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

Setting: The Middlesex-London Health Unit (MLHU) is a local public health agency serving a population of 500,000 people in southwestern Ontario.

Intervention: Public health can have a nearly infinite scope. Given the impact of our social, economic, and physical environments on health, everything can rightly be considered a "public health issue." However, the role of a local public health agency in addressing a "public health issue" varies widely and is not always clearly described. We have described and defined the interventions of a local public health agency and have developed a classification of common interventions. These interventions outline the work that we do for the community, clearly and concretely articulating the actions we take to protect and promote health.

Outcomes: The work of local public health agencies can be categorized and classified by these common interventions: • Communication and social marketing • Education and skill building • Healthy public policy development • Community and partner mobilization • Surveillance • Inspections • Investigations • Case, contact, and outbreak management • Clinical services delivery • Health resource inventory management • Vector control IMPLICATIONS: The benefits of defining the interventions of a local public health agency include an improved understanding of the skills required to do the work; opportunities to strategically target prioritized public health issues, utilizing the full suite of interventions to maximize impact; the ability to adapt to changing priorities; opportunities to effectively measure organizational performance; clarity with partners regarding roles and responsibilities in addressing public health issues; and an enhanced ability to tell others what we do and demonstrate our value.

Objective: Youth suicide, a major cause of death, is linked to poverty and other adverse experiences. Evidence of its association with food insecurity is unclear due to inadequate controls for household income in previous research. This cross-sectional study used independent reports of household income, food insecurity, and suicidal behaviours to examine these associations in a population-based sample.

Methods: The 2019 Canadian Health Survey on Children and Youth surveyed 6735 youth (15-17 years), gathering data on sadness/hopelessness, suicidal ideation, and suicide attempts. Adults provided information on household food insecurity using a multi-item scale and about diagnosed mood disorders in youth. Household income data were provided by government tax records. We used Poisson regressions to estimate the relative risk (RR) of each suicidal behaviour attributed to household food insecurity, adjusting for household income and other covariates.

Results: Approximately one in five (19.8%) youth experienced marginal (5.2%), moderate (7.9%), or severe (3.3%) food insecurity. Moderate or severe food insecurity was associated with increased risks of sadness/hopelessness, mood disorder, suicide ideation, and suicide attempts (RRs 1.30-2.17) after controlling for household income differences and other covariates. Generally, more severe food insecurity was positively associated with suicide behaviours.

Conclusion: Household food insecurity is associated with youth suicidal behaviours, independently of household income. Its underlying pathway to youth mental health includes social and psychological factors that require targeted policy intervention.

Objectives: Canadian Inuit children present more developmental vulnerabilities than other non-Indigenous children. Supporting the development of these children is therefore essential, especially in urban environments where the Inuit population is growing. This study aimed to identify the main resources used by Inuit families living in urban environments of southern Québec, (Canada) and to better understand their needs related to supporting the healthy development of their children.

Methods: A descriptive qualitative study was conducted using semi-structured interviews with 13 self-identified Inuit parents of at least one child aged 0 to 18 living in southern Québec.

Results: The study revealed that urban Inuit families primarily require support to meet their basic needs, ensure a safe family environment, promote their children's health, education, and socialization, foster the transmission of Inuit cultural and linguistic heritage, and, finally, enhance access to a culturally safe social environment. The study also revealed that despite living closer to a variety of resources intended to support their children's healthy development, families encounter significant barriers in accessing these resources. Moreover, families have specific needs that are often not adequately addressed by the resources currently available.

Conclusion: The study highlighted that the needs of Inuit families extend well beyond support for skills acquisition in the various developmental domains. Supporting the healthy development of Inuit children therefore requires a coherent and intensive response to families' most urgent needs. In the light of such findings, there is a clear need to improve access to existing resources, as well as to develop Inuit-led services that are adapted to realities and specific needs of the families.

Objectives: Cross-sectionally measured health disparities are well documented among sexual minority (lesbian, gay, bisexual) Canadian adults, yet the timing of these disparities is not understood, especially in harder-to-reach older adult populations. We estimated the prevalence and incidence of health and health-related outcomes over 6 years of follow-up in an older sample of Canadian adults.

Methods: Our analysis used data from the Canadian Longitudinal Study on Aging (CLSA), a prospective cohort of adults aged 45-85 (baseline, 2011-2015), with follow-up over 6 years (2015-2021; n = 45,079). Respondents who self-identified as lesbian, gay, bisexual, or another sexual minority identity at either baseline or first follow-up were considered LGB+. Study outcomes included physical health, mental health, health care service use, negative health behaviours, and other health-related behaviours (e.g., rentership). We computed adjusted prevalence ratios (PRs) and relative risks (RRs) stratified by sex (female/male) using modified Poisson regression with robust error variance.

