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

The publication of The Core Competencies for Public Health in Canada, Release 2.0 is the result of 3 years of collaborative efforts and is a rare opportunity to reflect on the transformative processes involved. The updated competencies provide a common language for effective practice and a baseline to fulfill the core functions of public health in Canada. The update process involving the public health community across the country generated powerful insights about the importance of equity, effective governance, meaningful engagement, and the evolving identity of public health in Canada. In this Commentary, we present the renewed Core Competencies for Public Health in Canada and share reflections on what we learned along the way.

Objectives: This study evaluates associations between school-level disadvantage (i.e., relative socioeconomic circumstances of student populations) and the accessibility of unhealthy food vendors near secondary schools across Ontario, Canada. It also examines how vendor distribution would change following the implementation of new distance-based regulations.

Methods: We identified and summed all unhealthy food vendors within successive 100 m network buffers around secondary schools up to 1600 m, and applied inverse distance weighting, giving greater weight to vendors located closer to schools than those farther away. We used the Jonckheere-Terpstra test to determine significant differences and negative binomial regression to evaluate the association between the accessibility of unhealthy food vendors in school neighbourhoods and school-level disadvantage, defined by the percentage of immigrant, non-English-speaking, and low-income students. We investigated five regulatory scenarios across the entire province and by level of urbanicity, removing food vendors within 100 m, 200 m, 300 m, 400 m, and 500 m of schools, and repeating our analyses for the broader neighbourhood food environment (i.e., 1600 m from school).

Results: Adjusted models show that unhealthy food vendors were inequitably distributed across school neighbourhoods, with more disadvantaged schools having significantly more unhealthy food vendors within most buffer zones than the least disadvantaged schools. Also, these inequities would persist following the implementation of hypothetical distance-based regulations.

Conclusion: Distance-based regulations which restrict retail locations around all schools may not be an effective tool for ameliorating socioeconomic disparities in unhealthy food accessibility across school neighbourhoods or, by extension, addressing broader concerns related to adolescents' dietary behaviours.

Objectives: Disparities in health outcomes exist among racial and ethnic minorities in Canada. However, no detailed and representative population-level data document these disparities, except for Indigenous populations. We aimed to identify frameworks for collecting race and ethnicity data in health settings and synthesize data collection practices to guide healthcare leaders on how practices could be standardized within the Canadian health system.

Methods: Using a scoping review method, we identified primary studies, review articles, and grey literature that include frameworks or other recommendations on race and ethnicity data collection and extracted data about their characteristics, context, attributes, and components. We summarized the data using frequencies and descriptions.

Synthesis: We identified 23 frameworks from the United States (n = 14) and Canada (n = 9). While 18 frameworks have been used in hospitals, health centers, public health units, and a clinical trial, five were developed as recommendations. Only few framework developers involved various stakeholder groups and used paper and electronic methods to collect race and ethnicity information from patients. All frameworks from the USA share a similar reference point for race and ethnicity categories, unlike those from Canada.

Conclusion: These findings provide a foundation for race and ethnicity data collection practices. Data collection can begin by engaging relevant stakeholders to develop or adapt an existing framework collaboratively. The goal should be to standardize collection practices, ensuring that racial and ethnic classifications can be aggregated to a national scale for decision-making for improved health outcomes for all.

Objectives: According to McLeroy's socio-ecological model, inter-organizational collaboration is important in shaping population health. This study aimed to investigate the association between public health unit (PHU) collaboration in secondary schools and student substance use over time.

Methods: Data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study were used to identify student-level substance use behaviours and school-level PHU engagement. Substance use was measured as self-reported use of alcohol, cannabis, cigarettes, and electronic cigarettes. Multilevel logistic regressions accounted for the hierarchical data structure.

