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

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.

Setting: The Middlesex-London Health Unit (MLHU) is a local public health agency serving a population of 500,000 people in southwestern Ontario.

Intervention: Public health can have a nearly infinite scope. Given the impact of our social, economic, and physical environments on health, everything can rightly be considered a "public health issue." However, the role of a local public health agency in addressing a "public health issue" varies widely and is not always clearly described. We have described and defined the interventions of a local public health agency and have developed a classification of common interventions. These interventions outline the work that we do for the community, clearly and concretely articulating the actions we take to protect and promote health.

Outcomes: The work of local public health agencies can be categorized and classified by these common interventions: • Communication and social marketing • Education and skill building • Healthy public policy development • Community and partner mobilization • Surveillance • Inspections • Investigations • Case, contact, and outbreak management • Clinical services delivery • Health resource inventory management • Vector control IMPLICATIONS: The benefits of defining the interventions of a local public health agency include an improved understanding of the skills required to do the work; opportunities to strategically target prioritized public health issues, utilizing the full suite of interventions to maximize impact; the ability to adapt to changing priorities; opportunities to effectively measure organizational performance; clarity with partners regarding roles and responsibilities in addressing public health issues; and an enhanced ability to tell others what we do and demonstrate our value.

Objective: Youth suicide, a major cause of death, is linked to poverty and other adverse experiences. Evidence of its association with food insecurity is unclear due to inadequate controls for household income in previous research. This cross-sectional study used independent reports of household income, food insecurity, and suicidal behaviours to examine these associations in a population-based sample.

Methods: The 2019 Canadian Health Survey on Children and Youth surveyed 6735 youth (15-17 years), gathering data on sadness/hopelessness, suicidal ideation, and suicide attempts. Adults provided information on household food insecurity using a multi-item scale and about diagnosed mood disorders in youth. Household income data were provided by government tax records. We used Poisson regressions to estimate the relative risk (RR) of each suicidal behaviour attributed to household food insecurity, adjusting for household income and other covariates.

Results: Approximately one in five (19.8%) youth experienced marginal (5.2%), moderate (7.9%), or severe (3.3%) food insecurity. Moderate or severe food insecurity was associated with increased risks of sadness/hopelessness, mood disorder, suicide ideation, and suicide attempts (RRs 1.30-2.17) after controlling for household income differences and other covariates. Generally, more severe food insecurity was positively associated with suicide behaviours.

Conclusion: Household food insecurity is associated with youth suicidal behaviours, independently of household income. Its underlying pathway to youth mental health includes social and psychological factors that require targeted policy intervention.

Objectives: Canadian Inuit children present more developmental vulnerabilities than other non-Indigenous children. Supporting the development of these children is therefore essential, especially in urban environments where the Inuit population is growing. This study aimed to identify the main resources used by Inuit families living in urban environments of southern Québec, (Canada) and to better understand their needs related to supporting the healthy development of their children.

Methods: A descriptive qualitative study was conducted using semi-structured interviews with 13 self-identified Inuit parents of at least one child aged 0 to 18 living in southern Québec.

Results: The study revealed that urban Inuit families primarily require support to meet their basic needs, ensure a safe family environment, promote their children's health, education, and socialization, foster the transmission of Inuit cultural and linguistic heritage, and, finally, enhance access to a culturally safe social environment. The study also revealed that despite living closer to a variety of resources intended to support their children's healthy development, families encounter significant barriers in accessing these resources. Moreover, families have specific needs that are often not adequately addressed by the resources currently available.

Conclusion: The study highlighted that the needs of Inuit families extend well beyond support for skills acquisition in the various developmental domains. Supporting the healthy development of Inuit children therefore requires a coherent and intensive response to families' most urgent needs. In the light of such findings, there is a clear need to improve access to existing resources, as well as to develop Inuit-led services that are adapted to realities and specific needs of the families.

Objectives: Cross-sectionally measured health disparities are well documented among sexual minority (lesbian, gay, bisexual) Canadian adults, yet the timing of these disparities is not understood, especially in harder-to-reach older adult populations. We estimated the prevalence and incidence of health and health-related outcomes over 6 years of follow-up in an older sample of Canadian adults.

Methods: Our analysis used data from the Canadian Longitudinal Study on Aging (CLSA), a prospective cohort of adults aged 45-85 (baseline, 2011-2015), with follow-up over 6 years (2015-2021; n = 45,079). Respondents who self-identified as lesbian, gay, bisexual, or another sexual minority identity at either baseline or first follow-up were considered LGB+. Study outcomes included physical health, mental health, health care service use, negative health behaviours, and other health-related behaviours (e.g., rentership). We computed adjusted prevalence ratios (PRs) and relative risks (RRs) stratified by sex (female/male) using modified Poisson regression with robust error variance.