Findings: Older sexual minority adults had a greater prevalence of and were at elevated risk of new-onset mental health diagnoses (e.g., depression: RR_F = 2.03, 95% CI: 1.39, 2.96; RR_M = 2.15, 95% CI: 1.50, 3.08). Older sexual minority adults also initiated psychological services more than older heterosexual adults (e.g., RR_F = 1.43, 95% CI: 1.10, 1.85; RR_M = 1.39, 95% CI: 1.05, 1.83). There was evidence of other prevalence differences between men and women, but with no difference in longitudinal risk (e.g., memory problems: PR_F = 1.78, 95% CI: 1.24, 2.55; RR_F = 1.70, 95% CI: 0.97, 2.95).

Conclusion: Older sexual minority Canadians face disproportionate health challenges, particularly in mental health. Our findings demonstrate the importance of inclusive and affirming gerontological care in supporting the healthy aging of sexual minority Canadians.

Objective: The objective of this study was to characterize new HIV diagnoses in key Ontario cities, in order to understand current drivers of continued HIV transmission to inform HIV testing and prevention efforts.

Methods: Chart reviews were carried out at four clinical sites in Ontario, Canada. The study population included individuals who were diagnosed with HIV in Ottawa, Hamilton, and Toronto between January 1, 2018, and December 31, 2020, and had no previous evidence of HIV documented.

Results: The total number of persons in this analysis was 359, from Toronto (n = 201), Ottawa (n = 88), and Hamilton (n = 70). More than half of the diagnoses were among those who immigrated to Canada, and many were diagnosed (11%) during the year they arrived. Many participants experienced a late diagnosis (43.2%), and while 116 (32.3%) had HIV testing history in Ontario, 155 did not (43.2%). Many participants were men who have sex with men (MSM) and had a previously recorded diagnosis of gonorrhea or chlamydia (n = 27; 7.5%) or syphilis (n = 39; 10.9%). Among women and heterosexual men, a diagnosis of hepatitis C (n = 18; 5.0%) appeared to signal a risk of HIV diagnosis.

Conclusion: These data show that HIV testing and prevention strategies should be targeted to (1) MSM with a history of syphilis, gonorrhea, or chlamydia; (2) heterosexual men and women with a history of hepatitis C; and (3) immigrants within the first 5 years of migration. To address the evolving epidemic, it will be necessary to employ targeted HIV screening and prevention measures.

Canada's universal healthcare system aspires to provide equitable care for all citizens, yet persistent health disparities among Indigenous, Black, and other racialized communities reveal significant gaps in service and outcomes. This commentary explores how race-based data collection could address these inequities by identifying at-risk populations, informing targeted interventions, and improving accountability within healthcare systems. The discussion includes an overview of existing challenges, such as mistrust stemming from historical research abuses, varied provincial approaches, and ethical complexities related to privacy and data sovereignty. Examples from within Canada highlight the effectiveness of standardized data collection policies, while international lessons-particularly from the United Kingdom's incentivized data reporting and the United States' mandated approaches-underscore the importance of consistent data-gathering and careful monitoring. The commentary emphasizes that community engagement and leadership are essential to the development of culturally safe practices, and that legal and ethical frameworks must safeguard data from commodification or other forms of misuse. By integrating race-based data collection into policy reforms, embracing Indigenous data governance principles, providing mandatory training for health providers, and establishing robust monitoring systems, Canada can advance meaningful strategies to reduce health disparities. This approach promotes a more equitable healthcare environment, ensuring the principle of universal coverage benefits all communities.

Objective: To systematically review and synthesize evidence from reviews about the effectiveness and cost-effectiveness of population-level policies to reduce alcohol use.

Methods: We searched peer-reviewed literature using eight electronic bibliographic databases, grey literature using two databases, two search engines, and two working paper repositories, and examined references of included studies. At least two reviewers independently screened articles for inclusion, extracted detailed characteristics, and assessed the risk of bias of each included study. We considered all reviews that included studies which quantitatively examined the relationship between alcohol consumption and population-level policies that seek to regulate the public availability and marketing of alcoholic beverages. After screening according to a set of predetermined criteria, we included 32 reviews.

Synthesis: We found consistent evidence that addressing alcohol availability (introducing or increasing minimum purchasing age, restrictions on temporal availability, decreasing outlet density, government monopolization) was associated with lower alcohol use; and a general lack of evidence on the associations between alcohol marketing (marketing self-regulation, advertising from government authorities, regulating the volume of advertising from alcohol manufacturers, and introducing warning labels) and alcohol consumption, which precludes any conclusions about these regulations. Additionally, we found scarce evidence about the cost-effectiveness of population-level policies to reduce alcohol use, which is likely due to the relatively low cost of implementation and enforcement of these policies.

Conclusion: The Government of Ontario began expanding privatized alcohol sales in 2015 with further expansions starting in August 2024. Evidence from reviews suggests that this increase in availability will result in increased alcohol consumption.

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.