Abstract: Abstract Rowan’s Law was recently introduced into Ontario legislation following the death of Rowan Stringer, a young rugby player for whom a string of head injuries culminated in her death. The law mandates the removal from play of any youth athlete suspected to have a concussion and makes concussion education mandatory for certain individuals involved with youth sport. This commentary addresses the larger issues within sport culture that may limit the effectiveness of the law, and describes how awareness alone is not sufficient to generate change. The law can sometimes lead to a false sense of security, as well as retaliatory actions for those who are motivated to hide concussion. We describe the role of all persons involved with youth sport in facilitating a cultural shift to honour the intent behind Rowan’s Law. PubDate: 2019-04-01
Abstract: Abstract In promoting healthier built environments, attention worldwide has focused largely on streetscapes and recreational spaces, with less regard given to housing form, in particular to the health effects of communal housing. Research demonstrates that communal housing models, such as cohousing and co-operative housing, promote social inclusion, and increase the perceived well-being and mental and physical health of residents, particularly of seniors. In Canada, relative to other countries, there is a paucity of evidence for the health effects of co-operatives and cohousing. Historically, some Indigenous communities constructed longhouses, connected dwellings situated around common areas, a form which may still be useful in promoting healthy communities. In this commentary, we suggest that improving access to co-operative and communal housing is an important area for public health involvement. PubDate: 2019-04-01
Abstract: Abstract The Lancet Commission on Pollution and Health, which conducted a comprehensive assessment of the health and economic impacts of key forms of toxic pollutants in air, water, and soil, estimated that 9 million people die annually from the impact of pollution, which represents 16% of all deaths worldwide. Over 90% of these pollution-related deaths occur in low- and middle-income countries. While Canada ranks seventh lowest in the world, the burden is still too high; many pollutants were not considered in the Commission’s work, and vulnerable populations—including the poor, women, children, and Indigenous peoples—are disproportionally affected by pollution in Canada. As Canadian co-authors in the Lancet Commission, here we consider the impact of pollution on the health of Canadians and discuss how best to address the problem. PubDate: 2019-04-01
Abstract: Objectives To estimate the proportion of the Canadian population that is more susceptible to adverse effects of ozone (O3) and fine particle (PM2.5) air pollution exposure and how this varies by health region alongside ambient concentrations of O3 and PM2.5. Methods Using data from the census, the Canadian Community Health Survey, vital statistics and published literature, we generated cross-sectional estimates for 2014 of the proportions of the Canadian population considered more susceptible due to age, chronic disease, pregnancy, outdoor work, socio-economic status, and diet. We also estimated 2010–2012 average concentrations of O3 and PM2.5. Analyses were conducted nationally and for 110 health regions. Results Restrictive criteria (age < 10 or ≥ 75; asthma, chronic obstructive pulmonary disease, heart disease, or diabetes; pregnancy) suggested that approximately one third of the Canadian population is more susceptible, while inclusive criteria (restrictive plus age 10–19 and 65–74, outdoor work, less than high school education, low vitamin C intake) increased this proportion to approximately two thirds. Across health regions, estimates ranged from 24.4% to 41.2% (restrictive) and 61.2% to 87.0% (inclusive). Ten health regions were in the highest quartile of both population susceptibility and O3 or PM2.5 concentrations, all of which were outside major urban centres. Conclusions A substantial proportion of the Canadian population exhibits at least one risk factor that increases their susceptibility to adverse effects of O3 and PM2.5 exposure. Both risk communication and management interventions need to be increasingly targeted to regions outside large urban centres in the highest quartiles of both susceptibility and exposure. PubDate: 2019-04-01
Abstract: Objectives Canadians have reason to care about indoor air quality as they spend over 90% of the time indoors. Although indoor radon causes more deaths than any other environmental hazard, only 55% of Canadians have heard of it, and of these, 6% have taken action. The gap between residents’ risk awareness and adoption of actual protective behaviour presents a challenge to public health practitioners. Residents’ perception of the risk should inform health communication that targets motivation for action. In Canada, research about the public perception of radon health risk is lacking. The aim of this study was to describe residents’ perceptions of radon health risks and, applying a theoretical lens, evaluate how perceptions correlate with protection behaviours. Methods We conducted a mixed online and face-to-face survey (N = 557) with both homeowners and tenants in Ottawa-Gatineau census metropolitan area. Descriptive, correlation, and regression analyses addressed the research questions. Results Compared to the gravity of the risk, public perception remained low. While 32% of residents expressed some concern about radon health risk, 12% of them tested and only 3% mitigated their homes for radon. Residents’ perceptions of the probability and severity of the risk, social influence, care for children, and smoking in home correlated significantly with their intention to test; these factors also predicted their behaviours for testing and mitigation. Conclusion Health risk communication programs need to consider the affective aspects of risk perception in addition to rational cognition to improve protection behaviours. A qualitative study can explore the reasons behind the gap between testing and mitigation. PubDate: 2019-04-01
