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

Objectives: The aim of this study was to examine an urban Indigenous food sharing initiative through an evaluation attending to the Food Share Initiative's implementation and early outcomes.

Methods: This project used a community-based participatory research methodology to guide an evaluation of process and initial outcomes. Storytelling methods including interviews and a sharing circle, which took place in July and August 2021, were used to create a relational context for the research team and project participants, which honour Indigenous research methodologies.

Results: A total of 14 self-identifying Indigenous people participated in this evaluation. Initiative staff and Food Share recipients identified community relationships as a shared initiative experience that contributed to the wholistic health effects experienced by recipients. All participants recognized capacity limitations of both Food Share recipients and operational staff were important constraints to the initiative's process and implementation. Participant recommendations to improve the Food Share included enhanced outreach to involve other Indigenous community members as well as infrastructure like long-term funding and a central location to strengthen the initiative's operational capacity.

Conclusion: As an important community food support, the Food Share's relational care approach fosters a meaningful and wholistic sense of nourishment for Indigenous community members in the Waterloo-Wellington Region.

Objective: Steatotic liver disease (SLD) is absent from global public health agendas. Our study is the first to comprehensively examine SLD prevalence in Canada, focusing on sex differences.

Methods: We used data from the Canadian Longitudinal Study on Aging between 2012 and 2018. Steatosis was identified using the validated NAFLD Ridge Score. Using the most recent diagnostic criteria, we defined metabolic (dysfunction)-associated steatotic liver disease (MASLD), metabolic dysfunction-associated alcohol-associated liver disease (MetALD), and alcohol-associated liver disease (ALD) and estimated prevalences by sociodemographic factors. Survey-weighted adjusted prevalence ratios (aPR) for MASLD (sex-stratified) and MetALD were estimated using Poisson regression with robust standard errors.

Results: A total of 24,888 people (51.4% female; median age 58 years) were included. The most common subtype of SLD was MASLD, 35% (95%CI, 34-36), followed by MetALD 2.6% (2.3-2.9), and ALD 0.8% (0.6-1.0). Overall, the prevalences for MASLD and MetALD were significantly higher among males at 46% (45-48) and 3.7% (3.2-4.2) compared to females at 24% (23-26) and 1.6% (1.2‒2.1), respectively. Lower household incomes were associated with higher MASLD prevalence in females (aPR, 2.9, 2.4-3.5) and males (aPR, 1.1, 1.0-1.3). Multimorbidity was high among the MASLD group; 31 unique MASLD phenotypes based on cardiometabolic characteristics were identified. Females with MASLD were also more likely to have more cardiometabolic conditions compared to males with MASLD.

Conclusion: In this large Canadian cohort, we found significant sex differences in SLD burden and cardiometabolic features. Epidemiological assessments are necessary to improve preparedness for the significant projected increase in advanced liver disease.

Objective: Robust public health systems are vital for preventing disease and injury, improving well-being, and promoting health equity. The study objective was to estimate the association between public health funding and fruit and vegetable intake.

Methods: Participants were residents aged 12 years and older living within 34 public health unit (PHU) regions in Ontario, Canada (n = 36,500). Secondary cross-sectional data from the population-representative 2013-2014 Canadian Community Health Survey (CCHS) were used. Vegetable and fruit intake was self reported in the CCHS along with individual covariates. PHU funding per capita and other area-level social characteristics were measured at the level of the public health region.

Results: PHU funding per capita was not associated with vegetable and fruit intake overall (OR = 1.02, 95% CI 0.97, 1.07) or in gender-stratified analyses (males: OR = 1.06, 95% CI 0.99, 1.13; females: OR = 0.98, 95% CI 0.92, 1.05). Associations were not heterogenous across various sociodemographic indicators (age, gender, race, marital status, country of birth, education, income, urbanicity).

Conclusion: PHU funding per capita was not associated with vegetable and fruit intake. More refined measures of PHU funding for vegetable and fruit intake may be beneficial for future research.

Objective: The objective of this study was to examine whether cannabis exposure calls to the British Columbia Drug and Poison Information Centre (DPIC) were impacted by the legalization of non-medical cannabis in Canada.

