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Abstract: Objective To estimate the association between publicly provided take-home naloxone kits and opioid-related deaths. Methods We analyzed 2732 opioid-related deaths and the distribution of 147,814 naloxone kits between January 2015 and June 2019 across five health zones in Alberta, Canada. We used a Poisson pseudo-maximum likelihood regression model with fixed effects to estimate the association between the number of kits in circulation and the number of monthly opioid-related deaths, controlling for population demographics, socio-economic indicators, other harm reduction strategies, police seizures of fentanyl and carfentanil, and an estimate of awareness. Results Every 10,000 kits in circulation was associated with a 23.9% (95% confidence interval (CI), 12.6–33.7) reduction in opioid-related deaths. Marginal analysis suggests that if no kits had been distributed, Alberta would have had 3548 deaths (95% CI, 2264–4831), 816 more deaths than were recorded during this 4.5-year period. If during this time 200,000 kits were consistently in circulation, Alberta would have had an estimated 1587 deaths (95% CI, 705–2468), 1145 fewer deaths than recorded. Conclusion This analysis provides evidence that the availability of naloxone kits is associated with a reduction in opioid-related deaths and suggests that a publicly funded program that allows the distribution of naloxone kits to all who request them reduces mortality. PubDate: 2025-06-03
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Abstract: Objectives Individuals experiencing homelessness have excess mortality as compared with the general population. This elevated risk of death may persist after individuals are housed, but there has been scant research on this topic. The objective of this study was to examine mortality among residents of a permanent supportive housing program serving people who were previously homeless. Methods Deaths were identified among individuals who resided in a 145-unit supportive housing program in Toronto, Canada, between January 1, 2018, and December 31, 2022. Kaplan–Meier curves were used to examine survival. Results Of 222 individuals who resided in the supportive housing program, 34 individuals died during the observation period, with 71% of deaths occurring in the housing unit and 21% in hospital. At least one third of deaths were caused by drug overdose. Mean age at death was 56.3 years. Crude mortality rate was 5.10 deaths per 100 person-years of observation. Survival at 5 years of follow-up was 78%, and individuals ≤ 40 years old did not have a survival advantage over those > 40 years old. Conclusion Interventions are needed to support health and reduce preventable deaths among formerly homeless residents of permanent supportive housing. PubDate: 2025-05-30
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Abstract: Objectives This nationwide longitudinal study investigates the impact of neighbourhood deprivation on psychological well-being of Canadian adults. Methods Utilizing data from the Longitudinal and International Study of Adults (LISA) spanning 2016, 2018, and 2020, we included individuals aged 15 and above across Canada. The 2016 and 2020 samples comprised approximately 17,700 and 12,700 respondents, respectively. LISA data were paired to Neighbourhood Material and Social Deprivation data derived from Canada’s 2016 Census. Psychological distress was assessed using the Kessler Scale (K-10), both dimensionally (score) and categorically (above the cut-point prevalence). Multi-level mixed-effects regressions were conducted, adjusting for individual-level variables. Results At baseline, participants’ mean age was 47.7 years (50.6% female), and higher social and material deprivation were associated with greater psychological distress. Longitudinally, psychological distress showed distinct temporal patterns based on the type of deprivation. Adjusted models revealed that residing in the most socially deprived neighbourhoods was linked to a greater increase in psychological distress scores over time as compared with the least socially deprived areas. Conversely, the highest degree of material deprivation showed a negative association with increasing distress, contrasting with the lowest material deprivation. A similar trend emerged regarding the prevalence of high psychological distress: in the most socially deprived neighbourhoods, there was an elevated prevalence over time, whereas the highest material deprivation was negatively associated with increasing prevalence. Conclusion This study supports the link between mental health and neighbourhood social deprivation, but differs from previous research regarding material deprivation. While material support remains crucial for disadvantaged communities, public health interventions should also address social deprivation. PubDate: 2025-05-27
