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

Objectives: This study aimed to examine the association between immigration status and women's contraceptive practices based on population data from government surveys.

Methods: A secondary data analysis was conducted on the Quebec Population Health Survey (2014-2015), which aimed to represent 98.8% of the population of Quebec aged 15 years and older through stratified sampling and data weighting (response rate of 61%). Univariate and multivariable analyses were used to compare contraceptive practices between immigrant and Canadian-born women. Two dependent variables were considered: (1) women who used contraception vs. no contraceptive method of any kind, and (2) among women who used contraception, those who used methods that required them to access health care (birth control pill, IUD, or tubal ligation) vs. women who used other methods (condom, coitus interruptus, other).

Results: The logistic regression results revealed a strong association between immigration status and contraceptive practices, at two levels: (1) immigrant women had lower odds to use contraception than Canadian-born women; and (2) of the women who use contraception, immigrants had lower odds than those born in Canada to use feminine medical contraception. These findings held true for immigrant women regardless of the number of years they have spent in Canada. Women who lived in low-income households or who had not had a medical consultation for more than one year also had lower odds to use feminine medical contraception.

Conclusion: Barriers in access to contraceptive care interfere with women's reproductive health and autonomy. The lower odds for immigrant women to use contraception, and particularly the most effective methods, suggest that their contraceptive care needs are at least partially unmet or inadequately addressed. This is concerning given that other studies show no differences in fertility intention between immigrant and Canadian-born women, and high rates of abortion for immigrant women.

Objective: The objective of this study was to examine whether cannabis exposure calls to the British Columbia Drug and Poison Information Centre (DPIC) were impacted by the legalization of non-medical cannabis in Canada.

Methods: We fit interrupted time series models to monthly counts of cannabis cases from 2013 to 2021, stratified by age and cannabis form. We set the intervention month to October 2018 legalization for cases involving inhaled dried cannabis and ingestible oils and capsules. We set the intervention month to January 2020 for cases involving edibles and inhaled concentrates to reflect their commercial rollout after their October 2019 legalization.

Results: DPIC managed 3989 cases involving cannabis exposure between 2013 and 2021. The rate (95% CI) of all cannabis cases increased by 17% (14%, 20%) annually from 2013 to October 2018 legalization. The highest pre-legalization increase was in pediatric edible cases with 52% (36%, 69%) and 57% (35%, 82%) annual increases among children aged 5 and under and 6 to 12, respectively. Upon legalization, the rate of cases consuming oil and capsule products spiked by 26% (- 19%, 96%) followed by a decrease, but remaining higher than the pre-legalization rate. Legalization did not have an immediate effect on the rate of cases involving edibles or inhaled cannabis, which all continued to increase post-legalization, albeit at slower rates.

Conclusion: Regardless of the contributing factors to cannabis case trends at DPIC, these data highlight the importance of poisoning prevention policies, promotion of low-risk use, and routine surveillance.

Objective: To systematically review and synthesize evidence from reviews about the effectiveness and cost-effectiveness of population-level policies to reduce alcohol use.

Methods: We searched peer-reviewed literature using eight electronic bibliographic databases, grey literature using two databases, two search engines, and two working paper repositories, and examined references of included studies. At least two reviewers independently screened articles for inclusion, extracted detailed characteristics, and assessed the risk of bias of each included study. We considered all reviews that included studies which quantitatively examined the relationship between alcohol consumption and population-level policies that seek to regulate the public availability and marketing of alcoholic beverages. After screening according to a set of predetermined criteria, we included 32 reviews.

Synthesis: We found consistent evidence that addressing alcohol availability (introducing or increasing minimum purchasing age, restrictions on temporal availability, decreasing outlet density, government monopolization) was associated with lower alcohol use; and a general lack of evidence on the associations between alcohol marketing (marketing self-regulation, advertising from government authorities, regulating the volume of advertising from alcohol manufacturers, and introducing warning labels) and alcohol consumption, which precludes any conclusions about these regulations. Additionally, we found scarce evidence about the cost-effectiveness of population-level policies to reduce alcohol use, which is likely due to the relatively low cost of implementation and enforcement of these policies.

Conclusion: The Government of Ontario began expanding privatized alcohol sales in 2015 with further expansions starting in August 2024. Evidence from reviews suggests that this increase in availability will result in increased alcohol consumption.

Objectives: The concept of "readiness to practice" has not been clearly delineated within an Indigenous health context. This systematic review occurred on a multi-database survey of published primary literature. The primary objective of this review was to determine what it takes for clinicians to be ready to practice with Indigenous populations.

Methods: This review identified articles published in the last 20 years within Canada, the United States, New Zealand, and Australia. The databases that were searched included CINAHL, Medline (via Ovid), Embase (via Ovid), Scopus, and Web of Science, with an additional hand search of references from relevant articles. This search took place from January to May 2022, with subsequent analysis from May to September 2022.

Results: Primary studies were coded using quantitative content analysis procedures and quantified codes were subjected to exploratory factor analyses. Four factors described a competent clinician across studies, including a relational disposition, decolonized practice, cultural immersion, and Indigenous professional support.

Conclusion: This sphere of literature is relatively novel and there do not appear to be many individuals directly commenting on attributes needed to be prepared to work with Indigenous communities. There exist potential gaps in knowledge that could be addressed by conversations with Indigenous stakeholders and implementation of health education programs that focus on developing Indigenous-specific competencies.

Objective: Using data from a population-based cross-sectional survey, we aim to measure the prevalence, risk factors, and impact of COVID-19 on household food insecurity, housing insecurity, and the double burden of experiencing both.