Abstract: Intervention UPnGO with ParticipACTION (UPnGO) is a 6-week workplace physical activity (PA) initiative aiming to increase habitual PA (steps) during the workday. Core intervention components included (1) self-monitoring of steps and action planning behaviours using a Web/mobile app with incentives and (2) organizational support, which included senior management’s role modeling and endorsement of the program. Research question What is the effectiveness and levels of implementation of the UPnGO intervention' What is the relationship between effectiveness and levels of implementation' Methods A single-arm, pre-/post-test study design was used. Participants were 660 employees from nine organizations who had valid step data and complete socio-demographic information at baseline. The primary outcome (mean daily steps) was assessed by Garmin VivoFit. Using the usage data from the UPnGO web-based system, a composite score for levels of implementation was calculated based on participant’s compliance with the self-monitoring component and senior management’s role modeling. Associations of interest were analyzed using linear mixed-effects models. Results Levels of implementation were highly variable across organizations (mean = 68.22% ± 18.75, range = 19.8 to 100%). A significant Time × Implementation (IM) status interaction effect was observed. When stratified by IM status, a significant increase in mean daily steps at week 6 was found among participants in the high (β = 540.01 ± 202.69, p = 0.011) but not low (β = − 81.54 ± 291.96, p = 0.78) implementation group. Conclusion Findings suggest significant intervention effects in increasing average daily steps among participants who were exposed to optimal levels of implementation (~ 70%). UPnGO may be a scalable workplace PA intervention at a national level, although this needs further verification with more rigorous study designs. PubDate: 2019-04-01
Abstract: Objectives The school environment is an ideal setting to introduce policies to prevent smoking behaviour. However, there may be variability in the strength of school board and secondary school tobacco policies, which may affect student smoking behaviours. This study assessed the strength of a sample of school board and secondary school tobacco policies and examined the association with student smoking behaviours. Methods Tobacco policies from school boards (n = 21/26) and secondary schools (n = 43/81) that participated in the COMPASS study during 2015–2016 were obtained online. A standardized instrument was used to assess the strength of school board and secondary school tobacco policies on four domains. Using the sample of students from schools with identified policies (n = 22,696), separate multilevel regression models examined the association between school policy scores and a student’s susceptibility to smoking, ever smoking, current smoking, and perceived support of the school environment. Results The mean school board tobacco policy score was 13.7/40 and the mean secondary school tobacco policy score was 11.3/40. Students were significantly less likely to report current smoking (OR 0.95, 95% CI 0.91–0.99) and more likely to report a supportive school environment (OR 1.06, 95% CI 1.04–1.08) with each four-unit (i.e., 10%) increase in school tobacco policy score. Conclusions The vast majority of school board and secondary school tobacco policies were missing components and therefore could not be considered comprehensive. Stronger school tobacco policies may help to reduce student current smoking behaviours. PubDate: 2019-04-01
Abstract: Setting The first regulated supervised inhalation site (safer smoking room) in North America has opened in Lethbridge, Alberta, as part of a supervised consumption site addressing all routes of consumption. When designing the service, we felt it was important to accommodate not just injection drug use but also inhalation because (1) it is not the method of drug use that kills but the drug itself, (2) all people who use drugs deserve service regardless of their mode of use, and (3) people who use drugs should have the opportunity to use the method with the lowest risk. Intervention We received approval from Health Canada to offer supervised inhalation services in addition to supervised injection services. Based on a European model, we worked with a local commercial heating, cooling, and ventilation (HVAC) company to create rooms with ventilation systems that complied with Canadian health and safety regulations. Outcome People who use drugs by inhalation have repeatedly told us that they want to use indoors and will do so given the option. Since opening the supervised consumption service at the end of February 2018, the response has been overwhelming and both of the inhalation rooms are constantly in use. Implications Supervised inhalation services provide an alternative to public drug use and an opportunity for people who use drugs to engage with harm reduction services. Other supervised consumption services in Canada may also wish to pursue exemptions for this service. PubDate: 2019-04-01
