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

Objectives: This qualitative study examines how trust has changed during and after the pandemic among our study participants. It reveals how they made meaning of trust in federal and provincial governments, scientific research, and digital platforms, and how this meaning-making process changed and was challenged by a global public health crisis.

Methods: We applied a descriptive phenomenological approach to semi-structured interviews that were conducted between July and November of 2024. In total, 41 interviews were conducted. Interview transcripts were analyzed using the descriptive phenomenological approach to understand participants' lived experiences of the pandemic, followed by how these lived experiences contributed to how they made meaning of public trust, both during and after the height of the pandemic. This analysis resulted in themes by giving attention to expressive language and past experiences, and ultimately revealing the "essence" or distinct nature of these participants' experiences of the pandemic.

Results: Research participants expressed polarized views on government trust, with provincial administrations often perceived as prioritizing economic or political interests over public health, while federal government were associated more with incompetence than with self-serving motives. Our participants experienced relatively stable trust in scientists, though they were concerned about transparency and profit-driven motives - particularly concerning the short time it took for vaccines to be developed. Social media was largely perceived as an unreliable source of information, yet it remained influential in shaping participants' perceptions, especially regarding vaccine hesitancy.

Conclusions: We found that participants' public trust during the pandemic in Canada was highly dynamic and subjective, and was greatly informed by histories, lived experiences, and preconceptions about various institutions, such as the government, public health officials, and scientists. Changes in trust experienced by participants were anchored in experts' ability to communicate reliable information. Participants further emphasized the need for transparent and consistent messaging, particularly from the Government of Canada, to rebuild lost trust and prepare for future public health crises.

Introduction: Vape use among Canadian adolescents has increased over time, posing a significant public health concern in Canada. However, the rate of increase may vary year to year because of regulatory initiatives related to the Tobacco and Vaping Products Act (TVPA) and the pandemic. Therefore, we aim to examine how the rate of vape use changed between 2014 and 2022 while also investigating differences in vape use by province and sociodemographic characteristics.

Methods: Data from the 2014-2015, 2016-2017, 2018-2019, and 2021-2022 Canadian Student Tobacco, Alcohol, and Drugs Survey was used. Data on vape use in the past 30 days at these four survey time points, participants' province, sex, gender, school level, type of area of residence, and Indigenous identity were used to run weighted logistic regression.

Results: Vape use in the past 30 days increased among adolescents between 2014 and 2019, coinciding with the introduction of the TVPA. However, current vape use plateaued between 2018-2019 and 2021-2022, suggesting stabilization that may reflect both the longer-term impact of regulatory measures and changes brought by the pandemic. Based on 2021-2022 data, high school students, rural residents, females, Indigenous adolescents, and those in Newfoundland and Labrador had the highest odds of reporting vape use in the past 30 days.

Discussion: Our results demonstrate a substantial increase in the current vape use among adolescents from 2014 to 2019, followed by a plateau. Therefore, increased and sustained efforts are needed to prevent and regulate vape use among Canadian adolescents, especially within at-risk groups.

Emerging from the pandemic and the largest mass vaccination campaign in history, governments at all levels are once again calling for the development of comprehensive vaccination registries. Yet these calls have persisted for decades at the federal level, and little progress has been made. At the heart of the challenge is the need to clarify the objectives of federal vaccine data collection and how these objectives dovetail with the federal government's constitutional role and jurisdiction in public health. We suggest that pan-Canadian immunization information collection initially focus on vaccine safety and effectiveness, as these would be most concordant with provincial/territorial aims and would fall under the federal government's jurisdiction. The federal spending power could be utilized to further support provincial/territorial systems to facilitate pan-Canadian data collection for coverage.

While mammography screening programmes improve early detection and reduce mortality for individuals aged 50-74, its extension to those aged 40-49 remains debated. In Canada, breast screening eligibility varies between provinces/territories, with Ontario lowering its eligibility age from 50 to 40 in 2024. This commentary examines recent evidence, including observational studies and simulation models, suggesting that mammography screening from age 40 may offer net benefits. Additionally, using data from Ontario Health (Cancer Care Ontario), we compared stage at diagnosis and 5-year survival rates among 18,639 women aged 40-51 diagnosed with breast cancer (2009-2017). Individuals aged 40-49 had comparable stage at diagnosis and 5-year survival rates to unscreened individuals aged 50-51. Meanwhile, screened individuals aged 50-51 demonstrated the earliest stage at diagnosis and highest 5-year survival rate. Our analysis illustrates the arbitrary nature of an age-based screening threshold at 50. We demonstrate that outcomes for women aged 40-49 resemble those of unscreened women aged 50-51, who were just above the eligibility cutoff. While expanding screening may increase upfront costs, these could be offset by avoiding late-stage treatments and integrating risk-stratified approaches. Overall, women in their 40s may benefit from organized screening programs through earlier detection and improved survival.

