods: To estimate the counts of hospitalizations and ED visits attributable to cannabis use, we acquired record-level hospital discharge data with ICD-10 diagnostic information for all fiscal years 2006/07 to 2020/21. Diagnostic information was used to associate each record to a health condition category for eight substances, including cannabis. The prevalence of cannabis use was estimated for each province or territory, calendar year, sex and age using national survey information. These estimates were used to adjust relative risk estimates derived from cannabis literature to calculate cannabisattributable fractions, which were in turn used to estimate the proportion of hospitalizations and ED visits that were attributable to cannabis use.

Results: Between 2007 and 2020, the overall rate of cannabis-attributable inpatient hospitalizations increased by 120%, from 6.4 in 2007 to 14.0 per 100 000 in 2020. Cannabis-attributable ED visits increased by 113%, from 52.1 per 100 000 in 2007 to 111.0 per 100 000 in 2019, and then decreased by 12% in 2020. This study found that the increases in hospitalizations and ED visits were partly attributed to neuropsychiatric conditions, particularly hospitalizations due to psychotic disorders and ED visits due to acute intoxication among children and youth.

Conclusion: Ongoing monitoring of cannabis-attributable harms is necessary to understand the harms related to use and the factors that influence the ways in which people use cannabis and seek care. Further research may distinguish the early effects of legalization trends from the early pandemic period data.

Eating disorders (EDs) and disordered eating present a significant health burden given their prevalence and associated health risks; however, there are notable gaps in population-level surveillance of EDs and disordered eating in Canada. These data gaps limit our understanding of the scope of the problem and present challenges to monitoring trends in EDs and disordered eating in response to changing health and policy contexts, such as the COVID-19 pandemic. We screened Canadian federal health surveillance surveys to identify measures of ED diagnosis, engagement in disordered eating behaviours (e.g. binge eating, self-induced vomiting) and related constructs (e.g. weight perception, body satisfaction). Among adults, there was a 10-year gap in ED measurement, and there has been no assessment of engagement in any type of disordered eating behaviours. Among children and adolescents, there have been recent improvements in the measurement of disordered eating behaviours, but there are no surveys that include measures of binge eating, the most common disordered eating behaviour. National surveillance data assessing EDs and disordered eating are necessary to quantify their burden, assess trends in relation to evolving health and policy contexts and identify individuals who face barriers to seeking treatment services. We conclude by providing recommendations for constructs that should be measured, as well as guidelines for measurement development in conjunction with community members and clinical and research experts.

Introduction: Positive mental health (PMH) is an essential component of mental health and well-being. While population-level data show a decrease in youth PMH during the COVID-19 pandemic, there are sex differences that have not been examined.

Methods: Data from the 2017, 2019 and 2021 Canadian Community Health Survey were used to examine youth (12-17 years) PMH before and during the COVID-19 pandemic. Sex-specific prevalence of high self-rated mental health (SRMH) and average life satisfaction (LS) for each year were calculated and disaggregated by sociodemographic characteristics. Differences between years were quantified, and statistical significance was determined using t tests (p value < 0.004 after Bonferroni correction).

Results: From 2019 to 2021, there were significant decreases in the prevalence of high SRMH (from 66.4% to 52.3%) and average LS (8.7 to 8.2) among female youth, at the overall level and across the majority of sociodemographic groups. As for males, no significant decreases were seen at the overall level. After disaggregation, a significant decrease in prevalence of high SRMH was observed from 2019 to 2021 among male youth living in Quebec and nonimmigrant male youth. There were no significant changes in the prevalence of high SRMH or average LS from 2017 to 2019. The sex-specific differences in PMH varied across sociodemographic characteristics.

Conclusion: The PMH of female youth appears to have been affected during the COVID-19 pandemic more than that of male youth. There were sex-specific differences in PMH across sociodemographic groups, suggesting that not all youth were equally affected. Ongoing surveillance with an intersectional lens is needed to better inform public health strategies.