Results: This study included 16,575 students attending 68 Canadian schools from 2016/2017 to 2018/2019. Among these schools, 65% had PHU engagement in addressing alcohol and/or cannabis use, and 65% had PHU engagement in addressing cigarette and/or e-cigarette use. Provision of information/resources/programs was associated with lower odds of binge drinking (adjusted odds ratio [AOR], 0.77; 95% confidence interval [CI], 0.62-0.96) and e-cigarette use (AOR, 0.74; 95% CI, 0.59-0.94) in 2017/2018, but higher odds of cannabis use in 2018/2019 (AOR, 1.51; 95% CI, 1.08-2.11). Joint problem solving/program implementation was associated with higher odds of binge drinking, cannabis use, and e-cigarette use over time (p < 0.05), but was not associated with alcohol use overall. PHU-led prevention programs in schools were associated with reduced cigarette use (AOR, 0.67; 95% CI, 0.46-0.97).

Conclusion: Different methods of PHU-school collaboration may be differently associated with substance use behaviours. Further research is needed to understand how this partnership can better protect adolescent health at a critical time in their development.

Objectives: Asthma is a common respiratory disease in Canada, representing a significant burden on the health of the population and the healthcare system. While studies have attributed an association between obesity and asthma, understanding of this relationship remains underexplored in the Canadian population. This study aims to describe the association between BMI and current asthma in adults living across Canada.

Methods: This study used cross-sectional data from the 2017-2018 Canadian Community Health Survey of individuals aged 18 years and older who reported currently having asthma. Current asthma was defined as having been previously diagnosed with asthma and experiencing asthma symptoms or asthma attacks in the past 12 months. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated using log-binomial regression, modelling the association between BMI (underweight/normal weight (< 25 kg/m²), overweight (25- < 30 kg/m²), and obese (≥ 30 kg/m²)) and current asthma, adjusting for relevant sociodemographic and health factors.

Results: Of the 7090 individuals with asthma in this study, 3627 (51.2%) experienced current asthma. The prevalence of current asthma was similar in overweight individuals (PR = 1.00, 95%CI 0.95, 1.05) when compared to those in the underweight/normal weight category, while individuals with obesity had a 5% higher prevalence (PR = 1.05, 95%CI 1.01, 1.10) when compared to those in the underweight/normal weight category.

Conclusions: This study provides evidence for the association between obesity and an increased prevalence of current asthma among adults. Weight management, particularly for individuals with obesity, may be an important consideration in asthma control.

Objectives: HIV pre-exposure prophylaxis (PrEP) is proven effective for HIV prevention and recommended for individuals at ongoing and high risk of HIV, including gay, bisexual, and other men who have sex with men (GBMSM) and people who inject drugs (PWID). We used existing national survey data to measure PrEP need in both populations and calculate percentages of use among those meeting indications within each group.

Methods: We conducted a secondary data analysis of nationally representative data to estimate the percentage of GBMSM and PWID meeting PrEP indications based on 2017 Canadian guidelines. We applied these percentages to recent population size estimates for both groups to estimate the number of people having PrEP indications in each group. Where available, we also used survey data to determine the percentage of people with indications who were not taking PrEP at the time of the survey.

Results: An estimated 24.1% (95% CI 13.3-39.7%) or 99,300 (95% CI 54,800-163,600) of GBMSM had PrEP indications in Canada as of 2021. The corresponding percentage and number for PWID were 22.3% (20.8-22.8%) and 22,400 (20,900-23,900). Two-thirds of GBMSM participants (Sex Now 2019 and 2021) who had PrEP indications were not taking PrEP at the time of the surveys. None of the participants with PrEP indication in the Tracks survey (2017-2019) among PWID reported PrEP use.

Conclusion: In Canada, the estimated number of people with PrEP indications among GBMSM and PWID far exceeded documented levels of use. Uptake of PrEP was lower among PWID compared to GBMSM. Efforts to improve PrEP access and uptake could help reduce HIV transmission in Canada.