Abstract: Abstract With the recent legalization of recreational cannabis use in Canada, questions remain concerning optimal regulation to minimize harms and ensure public health and safety. Patterns of use are subject to change following legalization, and it is important to consider the potential adverse effects that this may have on public health. Important areas of consideration are methods of consumption (e.g., vaping, edibles) and product proliferation; acute and long-term health and behavioural effects (including impaired driving); and use in vulnerable groups, such as children and youth, pregnant women, individuals with mental illness, individuals with low socio-economic status, and Indigenous populations. To support harm reduction measures and evidence-based policy, there is a need to anticipate the potential ramifications that legalization of recreational cannabis use may have on public health in Canada. PubDate: 2019-04-01
Abstract: Objectives Regular physical activity (PA) in children is essential for their development and prevention of overweight and obesity. Little is known about the effect of day-to-day variations in weather conditions on PA levels in school-aged children, particularly with regard to school compared to non-school days and girls compared to boys. Methods Daily step count (7:00 a.m.–9:00 p.m.) from 972 grade 5 students aged 10–11 years from 60 schools across Alberta, Canada, was collected using time-stamped pedometers (minimum wear time of two school and one non-school days) during March–June 2013. Time-matched weather conditions (actual and feels-like temperature, cloud coverage, and precipitation amount) were obtained from local weather stations in Alberta during the same period. Multilevel mixed-effect regression models were used to estimate the effect of each weather condition on daily step count. Results A 1 °C increase in feels-like temperature was associated with 26 more steps/day (p < 0.05), while 1-unit increase in cloud coverage was associated with 61 fewer steps/day (p < 0.01). Compared to no precipitation, heavy precipitation (> 5 mm/day) was associated with 1022 fewer steps/day (p < 0.01). Students’ PA levels were associated with weather conditions more on non-school vs. school days and more among girls vs. boys. Conclusion Results suggest that daily weather conditions can affect PA in school children, particularly outside school hours, and should be considered when evaluating PA levels or designing interventions to promote PA in children. Findings provide support for increased investment toward creating weather-appropriate physical activity opportunities for wet and colder days to prevent PA decline in children during inclement weather conditions. PubDate: 2019-04-01
Abstract: Objectives To use a predominately objective measurement approach to assess and describe: (1) the amount of time that children aged 10–13 years spend participating in outdoor active play, active travel, curriculum-based physical activity at school, and organized sport; (2) the movement intensity composition of these four types of physical activity (i.e., % of time spent at a sedentary, light, or moderate-to-vigorous intensity); and (3) the proportion of each movement intensity obtained by participating in these four types of physical activity. Methods Three hundred seventy-seven children aged 10–13 years from Kingston, Canada, were studied. Children wore an accelerometer and GPS watch for 7 days and recorded the start and end times of the school day, recess periods, and organized sport sessions on a log. These data were used to estimate time spent in the four types of physical activity and the movement intensity composition of these activities. Results Time spent in outdoor active play (36 min/day) and organized sport (40 min/day) was higher than that for active travel (17 min/day) and curriculum-based physical activity (26 min/day). With the exception of organized sport, values were higher for boys than for girls. Older children accumulated less outdoor active play and more active travel than younger children. The greatest proportion of light- and moderate-to-vigorous-intensity movement was attributed to outdoor active play. Conclusion We used a primarily objective measurement approach to assess and describe the amount of time children aged 10–13 participate in four types of physical activity. These descriptive findings could be used to identify target areas for physical activity interventions and policies. PubDate: 2019-04-01