Ten years since the Truth & Reconciliation Commission Report, Canadian institutions-including public health systems-have yet to advance the Calls to Action in a sustained, transformative way. As public health leaders in the territory now known as British Columbia, we witness tension as colleagues grapple with, "What is the work of Truth & Reconciliation? Whose work is it?". Too often, truth and reconciliation is delegated to a small Indigenous team (or, individual) dangling, isolated off the side of an organizational chart. We offer a metaphor highlighting two interconnected, but distinct areas of work to advance truth and reconciliation in public health. One is the work of reclaiming and resurgence of languages, culture, medicines, and connection to territory, undertaken by and for First Nations, Inuit, and Métis Peoples. The other is eradicating Indigenous-specific racism and white supremacy to advance cultural safety. It is not up to Indigenous people to eradicate racism; as it is constructed, maintained, and perpetuated by settlers, settlers are those with the power to eradicate it. As we move towards the anniversary of the TRC, we share a metaphor that helps our settler colleagues understand and claim their responsibility in truth, rights, and reconciliation in public health.

Objectives: Government-conducted population health surveys are important sources of data on health inequities for gay, bisexual, transgender, and queer men and nonbinary and Two-Spirit people (2S/GBTQ+). There is limited understanding of how vulnerable these surveys are to misclassification bias resulting from participants' reluctance to disclose their sexual orientation and gender identity. 2S/GBTQ+ people may be more willing to participate in community-based surveys, where they might feel safer disclosing their minority sexual orientation or gender identity than they would on a government survey. We sought to understand whether the proportion of 2S/GBTQ+ people who would disclose their sexual orientation on a government survey changed between 2012 and 2019 survey cycles, as well as the proportion of trans, nonbinary, and Two-Spirit participants who would reveal their gender identity, and the demographic factors associated with both.

Methods: We analysed data from the 2012 and 2019 cycles of Sex Now, a repeated cross-sectional Canada-wide online survey on the health and well-being of 2S/GBTQ+ people conducted by the Community-Based Research Centre. We computed frequencies and prevalence ratios of the likelihood of disclosing sexual orientation and gender identity on a Statistics Canada survey by a variety of demographic variables.

Results: We found that in 2019, 86.0% (95% CI [85.4, 86.7]) of all participants would reveal their sexual orientation, a significant increase from 2012 (69.5%, 95% CI [68.5, 70.4], Δ = 16.6%, 95% CI [15.4, 17.8]). However, participants who identified as bisexual, straight, or heteroflexible; who were in a relationship with a woman; or who were not "out" were less willing to reveal their sexual orientation. We found that 85% of trans men, nonbinary, and Two-Spirit participants would reveal their gender identity, which was more likely among those living with HIV or aged 19-29 years old.

Conclusion: These findings suggest that government datasets may significantly misclassify and underestimate the population size of 2S/GBTQ+ individuals. Persistent mistrust of government institutions within this community may exacerbate underreporting and non-disclosure, underscoring the need for research into methodologies that can enhance trust and improve the accuracy of population estimates. Researchers using existing government datasets should consider using statistical methods to account for potential misclassification error.

Objectives: Estimates of autism prevalence are critical for informing evidence-based decisions, allocating resources, and developing effective strategies to support autistic individuals and their families. In Canada, such estimates remain limited, with the most recent population-based data on autism prevalence and incidence in Manitoba spanning 2004-2015, underscoring the need for more current data.

Methods: We used linked, whole-population administrative health and clinical data to develop a validated identification algorithm. We determined annual prevalence and incidence rates of autism among Manitoba children and adolescents aged 0-17 from 2011 to 2022, and conducted regression modelling to examine changes over time, adjusting for sex, geography, and socioeconomic variables.

Results: We identified 9396 children and adolescents diagnosed with autism during the study period. The prevalence of autism diagnoses was 0.58% (95% CI 0.55-0.60) in 2011 and 1.67% (95% CI 1.63-1.72) in 2022. The incidence of autism diagnoses was 0.79/1000 (95% CI 0.69-0.90) in 2011 and 3.06/1000 (95% CI 2.87-3.27) in 2022. We found statistically significant year-over-year increases in both prevalence and incidence.