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Abstract: Objective Canada is undergoing a crisis in mental health, and the federal government has established a strategy that is attentive to mental health among Black people. Our objective is to inform this work by understanding the relationships between race, discrimination, and mental health outcomes. Methods We obtained a sample of 17,526 respondents from the Canadian Community Health Survey Rapid Response Module on Experiences of Discrimination, which asked about respondent race and other sociodemographic and socioeconomic characteristics, the validated Williams Everyday Discrimination Scale, and mental health outcomes (mood and anxiety disorders, substance use, and self-rated mental health). We ran descriptive statistics as well as crude, sociodemographic- and socioeconomic-adjusted logistic regressions to assess relationships in the overall sample between race and the Williams Discrimination Scale and between the Williams Discrimination Scale and mental health outcomes. Results Compared to white people, Black people had two to three times the odds of experiencing frequent discrimination, while Asian people were not statistically different from white people. Frequent experiences of everyday discrimination in the sample were associated with between 40% and two times the odds of experiencing adverse mental health outcomes, though white people had the highest prevalences of adverse mental health outcomes in the sample. Conclusion In Canada, experiences of discrimination can produce adverse mental health outcomes, and Black people in particular experience high degrees of discrimination compared to all other racial groups. National health surveys should contain larger and more representative samples of non-white individuals, which allow for more complex analyses. PubDate: 2025-05-21
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Abstract: 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. PubDate: 2025-05-21
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Abstract: 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. PubDate: 2025-05-19
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Abstract: Objectives People migrating to Canada are disproportionately impacted by tuberculosis (TB) disease. Prior to arrival, Immigration, Refugees and Citizenship Canada (IRCC) require an immigration medical exam (IME) intended to detect TB disease in all permanent and select temporary residents. People deemed high risk for TB are then referred for post-landing surveillance. This process has not substantially changed in four decades, prompting our review. Methods We performed a retrospective cohort study of people referred for post-landing surveillance in British Columbia (BC) from Aug 1, 2020, to May 31, 2022. Through chart review, clinical and demographic data were recorded from the IME and provincial TB registry. Participants were followed for 2 years to assess for TB disease and to record their clinical outcomes. Results Of 1700 participants, 19 (1.1%, 95% CI 0.7, 1.7) were diagnosed with TB disease after arriving in Canada; 580 (34.1%) had prior TB treatment noted on their IME, with a median time from treatment to arrival of 9 years (IQR 4–18 years). The post-landing process took a median of 211 days (IQR 160–282 days) to complete workup. Some participants (611; 35.9%) received either an interferon gamma release assay or tuberculin skin test with 127 (35.5%) and 166 (65.6%) positive results, respectively. Conclusion The post-landing surveillance process in BC is slow and resource-intensive for both migrants and the healthcare system, with uncertain impact on outcomes. These findings highlight existing inefficiencies in the process and the need to identify people who are at highest risk. PubDate: 2025-05-16
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Abstract: Supervised consumption services (SCS) and overdose prevention services (OPS) are core interventions for reducing risks of overdose death, HIV, and hepatitis C (HCV) and supporting the health of people who use drugs. However, most SCS/OPS are concentrated in major urban centres. There is an urgent need for the expansion of SCS/OPS in rural and small population centres across Canada, particularly given rising rates of drug-related mortality and morbidity in these settings. This commentary outlines current knowledge of SCS based in rural and small population centres, including availability and key barriers and facilitators of implementation and access. To support a public health approach that reduces drug-related mortality and morbidity, further research is needed on scaling up SCS/OPS in communities of all sizes. Alternative delivery models, including virtual and mobile, and the role of informal peer networks have the potential to enhance SCS/OPS in rural and other low resource settings. PubDate: 2025-05-13
