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

Setting: The impacts of colonization have resulted in disruptions to food systems, land, language, and the overall health and well-being of Indigenous Peoples across Turtle Island. Food insecurity affects Indigenous People's health disproportionately due primarily to poverty and inequity, anti-Indigenous racism, and the ongoing effects of settler colonialism. Despite these challenges, Indigenous communities have used food as a tool for the resurgence of their cultures, identities, and self-determination.

Intervention: Understanding Our Food Systems (UOFS) is a participatory, community-engaged action project led by the Thunder Bay District Health Unit, a team of researchers and community development professionals, and a circle of Indigenous Elders and Knowledge Keepers working to build a deeper understanding of food security, Indigenous food sovereignty, and self-determination in Northwestern Ontario. The project takes leadership from and supports fourteen First Nations within the Thunder Bay District (Robinson Superior Treaty of 1850 and Treaty 9 areas) in their efforts to reclaim their traditional food systems.

Outcomes: Since 2018, the UOFS project has helped to establish and implement food sovereignty visions, priorities, and action plans for each of the First Nations communities; provided ongoing funding, workshops, training, and general assistance; hosted regular gatherings to learn, share, and plan collaboratively; and developed resources to support Indigenous food sovereignty across the region.

Implications: The UOFS project has contributed to enhancing Indigenous food sovereignty and self-determination across Northwestern Ontario. The project has also resulted in building a network of First Nations communities and reflective learning among the TBDHU and non-Indigenous participants about how to work in partnership and support First Nations to achieve their food sovereignty priorities.

Objective: To investigate the seasonality of suicide mortality in Canada and explore differences across sex and age.

Methods: We analyzed monthly suicide deaths spanning January 2001 to December 2015 from the Canadian Vital Statistics Death Database. Data from 2016 onwards were not included in the main analysis as Ontario and Yukon data were unavailable due to data-sharing agreement limitations. However, data from 2016-2019 were included in the sensitivity analyses. Seasonal variations were assessed by evaluating the timing of peak and trough monthly suicide mortality rates, and amplitude (peak-to-trough risk ratio) overall and by sex and age groups. Statistical significance was tested using the Seasonal Autoregressive Integrated Moving Average procedure.

Results: With 40,405 recorded suicides, results indicated a peak in suicide rates in July (0.95 per 100,000 people), 6.74% higher than the monthly average, and a trough in February (0.78 per 100,000 people), 12.36% lower than the monthly average. The peak/trough relative risk (RR) was 1.22 (95% CI: 1.00, 1.47). Seasonality patterns were similar between sexes, but stronger and more stable among males. Seasonality patterns were similar across age groups, but the amplitude was larger among those aged 65+.

Conclusions: This study confirms seasonal patterns in suicide mortality in Canada, peaking during the summer months. Such patterns are more prominent and stable among males, and its amplitude was larger among older adults. Contrary to the common perception that suicide rates peak in January, our findings show a summer peak. Future research should explore the underlying mechanisms driving these seasonal variations and their demographic differences.

Objectives: A pilot population health intervention (5A-QUIT-N) was implemented in a French region with the aim of organizing smoking cessation counselling during pregnancy. The intervention is offered to pregnant women regardless of the stage of pregnancy. This initiative took place in a national context where smoking screening is established, but systematic smoking cessation support is not yet in place. The objective of this research was to assess the viability of the intervention by exploring four criteria: "practical", "affordable", "suitable", and "helpful". The study aimed to identify enablers and barriers for each criterion, based on the experiences of midwives and women who smoked during pregnancy.

Method: A qualitative methodology was used to explore enablers and barriers to the 5A-QUIT-N pilot intervention viability. Semi-structured interviews were conducted with midwives involved in the intervention and women who smoked during pregnancy and gave birth in the maternity ward of the pilot area. Interview data were analyzed thematically, using viability criteria as categories.

Results: Among the four viability criteria explored, barriers and levers were identified at three levels: factors related to women and their environment; factors related to healthcare professionals' practices; and factors related to the healthcare system and its organization. Smoking cessation counselling was considered relevant and was highly valued by women. The intervention led to a change in the smoking cessation practices of midwives. Barriers were identified by both groups such as living with a smoker for women and women's reluctance to attempt to quit, according to midwives.

Conclusion: Some adaptations are needed to better align the intervention with the daily difficulties of pregnant smokers as well as the way healthcare professionals can encourage them to quit. This study shows that the intervention meets the viability criteria. These results are encouraging for broader implementation in other contexts.

