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

Objectives: The COVID-19 pandemic fueled a surge in anti-Asian sentiment in Canada, which negatively impacted the health and well-being of Asian Canadians. This study examines whether anti-Asian racism has decreased since the end of the COVID-19 pandemic.

Methods: We conducted a trend analysis of anti-Asian racism in Canada by synthesizing and analyzing two key sources of data that capture changes in both objective and subjective dimensions of anti-Asian racism before, during, and after the pandemic. First, we used a census of all racially motivated hate crimes known to police services in Canada (2014-2023). Second, we used a series of anti-Asian racism surveys conducted at different time points by various research teams in collaboration with the Angus Reid Institute, including most recently, the Asian Canadians' Experiences Survey conducted by our team in June 2023.

Results: Our analysis of police-reported data suggests that the number of hate crimes targeting East or Southeast Asians rose sharply from 67 in 2019 to 263 in 2020-a 293% increase. The number peaked at 312 in 2021, then declined to 213 in 2022 and further to 158 in 2023. These figures suggest a decline in anti-Asian racism following the pandemic; however, the levels have not returned to their pre-pandemic baseline. Our analysis of survey data indicates Asian Canadians continue to encounter more subtle forms of racism, including micro-aggressions, racist media representations, reduced respect in social interactions, and derogatory name-calling. We highlight that such experiences, though not always explicitly violent, foster a hostile environment that can profoundly affect the overall well-being of Asian Canadians.

Conclusion: Anti-Asian racism is multifaceted and persistent. Policymakers and public health practitioners need to also pay attention to the negative health impacts of micro-aggressions and other less overt forms of racial discrimination, including subjective experiences of racism.

Canada has faced numerous public health challenges but remains inadequately prepared for future crises. For example, despite extensive reports and plans following the 2003 SARS-CoV-1 outbreaks, the country was unprepared for COVID-19 and lessons learned from the pandemic emphasized the need for immediate action to enhance preparedness. In the current era of poly-crisis, Canada must be ready for diverse challenges, including potential conflicts and their impacts on public health and health systems. The conflict in Ukraine highlights the need for extensive medical resources for returnees, which could strain public health and health systems alongside other concurrent threats. Exercise Trillium Cura (ETC) in 2024 simulated Ontario's health system response to a prolonged conventional war, revealing both successes and challenges. Key issues included leadership and resource needs, with recommendations for specific actions like creating a repatriation hub and a trauma registry. ETC emphasized a "whole of society" approach, engaging civil society in planning and highlighting the importance of integrated preparedness. Tabletop exercises like ETC are crucial for building relationships, shared learning, and innovative solutions. They help prepare for complex crises by fostering collaboration and readiness. Regular exercises are recommended to enhance preparedness and resilience, ensuring effective responses to future health emergencies.

Objectives: Black-White disparities in maternal and neonatal morbidity and mortality highlight health inequities in several settings, yet such racial disparities in Canada are not well defined. Our objective was to conduct a scoping review to identify the extent of epidemiologic evidence assessing Black-White disparities in maternal and neonatal health in Canada.

Methods: We included peer-reviewed epidemiologic studies which measured maternal or neonatal outcomes in Black versus White individuals in Canada. We searched OVID platforms (MEDLINE, Embase, Emcare) from inception to May 9, 2024, using keywords and controlled vocabulary terms related to race and maternal and neonatal morbidity and mortality. Results synthesis was carried out using descriptive analysis.

Synthesis: After exclusions, six retrospective cohort studies were included in the scoping review. The majority of the included studies used data obtained from provincial datasets (n = 5), defined maternal race using self-reported race (n = 5), and were set in Ontario (n = 4). All studies reported one or more significant associations between race and adverse maternal or neonatal outcomes, with Black individuals experiencing higher rates of spontaneous fetal loss (n = 1), perinatal mortality (n = 1), preterm birth (n = 3), small for gestational age infants (n = 1), low Apgar scores (n = 2), congenital heart disease (n = 1), neonatal intensive care unit admission (n = 1), preeclampsia (n = 2), gestational diabetes (n = 1), and inadequate gestational weight gain (n = 1).

Conclusion: Although literature on the topic is sparse, Black-White disparities in maternal and neonatal health in Canada are apparent. National, population-based data are needed to provide a comprehensive understanding of racial disparities in maternal and neonatal health and the factors driving these differences.

Introduction: In September 2024, the province of Ontario expanded alcohol sales into convenience stores. It is important to examine differences in alcohol sales expansion by socioeconomic status (SES) as lower SES groups experience a disproportionately higher burden of alcohol-attributable harms.

Methods: This repeated cross-sectional study examined whether neighbourhood SES was associated with increases in alcohol outlets immediately following the expansion of alcohol sales. A spatial BYM2 Poisson regression model was used to estimate the association between neighbourhood SES and the number of alcohol outlets.

Results: Immediately following expansion, 4200 alcohol outlets were licensed in Ontario. The median increase in alcohol outlets within 1500 m of a neighbourhood was greater in the lowest SES neighbourhoods (400% increase) compared to the highest (183%). In adjusted models, the lowest SES quintile was associated with a greater increase in outlets (relative risk = 2.26, 95% credible interval:1.98-2.58) compared to the highest quintile, with a dose-response relationship by SES quintile.