Methods: We fit interrupted time series models to monthly counts of cannabis cases from 2013 to 2021, stratified by age and cannabis form. We set the intervention month to October 2018 legalization for cases involving inhaled dried cannabis and ingestible oils and capsules. We set the intervention month to January 2020 for cases involving edibles and inhaled concentrates to reflect their commercial rollout after their October 2019 legalization.

Results: DPIC managed 3989 cases involving cannabis exposure between 2013 and 2021. The rate (95% CI) of all cannabis cases increased by 17% (14%, 20%) annually from 2013 to October 2018 legalization. The highest pre-legalization increase was in pediatric edible cases with 52% (36%, 69%) and 57% (35%, 82%) annual increases among children aged 5 and under and 6 to 12, respectively. Upon legalization, the rate of cases consuming oil and capsule products spiked by 26% (- 19%, 96%) followed by a decrease, but remaining higher than the pre-legalization rate. Legalization did not have an immediate effect on the rate of cases involving edibles or inhaled cannabis, which all continued to increase post-legalization, albeit at slower rates.

Conclusion: Regardless of the contributing factors to cannabis case trends at DPIC, these data highlight the importance of poisoning prevention policies, promotion of low-risk use, and routine surveillance.

Intervention: School Street initiatives are traffic-free zones around the entrances of primary schools designed to make it safer for children to come and go from school. Beyond increasing safety, these initiatives offer opportunities for children to increase their engagement in active school travel and to become more independently mobile.

Research question: How does the implementation of a School Street intervention influence children's active travel and independent mobility on their way to school?

Methods: A School Street intervention was implemented every Friday at a primary school in Montreal from September 2022 to June 2023. Bi-monthly direct observations were conducted to collect data on children's modes of travel and whether they travelled independently or with an adult before the start of classes.

Results: Independent, active travel was more frequently observed on School Street days compared to non-School Street days. Additionally, a progressive increase in active transportation and independent mobility was observed throughout the school year, regardless of School Street designation.

Conclusion: This study underscores the potential impact of School Street interventions on enhancing children's active school travel and independent mobility. Establishing safe zones near schools can positively influence children's commuting behaviours, fostering healthier and more autonomous travel habits.

Objectives: Many Canadian Armed Forces (CAF) members and veterans will receive a mental disorder diagnosis, and a high percentage will also experience suicidal behaviours. This study examined demographic characteristics, distal and proximal risk factors, and protective factors, and their relationship to suicidal behaviour (ideation, plans, and attempts) among CAF members and veterans who met criteria for a mental disorder at baseline.

Methods: Data from the 2018 CAF Members and Veterans Mental Health Follow-up Survey (n = 2941) were utilized. Mental disorder diagnoses were assessed through structured diagnostic interview. Generalized linear models were conducted using subsamples of individuals with a lifetime baseline diagnosis of (a) major depressive episode (MDE), (b) posttraumatic stress disorder (PTSD), and (c) an anxiety disorder (AD; social phobia, generalized, panic).

Results: Across mental disorder subsamples of those with MDE and AD, land environmental command at baseline was associated with increased prevalence of suicidal behaviour. Risk factors for suicidal behaviour across all subsamples included baseline suicidal behaviour, greater level of self-medication and avoidant coping style, greater level of baseline work stress, greater number of traumatic experiences, persistence or recurrence of index mental disorder, current comorbid mental disorder, current physical health condition, exposure to "other" traumatic experiences, and alcohol use disorder. Protective factors across all subsamples included greater level of current problem-solving coping style. Disorder-specific factors were also identified.

Conclusion: This study identified characteristics of individuals living with mental disorders who might be at high risk of suicidal behaviour, highlighting potential areas for targeted interventions in this key population.

Objectives: A pilot population health intervention (5A-QUIT-N) was implemented in a French region with the aim of organizing smoking cessation counselling during pregnancy. The intervention is offered to pregnant women regardless of the stage of pregnancy. This initiative took place in a national context where smoking screening is established, but systematic smoking cessation support is not yet in place. The objective of this research was to assess the viability of the intervention by exploring four criteria: "practical", "affordable", "suitable", and "helpful". The study aimed to identify enablers and barriers for each criterion, based on the experiences of midwives and women who smoked during pregnancy.

