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

Setting: This paper describes an action research project with the Centre universitaire intégré de santé et de services sociaux - Capitale Nationale (CIUSSS-CN) who identified a need to assess vulnerability in their territories in order to ensure equitable distribution of the Integrated Perinatal and Early Childhood Services (SIPPE) program funds. The objective was to design and validate a multicriteria model to provide a more accurate portrait of vulnerability based on recent social realities.

Intervention: Our multidisciplinary research team of 7 members included experts in analytics, decision aiding, and community and public health. In collaboration with 6 CIUSSS-CN professionals, we co-constructed, during 9 workshops, a multicriteria model to aggregate the multiple dimensions of vulnerability. We used a value-focused thinking approach and applied the method MACBETH assisted by a geographic information system.

Outcomes: Criteria, scales, and weights were validated and led to a vulnerability score for each CIUSSS-CN territory. This score provides a more accurate portrait of territorial disparities based on data and the participants' experience. The model was implemented in a dynamic user-friendly tool and serves to support decision-makers in the resource allocation process. Knowledge transfer was conducted during and after the process.

Implications: This multidisciplinary research has served to anchor public health funding in local realities, with an emphasis on equity and stakeholder engagement. Our mixed-method approach integrating qualitative and quantitative data is adaptable to other contexts. Our results can enhance intervention effectiveness and allow for a better response to the needs of the population targeted by the SIPPE program.

The nearly 115-year history of the Canadian Journal of Public Health (CJPH) provides an important opportunity to reflect on and learn from our past. In response to an invitation to members of the CJPH Editorial Board to curate historical articles around a theme, we undertook a historical examination of our field's engagement, as gleaned through the pages of CJPH, with economic policy. This was inspired by the now well-established connections among political economic policy, population well-being, and health equity. Our analysis of six historical volumes (1917, 1933, 1941, 1961, 1995, and 2013) led to three key findings. First, we found only a slim historical foundation for public health engagement with the economy overall. Second, we observed a strong and seemingly subconscious allegiance to dominant economic paradigms, despite their incompatibility with root causes of health inequities. Third, even though socio-economic inequalities in health are a long-standing preoccupation of CJPH authors, those inequalities are consistently and curiously divorced from their roots in political economic systems. Our findings provide a historical foundation for thinking about how our public health community could be encouraged to engage constructively towards an economic system that supports, rather than obstructs, population well-being and health equity.

Cannabis control policies are increasingly being liberalized, including the legalization of non-medical cannabis use and supply in multiple settings, for example in Canada, with main policy objectives focusing on improved public health. An important while contested matter has been the appropriate design of legal cannabis supply structures and sources. These, in most Americas-based legalization settings, have included provisions for (limited) 'home cultivation'. Recent data suggest that about 8% of active consumers engage in cannabis home cultivation for their own supply, while approximately 14% are exposed to it in/around their home. Home cultivation commonly exceeds legal limits and/or occurs where not allowed, and is disproportionately associated with high-frequency and/or other risk patterns of cannabis use. In addition, home cultivation may facilitate exposure or diversion of cannabis to minors, as well as pose possible environmental exposure risks especially when occurring indoors. Given its placement in private spaces, related regulations are largely shielded from enforcement. Home cultivation, therefore, bears substantive potential to circumvent or work counter to public health‒oriented legalization policy objectives. Recent assessments of health outcomes from cannabis legalization show mixed-including multiple adverse-results, implying the need for regulatory revisions towards protecting public health outcomes. Especially in settings where extensive (e.g. commercial) retail systems were established to provide regulated, legal cannabis products to consumers, it is questionable whether home cultivation overall serves primary public health‒oriented objectives; relevant data should be expanded and used to review related provisions.

Objectives: The Canadian 24-Hour Movement Guidelines include recommendations for healthy levels of physical activity, sedentary behaviour, and sleep. Meeting these recommendations could help immigrants stay healthy. However, little is known about the movement behaviours of adult immigrants in Canada nor how these differ in relation to non-immigrants or time since immigration. The objectives were to estimate and compare the prevalence of meeting the 24-Hour Movement Guideline recommendations among adult non-immigrants, established immigrants, and recent immigrants in Canada across different sex groups.