Intervention: Live Well PEI provides individuals and organizations in PEI with information and tools to support healthy behaviours. This paper describes the development of the Live Well PEI community-mobilization intervention, consisting of a website and integrated community granting program for health promotion initiatives.

Research questions: (1) What is an effective design of a web-based community-mobilization intervention for community-led health promotion and (2) what lessons can be learned and shared for community-engaged, evidence-informed public health intervention development?

Methods: Intervention development followed the Six Steps in Quality Intervention Development (6SQuID) process. Through literature reviews, jurisdictional scans, expert consultations, and community engagement, evidence for conditions that foster community mobilization was gathered and used to inform development of intervention components. The intervention was refined through iterative expert and community consultations.

Results: Four conditions that foster community-led health promotion were identified: accessibility of grant funding, availability of community data, resources to enhance capacity, and community collaboration. These conditions informed outputs of a Theory of Change. Intervention design that supports these conditions included website elements such as collections of evidence-informed health promotion interventions, stories of prior community-led projects, and community health status and needs information. The granting program integrates research and community feedback on project eligibility, grant administration and support for awardees. Findings from an evaluability assessment support pilot-testing implementation of the intervention.

Conclusion: Development of the community-mobilization intervention provides a prime case example of evidence-informed, community-engaged public health intervention co-design. Learnings are applicable to community-focused health promotion initiatives across Canada.

Introduction: In Quebec, 87% of women diagnosed with breast cancer report lingering after-effects, such as fatigue, chronic pain, and difficulty returning to work after treatment. The Continuum PAROLE-Onco (CPO) 360 program addresses these complex and various unmet needs through a comprehensive and patient partnership intervention.

Objectives: The objectives of this study are to (1) explore the development process of the CPO 360 program during its inaugural year, with particular focus on the co-construction approach involving patient co-investigators (PCIs) and accompanying patients (APs), and (2) identify key insights to inform subsequent phases of feasibility and pilot testing, evaluation, and implementation, in alignment with a framework on complex interventions.

Methodology: A qualitative multiple-case study was conducted across three Quebec university hospitals to evaluate the first year of the CPO 360 program's implementation. The study focuses on how key components of this complex intervention were developed and adapted within real-world settings. Data sources included program documents, semi-structured interviews with accompanying patients, and a focus group with patient co-investigators. Thematic analysis was used to interpret the data, and the findings were reported in accordance with the COREQ checklist for qualitative research.

Results: The findings highlight several key developments: the creation of training programs for accompanying patients (APs), the design of tools to support patients during care transitions, challenges related to data access and the implementation of needs-based stratification, the development of strategies to educate and engage healthcare professionals, and efforts to raise awareness among primary care teams regarding patient follow-up.

Conclusion: This first phase in the development of the CPO 360 intervention is part of a dynamic, iterative, creative process that is open to change and forward-looking in its implementation. The co-construction process involving patients, professionals, and the community from the outset enables the development of a shared vision of how to improve the transition process in three different environments. Adjustments to its implementation will need to take account of intersectoral coordination and access to clinical resources.

Objectives: Latin Americans are among the fastest-growing racialized groups in Canada but remain largely invisible in cancer surveillance and research. This study examines cancer diagnosis among Latin Americans compared to non-Latin American White and other racialized populations and explores how diagnosis varies across sociodemographic subgroups.

Methods: Secondary analysis of pooled data from the Canadian Community Health Survey (2015-2018) was conducted. The analytic sample included 177,754 adults aged 18 or older, of whom 1799 identified as Latin American. Logistic regression models estimated the association between ethnicity and self-reported cancer diagnosis, with interaction terms testing moderation by sex, education, income, and immigration status.

Results: Latin Americans had lower odds of reporting a cancer diagnosis than non-Latin American Whites (OR = 0.69; 95% CI, 0.52-0.92). Subgroup analyses showed stronger protection among males than females, those with mid-range incomes compared to lower or higher earners, and immigrants relative to Canadian-born Latin Americans. Individuals with graduate or limited secondary education also showed greater protection than other education levels.

Conclusions: While Latin Americans in Canada appear to experience a protective advantage in overall cancer prevalence, this advantage is not uniform. Disparities persist across sex, socioeconomic position, and immigration status, pointing to structural inequities that remain despite universal coverage. Equity-oriented cancer prevention strategies-including culturally tailored outreach, improved screening access, and systematic collection of race and ethnicity data-are needed to ensure that Latin Americans are not rendered invisible in Canadian cancer care.