Method: A qualitative methodology was used to explore enablers and barriers to the 5A-QUIT-N pilot intervention viability. Semi-structured interviews were conducted with midwives involved in the intervention and women who smoked during pregnancy and gave birth in the maternity ward of the pilot area. Interview data were analyzed thematically, using viability criteria as categories.

Results: Among the four viability criteria explored, barriers and levers were identified at three levels: factors related to women and their environment; factors related to healthcare professionals' practices; and factors related to the healthcare system and its organization. Smoking cessation counselling was considered relevant and was highly valued by women. The intervention led to a change in the smoking cessation practices of midwives. Barriers were identified by both groups such as living with a smoker for women and women's reluctance to attempt to quit, according to midwives.

Conclusion: Some adaptations are needed to better align the intervention with the daily difficulties of pregnant smokers as well as the way healthcare professionals can encourage them to quit. This study shows that the intervention meets the viability criteria. These results are encouraging for broader implementation in other contexts.

Intervention: Live Well PEI provides individuals and organizations in PEI with information and tools to support healthy behaviours. This paper describes the development of the Live Well PEI community-mobilization intervention, consisting of a website and integrated community granting program for health promotion initiatives.

Research questions: (1) What is an effective design of a web-based community-mobilization intervention for community-led health promotion and (2) what lessons can be learned and shared for community-engaged, evidence-informed public health intervention development?

Methods: Intervention development followed the Six Steps in Quality Intervention Development (6SQuID) process. Through literature reviews, jurisdictional scans, expert consultations, and community engagement, evidence for conditions that foster community mobilization was gathered and used to inform development of intervention components. The intervention was refined through iterative expert and community consultations.

Results: Four conditions that foster community-led health promotion were identified: accessibility of grant funding, availability of community data, resources to enhance capacity, and community collaboration. These conditions informed outputs of a Theory of Change. Intervention design that supports these conditions included website elements such as collections of evidence-informed health promotion interventions, stories of prior community-led projects, and community health status and needs information. The granting program integrates research and community feedback on project eligibility, grant administration and support for awardees. Findings from an evaluability assessment support pilot-testing implementation of the intervention.

Conclusion: Development of the community-mobilization intervention provides a prime case example of evidence-informed, community-engaged public health intervention co-design. Learnings are applicable to community-focused health promotion initiatives across Canada.

Introduction: In Quebec, 87% of women diagnosed with breast cancer report lingering after-effects, such as fatigue, chronic pain, and difficulty returning to work after treatment. The Continuum PAROLE-Onco (CPO) 360 program addresses these complex and various unmet needs through a comprehensive and patient partnership intervention.

Objectives: The objectives of this study are to (1) explore the development process of the CPO 360 program during its inaugural year, with particular focus on the co-construction approach involving patient co-investigators (PCIs) and accompanying patients (APs), and (2) identify key insights to inform subsequent phases of feasibility and pilot testing, evaluation, and implementation, in alignment with a framework on complex interventions.

Methodology: A qualitative multiple-case study was conducted across three Quebec university hospitals to evaluate the first year of the CPO 360 program's implementation. The study focuses on how key components of this complex intervention were developed and adapted within real-world settings. Data sources included program documents, semi-structured interviews with accompanying patients, and a focus group with patient co-investigators. Thematic analysis was used to interpret the data, and the findings were reported in accordance with the COREQ checklist for qualitative research.

Results: The findings highlight several key developments: the creation of training programs for accompanying patients (APs), the design of tools to support patients during care transitions, challenges related to data access and the implementation of needs-based stratification, the development of strategies to educate and engage healthcare professionals, and efforts to raise awareness among primary care teams regarding patient follow-up.

Conclusion: This first phase in the development of the CPO 360 intervention is part of a dynamic, iterative, creative process that is open to change and forward-looking in its implementation. The co-construction process involving patients, professionals, and the community from the outset enables the development of a shared vision of how to improve the transition process in three different environments. Adjustments to its implementation will need to take account of intersectoral coordination and access to clinical resources.