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

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.

Intervention: Governments are investing in safer cycling infrastructure to provide transportation options that support health, mobility, and environmental outcomes; these can be considered population health interventions.

Research question: We aimed to measure change from 2022 to 2024 in cycling infrastructure in Canada to understand what and where changes happened, and who was impacted.

Methods: We extracted data from OpenStreetMap.org (OSM) in 2022 and 2024 and coded them according to the Canadian Bikeway Comfort and Safety (Can-BICS) classification system (high, medium, or low comfort and safety). We measured differences (2022-2024) in length and type of cycling infrastructure within census subdivisions. We related differences in cycling infrastructure metrics with population composition within dissemination areas, nationally, by city size, and for particular cities, examining specific population groups (children, older adults, recent immigrants, racialized people, and low-income populations).

Results: Total Can-BICS-OSM cycling infrastructure in 2024 increased to 27,098 km (15.3%) from 23,502 km in 2022. Most new infrastructure was multi-use paths (2725 km). High-comfort bike-only paths increased by nearly 50% (49 km). Nationally, access increased for recent immigrants, racialized people, and people with low incomes. Overall, areas with more children and older adults saw less increase in access to infrastructure, but within small and medium cities there were often increases.

Conclusion: Using a national dataset, we detected an increase in cycling infrastructure in Canadian communities, with mobility and health implications for many equity-deserving population groups. The greatest increases, proportionally, in cycling infrastructure were seen in small- and medium-sized cities.

Objective: Though sufficient and stable funds are critical to effective public health systems, existing literature on public health system financing is limited. This study aimed to address this gap by uncovering the salient factors influencing public health system financial decision-making.

Methods: We conducted a qualitative case study of public health system financing in British Columbia, consisting of a jurisdictional review of academic and grey literature, and semi-structured interviews with 14 participants influential in public health budget-setting. Taking an inductive analytical approach, we constructed a conceptual model of the political, structural, and external factors influencing public health funding trends. Building on insight from participants, we identified promising policy considerations for improving the sustainability of public health funding.

Results: Participants identified that external factors such as public health crises and major sociopolitical events create windows of opportunity for investments or cuts. They reported that structurally separating public health budgets from other health service budgets seems to protect public health funding. Political priorities of top decision-makers were highlighted as the most influential political factor, though advocacy has been successful in bringing public health issues onto the political agenda. Strong relationships between public health actors and decision-makers such as senior executives are seen as important for promoting investment in public health programs.

Conclusion: This study sheds light on some of the possible policy strategies for sustaining public health funding, such as inclusion of public health experts in financial decision-making and developing public health performance indicators, which may inform current public health system strengthening efforts.

Objective: Men often self-rate their mental health better than women and other gender groups. To better assess how gender is related to self-rated health, this study goes beyond the binary approach and explores how variations in self-rated mental health across multiple fixed gender categories are associated with variations along the continuous masculinity and femininity scales.

Methods: Data came from a large sample of Canadian adults (n = 11,712) collected from August 17 to September 19, 2021. Gender identity is measured using both fixed categories (i.e., men, women, and TNO-trans, non-binary, or other genders) as well as self-ratings of masculinity and femininity on a scale from 0 to 100. Self-rated mental health includes four categories: poor, fair, good, and excellent. Logistic regression models were used in estimations.

Results: Men reported better self-rated mental health than women and individuals who identify as trans, non-binary, or other genders. These gender gaps become non-significant once femininity and masculinity scales are taken into account. Overall, both femininity and masculinity are positively and non-linearly associated with self-rated mental health, and the positive associations get stronger at higher levels of femininity and masculinity. When separated by fixed gender categories, the accelerating positive effect of masculinity on self-rated mental health is present among both men and women, but not among TNO individuals. In contrast, the accelerating positive effect of femininity is observed only among men.

Conclusion: The gender gaps in self-rated mental health are primarily driven by the differing relationships between mental health and masculinity and femininity across gender categories. Improvement in measuring gender identity can provide valuable insights into how gender is a critical determinant of mental health and mental health disparities. It can also help identify those most affected and enable more targeted prevention and treatment services.

Objectives: Air pollution remains a significant public health challenge, contributing to substantial morbidity and mortality. The aim of this study is to identify effective intervention strategies for mitigating air pollution and its health effects in southern Quebec.

Methods: We employ the Polair3D chemical transport model to estimate population-weighted concentrations of fine particulate matter (PM_2.5), nitrogen dioxide (NO₂), and ozone (O₃) at the census division level under four scenarios: replacing residential wood stoves with U.S. Environmental Protection Agency (EPA)-certified models (EPA), eliminating industrial emissions (IND), full vehicle electrification (EV), and removing emissions from refineries and smelters (RS). Health impacts were quantified with the Air Quality Benefits Assessment Tool for chronic PM_2.5 exposure and chronic NO₂ exposure, in addition to the commonly assessed acute NO₂ exposure and acute O₃ exposure.

Results: All scenarios reduced air pollutant concentrations and associated mortality to varying degrees. The EPA and EV interventions are the most effective in reducing mortality, lowering deaths attributable to pollutants by 15.26% (789 deaths from 5169 to 4380) and 16.13% (834 deaths from 5169 to 4335), respectively. The EPA scenario yields the greatest reduction in PM_2.5-related mortality, while the EV scenario provides the most benefit for NO₂-related mortality.

Conclusion: Targeted interventions can significantly reduce air pollution-related mortality. Replacing residential wood stoves and fully electrifying vehicles are particularly effective, with distinct benefits for PM_2.5- and chronic NO₂-related health outcomes. A multi-sectoral approach is essential to maximize public health gains.

Setting: Partner and stakeholder engagement (PSE) in public health that involves tokenistic and performative practices results in further marginalization of priority populations. Inclusive, intentional, and mutually respectful engagement requires an intersectional approach to account for the overlapping and compounding impacts of multiple systems of power on the lived experiences of priority populations. However, there is a lack of practical guidance on methods, strategies, or approaches for how public health initiatives can meaningfully engage with priority populations.

Intervention: An evidence synthesis on intersectional approaches to PSE in public health was conducted to inform the development of an evidence-informed tool. Engagement approaches were evaluated based on (1) integration of intersectionality, as defined by the Intersectionality-Based Policy Analysis Framework and (2) level of stakeholder engagement achieved, from communication to co-production.

Outcomes: The resulting tool offers "key considerations" for incorporating intersectionality principles in PSE in public health, encouraging critical reflection on the who, why, and how of PSE. Organized by the development, implementation, and monitoring and evaluation phases of public health initiatives, these considerations guide users through critical reflection by posing open-ended questions.

Implications: The tool's "key considerations" are relevant for all public health practitioners, with an emphasis on those in public health institutions. It guides users in navigating structural and interpersonal power imbalances with systemically marginalized priority populations. Adopting an intersectional lens enhances the ability to identify and address the complex array of determinants of health, tailored to population-specific needs and priorities.