Canadian Journal of Public Health-Revue Canadienne De Sante Publique最新文献

Objectives: Emergency department (ED) opioid prescribing has been implicated in the opioid crisis, yet Canadian ED prescribing patterns and related harms remain poorly described. We analyzed trends in ED opioid prescribing and adverse outcomes in Alberta, Canada, from 2010 to -2020.

Methods: We conducted a population-based retrospective cohort study using linked administrative health data for all Alberta ED visits, 2010-2020. We included discharged patients ≥ 12 years and excluded those with long-term opioid use (LTU) or possible opioid use disorder (OUD; prior opioid-related ED visit, hospitalization, or opioid agonist therapy). We measured opioid dispensations within three 3 days of discharge and adverse events (LTU and possible OUD) within 12 months. Interrupted time series assessed associations between opioid prescribing guidelines (United States (US): March 2016; Canada: May 2017), prescribing rates, and adverse events.

Results: Among 12.1 million ED visits, opioids were prescribed in 7.4% overall, rising from 6.8% (2010) to 8.2% (2016), then declining to 7.1% (2020). Of those prescribed opioids, 3.6% developed LTU and 0.12% possible OUD within one 1 year. LTU incidence decreased over time and appeared uncorrelated with prescribing rates, while possible OUD increased steadily. The US guideline release was associated with reduced prescribing; Canadian guidelines had no impact.

Conclusion: ED opioid prescribing in Alberta peaked in 2016 before declining. Prescribing rates did not correlate with adverse outcomes (LTU or possible OUD). This decoupling of exposure from outcomes suggests a limited role for ED prescribing in the opioid crisis.

Objectives: HIV self-testing is a strategy to scale up HIV testing for communities that face significant barriers to facility-based testing services. The I'm Ready program-an integrated technology solution-is an implementation strategy designed to promote the uptake and use of HIV self-testing kits in Canada. The objective of this study is to examine the reach and effectiveness of the I'm Ready program among Black people in Canada.

Method: We performed a secondary analysis of data for Black people who participated in the I'm Ready implementation study from June 2021 to Dec 2023. We defined reach as the number and percentage of persons with indications for HIV testing who accessed the intervention and effectiveness as the number and percentage of those who ordered test kits and reported test results through the app. Participants' characteristics and variables of interest were summarized using descriptive statistics.

Results: Overall, 3082 (22%-3082/14,071) Black participants accessed the intervention between June 2021 and December 2023. The intervention reached a majority (86%-1846/2141) of Black people with indications for HIV testing who were either first-time testers (38%-824/2190) or had not tested in the previous 1 year (33%-712/2190). Overall, 29% (894/3082) ordered test kits through the app and 31% (274/894) of those who ordered test kits reported their test results. The majority (72%-240/333) of the test results were negative, 26% (87/333) were invalid, and 2% (6/333) of the results reported were positive.

Conclusion: The I'm Ready program reached Black people with indications for HIV testing and facilitated the uptake of HIV self-testing. It could be a potential way to increase HIV testing in Black communities in Canada.

Setting: The Queen Elizabeth II (QEII) Health Sciences Centre in Halifax, Nova Scotia, is an academic, tertiary care hospital that lacked policies related to unregulated substance use, harm reduction, and addiction care. Substance use care was of poor quality and inconsistent, and the community-based standard-of-care was unavailable to hospitalized patients.

Intervention: A group of frontline hospital- and community-based healthcare providers, trainees, harm reduction workers, and people with lived experience organized to navigate this "policy vacuum". We invited community-based groups and resources into the hospital, developed informal policies and procedures to standardize care, and trained ourselves and others in substance use care best practices.

Outcomes: We introduced several harm reduction initiatives from the community-including take-home naloxone kits, needle and syringe distribution, and oral and injectable opioid agonist treatment-without institutional policy support. We drafted our own informal harm reduction policies for the internal medicine inpatient unit, holding a focus group with people with lived experience for feedback and revision. This work contributed to funding for an addiction medicine consultation service and an institutional commitment to implement harm reduction-oriented substance use policies for healthcare settings across the province.

Implications: Despite a lack of institutional policies or buy-in from senior leadership, harm reduction measures can be implemented in hospitals from the bottom-up and the outside-in-by healthcare providers organizing, leveraging existing community resources, and listening to people who use drugs. Clinicians at other hospitals could model our collaborative approach to improve care and push their health systems towards institutional change.

Setting: The ongoing drug poisoning crisis continues to cause significant mortality, with a disproportionate number of overdose deaths occurring when individuals use drugs alone. While supervised consumption sites (SCS) have proven effective in reducing overdose fatalities, their impact is limited by geographic, social, and systemic barriers. In response, overdose response technologies have emerged to expand access to life-saving interventions beyond the reach of traditional harm reduction infrastructure.

Intervention: Overdose response technologies (e.g., National Overdose Response Service (NORS)) and applications (e.g., Lifeguard App, UnityPhilly) offer real-time monitoring during solitary substance use. Hotlines provide peer-operated support and activate emergency responses if a caller becomes unresponsive, while apps use timers and geolocation to trigger automatic emergency services dispatch. Despite promising early outcomes, these services operate in a fragmented policy landscape without formalized regulatory guidance or implementation best practices.

