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

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.

Objective: To examine the associations between food security status and dietary patterns among first-time food-aid users.

Methods: From September 2018 to January 2020, a sample of 1001 newly registered food-aid users from 106 community-based food donation organizations were recruited across urban, rural, and peri-urban areas in four administrative regions of the province of Quebec, Canada. The Household Food Security Survey Module (HFSSM) and the Short Diet Questionnaire (SDQ) were used to assess food security status and food intake, respectively. A posteriori dietary patterns were identified through principal component analysis. Regression analyses were performed on 987 participants with complete data to quantify the association between food security status and dietary patterns.

Results: Three main dietary patterns were identified: prudent (intake of fruits and fruit juice, plant-based beverages and legumes, green salad, carrots, other vegetables, whole grains, and fish), western (intake of poultry, red meat, potatoes and fried potatoes, rice, and pasta and refined grains), and snack foods (intake of salty snacks, cheese, butter and margarine, sweets, condiments, sweet beverages, and processed meat). Food insecurity was negatively associated with the prudent dietary pattern and positively associated with the snack food dietary pattern.

Conclusion: This study highlights the complexity of dietary patterns in a vulnerable population of first-time food-aid users, especially among those who are severely food insecure.

Setting: In Canada, racialized and immigrant women are typically under-screened for breast and cervical cancer. Under-screening is linked to numerous barriers to access, including lack of awareness, fear of pain, the stigma of cancer, socio-cultural factors like language, and various socio-economic factors. To address these barriers, our team developed a series of initiatives to promote awareness of breast and cervical health among Black women.

Intervention: Building on the development of a breast cancer resource hub for Black women, and in partnership with relevant community organizations, we implemented a series of virtual educational and cancer screening events (two of each thus far). Both event series were targeted towards Black women and tailored to their needs.

Outcomes: Each educational event attracted more than 450 attendees and had average attendance times > 1 h. Most (> 87%) survey respondents agreed that an event specifically for Black women helped them feel supported. The 2022 and 2023 screening events provided breast and/or cervical cancer screening for 46 and 48 women, respectively. In both years, most women (> 90% of question respondents) noted that they were (extremely) likely to go for a mammogram or Pap test when next due.

Implications: Both event series provided targeted opportunities for Black women to learn about prevention, risk factors, resources, and screening related to women's cancers. It is possible that, over time, such culturally tailored events can reduce or remove the stigmas associated with cancer and decrease differences in cancer-related knowledge and behaviours between racialized and non-racialized groups.

Canada is unique in that it has established four national strategies in support of sport, physical activity, and/or recreation (SPAR). Though some of these strategies identify potential social and environmental correlates of SPAR, and articulate societal outcomes such as changes in behaviour and health, there are no explicit links to larger global initiatives such as the United Nations' Sustainable Development Goals (SDGs). Given that countries are expected to propose a plan for addressing the 17 SDGs, and that obvious overlap exists between several of the proposed development goals and SPAR, Canada should consider whether common indicators can be identified across these strategies and the SDGs simultaneously to facilitate more efficient and effective action. To date, the only SPAR-related indicator proposed in the Canadian plan for SDGs is the health benefit(s) associated with engagement in daily physical activity under Goal 3. Taking an evidence-informed approach for identifying those SDGs for which there are synergies with existing SPAR strategies, we suggest that other goals addressing gender equality, sustainable communities, climate action, life on the land, and peace and justice also share co-benefits with SPAR in Canada. Thus, any revisions to the existing SPAR strategies should identify linkages to the SDGs and indicators.

Setting: Homelessness is a significant and growing public health concern across Canada. In Kingston, Ontario, the number of people experiencing chronic homelessness has more than doubled from 136 people in 2020 to 296 in 2023.

Intervention: An emergency shelter-in-place hotel program was established in April 2020 to provide non-congregate shelter to people experiencing homelessness and vulnerable to SARS-CoV-2 infections. Beyond preventing COVID transmission, the unintentional consequence was that a population that experienced chronic homelessness reduced drug consumption and became stable. In 2022, with increased funding from the Ministry of Health and the City of Kingston, a new Housing First program was implemented to transition individuals from homelessness to long-term stable housing.

Outcomes: Between November 2022 and June 2023, a total of 34 clients initiated the program. Of these clients, 10 completed the program and were successfully housed, 10 remained active participants, and 14 were discharged before completion. Strengths and challenges were identified. Diverse services provided to meet the population's needs and strong collaborations with various community partners were facilitating factors. Inadequate external resources, a lack of evening and prosocial activities, and outside peers (not part of the program) who influenced recovery plans were identified as challenges.