Discussion: A large increase in alcohol outlets was seen across Ontario neighbourhoods. Lower SES neighbourhoods experienced a greater increase in outlets, which may disproportionately increase harms related to the expansion of alcohol sales. These findings highlight the need for strategies to mitigate potential harm in low SES groups and the widening of existing inequities.

Objectives: To develop a national atlas of (1) Canadian cohorts studying or with the potential to study adults living with long COVID (LC) and (2) harmonize provincial and territorial administrative datasets to facilitate the creation of validated case-ascertainment algorithms and foster national collaboration on LC research.

Methods: We conducted a multifaceted environmental scan that included a comprehensive literature search and a survey of members of Canada's national LC research network between August 21, 2023, and November 10, 2023. We identified provincial and territorial cohorts, including those that were linkable to administrative data and common data elements among administrative datasets.

Results: We included 19 Canadian cohorts from five provinces (Alberta, British Columbia, Manitoba, Ontario, and Québec) containing data on over 580,000 adults. The majority of the cohorts measured sociodemographic data (e.g., age, sex) and measures of healthcare use, whereas equity-related measures such as gender, ethnicity, and race were limited. There was wide variability in the definitions of LC used across all cohorts. Comparable population-level administrative data are currently available in Alberta, British Columbia, Manitoba, Ontario, Québec, New Brunswick, Newfoundland and Labrador, Nova Scotia, and Saskatchewan.

Conclusion: Canada has a rich repository of LC datasets that are limited by variable definitions of LC and inadequate equity-related measures such as gender, ethnicity, and race. Standardization and diversification of these measures will facilitate efforts to study healthcare use and develop health policy to improve the care of Canadian adults living with LC at a population level.

Objectives: Oral nicotine pouches are gaining global popularity as a novel alternative nicotine product. Our objective was to examine nicotine pouch use among a large sample of Québec adolescents, including sociodemographic and health-related risk factors, co-use with cigarettes and e-cigarettes, and risk perceptions.

Methods: We surveyed 13,914 Quebec secondary school students as part of the 2024 COMPASS study. Participants answered questions on past-month use of oral nicotine pouches, e-cigarettes, and cigarettes, as well as perceived addictiveness and health risks. Poisson regression was used to examine relative risks for current nicotine pouch use by sociodemographic and health factors, current smoking and vaping status, and risk perceptions. Risk perceptions were compared across nicotine products.

Results: Nicotine pouches were the most used alternative nicotine product following e-cigarettes, with prevalence of current use (2.6%) comparable to cigarette smoking (3.0%). Older adolescents, cisgender boys, gender diverse adolescents, academically at-risk youth, and current cigarette and e-cigarette users had higher relative risks for nicotine pouch use. Nearly one-quarter of adolescents were unsure of the health risks of nicotine pouches and 16% did not know whether they were addictive. Lower risk perceptions were associated with increased likelihood of current use.

Conclusion: Nicotine pouches are an emerging nicotine product that appear to be gaining popularity among Canadian youth. Given their design features which allow for use in most situations and environments, nicotine pouches have considerable potential to follow the same popularity trajectory as e-cigarettes if not regulated appropriately.

Fifty years after the Lalonde Report, public health must move beyond individual-level determinants to confront the structural forces that shape health. Drawing on 27 years of research on the social and structural determinants of health, this commentary reflects on the persistent health inequities in Canada and argues for a future public health agenda rooted in intersectionality, structural analysis, and community engagement. Framing the Lalonde@50 conference contributions by Frohlich, Watson-Creed, Delormier, and Ndumbe-Eyoh, this piece highlights the urgency of upstream interventions, ontological humility, Indigenous self-determination, and anti-racist practice. By integrating concepts such as the inverse care law and fundamental causes of disease, it argues that inequalities will continue to emerge as long as resources remain unequally distributed. Thus, public health must remain structurally attuned and anticipatory in order not only to respond to inequities but to get ahead of them.

The Lalonde report's limited references to Indigenous Peoples primarily address federal responsibilities for healthcare service provision and identify Indigenous Peoples as high-risk populations. However, the report paved the way for robust frameworks to address the social determinants of Indigenous Peoples' health inequities. Colonialism and structural racism, as distinct social determinants, constrain opportunities for Indigenous Peoples to achieve health equity relative to the general Canadian population. Decolonizing relationships that center Indigenous Peoples' self-determination and lands is foundational for achieving health equity. The Kahnawà:ke Schools Diabetes Prevention Program (KSDPP) exemplifies Indigenous health promotion and the Kahnawà:ke community's self-determination to take control over their health determinants. Declining incidence of type 2 diabetes (T2D) may indicate promising impacts. However, the impacts of community-level programs will be limited if Canada fails to advance Indigenous self-determination as the path to health equity.

Fifty years after the release of the seminal Lalonde Report, public health in Canada is faced with some questions regarding the next 50 years and beyond. To what degree is public health ready to help expose or define Canadian societal values? To what degree is public health ready to engage with the complex nature of structural determinants and the power dynamics that they necessarily invoke? Can public health evolve its discourse regarding social determinants of health and, in doing so, is it ready to perhaps join in with work already in progress, like that related to wellbeing? This brief commentary explores these issues.