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

Objectives: Our Health Counts (OHC) methods are designed to address gaps in urban-based Indigenous health information. In partnership with local Indigenous health service providers, we have successfully implemented OHC in six Ontario cities. The aim of this study is to summarize findings regarding Indigenous population undercount, health inequities, and health service access barriers across study sites.

Methods: We estimated Indigenous population size using OHC census participation survey responses and a multiplier approach. Health inequities between Indigenous populations and overall populations in each city were examined using respondent-driven sampling (RDS), adjusted OHC survey results, and existing public data. Measures included health status outcomes; determinants of health; barriers to health service access, including discrimination by health service providers; and unmet health needs.

Results: Indigenous social networks were strong and extensive, and the urban populations demonstrate resilience and cultural continuity across multiple measures. Self-reported rates of census participation for Indigenous populations were markedly lower than those for the general population in each city, and OHC Indigenous population size estimates were consistently 2‒4 times higher than reported in the census. Indigenous to general population health inequities cut across measures of chronic disease, determinants of health, and unmet health needs. Indigenous populations experienced multiple barriers to health services access, including racial discrimination by health service providers.

Conclusion: The Canadian census appears to markedly underestimate Indigenous population size in urban areas. Indigenous health inequities and service access barriers are striking and cross-cutting. Timely adaptation of health policies, services, and funding allocations in response to these findings is recommended.

Objectives: Our Health Counts (OHC) Toronto, an Indigenous population database which addresses gaps in urban health information, was used to measure Thistle's (2017) 12 dimensions of Indigenous homelessness. Using this framework, we examine the sociodemographic characteristics of First Nations, Inuit, and Metis (FNIM) adults living in Toronto, the 12 dimensions as experienced by this population, and the distinctions between FNIM adults who were and those who were not experiencing physical homelessness.

Methods: Respondent-driven sampling (RDS)-II proportions and 95% confidence intervals were produced from the database (n = 915 FNIM adults) to describe key sociodemographic characteristics of the population and to estimate the proportion and number of dimensions of Indigenous homelessness experienced by FNIM adults. Results were compared between those who were and those who were not living physically homeless.

Results: This study shows that 27.3% of FNIM adults in Toronto were living physically homeless. The proportion of homelessness was significantly higher among males, adults aged 26 to 54, and unemployed individuals. Using the OHC database, 7 of the 12 dimensions were measurable. Almost all FNIM adults had experienced one or more of the 7 measurable dimensions. The most common were cultural disintegration and loss, mental disruption and balance, contemporary geographic separation, and relocation and mobility. These dimensions were significantly more common among FNIM adults experiencing physical homelessness.

Conclusion: Results show that FNIM adults living physically homeless are more likely to experience other dimensions of homelessness. Using existing data, 5 of the 12 dimensions were not measurable. This points to a critical need to develop new survey tools to fully understand the historical, environmental, social, political, spiritual, and emotional factors that influence pathways into homelessness among FNIM populations.

Objectives: Methods for enumeration and population-based health assessment for First Nations, Inuit, and Metis (FNIM) living in Canadian cities are underdeveloped, with resultant gaps in essential demographic, health, and health service access information. Our Health Counts (OHC) was designed to engage FNIM peoples in urban centres in "by community, for community" population health assessment and response.

Methods: The OHC methodology was designed to advance Indigenous self-determination and FNIM data sovereignty in urban contexts through deliberate application of Indigenous principles and linked implementation strategies. Three interwoven principles (good relationships are foundational; research as gift exchange; and research as a vehicle for Indigenous community resurgence) provide the framework for linked implementation strategies which include actively building and maintaining relationships; meaningful Indigenous community guidance, leadership, and participation in all aspects of the project; transparent and equitable sharing of project resources and benefits; and technical innovations, including respondent-driven sampling, customized comprehensive health assessment surveys, and linkage to ICES data holdings to generate measures of health service use.

Results: OHC has succeeded across six urban areas in Ontario to advance Indigenous data sovereignty and health assessment capacity; recruit and engage large population-representative cohorts of FNIM living in urban and related homelands; customize comprehensive health surveys and data linkages; generate previously unavailable population-based FNIM demographic, health, and social information; and translate results into enhanced policy, programming, and practice.

Conclusion: The OHC methodology has been demonstrated as effective, culturally relevant, and scalable across diverse Ontario cities.