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Abstract: Jurisdictions across Canada are experiencing high and increasing numbers of drug toxicity (overdose) deaths. To effectively respond to this crisis, a recognition and adaptation to shifting substance use patterns is needed. People may use one or more modes of consumption (e.g. injection, inhalation, snorting, oral, rectal), with different modes of consumption presenting different opportunities and challenges for public health education and intervention. In recent years, inhalation has increasingly been identified as a major mode of consumption for unregulated substances. We discuss the implications and what is needed to respond. We argue that (1) more research and evidence focused specifically on services for people who smoke unregulated substances is needed; (2) inhalation services that have an acceptable evidence base, even if incomplete, should be implemented and rigorously monitored, to be responsive to an ongoing public health crisis; and (3) there is a need to be mindful of the implications of delays in services for people who inhale drugs. We acknowledge the efforts of public health decision-makers to learn from the context of public health emergencies when it comes to upholding evidence-based practice standards. In this context, it will be important for decision-makers to remain agile in responding to complex public health issues that are characterized by ongoing and acute harms, political tensions, and a growing yet incomplete body of evidence, such as the evolving drug toxicity crisis. PubDate: 2025-05-09
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Abstract: 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. PubDate: 2025-05-05
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Abstract: 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. PubDate: 2025-05-01
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Abstract: Objectives To describe mental health indicators according to regular (i.e., weekly or daily) alcohol, cannabis, and/or nicotine use in a population-based sample of young adults. Methods Data for 733 participants (mean age = 30.6 years) were drawn from cycle 23 of the ongoing Nicotine Dependence In Teens study, Montreal, Canada. The associations between (i) number of substances used and (ii) pattern of polysubstance use and each of depressive symptoms, anxiety symptoms, and positive mental health (PMH) were modeled using multivariable linear regression adjusting for age, sex, and education. Results Median (IQR) scores for depressive symptoms (range 0–50), anxiety symptoms (range 0–21), and PMH (range 0–70) were 8.0 (7.0), 4.0 (6.0), and 43.0 (18.0), respectively. One third (37%) of participants did not report regular use of any substance; 42%, 16%, and 5% reported regular use of one, two, or three substances, respectively. There was no dose–response association between number of substances used and any mental health indicator. Relative to no substance use, regular use of two substances was associated with more frequent anxiety symptoms ($$\widehat{\beta }$$ [95% CI] = 1.32 [0.34, 2.31]) and lower PMH (–3.64 [–6.34, –0.95]). Specifically, the cannabis-nicotine combination was associated with more frequent anxiety symptoms (2.58 [1.06, 4.10]) and lower PMH (–5.90 [–10.04, –1.76]). The alcohol-nicotine combination was associated with lower PMH (–3.70 [–7.30, –0.10]). Conclusion Specific pairings of alcohol, nicotine, and cannabis may be important in their associations with mental health. Longitudinal studies in population-based samples of young adults are needed to replicate these findings before their implications for public health programming can be considered. PubDate: 2025-04-29
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Abstract: Objectives This cross-sectional study assessed naloxone awareness, acquisition rates, and reasons for acquisition among postsecondary students in Canada aged 17‒25 years. Methods Using data from the 2021‒2022 Canadian Postsecondary Education Alcohol and Drug Use Survey, we conducted descriptive analyses of 31,643 students to characterize naloxone awareness, acquisition, and reasons for acquisition overall and by age, gender, race, international student status, and opioid pain reliever (OPR) use. Using multivariable logistic regression, we assessed the relationship between demographic variables and naloxone awareness and acquisition. Results Among postsecondary students in Canada, only 47% had heard of naloxone, and only 5% had acquired it in the past year. Significant predictors of naloxone awareness and acquisition included gender, age, race, international student status, and OPR use. Older students, non-binary students, domestic students, and Indigenous students had higher odds of both naloxone awareness and acquisition. Students who had used OPRs in the past year were less likely to be aware of naloxone (AOR = 0.85, 95% CI: 0.80–0.91). However, among those who were aware, they were more likely to have acquired naloxone (AOR = 1.16, 95% CI: 1.01–1.34) than those who had not used OPRs. Among students who had acquired naloxone in the past year, 97% reported their main reason for obtaining it was for use in emergencies involving other people. Conclusion Low naloxone awareness and acquisition among postsecondary students in Canada represent an important public health gap. Increasing naloxone awareness and acquisition may play an important role in enhancing safety on campuses and beyond. PubDate: 2025-04-28