Objectives: This article explores the methods and benefits of involving patients and the public in primary prevention (PP) cancer research. Through the experience of the CANCEPT PP research network, it aims to clarify practices and propose methodological guidelines for developing interventions tailored to the needs of populations.

Methods: The Methodological Exchange Group GEM MIXTE, made up of 9 researchers and 9 co-researchers, met monthly (2023-2024, France) in order to define public and patient involvement in PP, take stock of participatory practices among CANCEPT members via a questionnaire (14 researchers, 8 institutions, 22 projects), and develop methodological guidelines in the form of a mind map. The participatory approaches were evaluated using the Public and Patient Engagement Evaluation Tool (PPEET) questionnaire.

Results: GEM MIXTE has enabled us to clarify the methodology of participatory research in PP and to propose practical guidelines. This work highlights the importance of diversifying the profiles of the co-researchers to enhance the relevance of interventions, while emphasizing the role of the group coordinator in structuring and facilitating exchanges. The PPEET evaluation confirmed that the co-researchers were committed to the objectives, although socio-cultural diversity remains a challenge.

Conclusion: This work proposes a methodological framework for integrating lived experience into research. The guidelines developed provide tools to inspire other networks to structure their approaches effectively, thereby strengthening citizen participation in public health.

Setting: Timiskaming District in Northern Ontario has a population of 32,394 people across 24 municipalities, two unincorporated areas, and four First Nations. During the time of these case studies, public health services were provided by the Timiskaming Health Unit, one of 34 local public health agencies in Ontario.

Intervention: To address local public health priorities in this rural region, the Timiskaming Health Unit implemented the Collective Impact framework, establishing governance structures for two initiatives: the Timiskaming Community Safety and Wellbeing Plan (CSWB) and Timiskaming Drug and Alcohol Strategy (TDAS). Acting as the backbone organization, the Health Unit facilitated a common agenda, shared progress measures, and coordinated mutually reinforcing activities.

Outcomes: The 2023 CSWB Plan, co-funded by all 24 municipalities, established a steering committee and three working groups to address safety and well-being goals. TDAS, launched in 2022, engages over 20 organizations and community members through a steering committee and four working groups. Deliverables include public events, navigational resources, social marketing campaigns, capacity building, new health infrastructure, improved collaboration, and advocacy for healthy public policy.

Implications: These initiatives demonstrate how local public health units can use the Collective Impact framework to address complex rural public health challenges. By integrating a continuous learning approach, implementation can integrate knowledge to foster collaboration that leads to community engagement and policy change. However, sustainable funding is critical for supporting collaborative governance and mitigating challenges like limited rural data availability.

Objectives: Obesity (body mass index, BMI ≥ 30 kg/m²) is a predictor of patient outcomes across surgical disciplines, but is not accurately captured by diagnostic codes in administrative databases. The objective of this study was to determine the validity of surgeon and anaesthetist billing claims indicating that their patients had concurrent class III obesity (BMI > 40) as compared to patients' self-reported BMI.

Methods: We performed a cross-sectional study of adult patients who had undergone major abdominopelvic, neck, and hip surgery in Ontario from 2011 to 2019, and had also reported their BMI on either the Canadian Community Health Survey or the Ontario Health Study. Physician billing claims for class III obesity were compared to self-reported BMI, and measures of diagnostic accuracy with 95% confidence intervals were calculated.

Results: We identified 52,515 patients who had undergone surgery (80.6% abdominopelvic; 19.4% neck/hip) with median age 57 years and median BMI 26 (range 15-108); 2189 patients (4.2%) reported a BMI > 40. When self-reported BMI was collected within 1 year of surgery, billing claims submitted by either the surgeon, surgical assistant, or anaesthetist had sensitivity 82.9% (95% CI 79.1-86.7), specificity 95.5% (95.0-96.0), positive predictive value 52.9% (50.1-58.5), and negative predictive value 98.9% (98.7-99.2) for the identification of BMI > 40. Positive predictive value for the identification of BMI > 30 was 95.4% (93.7-97.0).

Conclusion: Physician billing claims are specific and sensitive for the identification of patients with BMI > 40 undergoing surgery, enable accurate selection of a population with BMI > 30, and are valid for use in studies conducted with health administrative data.