Outcomes: Preliminary data show that services like NORS have successfully prevented overdose deaths; however, published outcomes for most services remain limited. Key areas of priority for standards include the following: ensuring privacy for service, balancing data usage for quality improvement and research, building capacity to further equity of access to healthcare and harm reduction using the virtual platform, standardizing overdose response, and providing appropriate education around the efficacy of services.

Implications: To enhance the effectiveness and sustainability of overdose response technologies, a comprehensive policy or standards framework is needed. This includes guidance on data privacy, service equity, public education, capacity-building, and outcome evaluation, laying the groundwork for safer, scalable, and more accessible overdose prevention interventions.

Objectives: To explore childhood maltreatment as a risk factor for mental-physical multimorbidity and examine gender as an effect modifier. Explorer la maltraitance durant l'enfance en tant que facteur de risque de multimorbidité mentale-physique et voir si le genre a un effet modificateur.

Methods: We analyzed data from the 2022 Mental Health and Access to Care Survey. We described sample characteristics with unweighted counts, survey-weighted percentages, and weighted chi-square tests. Missing data were addressed via multiple imputation. Entropy balancing adjusted for age, gender, LGBTQ2+ identity, visible minority group, and immigration status and multinomial logistic regression was used to estimate associations between the number of childhood maltreatment subtypes (physical abuse, sexual abuse, and exposure to domestic violence) reported and physical (≥ 2 physical conditions but no mental), mental (≥ 2 mental conditions but no physical), and mental-physical (≥ 1 mental and physical condition) multimorbidity. Survey weights were applied during both entropy balancing and regression modeling. Effect modification by gender was examined, and sub-analyses of mental-cardiometabolic, mental-inflammatory, mental-somatic multimorbidity, and subtype-specific exposures were conducted.

Results: A total of 8967 respondents were included. Mental-physical multimorbidity increased with maltreatment: 3.4% (none, n = 4647), 6.3% (1 type, n = 2804), 10.1% (2 types, n = 1208), and 18.2% (3 types, n = 308). Adjusted odds ratios for mental-physical multimorbidity ranged from 2.15 (95% CI, 1.90-2.44) for 1 type to 8.72 (95% CI, 7.01-10.85) for 3 types compared to physical (aOR = 1.31-2.00) and mental (aOR = 1.90-3.63) multimorbidity. Men showed higher odds of mental-physical multimorbidity at high exposure (aOR = 6.14, 95% CI, 4.90-7.70 in women; aOR = 13.96, 95% CI, 9.58-20.34 in men) with varying effect sizes across disease areas.

Conclusion: Childhood maltreatment shows a strong dose-response association with mental-physical multimorbidity. Further research is needed to clarify gender-specific pathways.

Objectives: The incidence of congenital (CS) in Canada increased from 2.1 to 14.5 reported confirmed cases/100,000 live births from 2017 to 2023 (from 8 to 53 cases). We aimed to document prenatal characteristics and contributing factors to CS among mothers or birthing parents (M/BP) of infants with CS in Canada.

Methods: Participants of the Canadian Paediatric Surveillance Program, which includes both paediatricians and paediatric subspecialists, were invited to report on CS cases meeting the study case definition between June 2021 and May 2023. A detailed questionnaire was completed by the reporting clinician. We used descriptive statistics in the assessment of prenatal risk factors among cases, including data on healthcare access, diagnosis, and treatment as well as on socio-demographic, socio-economic and socio-behavioural determinants.

Results: During the 24-month study period, 245 live-born cases of CS were reported, including 81 (33.1%) confirmed and 164 (66.9%) probable cases from seven provinces and territories. Substance use in pregnancy was reported in 65% of cases. Only half of M/BP had at least 1 prenatal care visit during their pregnancy, while only one-quarter had ≥ 1 prenatal care visit in each trimester. In a quarter of cases, no syphilis screening was performed during pregnancy. Prenatal syphilis treatment was not initiated among 20% who screened positive.

Conclusion: In this country-wide assessment, we identified substantial failures in the delivery of adequate prenatal care to M/BP of live-born infants diagnosed with CS. Public health action, such as community outreach to ensure prenatal care for all pregnant people, with specific attention to the prenatal healthcare needs and engagement in the care of those who use substances, is pressing.

Introduction: The use of psychedelics has increased in Canada in recent years. Although non-medical psilocybin use is prohibited under the Controlled Drugs and Substances Act, we previously documented the emergence of grey-market brick-and-mortar psilocybin retailers. This study examined changes in the number, composition, and geographic distribution of Canadian psilocybin retail stores between 2024 and 2025.

Methods: We conducted a repeated cross-sectional assessment of psilocybin retail stores with a physical storefront in Canada that were publicly visible and indexed through systematic Google and Google Maps searches between May 2024 and July 2025. Data were collected on store location, operating status, chain affiliation, and product offerings. Per capita availability and geographic clustering were calculated using Canadian census metropolitan area and dissemination area data.