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Abstract: Objective The City of Toronto opened COVID-19 Isolation and Recovery Sites (CIRS) in 2020 in response to the need for supported isolation spaces for people experiencing homelessness. As a team of academic researchers and community partners, we assessed how lessons from the CIRS can inform post-pandemic policies for people experiencing homelessness. We focused on identifying models and systems of care for understanding existing services and integration, identifying innovations, and imagining how care can be transformed to be more caring and just. Methods We conducted 43 key informant interviews with clinicians, peer and harm reduction workers, executive leaders, operational leaders, and people who worked for funding or decision-making organizations. Data were coded and analyzed using deductive content analysis. Results The CIRS presented a new service model that moved away from being overly medicalized towards having a community orientation, which involved greater integration of services for people experiencing homelessness, transparent decision-making, and open communication. Key to this approach were clinical case management, harm reduction services, strong support of peer workers, and adequate and consistent funding. Future models will need to address power imbalances and hierarchies through formal agreements and processes as well as establishing collaborative cultures. Conclusion The CIRS offer an important opportunity to rethink services offered within shelter settings. Such change will require a strong vision, sufficient funding, political will, and accountability among all stakeholders. The COVID-19 pandemic offers decision makers an opportunity to consider system-level transformation by looking at largely successful elements of the crisis responses. PubDate: 2025-04-25
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Abstract: Incentives for participation can help enable more equitable public health research practices, particularly when working with people from structurally disadvantaged populations, such as people who use drugs or people experiencing homelessness. Administrative and perceived ethical advantages have solidified gift card incentives in research, even though participants tend to prefer cash incentives for their time, knowledge, and contribution of lived experiences. The use of cash instead of gift cards may merit fresh attention. Drawing from research with marginalized groups, we summarize concerns with gift cards and argue that cash incentives align better with public health ethical principles. Gift cards, while convenient for researchers, can constrain participants’ economic autonomy, foster mistrust, and magnify inequities and power imbalances between researchers and participants. Cash can help to affirm participants’ autonomy, reduce stigma, demonstrate solidarity and trustworthiness, and directly benefit health. Public health researchers and ethics boards can enable cash incentive practices that centre participant welfare over researcher and institutional convenience. In so doing, they uphold more equitable and respectful relationships with study participants, advancing both public health research and ethical standards. PubDate: 2025-04-25
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Abstract: Artificial intelligence (AI) is poised to transform healthcare delivery; this may be particularly important to underserved rural, remote, and Indigenous communities. This commentary explores the potential of AI to enhance healthcare access and outcomes of these populations while emphasizing the need for culturally safe and ethical implementation. By integrating AI with Indigenous knowledge systems through the Two-Eyed Seeing approach, we propose a framework that ensures that AI-driven healthcare is equitable, culturally sensitive, and effective. This public health perspective highlights the importance of approaching AI advancements with a culturally appropriate and relevant lens. PubDate: 2025-04-23
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Abstract: 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 (B... PubDate: 2025-04-16
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Abstract: Objectives To generate concrete, youth-derived recommendations to support Canada’s post-pandemic recovery from COVID-19 to support youth mental health and substance use (MHSU), economic, and educational recovery. Methods Using a virtual, modified Delphi, participants rated recommendation items over three rounds, with the option to create their own recommendation items. A priori consensus was defined as ≥ 70% of the entire group, or subgroups of youth (e.g., age, race/ethnicity, gender and sexual identities), rating items at a 6 or 7 (on a 7-point Likert scale). Items were dropped in subsequent rounds if they did not achieve consensus. Qualitative responses were analyzed using content analysis for Round 1. Results A total of 40 youths participated in Round 1, with good retention (97.5%) in subsequent rounds. Youths achieved consensus on eight recommendations to support post-pandemic recovery. Youths endorsed post-pandemic strategies that prioritize the implementation of effective, accessible, and low-cost MHSU services in schools, workplaces, and communities; the integration of MHSU education into school lessons; increased awareness about MHSU services in schools and workplaces; and the prioritization of health and well-being in schools and workplaces. Conclusion Findings indicate the need for stronger partnerships between schools, community-based MHSU services, and hospitals, and job opportunities that pay a living wage. PubDate: 2025-04-16
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