Implications: This program illustrates that simultaneously integrating housing, community building, mental health, and addiction services is possible and provides an innovative way to stabilize this vulnerable population of people experiencing homelessness. Results from this program and the knowledge generated through implementation are being used to further scale up the program.

Objectives: There is conflicting published evidence that unemployment impacts workplace safety. Some studies suggest that the workplace injury rate decreases during economic contractions, while others propose an increased rate of injuries during periods of economic contractions. This study investigated the association between unemployment rates and traumatic work-related non-fatal injury (WRNFI) in Saskatchewan, 2007-2018, in order to provide new insight into injury prevention.

Methods: Saskatchewan's retrospective linked workplace claims data from 2007 to 2018 were grouped by year, season, and worker characteristics (e.g., age and sex). Total employment, total labour force, and the number of unemployed workers from the Statistics Canada Labour Force Survey were grouped by year, season, sex, and age. These data were linked to the worker's compensation board injury claim data to determine the number of people at risk, serving as the denominator (offset term) for WRNFI rates, calculated as WRNFI cases per total employed workers. A negative binomial generalized additive model was used to examine the association between unemployment rates and WRNFI, adjusted for age, sex, industry types, and seasons.

Results: The WRNFI rate has declined since 2007. On average, workers aged 20-29 years had the highest WRNFI rate (541.6 ± 84.8/100,000). Men had 3.2 times higher WRNFI risk than women (RR = 3.2, 95% CI 3.12-3.22), with the highest WRNFI risk observed in the manufacturing (RR = 1.68, 95% CI 1.63-1.73) and construction (RR = 1.67, 95% CI 1.63-1.72) industries. WRNFI risk decreased non-linearly with an increasing unemployment rate, indicating a pro-cyclic pattern.

Conclusion: This analysis showed that WRNFI rates tracked unemployment rates. This suggests a need to increase prevention strategies and reduce disincentives for under-reporting during an economic downturn.

Health Canada recently issued a Marketing Authorization to expand the eligibility of the dairy-related exemption for Canadian front-of-pack labelling (FOPL) regulations. The 2024 Marketing Authorization exempts dairy-related products that are a 'source of calcium,' rather than only 'high in' calcium as previously regulated, from displaying a 'High in' front-of-pack nutrition symbol, regardless of their saturated fat and sodium levels. The Marketing Authorization, heavily influenced by the food industry, lacks strong scientific evidence to support its adoption. Although there is a high prevalence of inadequate calcium intakes among Canadians, the Marketing Authorization will exempt more dairy-related products that are significant contributors of saturated fat and sodium for Canadians. While providing very little calcium, many dairy-related products, particularly cheese products, are 'high in' saturated fat and/or sodium. Expanding the exemption criteria will allow dairy-related products with little health benefits to be reflected as 'healthy' (i.e., not display a 'High in' nutrition symbol), blunting the potential impact that FOPL regulations could have on improving the diets of Canadians. We strongly urge Health Canada to reconsider the expansion of the exemption and encourage others to conduct policy-relevant research and participate in the policy decision-making process to promote evidence-informed public health policies for the health of Canadians.

Objective: For First Nations people and Inuit who live on reserves or in rural and remote areas, a guideline requires their travel to urban centres once their pregnancy reaches 36-38 weeks gestation age to await labour and birth. While not encoded in Canadian legislation, this guideline-and invisible policy-is reinforced by the lack of alternatives. Research has repeatedly demonstrated the harm of obstetric evacuation, causing emotional, physical, and financial stress for pregnant and postpartum Indigenous women and people. Our objective was to describe the costs of obstetric evacuation, as reported in the literature.

Methods: We conducted a systematic review using online searches of electronic databases (Ovid EMBASE, CINAHL, Ovid Healthstar, PubMed, ScienceDirect, PROSPERO, and Cochrane Database of Systematic Reviews) and identified studies that reported costs related to medical evacuation or transportation in rural and remote Indigenous communities. We performed critical appraisal of relevant studies.

Synthesis: We identified 19 studies that met the inclusion criteria. The studies reported various types of cost, including direct, indirect, and intangible costs. Medical evacuation costs ranged from CAD $7714 to CAD $31,794. Indirect and intangible costs were identified, including lost income and lack of respect for cultural practices.

Conclusion: Costs associated with obstetric evacuation are high, with medical evacuation as the most expensive direct cost identified. Although we were able to identify a range of costs, information on financing and funding flows was unclear. Across Canada, additional research is required to understand the direct costs of obstetric evacuation to Indigenous Peoples and communities.