Abstract: Objective This study investigated whether a move to public housing affects people’s use of healthcare services. Method Using administrative data from Manitoba, the number of hospitalizations, general practitioner (GP), specialist and emergency department (ED) visits, and prescription drugs dispensed in the years before and after the housing move-in date (2012/2013) were measured for a public housing and matched cohort. Generalized linear models with generalized estimating equations tested for differences between the cohorts in utilization trends. The data were modeled using Poisson (rate ratio, RR), negative binomial (incident rate ratio, IRR), and binomial (odds ratio, OR) distributions. Results GP visits (IRR = 1.04, 95% CI 1.01–1.06) and prescriptions (IRR = 1.04, 95% CI 1.02–1.05) increased, while ED visits (RR = 0.90, 95% CI 0.82–1.00) and hospitalizations (OR = 0.95, 95% CI 0.93–0.96) decreased over time. The public housing cohort had a significantly higher rate of GP visits (IRR = 1.08, 95% CI 1.04–1.13), ED visits (RR = 1.18, 95% CI 1.01–1.37), and prescriptions (IRR = 1.09, 95% CI 1.05–1.13), and was more likely to be hospitalized (OR = 1.39, 95% CI 1.21–1.61) compared to the matched cohort. The rate of inpatient days significantly decreased for the public housing cohort, but did not change for the matched cohort. Conclusion Healthcare use changed similarly over time (except inpatient days) for the two cohorts. Public housing provides a basic need to a population who has a high burden of disease and who may not be able to obtain and maintain housing in the private market. PubDate: 2019-04-01
Abstract: Objectives To assess the performance of the Canadian Hospitals Injury Reporting and Prevention Program’s newly developed self-harm surveillance tool (CHIRPP-SI) designed to improve emergency department (ED) hospital surveillance of youth self-inflicted injury (SI). Methods This was a prospective, single-centre cohort study from February 2015 to September 2015. Eligible participants were aged 6–17.99 years and presented to the ED with a primary mental health complaint. The frequency of SI cases was extracted from three data sources (CHIRPP-SI, medical chart, and the National Ambulatory Care Reporting System Metadata (NACRS)). Cohen’s kappa statistic was used to examine the level of agreement between data sources. Results Of the 250 participants who received a medical chart review, 70 completed the CHIRPP-SI. Of those who did not complete the CHIRPP-SI, 86% (n = 154) reported no SI related to their presentation, 12% (n = 22) declined to participate without specifying self-injury status, and 2% (n = 4) were unable to be interviewed prior to discharge. The three sources of surveillance data varied considerably; the medical chart captured the highest frequency of individuals reporting SI related to their ED visit (33.6%), followed by the CHIRPP-SI (28.0%), and the NACRS database (8.4%). The CHIRPP-SI captured the method of SI and the place of occurrence in 100% of individuals, and the bodily location harmed in 98.6% of individuals. Conclusions Study findings highlight the disparity between different sources of data, in relation to the capture of paediatric SI, presenting to hospital EDs. If greater details of SI events are to be identified, surveillance tools such as the CHIRPP-SI should be considered. PubDate: 2019-04-01
Abstract: Objectives Globally, engaging people who have used drugs, or peers, in decision-making has been increasingly touted as a best practice approach to developing priorities, programs, and policies. Peer engagement ensures decisions are relevant, appropriate, and effective to the affected community. However, ensuring that inclusion is accessible and equitable for those involved remains a challenge. In this study, we examined the perspectives of people who use or have used illicit drugs (PWUD) on peer engagement in health and harm reduction settings across British Columbia (BC), Canada. Methods The Peer Engagement and Evaluation Project used a participatory approach to conducting 13 peer-facilitated focus groups (n = 83) across BC. Focus group data were coded and analyzed with five peer research assistants. Themes about the nature of peer engagement were generated. From this analysis, peer engagement barriers and enablers were identified. Results Barriers to peer engagement included individual, geographical, systemic, and social factors. Issues related to stigma, confidentiality, and mistrust were intensely discussed among participants. Being “outed” in one’s community was a barrier to engagement, particularly in rural areas. Participants voiced that compensation, setting, and the right people help facilitate and motivate engagement. Peer networks are an essential ingredient to engagement by promoting support and advocacy. Conclusion PWUD are important stakeholders in decisions that affect them. This cross-jurisdictional study investigated how PWUD have experienced engagement efforts in BC, identifying several factors that influence participation. Meaningful engagement can be facilitated by attention to communication, relationships, personal capacity, and compassion between peers and other professionals. PubDate: 2019-04-01
Abstract: Abstract In the context of cannabis legalization, an important question among clinicians, policymakers, and the public is whether availability of legal cannabis will significantly reduce consumption (demand) of illegal cannabis. Using paradigms from behavioural economics, we tested the prediction that legal cannabis would be an asymmetrical substitute for illegal cannabis, with legal cannabis operating as a superior commodity based on its regulated status. In a sample of 289 adult cannabis users in Ontario, we found evidence of substitutability for both legal and illegal cannabis, but significantly lower substitutability of illegal for legal cannabis, a pattern that was also present for price elasticity (α) and Pmax. Thus, the data indicated asymmetric substitution such that the availability of legal cannabis substantially decreased demand for illegal cannabis, but a significantly smaller effect in reverse. These results suggest that the introduction of legal cannabis into the market may disrupt and reduce illegal purchases, contributing to the reduction of the potential harms associated with the illegal market. However, in revealing price windows in which legal cannabis is preferred over the contraband alternative, these data also have significant implications for pricing policies. PubDate: 2019-04-01