Objectives: Mental health and psychiatric disorders significantly affect individuals on personal and social levels. Indigenous populations in Canada have disproportionately high rates of mental health diagnoses. Our Health Counts (OHC) Toronto assessed mental health, racism, family disruption, and cultural continuity among urban Indigenous people. The objectives of this study were to understand (1) the demographics and characteristics of Indigenous adults with a diagnosed psychological/mental health disorder and (2) potential associations of psychological/mental health diagnoses with experiences of colonization and cultural continuity among Indigenous adults in Toronto.

Methods: Using community-based participatory research methods, Indigenous adults in Toronto were recruited by respondent-driven sampling (RDS) to complete a comprehensive health assessment survey. RDS-II weights were applied to calculate population-based estimates, and adjusted odds ratios with 95% confidence intervals were produced using logistic regression, controlling for age and gender.

Results: Among Indigenous adults, nearly half (45%) reported receiving a mental health diagnosis. Participants reported lifetime anxiety disorders (53%), major depression (51%), and high rates of suicide ideation (78%). Of Indigenous adults with a diagnosed mental health disorder, 72.7% reported participating in ceremony. Attending residential schools (OR: 7.82) and experiencing discrimination (OR: 2.69) were associated with having a mental health disorder.

Conclusion: OHC Toronto responded to the gaps in health assessment data for urban Indigenous people. Despite historic and ongoing trauma, Indigenous people have maintained cultural practices and a strong sense of identity. Efforts aimed at supporting Indigenous well-being must respond to the roots of trauma, racism, and existing Indigenous community knowledge and strengths.

There have been growing ethical concerns about the widespread use of HIV-related molecular epidemiological public health surveillance and research-or what has come to be known as molecular HIV surveillance. The varied concerns of the practice originate due to lack of informed consent, lack of demonstrated benefit for communities, potential for eroded patient care relationships leading to poor health outcomes, and potential implications for information sharing and findings which could increase stigmatization and other negative impacts in contexts where HIV, drug use, sex work, migration, and poverty are criminalized. As people living with HIV, lawyers, clinicians, and social scientists, we are part of the growing movement calling for critical and ethical attention to the practice of molecular HIV surveillance and the public health logic which underwrites the practice. We urge Canadian public health actors and researchers working with molecular surveillance data to heed global guidance and recommendations for culturally informed ethical practices, to engage community members in HIV surveillance programs, and to ensure that people living with HIV are provided appropriate consent processes for uses of secondary data analysis. Furthermore, we urge researchers and Research Ethics Boards to interrogate assumptions of impracticality in seeking subsequent consent to use persons' health information held in data repositories and explore new methods of informed consent.

Objective: A decline in routine vaccination coverage in children has been observed after the onset of the COVID-19 pandemic, but it is unclear whether these declines were sustained over time. This analysis assessed changes in vaccination coverage at ages 2 and 7 years for routinely administered vaccinations before, during, and after the COVID-19 pandemic.

Methods: Vaccination coverage was measured using yearly data from the Standardized Reporting on Vaccination (STARVAX) surveillance system between December 31, 2019, and December 31, 2023. Four provinces (Alberta, Saskatchewan, Manitoba, and New Brunswick) and one territory (Yukon) produced reports from their immunization registries and provided the Public Health Agency of Canada with the numbers of vaccinated 2-year-old and 7-year-old children. Population estimates from Statistics Canada and the Yukon Bureau of Statistics were used as the denominators.

Results: There was a decline in vaccination coverage in 2023 compared to 2019. In 2-year-olds, coverage for one dose of the measles, mumps, and rubella (MMR) vaccine and four doses of the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine decreased from 89.5% to 82.5% and from 79.9% to 72.1%, respectively. Among 7-year-olds, DTaP (up-to-date) and MMR (two doses) vaccination coverage decreased from 77.1% to 68.8% and 86.3% to 75.6%, respectively.

Conclusion: These declines are of concern and suggest that health care professionals should provide parents with accurate information regarding vaccines and encourage them to have their children vaccinated and keep vaccinations up to date.

Objectives: The behavioural sciences provide useful evidence to design effective health promotion interventions, but evidence is infrequently integrated in practice. This study examined associations between theoretical domains framework (TDF) constructs and public health practitioners' use of behavioural science evidence to plan public health actions.