Results: Between 2024 and 2025, the number of psilocybin retail stores in Canada increased from a total of 57 to 75, a 33% increase in stores per 100,000 individuals (0.18 to 0.24). The proportion of Canadians residing within a 10-min walk of a psilocybin retail store increased from 1.4 to 1.7%. In this period, 30 of 57 outlets (52.6%) that were open in 2024 closed, while 48 new stores opened. In 2025, two large chains operated 44% of all stores in Canada. All but 2 stores (97%) were located in Ontario and British Columbia. In Toronto and Vancouver, Canada's first- and third-most populous cities, 9.5% and 29.0% of residents, respectively, lived within a 10-min walk of a psilocybin store. Psilocybin retail stores with a website sold a wide variety of products online, including dried mushrooms (98%), microdose capsules (100%), and infused edibles (89%). Sixty-nine percent offered products packaged to resemble commercial snack brands, such as Scooby-Doo Fruit Snacks and psilocybin-infused drinks styled after Arizona Iced Tea. Among outlets with online listings, 49% advertised the sale of additional psychoactive substances, most commonly N,N-dimethyltryptamine (93%) and cannabis (87%).

Discussion and conclusion: The Canadian psilocybin retail market continues to expand substantially despite ongoing federal prohibition. The market is characterized by rapid turnover, increasing dominance of large chain operators, widespread sale of ordinary food brand-mimicking products, and marked geographic concentration in Ontario and British Columbia. The presence of a grey market may expose individuals to unregulated products and unverified health claims. Continued surveillance is warranted to monitor market evolution and to inform policy discussions regarding psilocybin regulation in Canada and elsewhere.

Body Mass Index (BMI; kg/m²) is a widely used anthropometric indicator of obesity in epidemiologic and public health research. Recent clinical guidelines no longer support the use of BMI as a diagnostic measure of obesity, recommending instead that it be reserved for screening, surveillance, and research purposes. In this Commentary, we describe key challenges related to the use of BMI in public health research and highlight the use of BMI-for-age percentiles for older adults as an approach to address these challenges. We argue that BMI can, and should, continue to be considered as a measure of obesity status in public health research on older adults using sex-stratified BMI-for-age percentiles. We demonstrate this concept by providing evidence from an analysis examining the association between obesity and cardiometabolic risk among adults in Canada using data from the Canadian Longitudinal Study on Aging (CLSA).

Setting: Cancer screening enables early detection, reducing morbidity, mortality, and healthcare costs. Canada's primary care crisis has left many individuals unattached, creating barriers to cancer screening and exacerbating disparities.  INTERVENTION: The Champlain Screening Outreach (CSO) program provided cancer screening to unattached individuals and underserved populations. CSO collaborated with public health, community health centers, and community organizations to increase engagement with typically underscreened populations. A nurse practitioner superscreener conducted screening consultations, ordered tests, and followed up on results. Data from the program's inaugural year were analyzed, including participation, test completion, high-risk referrals, and abnormal findings. Sociodemographic data characterized unattached and neverscreener populations.

Outcomes: In its first year, CSO conducted 527 consultations and facilitated 786 screening tests. High-risk referrals were significantly higher than provincial rates for colorectal (41.5% vs. 2.6%, p < 0.01) and breast cancer (27.3% vs. 1.1%, p < 0.01). Among participants, 195 (36.4%) were neverscreeners. Abnormal result rates were elevated across cancer types: cervical (5%), breast (13.1%), colon (28.1%), and lung (16.6%). FIT return rates (53.3%) were lower than the provincial average. CSO participants predominantly resided in lower-income neighborhoods with high immigrant and visible minority populations. Neverscreeners were more likely to experience neighborhood instability.

Implications: CSO effectively improved cancer screening access for unattached individuals and reduced screening disparities. Elevated rates of abnormal findings and high-risk referrals highlighted the importance of collaboration with community organizations to reach underscreened populations and the efficacy of targeted screening assessments. CSO's outcomes demonstrate its potential as a centralized, scalable, and proactive solution to enhance cancer screening equity and mitigate the impact of the primary care crisis.

Setting: The Bentway, a public space in Toronto, Canada, transformed the underside of an active expressway into a new active public space and programming platform. It features free public art, performances, and recreational programs on a year-round basis.

Intervention: The Softer City season, running from May to October 2024, aimed to explore the role that public space and programming play in facilitating social connections.

Outcomes: The evaluation found that being at The Bentway increased respondents' sense of physical and mental health, social connection, and belonging; reduced feelings of loneliness among visitors; enhanced a sense of safety among visitors; and positively influenced social interactions through its design elements, such as natural features and public seating.

Implications: The findings suggest that public spaces like The Bentway, and the programming they support, can play a crucial role in promoting community health, reducing social isolation, and fostering a sense of belonging. Future studies should explore these benefits in more detail and consider the potential of similar initiatives in other urban areas.