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

Setting: The Quw'utsun Preterm Birth Study used a community-led and participatory action research methodology to investigate preterm birth in Quw'utsun, a First Nations community in Cowichan Valley, British Columbia (BC). Quw'utsun people and staff from the community's Ts'ewulhtun Health Centre partnered with the BC First Nations Health Authority, Island Health (regional health authority), and the University of British Columbia to develop Nuts'a'maat shqwaluwun (one heart, one mind), a framework for conducting research activities.

Intervention: Guided by Elders, Nuts'a'maat shqwaluwun incorporated Quw'utsun standards for research ethics by knitting together snuw'uy'ulh (ways of life), such as Stsi'elh stuhw tu Sul-hween (honour the Elders), with federal policy for ethical conduct of research involving Indigenous people. Situating the study at Cowichan Tribes strengthened the community's authority to lead.

Outcome: The framework, Nuts'a'maat shqwaluwun, fostered a research environment where we could Ti'tul'atul' tst (learn from one another). We learned to bring our knowledges together to conduct the study in ways that respected snuw'uy'ulh. This research was meaningful to Quw'utsun people because snuw'uy'ulh were respected. Our partnerships resulted in the first-ever report of preterm birth rates and risk factors among Quw'utsun people. Knowledge translation activities enhanced community access to results.

Implications: Indigenous Peoples have an inherent and legislated right to self-determination, including the right to lead research involving them. Several principles within Nuts'a'maat shqwaluwun enabled Quw'utsun people to lead this research: (1) trusting relationships; (2) respecting community-specific ways of life; (3) community ownership and access to data; and (4) training opportunities to lead research.

Objectives: Previous research on the association between income inequality and population health measures has yielded mixed results. This reflects, in part, the level of income inequality and surrounding political economic context of the setting in question. Previous research in Canada has not consistently identified an association between income inequality and population health measures. Those studies, however, largely focused on time periods prior to the manifestations of neoliberal policy reforms, which led to high levels of income inequality characterized by rising income at the top of the distribution. Our objective was to investigate the population-level association between income inequality and life expectancy in Canada during the years 1996-2019, a period of high after-tax income inequality in Canada.

Methods: We used ordinary least squares panel multivariate regression analysis of publicly available aggregate data on after-tax income inequality and life expectancy for the 10 Canadian provinces during the period 1996-2019. We used an inequality variable that is sensitive to the disproportionate growth in income at the top of the income distribution (share of income held by top 5%); we took into account the proportion of the First Nations, Métis, and Inuit populations across provinces and over time; and we separately analyzed female, male, and total populations.

Results: We found a robust, negative and statistically significant association where higher population-level after-tax income inequality was associated with lower average life expectancy in Canada.

Conclusion: Our findings speak to the far-reaching consequences of neoliberalism, and to the need for public policy that will reduce income inequality in the interest of the public's health.

Objectives: Unpaid caregiving can negatively impact well-being, but not all caregivers are affected equally. We explored factors associated with unpaid caregivers' health and financial outcomes.

Methods: We conducted a cross-sectional analysis of a panel survey from (n = 1977; 11% response rate) the Canadian Centre for Caregiving Excellence's "National Caregiving Survey" using logistic regression to assess the adjusted odds (aOR) of poor physical, mental, and financial health by caregiver, care recipient, and caregiving intensity characteristics.

Results: Twenty percent of respondents reported poor physical health, 25% poor mental health, and 38% financial hardship. When adjusting for all other covariates, those who had a lower income or provided care to younger adult individuals (18-64 years) were more likely to report all three co-primary outcomes (aORs ranging from 1.68 to 1.80) and caregivers of sexual minorities were more likely to report poor physical and mental health (aOR 1.66, 95%CI 1.13-2.45, and 2.15, 95%CI 1.51-3.05, respectively). Compared with young adult caregivers (18-24 years), older caregivers (≥65 years) were less likely to report poor mental health (aOR 0.39, 95%CI 0.23-0.66), while middle-aged (45-64 years) and older (> 65 years) caregivers were more likely to report poor physical health (aORs 2.21, 95%CI 1.22-4.04, and 1.87, 95%CI 0.99-3.51, respectively). Those identifying as women were more likely to report poor mental health and those providing more intense care were more likely to experience financial hardship.

Conclusion: Specific unpaid caregiver subgroups may be more at risk of poor physical, mental, and financial health and may be important targets for interventions aimed at improving these outcomes.

The Health Promotion Solutions Surveillance (HPSS) framework is proposed to enhance public health systems by systematically identifying, cataloguing, and supporting community-driven public health solutions. Developed in response to limited public health resources and the dominance of problem-focused health protection surveillance systems, this framework can complement current infrastructure using a proactive and solutions-oriented approach. Designed for implementation by government public health systems, it focuses on interdisciplinary collaboration, equity, and engagement with communities and their grassroots initiatives. Rooted in health promotion principles, it seeks to address systemic inequities and bridge public health gaps that fail to adequately resource people and communities to address identified public health issues. Although the framework has not been implemented in its intended context, its ability to recognize various methodologies and use diverse methods, including community network identification, digital ethnography, and participatory action research, would position public health systems to promote innovation, collaboration, and sustainable public health outcomes. An accompanying visual guide outlines practical steps and principles for operationalizing this framework, offering public health professionals and policymakers a tool to align local interventions with public health goals.

Objectives: The COVID-19 pandemic had a disproportionate impact on members of Canada's Black community. Morbidity and mortality rates were higher among Blacks, and the mental health of Black youth was particularly affected by health policy measures undertaken during the pandemic, such as social distancing and isolation. Despite this understanding, a lack of awareness remains regarding how containment measures from COVID-19, such as school closures, physical distancing, and lockdowns, impacted the mental health of Black youth in Canada.

