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

Survivors of childhood cancers can face life-long health risks. In this study we describe the prevalence of childhood cancer in Canada by type, geographic region, year, age group and sex, using publicly available data in the Cancer in Young People in Canada (CYP-C) data tool. By 2021, 4325 people aged less than 20 years who had received a cancer diagnosis within the previous 5 years were still alive. The age-standardized 5-year prevalence increased by 12% over the past 15 years. Leukemia was the most prevalent childhood cancer. The CYP-C data tool provides comprehensive and timely public health surveillance statistics to understand the burden of childhood cancer.

Introduction: Disability-adjusted life-years (DALYs) integrate mortality and prevalence (or incidence) data. DALYs can be used as a surveillance measure to assess dementia burden and inequalities.

Methods: We utilized dementia case and mortality counts from linked administrative data to estimate incidence, prevalence, cause-specific mortality and DALYs in people aged 65 years and older, from 2001 to 2022, in British Columbia, Canada. Dementiaspecific mortality rates adjusted for changes in death certification practices over time were estimated using logistic regression that incorporated multiple cause-of-death data from vital statistics records. All measures were stratified by sex; DALYs were also stratified by age and area-based socioeconomic status (SES) quintiles. Average annual percent change (AAPC) in rates was estimated using joinpoint regression.

Results: Age-standardized dementia incidence and prevalence have declined since 2013, while mortality has increased by, on average, 1.6% per year since 2001 (95% CI: 1.4% to 1.8%). Age-standardized DALYs have increased by, on average, 1.4% per year (95% CI: 1.3% to 1.4%). DALY rates are highest in females aged 90 years and older but are increasing more rapidly in males. DALYs have declined for those in the least deprived SES quintile (AAPC: -0.6%; 95% CI: -1.0% to -0.3%) and conversely, have increased - with recent rates the highest - in the most deprived quintile (AAPC: 2.9%; 95% CI: 2.5% to 3.2%).

Conclusion: The socioeconomic gap in dementia disease burden has widened over time in British Columbia. DALYs are highest in females aged 90 years and older, but the overall gap between males and females has declined.

Health promotion is more effective when health communicators are considered trustworthy. However, health communicators must often deal with uncertainties in the knowledge base on which they rely. In this commentary, we discuss the benefits of acknowledging uncertainty, with caveats and best practices to cultivate trust. We recommend determining the type of uncertainty involved and selecting appropriate communication approaches. We also advise that communicators emphasize the positive elements of the uncertainty, whenever possible, such as when it reflects a growing evidence base. Health promoters should consider the long-term outcomes of communicating uncertainty, as these may differ from the short-term outcomes. We identify knowledge gaps and areas ripe for future research. We also show that uncertainty can often be communicated without harming trust in the communicator, and that communicators should rely on evidence-based best practices. We aim to provoke further discussion on how uncertainty should be understood and framed in health promotion efforts, guiding communicators on how to maintain public trust amid unknowns.

Introduction: Household food insecurity (HFI) is a persistent and important public health and policy concern within Canada that continues to be widespread in the face of economic uncertainties and inflation. The objective of this systematic review was to synthesize the evidence on food-based interventions that could reduce HFI in Canada.

Methods: Studies that assessed a food-based intervention that might reduce food insecurity and measured HFI were included, regardless of whether that was the primary purpose of the study. Four databases were searched up to 19 February 2025. Screening of abstracts and full texts, data extraction, assessments of risks of bias and certainty of the evidence were conducted independently by two reviewers. PROSPERO CRD42021254450.

Results: Exposure to food voucher programs may reduce HFI, but exposure to food box, community gardening, school food, hunting and fishing, and food charity programs may have little to no effect on HFI. The rate of utilization of food banks by food-insecure households may be low and depends upon food insecurity level and population group.

Conclusion: Food charities may be a last resort for those in need of short-term access to emergency food (i.e. populations experiencing homelessness). However, given the pervasive nature of HFI as a marker of deprivation, it is unlikely that food-based responses will have a major impact on overall HFI, which is primarily an economic problem. A more comprehensive public policy approach to mitigate HFI is likely required.

Introduction: Emergency departments (EDs) are important health care access points for people who use drugs (PWUD), but little is known about whether the onset of the COVID-19 pandemic was associated with changes in opioid-related emergency presentations. We investigated whether (1) the onset of the COVID-19 pandemic was associated with any change in average rates of opioid-related ED visits in Alberta; and (2) this varied across regions with different COVID-19 case rates.

Methods: We conducted maximum-likelihood interrupted time series analyses to compare opioid-related ED visits during the "prepandemic period" (3 March 2019-1 March 2020) and the "pandemic period" (2 March 2020-14 March 2021).

Results: There were 8883 and 11 657 opioid-related ED visits during the prepandemic and pandemic periods, respectively. The onset of the COVID-19 pandemic was associated with an increase in opioid-related ED visits (Edmonton: IRR = 1.37, 95% CI: 1.30- 1.44, p < 0.05; Calgary: IRR = 1.14, 95% CI: 1.07-1.20, p < 0.05; Other health zones: IRR = 1.14, 95% CI: 1.07-1.21, p < 0.05). Changing COVID-19 case counts did not correspond with changing rates of opioid-related ED visits across regions.

Conclusion: The increase in opioid-related ED visits associated with the onset of the COVID-19 pandemic was unrelated to COVID-19 case prevalence in Alberta.

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.