Findings: Older sexual minority adults had a greater prevalence of and were at elevated risk of new-onset mental health diagnoses (e.g., depression: RR_F = 2.03, 95% CI: 1.39, 2.96; RR_M = 2.15, 95% CI: 1.50, 3.08). Older sexual minority adults also initiated psychological services more than older heterosexual adults (e.g., RR_F = 1.43, 95% CI: 1.10, 1.85; RR_M = 1.39, 95% CI: 1.05, 1.83). There was evidence of other prevalence differences between men and women, but with no difference in longitudinal risk (e.g., memory problems: PR_F = 1.78, 95% CI: 1.24, 2.55; RR_F = 1.70, 95% CI: 0.97, 2.95).

Conclusion: Older sexual minority Canadians face disproportionate health challenges, particularly in mental health. Our findings demonstrate the importance of inclusive and affirming gerontological care in supporting the healthy aging of sexual minority Canadians.

Objective: The objective of this study was to characterize new HIV diagnoses in key Ontario cities, in order to understand current drivers of continued HIV transmission to inform HIV testing and prevention efforts.

Methods: Chart reviews were carried out at four clinical sites in Ontario, Canada. The study population included individuals who were diagnosed with HIV in Ottawa, Hamilton, and Toronto between January 1, 2018, and December 31, 2020, and had no previous evidence of HIV documented.

Results: The total number of persons in this analysis was 359, from Toronto (n = 201), Ottawa (n = 88), and Hamilton (n = 70). More than half of the diagnoses were among those who immigrated to Canada, and many were diagnosed (11%) during the year they arrived. Many participants experienced a late diagnosis (43.2%), and while 116 (32.3%) had HIV testing history in Ontario, 155 did not (43.2%). Many participants were men who have sex with men (MSM) and had a previously recorded diagnosis of gonorrhea or chlamydia (n = 27; 7.5%) or syphilis (n = 39; 10.9%). Among women and heterosexual men, a diagnosis of hepatitis C (n = 18; 5.0%) appeared to signal a risk of HIV diagnosis.

Conclusion: These data show that HIV testing and prevention strategies should be targeted to (1) MSM with a history of syphilis, gonorrhea, or chlamydia; (2) heterosexual men and women with a history of hepatitis C; and (3) immigrants within the first 5 years of migration. To address the evolving epidemic, it will be necessary to employ targeted HIV screening and prevention measures.

Canada's universal healthcare system aspires to provide equitable care for all citizens, yet persistent health disparities among Indigenous, Black, and other racialized communities reveal significant gaps in service and outcomes. This commentary explores how race-based data collection could address these inequities by identifying at-risk populations, informing targeted interventions, and improving accountability within healthcare systems. The discussion includes an overview of existing challenges, such as mistrust stemming from historical research abuses, varied provincial approaches, and ethical complexities related to privacy and data sovereignty. Examples from within Canada highlight the effectiveness of standardized data collection policies, while international lessons-particularly from the United Kingdom's incentivized data reporting and the United States' mandated approaches-underscore the importance of consistent data-gathering and careful monitoring. The commentary emphasizes that community engagement and leadership are essential to the development of culturally safe practices, and that legal and ethical frameworks must safeguard data from commodification or other forms of misuse. By integrating race-based data collection into policy reforms, embracing Indigenous data governance principles, providing mandatory training for health providers, and establishing robust monitoring systems, Canada can advance meaningful strategies to reduce health disparities. This approach promotes a more equitable healthcare environment, ensuring the principle of universal coverage benefits all communities.

Objective: To systematically review and synthesize evidence from reviews about the effectiveness and cost-effectiveness of population-level policies to reduce alcohol use.

Methods: We searched peer-reviewed literature using eight electronic bibliographic databases, grey literature using two databases, two search engines, and two working paper repositories, and examined references of included studies. At least two reviewers independently screened articles for inclusion, extracted detailed characteristics, and assessed the risk of bias of each included study. We considered all reviews that included studies which quantitatively examined the relationship between alcohol consumption and population-level policies that seek to regulate the public availability and marketing of alcoholic beverages. After screening according to a set of predetermined criteria, we included 32 reviews.

Synthesis: We found consistent evidence that addressing alcohol availability (introducing or increasing minimum purchasing age, restrictions on temporal availability, decreasing outlet density, government monopolization) was associated with lower alcohol use; and a general lack of evidence on the associations between alcohol marketing (marketing self-regulation, advertising from government authorities, regulating the volume of advertising from alcohol manufacturers, and introducing warning labels) and alcohol consumption, which precludes any conclusions about these regulations. Additionally, we found scarce evidence about the cost-effectiveness of population-level policies to reduce alcohol use, which is likely due to the relatively low cost of implementation and enforcement of these policies.

Conclusion: The Government of Ontario began expanding privatized alcohol sales in 2015 with further expansions starting in August 2024. Evidence from reviews suggests that this increase in availability will result in increased alcohol consumption.