Methods: We employed a qualitative description approach informed by Youth Participatory Action Research and guided by intersectionality theory as our methodological framework. Semi-structured interviews were used as the primary data generation method, enabling Black youths from across Canada to share their experiences of how the COVID-19 pandemic uniquely impacted their mental health. Thematic analysis was applied to analyze the data and identify key patterns and themes.

Results: We recruited 48 Black youth, aged 16 to 30 years. Analysis revealed heightened stress, depression, and anxiety during the COVID-19 pandemic. These mental health challenges were linked to prolonged isolation, academic disruptions, financial insecurity, precarious employment, and fears of police brutality, all of which were exacerbated by the pandemic's disproportionate impact on Black communities.

Conclusion: The COVID-19 pandemic has had a profound impact on the mental health of Black youth in Canada. The results of this study highlight the urgent need for increased attention and investment in mental health initiatives specifically targeting Black youth across the country.

Objectives: To describe mental health indicators according to regular (i.e., weekly or daily) alcohol, cannabis, and/or nicotine use in a population-based sample of young adults.

Methods: Data for 733 participants (mean age = 30.6 years) were drawn from cycle 23 of the ongoing Nicotine Dependence In Teens study, Montreal, Canada. The associations between (i) number of substances used and (ii) pattern of polysubstance use and each of depressive symptoms, anxiety symptoms, and positive mental health (PMH) were modeled using multivariable linear regression adjusting for age, sex, and education.

Results: Median (IQR) scores for depressive symptoms (range 0-50), anxiety symptoms (range 0-21), and PMH (range 0-70) were 8.0 (7.0), 4.0 (6.0), and 43.0 (18.0), respectively. One third (37%) of participants did not report regular use of any substance; 42%, 16%, and 5% reported regular use of one, two, or three substances, respectively. There was no dose-response association between number of substances used and any mental health indicator. Relative to no substance use, regular use of two substances was associated with more frequent anxiety symptoms ( $\hat{\beta }$  [95% CI] = 1.32 [0.34, 2.31]) and lower PMH (-3.64 [-6.34, -0.95]). Specifically, the cannabis-nicotine combination was associated with more frequent anxiety symptoms (2.58 [1.06, 4.10]) and lower PMH (-5.90 [-10.04, -1.76]). The alcohol-nicotine combination was associated with lower PMH (-3.70 [-7.30, -0.10]).

Conclusion: Specific pairings of alcohol, nicotine, and cannabis may be important in their associations with mental health. Longitudinal studies in population-based samples of young adults are needed to replicate these findings before their implications for public health programming can be considered.

Objective: The City of Toronto opened COVID-19 Isolation and Recovery Sites (CIRS) in 2020 in response to the need for supported isolation spaces for people experiencing homelessness. As a team of academic researchers and community partners, we assessed how lessons from the CIRS can inform post-pandemic policies for people experiencing homelessness. We focused on identifying models and systems of care for understanding existing services and integration, identifying innovations, and imagining how care can be transformed to be more caring and just.

Methods: We conducted 43 key informant interviews with clinicians, peer and harm reduction workers, executive leaders, operational leaders, and people who worked for funding or decision-making organizations. Data were coded and analyzed using deductive content analysis.

Results: The CIRS presented a new service model that moved away from being overly medicalized towards having a community orientation, which involved greater integration of services for people experiencing homelessness, transparent decision-making, and open communication. Key to this approach were clinical case management, harm reduction services, strong support of peer workers, and adequate and consistent funding. Future models will need to address power imbalances and hierarchies through formal agreements and processes as well as establishing collaborative cultures.

Conclusion: The CIRS offer an important opportunity to rethink services offered within shelter settings. Such change will require a strong vision, sufficient funding, political will, and accountability among all stakeholders. The COVID-19 pandemic offers decision makers an opportunity to consider system-level transformation by looking at largely successful elements of the crisis responses.

Artificial intelligence (AI) is poised to transform healthcare delivery; this may be particularly important to underserved rural, remote, and Indigenous communities. This commentary explores the potential of AI to enhance healthcare access and outcomes of these populations while emphasizing the need for culturally safe and ethical implementation. By integrating AI with Indigenous knowledge systems through the Two-Eyed Seeing approach, we propose a framework that ensures that AI-driven healthcare is equitable, culturally sensitive, and effective. This public health perspective highlights the importance of approaching AI advancements with a culturally appropriate and relevant lens.

Objective: Canada is undergoing a crisis in mental health, and the federal government has established a strategy that is attentive to mental health among Black people. Our objective is to inform this work by understanding the relationships between race, discrimination, and mental health outcomes.

Methods: We obtained a sample of 17,526 respondents from the Canadian Community Health Survey Rapid Response Module on Experiences of Discrimination, which asked about respondent race and other sociodemographic and socioeconomic characteristics, the validated Williams Everyday Discrimination Scale, and mental health outcomes (mood and anxiety disorders, substance use, and self-rated mental health). We ran descriptive statistics as well as crude, sociodemographic- and socioeconomic-adjusted logistic regressions to assess relationships in the overall sample between race and the Williams Discrimination Scale and between the Williams Discrimination Scale and mental health outcomes.

Results: Compared to white people, Black people had two to three times the odds of experiencing frequent discrimination, while Asian people were not statistically different from white people. Frequent experiences of everyday discrimination in the sample were associated with between 40% and two times the odds of experiencing adverse mental health outcomes, though white people had the highest prevalences of adverse mental health outcomes in the sample.

Conclusion: In Canada, experiences of discrimination can produce adverse mental health outcomes, and Black people in particular experience high degrees of discrimination compared to all other racial groups. National health surveys should contain larger and more representative samples of non-white individuals, which allow for more complex analyses.