Methods: Self-reported data from the 2017 and 2018 cycles of the Canadian Community Health Survey were used. Meeting the guideline recommendations was based on the following: accumulating ≥ 150 min/week of moderate-to-vigorous physical activity (MVPA), limiting screen time to ≤ 3 h/day, and getting 7-9 h/day of sleep for adults aged 18-64 or 7-8 h/day of sleep for adults aged 65 + . Logistic regression was used to compare guideline adherence according to immigration status while controlling for age, sex, income, marital status, and education.

Results: Among immigrants, 21.5% met all three guideline recommendations, 43.7% met 2 of 3 recommendations, and 28.5% met a single recommendation. The corresponding values for non-immigrants were 26.2%, 42.7%, and 24.6%. Compared to established immigrants, recent immigrants were more likely to meet all three recommendations (OR = 1.27; 95% CI (1.07, 1.50)) and to meet the sleep recommendation (OR = 1.29; 95% CI (1.07, 1.54)) after controlling for confounders.

Conclusion: Approximately 1 in 5 immigrants in Canada met all three recommendations of the 24-Hour Movement Guidelines. Movement behaviours vary according to immigrant status.

Objectives: Staff at violence against women (VAW) organizations provide essential services for survivors of violence. The increase in VAW during the COVID-19 pandemic placed additional pressures on VAW staff. We investigated the impacts of the pandemic on the mental health of VAW staff in the Greater Toronto Area to inform recommendations for policy and practice.

Methods: We conducted a community-based, mixed-methods study on the processes, experiences, and outcomes of adapting VAW programming during the pandemic using a sequential explanatory approach. Throughout 2021, we conducted a survey of direct support and leadership staff who worked on VAW services ("VAW staff") followed by semi-structured interviews with VAW staff purposively sampled from the survey. We descriptively analyzed quantitative survey data on the mental health of 127 VAW staff. We then applied thematic analysis to qualitative data from 18 interviews with VAW staff. We used the qualitative data to support interpretation and enrich the quantitative findings regarding staff mental health.

Results: In the survey, 81% of leadership and 61% of direct support staff indicated that their work was more distressing during the pandemic. Participants reported moderate symptoms of vicarious trauma and mild symptoms of anxiety and depression. We generated three themes from the qualitative data to help explain these findings: (1) challenges related to changing work environments; (2) distress over not meeting client needs; and (3) difficulties in adapting self-care strategies in response to pandemic stressors.

Conclusion: VAW organizations require increased resources and flexible funding to hire and retain more staff to respond to higher and more complex caseloads during public health emergencies. With more structural supports in place, VAW organizations could create more time and space to develop their trauma-informed organizational practices: for example, establishing a culture of connection and learning among staff virtually and in-person and facilitating a range of self-care opportunities.

Objective: Out-of-hospital mortality rates surged during the early COVID-19 pandemic. While expecting a return to pre-pandemic levels, the evolving patterns of out-of-hospital mortality in Canada remain uncertain. We investigated whether these rates returned to pre-pandemic levels.

Methods: This retrospective study, employing linked administrative data, analyzed out-of-hospital mortality trends among adult residents in Ontario, Alberta, and Nova Scotia. Interrupted time series analysis assessed trends in age- and sex-standardized rates/100,000/quarter during pre-pandemic (April 2014-March 2020) and pandemic periods (April 2020-March 2022), while considering April to June 2020 as the pandemic onset period. Crude mortality rates were also examined, stratified by sex and age groups.

Results: Pre-pandemic, Ontario's standardized out-of-hospital mortality rates were rising, while Alberta's and Nova Scotia's remained stable. At the pandemic onset, all provinces experienced significant increases in standardized out-of-hospital mortality rates/100,000 (Ontario: β 14.6, 95% CI [3.97, 25.22]; Alberta: 21.3, 95% CI [9.26, 33.34]; Nova Scotia: 10.5, 95% CI [1.06, 19.88]). During the pandemic, standardized out-of-hospital mortality rates/100,000/quarter remained above pre-pandemic levels, with no significant departure from the increased pandemic onset levels (Ontario: - 1.6, 95% CI [- 3.63, 0.52]; Alberta: 0.45, 95% CI [- 1.47, 2.36]; Nova Scotia: - 0.06, 95% CI [- 2.18, 2.06]). Crude out-of-hospital mortality rates increased most prominently among individuals aged 18 to 45 in Alberta and Ontario, and among males across all provinces.