Methods: Using a cross-sectional design, a convenience sample of 160 practitioners were recruited from public health agencies across Canada. Respondents completed an online questionnaire assessing TDF constructs and the use of behavioural science theory and approaches (i.e., evidence) in their practice. Logistic regression analyses allowed for identification of factors associated with evidence use and intentions. All analyses were adjusted for sex, years of experience, and type of public health agency.

Results: Greater skills (OR_adj = 4.1, 95%CI 1.3, 13.5) and stronger intentions/aligned goals (OR_adj = 9.2, 95%CI 2.3, 36.1) were associated with greater use of behavioural science evidence to plan public health actions. Greater perceived capacity to overcome widespread absence of use of behavioural science evidence in their organization (OR_adj = 7.2, 95%CI 1.7, 30.3) was also associated with greater use. More knowledge (OR_adj = 8.6, 95%CI 1.9, 39.1) and stronger beliefs about consequences (OR_adj = 4.0, 95%CI 1.1, 14.7) were significantly associated with stronger intentions/aligned goals.

Conclusion: Findings show that more knowledge, positive attitudes, and stronger perceived competence are associated with greater likelihood of using behavioural science evidence to plan interventions. The use of behavioural science evidence will also require strengthening the norm pertaining to this professional practice in public health organizations.

Objectives: Experiences of discrimination reported during pregnancy are common and are associated with poor mental health and adverse birth outcomes. No Canadian studies have investigated interpersonal discrimination during pregnancy. This study aimed to quantify and identify lived-experiences of discrimination in a Canadian cohort of pregnant individuals, and examine associations with concurrent prenatal anxiety and depression symptoms.

Methods: Pregnant individuals from the pan-Canadian Pregnancy During the Pandemic (PdP) study (n = 1943) completed the Everyday Discrimination Scale (EDS), demographic measures and self-report measures of depression and anxiety symptoms. Descriptive statistics and ANCOVA were used to assess prevalence of discrimination and associated mental health outcomes. Open-text responses (n = 189) to a question investigating reasons for discrimination were analyzed using conventional content analysis.

Results: Approximately three quarters (72%) of pregnant individuals experienced at least one instance of discrimination during their pregnancy or within the year prior. Pregnant individuals experiencing more frequent and/or more types of discrimination were more likely to identify as non-white, not be partnered, have lower socioeconomic status, and have a pre-pregnancy history of anxiety and depression. The most common attributions for interpersonal discrimination were gender, age, and education/income level. Pregnant individuals who experienced more frequent discrimination and/or more types of discrimination were more likely to report clinically significant symptoms of depression and anxiety (n = 623; 35.2% and 49.1%, respectively) compared to those who reported no discrimination (n = 539; 11.5% and 19.1%, respectively). Conventional content analysis of open-text responses generated the following main themes: (1) personal attributes and sociodemographic characteristics, (2) occupation, (3) the COVID-19 pandemic, (4) pregnancy and parenting, and (5) causes outside the self.

Conclusion: Frequent discrimination was associated with more adverse concurrent mental health symptoms. Understanding experiences of discrimination can inform interventions that better address the needs of pregnant individuals and their infants.

Setting: This study evaluates the impact of sunscreen dispensers in increasing sunscreen usage and awareness in Summerside, Prince Edward Island, Canada.

Intervention: In June 2022, three touchless sunscreen dispensers offering free Health Canada-approved SPF 30 sunscreen were installed in areas of high pedestrian traffic. A team of four city workers gathered observational data over a 17-day span between July and August 2022.

Outcomes: Seven days of monitoring took place at the city ballpark, seven at a children's park, and three at the city beachfront boardwalk. In total, 1202 individuals were observed near the dispensers, of whom 209 utilized the dispensers, yielding a usage rate of 17.4 per 100 persons. The usage rate varied by location, with the children's park recording a higher average (40.0 users per 100 persons), and was also weather-dependent, with increased usage on sunny days (average of 52.2 users per 100 persons). The majority of users were classified with a Fitzpatrick skin type of I or II. The sunscreen bags, designed for 2000 applications, did not require refilling during the observation period. The QR code associated with the dispensers was scanned 14 times.

Implications: The findings of this study indicate that installing sunscreen dispensers in public spaces may increase the frequency of sunscreen application. Both the location of the dispensers and the perception of weather conditions seem to impact usage rates.