Canada is in the throes of a continuing drug toxicity crisis that causes significant harms related to substance use. While governments at all levels grapple with these challenges, this commentary proposes an evidence-based framework that policymakers can utilize to inform decisions. The Substance Use Stabilization Framework suggests an intersectoral approach to prompt cohesive community and individual outcomes by simultaneously addressing housing, decriminalization, regulated supply, and treatment that rests on the principles of harm reduction. Only when these elements are addressed can we expect to see significant advances in addressing substance use concerns in Canada.

Objectives: Canadian Armed Forces (CAF) Veterans and former Royal Canadian Mounted Police (RCMP) members ("Veterans/former RCMP members") may be at increased risk of mental health disorders necessitating psychiatric hospitalization relative to non-Veterans. Differences in occupational experiences may further influence risk across subgroups of Veterans/former RCMP members. We compared the likelihood of a psychiatric hospitalization between Veterans/former RCMP members and non-Veterans residing in Ontario, Canada: (1) overall; by (2) sex and (3) length of service.

Methods: This retrospective cohort study used administrative healthcare data to exact-match non-Veterans to Veterans/former RCMP members (4:1) residing in Ontario between March 18, 2002, and March 31, 2020, on age, sex, geography, and income. Sex-stratified Fine-Gray regression models were used to estimate the adjusted hazard ratio (aHR) of psychiatric hospitalizations within the first 10 years of follow-up.

Results: In total, 2.5% of the 18,841 Veterans/former RCMP members (n = 476) and 0.9% of the 75,364 non-Veterans (n = 663) included in this study had a psychiatric hospitalization within the first 10 years of follow-up. Veterans/former RCMP members had a higher aHR of psychiatric hospitalizations than non-Veterans (aHR, 2.93; 95% CI, 2.61-3.29). Effects were stronger among females (aHR, 4.54; 95% CI, 3.34-6.17) and those with fewer years of service (e.g. 5-9 years aHR, 5.78; 95% CI, 4.27-7.83).

Conclusion: The risk of psychiatric hospitalizations is almost three times higher among Veterans/former RCMP members compared to non-Veterans, with larger effects among females and individuals with fewer years of CAF/RCMP service. These occupational subgroups may benefit from targeted healthcare planning and resources.

Background: Against the backdrop of a severe drug toxicity crisis, this study examined socioeconomic inequities in drug poisoning mortality among working-age adults in Canada.

Methods: We conducted a population-based cohort study using the 2016 Canadian Census Health and Environment Cohort (n = 4,588,745). Census respondents aged 25-64 were linked to mortality records for the period 2016-2021. We used Poisson regression models to estimate rate ratios and rate differences in drug poisoning deaths by education, household income, and employment status. Analyses were conducted separately for women and men, adjusting for various sociodemographic factors.

Results: The crude rate of drug poisoning mortality was 8.7 and 17.5 deaths per 100,000 person-years among women and men, respectively. We observed pronounced inequities in drug poisoning mortality according to education, household income, and employment status. For example, among women and men, respectively, rates of drug poisoning mortality were 7.55 (95% CI, 6.73-8.36) and 7.70 (95% CI, 7.01-8.39) times higher among individuals without a high school degree (compared to university graduates), 6.70 (95% CI, 5.96-7.44) and 4.60 (95% CI, 4.27-4.93) times higher among individuals in the lowest quintile of household income (compared to the highest earners), and 5.58 (95% CI, 4.94-6.22) and 3.56 (95% CI, 3.32-3.80) times higher among unemployed individuals (compared to full-time workers).

Conclusion: The findings draw attention to persistent socioeconomic inequities in drug poisoning deaths among working-age adults in Canada. Interventions are urgently needed to address the growing drug toxicity crisis, as well as socioeconomic inequities therein.

Canada was the last of the G7 countries to adopt a program and dozens of other jurisdictions around the world had previously instituted forms of vaccine injury compensation. The program was formally launched in June of 2021 and has come under increased scrutiny recently. As the first stage of the program nears its end, we provide an overview on the path to a vaccine injury compensation program in Canada, challenges it has faced, and recommendations for ensuring the program meets its intended goals.