Abstract: Objective Recent research found that inmates experience undesirable and rapid weight gain during incarceration in Canadian federal penitentiaries. However, little is known about what factors and daily movement behaviours (e.g., physical activity, screen time, and sleep) influence weight gain during incarceration. This study examines how these 24-h movement/non-movement behaviours contribute to weight gain during incarceration. Methods This retrospective cohort study explored how weight change outcomes during incarceration (weight change, body mass index (BMI) change, and yearly weight gain) were influenced by physical activity, screen time, and sleep in a convenience sample of 754 inmates. The outcome measures were taken twice, once from participants’ medical chart at admission and again during a face-to-face follow-up interview (conducted in 2016–2017; mean follow-up time of 5.0 ± 8.3 years). Physical activity, screen time, and sleep were self-reported. The statistical analysis was chi-square testing, non-parametric median comparison testing, and regression analysis to control for confounders. Results Inmates who engaged in at least 60 min of daily physical activities gained less weight (4.5 kg) compared to inmates who reported not exercising (8.3 kg). Different types of exercise (cardiovascular exercises, weight lifting, and team sports) were helpful at limiting weight gain, but playing sports was the most effective. Screen time and sleep were not associated with weight gain outcomes. Conclusion Among the behaviours examined, physical inactivity was significantly associated with higher weight gain during incarceration. However, even high levels of physical activity (> 60 min/day) were not sufficient to eliminate weight gain during incarceration in Canada. PubDate: 2019-04-01
Abstract: Abstract Public health is critical to a healthy, fair, and sustainable society. Realizing this vision requires imagining a public health community that can maintain its foundational core while adapting and responding to contemporary imperatives such as entrenched inequities and ecological degradation. In this commentary, we reflect on what tomorrow’s public health might look like, from the point of view of our collective experiences as researchers in Canada who are part of an Applied Public Health Chairs program designed to support “innovative population health research that improves health equity for citizens in Canada and around the world.” We view applied public health research as sitting at the intersection of core principles for population and public health: namely sustainability, equity, and effectiveness. We further identify three attributes of a robust applied public health research community that we argue are necessary to permit contribution to those principles: researcher autonomy, sustained intersectoral research capacity, and a critical perspective on the research-practice-policy interface. Our intention is to catalyze further discussion and debate about why and how public health matters today and tomorrow, and the role of applied public health research therein. PubDate: 2019-03-18
Abstract: Objectives Distracted walking poses a safety concern while crossing roads. A 2014 Canadian survey showed that 51% of teenagers were hit or almost hit while crossing the street, many of whom were distracted by mobile technology. An American study demonstrated that 1 in 5 high school students engaged in distracted walking; however, prevalence estimates in Canada have not been described. This study aimed to obtain a prevalence estimate of distracted walking in high school students in Calgary and Edmonton, Alberta, Canada. Methods Students were observed crossing the street at 20 high schools following afternoon school dismissal times during September to November 2017. Behaviours included talking on mobile phone, using earbuds, looking down at phone, and engaging in more than one of these behaviours. Also recorded were median household income of surrounding neighbourhood, outside temperature, gender, and crosswalk type. Results A total of 3553 students were observed, with 666 engaged in distracted walking (18.7%). Females engaged in distracted walking more than males (19.9% vs. 17.6%, respectively). The most prevalent behaviour was using earbuds (66.5%). Males had a lower prevalence of distracted walking compared with females. Distracted walking was more prevalent when the temperature was above 10 °C compared with less than 0 °C and less prevalent at signaled compared with non-signaled intersections. Conclusion This study demonstrates that approximately 1 in 5 high school students in Calgary and Edmonton, Alberta, Canada, engage in distracted walking behaviours while crossing the street. These results may help raise awareness and inform policy to decrease risk of pedestrian injury. PubDate: 2019-03-18
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