Methods: Data were collected from July to November 2022. We used simple and multivariable logistic regression models to investigate the factors contributing to food insecurity, housing insecurity, and the double burden. Additionally, we computed the relative excess risk due to interaction (RERI) to determine whether any significant interactions contributed to the increased risk of experiencing the double burden.

Results: Around 27% of our study participants were food insecure, 54% were housing insecure, and 22% were food and housing insecure (double burden). Respondents' gender, age, ethnicity, education, and income were associated with experiencing the double burden of food and housing insecurity. Additionally, this study found a significant statistical interaction between residence location and employment status, with both employed and unemployed individuals in urban areas facing higher odds of experiencing the double burden of food and housing insecurity compared to retired individuals in either urban or rural areas; the relative excess risk due to interaction analysis suggests that increasing employment opportunities may have a more substantial impact on reducing this burden in urban areas.

Conclusion: Findings from this study provide important insights into addressing the issue of food and housing insecurity, especially through improving employment opportunities for vulnerable populations in Canada. Comprehensive systems-oriented intersectoral policies are much needed to improve households' experience of multiple need insecurities.

The overdose and drug toxicity crisis continues to devastate communities across Canada. British Columbia has an overdose mortality rate nearly double the Canadian national average, emphasizing a dire need for proactive public health approaches. Within the general population, men experience higher overdose mortality rates in comparison to women; however, among people with HIV, the disparity is inverted such that women with HIV experience higher overdose mortality rates than men with HIV. Less is known concerning the epidemiology of nonfatal overdoses among people with HIV, and understanding gender disparities in nonfatal overdoses would allow public health practitioners and policymakers to focus evidence-informed interventions and clinical guidelines for people most in need. In this commentary, we propose that systemic and structural barriers function to hinder access to crucial services for women with HIV, thus placing them at a disproportionately high risk for nonfatal overdose. We argue that additional research is needed to understand how to completely address these barriers in order to create programmatic changes. Fatal overdoses are a failure of the healthcare system; intervening after the occurrence of a nonfatal overdose is crucial in order to prevent a subsequent fatal overdose.

Canada's toxic drug crisis continues to worsen in the country's urban centres, with the unregulated drug supply becoming more deadly and causing life-altering harms. The increasingly toxic mix of substances in the unregulated supply is the primary driver of drug poisoning deaths. We anticipate that the current toxicity of the supply will persist, and may worsen, until people are able to access alternatives to the poisoned supply. As the leaders responsible for public health in the country's largest urban centres, we understand that harm reduction and addiction treatment services are complementary medically necessary health services that enable people who use substances to survive and work toward their health and wellness goals. Harm reduction and treatment, along with prevention, are pillars of a serious response to the drug toxicity crisis. Neither should be prioritized to the exclusion of the other. In this commentary, we highlight the critical harm reduction measures that are being implemented to save lives and reduce the risks of substance use, and we point to some of the ways that these programs could be expanded to improve the health and well-being of people who use drugs and the capacity of the public health system to respond to the crisis.

Setting: The Dalla Lana School of Public Health (DLSPH) at the University of Toronto.

Intervention: The DLSPH entered its inaugural cohort of Doctor of Public Health (DrPH) students in 2021. Development and launch of the program stemmed from the school's strategic plan to offer advanced public health training and was the first such university offering the DrPH in Canada. This paper reflects on the overarching launch experience of the program and its innovation in practice.

Outcomes: Early interest in the program is strong and the entry requirement for at least 5 years of real-world experience drives the program's distinction in Canada. The inaugural cohort was instrumental in constructive criticism and harvestable suggestions via evaluations, reflections, and appreciative inquiry-a likely result of the lived professional experiences of students who enrolled in this program. A key feature is the hybrid nature of the program consisting of a series of in-person on-campus forums ("burst weeks") over the first half of the degree requirements. In addition to allowing in-person components of the core course, agenda components continually evolve to meet students' stated needs and competencies.

Implications: The deliberate focus on the foundational competencies of leadership was fostered through classes on leadership of self as well as leadership and governance of organizations. Special lectures are curated to ensure that new and emerging concepts challenging society and today's public health leaders are addressed in an ongoing leadership series. The focus is not on developing new leaders but on catalyzing the leaders who constitute this professional cohort to higher levels of responsibility.

Canada's universal healthcare system aspires to provide equitable care for all citizens, yet persistent health disparities among Indigenous, Black, and other racialized communities reveal significant gaps in service and outcomes. This commentary explores how race-based data collection could address these inequities by identifying at-risk populations, informing targeted interventions, and improving accountability within healthcare systems. The discussion includes an overview of existing challenges, such as mistrust stemming from historical research abuses, varied provincial approaches, and ethical complexities related to privacy and data sovereignty. Examples from within Canada highlight the effectiveness of standardized data collection policies, while international lessons-particularly from the United Kingdom's incentivized data reporting and the United States' mandated approaches-underscore the importance of consistent data-gathering and careful monitoring. The commentary emphasizes that community engagement and leadership are essential to the development of culturally safe practices, and that legal and ethical frameworks must safeguard data from commodification or other forms of misuse. By integrating race-based data collection into policy reforms, embracing Indigenous data governance principles, providing mandatory training for health providers, and establishing robust monitoring systems, Canada can advance meaningful strategies to reduce health disparities. This approach promotes a more equitable healthcare environment, ensuring the principle of universal coverage benefits all communities.