Conclusion: The sustained increase in out-of-hospital mortality, observed from the pandemic's onset, spanning more than 2 years, potentially suggests its persistent direct and indirect effects on population health in Canada.

The 2021 federal budget committed funding to a co-sponsored Statistics Canada and Environment and Climate Change Canada initiative aimed at conducting a 'census' of Canadian environments. The goal of the Census of Environment (CoE) is "to deliver a full picture of the complex relationship between ecosystems and the economy, society, and human well-being", with obvious implications for the ongoing monitoring and surveillance of environmental influence on human health. This commentary reflects on the evolution of the CoE initiative in describing two opportunities for population and public health researchers, practitioners, and policy-makers in engaging with the CoE and its data. First, it describes stated CoE commitments to enhancing access to complex environmental data and the provision of data processing to support novel analyses and data utilization. Second, it highlights the relative importance of disaggregating environmental data across a variety of bio-geographical scales to engender a holistic understanding of the health of multiple elements that comprise living systems, including consideration of environmental health equity and intersectoral action. It ends with a constructive critique of the CoE's framing of 'ecosystem accounting' to support its maturation, and advocates for public health involvement in centring the importance of health in this initiative into the future.

Objectives: While studies indicate that 2SLGBTQ + youth are more likely to experience negative psychological outcomes compared to their heterosexual and cisgender peers, less is known about the positive mental health (PMH) of 2SLGBTQ + youth in Canada. To fill this gap, we investigated disparities in PMH by self-reported sexual attraction among 15‒17-year-olds and gender modality among 12‒17-year-olds.

Methods: We analyzed data from youth respondents in the 2019 Canadian Health Survey on Children and Youth. We obtained estimates of average life satisfaction and high self-rated mental health, happiness, autonomy, competence, and relatedness for youth with an exclusively heterosexual attraction and youth with a minority sexual attraction (those exclusively attracted to the same gender, and those attracted to both females and males), and for cisgender and gender minority youth. Regression analyses were conducted to test for disparities on each PMH outcome.

Results: Compared with exclusively heterosexual youth, sexual minority youth reported lower life satisfaction and were less likely to report high self-rated mental health, happiness, autonomy, competence, and relatedness. Significant disparities were more consistently found for youth attracted to both females and males than youth exclusively attracted to the same gender. Gender minority (versus cisgender) youth also reported lower average life satisfaction and were less likely to report high self-rated mental health, happiness, autonomy, competence, and relatedness.

Conclusion: Although this study provides evidence for the presence of disparities in PMH, its strength-based focus on PMH also documents the presence of well-being among many sexual and gender minority youth in Canada.

Objectives: Research has shown that insomnia and chronic diseases can simultaneously impact overall health, including physical, mental, emotional, and spiritual health. This study aims to find the association between insomnia and the four domains of health based on an Indigenous Medicine Wheel and to find the role of multimorbidity as a mediator between this relation among First Nations people.

Methods: We used data (n = 588) from the First Nations Sleep Health Project, a collaboration between two Cree First Nations communities in Saskatchewan and a research team at the University of Saskatchewan. Insomnia was measured by the Insomnia Severity Index (ISI). A multivariable logistic regression model was fitted, and the strength of significant predictors was presented as odds ratio (OR) and 95% confidence interval (CI). Using generalized structural equation modelling, we assessed the mediating effect of multimorbidity after adjusting confounders.

Results: Most participants (~ 70%) reported good or better health in the four domains. After adjusting for potential risk factors, we found that the probability of having poor or fair health in all four domains (physical, mental, emotional, and spiritual) was higher among people with severe to moderate insomnia (OR = 3.06 (1.76-5.30), 2.77 (1.54-4.99), 3.19 (1.85-5.52), and 1.57 (0.88-2.80), respectively). Additionally, the total effect of ISI on physical, mental, emotional, and spiritual health was 51.34%, 61.72%, 44.81%, and 57.27%, respectively, mediated by multimorbidity.

Conclusion: The impact of insomnia on four domains of health and the mediation effect of multimorbidity on this path are unique findings. Early diagnosis and treatment of these conditions might improve overall health.