Conclusions: Increasing autism prevalence indicates a pressing public health need for sustained investment in specialized healthcare services and supports that promote the full inclusion of autistic people in society. Strengthening surveillance systems across Canada is essential for generating high-quality population-based data to inform policy development and resource allocation and ensuring the health and social needs of autistic people and their families are met.

Objectives: To examine (1) the alignment of an on-shelf nutrition labelling system with classifications of food processing; and (2) the impact of the system on food sales by type of food processing.

Methods: Transaction data from three supermarket banners of a major Canadian supermarket chain were examined before and after the Guiding Stars® system, an on-shelf nutrition labelling system, was implemented in control and intervention supermarkets (n≈1.88 billion products sold). Descriptive analyses examined alignment between Guiding Stars® and the NOVA categorization for type of food processing for 61,456 food and beverage products available for purchase, and percentage of products sold by type of processing. Changes in selling 100 units of products across processing type overall and within 11 food categories were evaluated.

Results: The Guiding Stars® and NOVA systems were moderately consistent in categorizing products by healthiness. The majority of products sold (53.7%) were ultra-processed foods (UPF). Small but significant positive shifts were observed in the intervention sites with increased purchases of un/minimally processed products in three categories and processed products in three categories relative to the change in UPF. Negative shifts were observed with increased purchases of UPF relative to changes in un/minimally processed products in one category and processed products in two categories.

Conclusions: On-shelf nutrition labelling systems may affect small shifts in food sales with an overall shift away from UPF, but with differential impact across food categories. Incorporating food processing into nutrient profiling systems for on-shelf labelling may result in greater reductions in UPF purchasing.

In the mid-1980s, a remarkable polymath, Dr Fraser Mustard, founded the Canadian Institute for Advanced Research (now CIFAR - https://cifar.ca/ ), as a unique way to develop, across Canadian and selected international universities, over a dozen multi-disciplinary groups of researchers tackling major intellectual challenges of that era. Among these groups was the Population Health Program (PHP), led for its initial decade by the brilliant Canadian health economist Prof Bob Evans. Over the next decade-and-a-half, the PHP met nearly fifty times with top international scholars in all types of health research. Out of these interactions, the Program's membership formulated a set of ideas about how the health of entire human populations and societies is determined, as well as enunciated clear policy and program implications of those ideas. This paper summarizes, from the point of view of the author (a Scholar, then Fellow in the PHP) the main themes that the PHP enunciated during its initial decade, culminating in the widely read volume "Why are Some People Healthy and Others Not"?. Finally, developments in the field of Population Health in the two decades since the "sunsetting" of the PHP are reviewed and commented upon.

Objective: Hand and wrist injuries send high volumes of patients to Emergency Departments (EDs) internationally but are an understudied health issue in Canada. This population-based descriptive study examined patterns in ED visits for hand and wrist trauma in Ontario, Canada, over 11 years.

Methods: National Ambulatory Care Reporting System (NACRS) data were used to identify hand and wrist injuries in adults 18-65 years treated in Ontario EDs from 2006 to 2017. Population data from the Ontario Registered Persons Database (RPDB) were used to calculate annual incidence rates and assess temporal trends by sex. NACRS data were used to describe patient and injury characteristics by sex and repeat injury status (index vs. repeat injury).

Results: From 2006 to 2017, Ontario adults experienced 2,045,950 ED visits for hand and wrist trauma. The annual incidence was 211/10,000 persons (269/10,000 men vs. 157/10,000 women). Hand and wrist injuries declined by 9% over time, driven by a 12% decrease in injuries among men. Compared to women, men were younger, more often injured at work, and less often had a history of mental health and addiction (MHA) service use. Twenty-five percent of ED visits for hand and wrist trauma were repeat injuries. Men were overrepresented in the repeat injury group, as were adults living outside of major urban areas, and those with a history of MHA service use.

Conclusion: Hand and wrist injuries represent a major public health burden in Ontario. While injury incidence is higher among men than women, men have experienced a significant decline in injuries over time. This study identifies groups that may be at an increased risk for hand and wrist trauma and its recurrence. Additional research is needed to improve our understanding of the modifiable determinants of these injuries with the goal of prevention.