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

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.

The absence of historical context in public health has contributed to the persistent neglect of structural racism as a major determinant of health inequities. This commentary critically highlights the omissions of the Lalonde Report, a foundational document in population health, and explores the enduring impacts of slavery, colonialism, and systemic racism on Black health in Canada. Anti-Black racism continues to shape racial health inequities through economic, political, and social marginalization. However, public health research, policy, and practice have largely failed to address the structural dimensions of racism. Yet, Black communities in Canada have long resisted these injustices through grassroots movements, community advocacy, and systems transformation. A decolonial, anti-racist approach is necessary to disrupt these patterns, shift power and resources, and promote health equity. This requires interdisciplinary education, policy change, and investments in social systems that promote equity for Black communities. Centring community-led solutions, institutional accountability, and leveraging legislative tools are critical steps toward meaningful change. Public health must actively engage in dismantling white supremacy to achieve equitable health outcomes for Black communities.

Objectives: There has been increased efforts to identify wise practices among research efforts completed in partnership with Indigenous communities. Community-based participatory research (CBPR) has been a leading guideline for this work in recent years, as such frameworks emphasize collaboration, partnership, and community-guided efforts; however, no work to date has examined how various CBPR standards, ethical guidelines, and practices may vary by community or regional context.

Method: The purpose of this scoping review was to summarize Indigenous-specific research practices among relevant frameworks, to identify more common collective values and practices, and other, potentially more unique or distinctive aspects of frameworks within Canadian, Australian, New Zealand, and United States (CANZUS) nation-based Indigenous communities. A scoping review of six databases to retrieve relevant literature describing community-based research principles, guidelines, and ethical standards specifically related to an Indigenous population or community.

Synthesis: We retrieved 46 sources proposing an Indigenous-based principle, guideline, and/or ethical standard. When these studies were descriptively analyzed, we derived eight common themes across these frameworks: Benefit to Community, Respect, Reciprocal Relationships, Recognize Diversity, Embed Indigenous Culture, Autonomous and Active Participation, Consultation, and Authenticity. Specific research practices that align within framework values across a research process were also identified across ten themes, and 38 sub-themes. Practices included Learn About Culture, Region, Community, or Nation, Establish and Maintain Meaningful Relationships, Community Engagement or Consultation, Project Design, Develop a Research Agreement, Data Agreement, and/or Protocols, Project Management, Methods, Data Analysis and Interpretation, Knowledge Translation and Exchange, and Post-Research Relationships.

Conclusion: Several common values and practices underscore many Indigenous community-based research guidelines, principles, and ethical standards. This review may be used to increase knowledge on Indigenous approaches to research across disciplines, facilitate the evaluation of research conducted with Indigenous communities, and assist communities in developing independent practices, principles, and ethical guidelines.

Objectives: The CLSA is a national data platform for aging research that used epidemiology-based sampling methods and explicitly excluded people living on First Nations Reserves and other provincial First Nations settlements as possible CLSA participants. As such, the CLSA research approach did not use Indigenous community engagement. Nevertheless, the CLSA sample includes a sizeable subsample of participants who self-identified as First Nations, Métis, or Inuit. This project seeks to describe the self-identified Indigenous subsample of the CLSA from the baseline data collection and interpret that description with the aid of an Elder Advisory Circle.

Methods: We conducted a descriptive analysis of the self-identified Indigenous subsample of the CLSA from the baseline data collection. The analysis was presented to an Elder Advisory Circle for consultation.

Results: The lack of community-engaged approaches to Indigenous research and sampling approaches appears to have resulted in a sociodemographic profile of older Indigenous Peoples that does not match the lived experience of the Elder Advisory Circle and contrasts with other data available on Indigenous Peoples in Canada. We feel the existing CLSA data does not reflect the sociodemographic profile of older Indigenous Peoples.

Conclusion: We use this community consultation process to provide recommendations for the appropriate use of the Indigenous-identified data in the CLSA, and we conclude by recommending great caution when using the data from the Indigenous subsample in the CLSA data.

Objectives: To investigate dispensing trends and the characteristics of First Nations People in Ontario dispensed an opioid for pain and concurrent benzodiazepine treatment.

Methods: We conducted a population-based serial cross-sectional study by quarter of registered (Status) First Nations People in Ontario who were dispensed an opioid for pain between April 1, 2013, and December 31, 2021. We reported quarterly trends in prevalent and incident opioid dispensing (rates per 1000 people), and the prevalence of concurrent benzodiazepine use among individuals receiving opioids for pain. For the final year (2021), we stratified rates by age, place of residence (within or outside First Nations communities), and sex.

Results: Between 2013 and 2021, the quarterly rate of opioid dispensing for pain decreased by 25.0% among First Nations People in Ontario, from 74.7 to 56.0 per 1000 people. In stratified analyses for the year 2021, opioid use for pain was more frequent among First Nations People living outside versus within First Nations communities (118.2 vs. 91.2 per 1000, respectively) and among females relative to males (124.6 and 93.9 per 1000, respectively). Concurrent prescription benzodiazepine use among First Nations People receiving a prescription opioid for pain decreased from 20.9% in Q2 2013 to 16.7% in Q4 2021. In stratified analyses, concurrent use was more prevalent among females, adults aged ≥ 65 years, and First Nations People living outside First Nations communities.

Conclusion: Opioid analgesic prescribing patterns for First Nations People living in Ontario indicate a decrease in both overall prescribing rates and concurrent benzodiazepine use.