Canadian Journal of Public Health

Hepatitis C virus (HCV) infection is highly prevalent in illicit drug user populations, with three in four new HCV infections related to this risk behaviour and a growing HCV disease burden in Canada. Using data from a multi-site cohort study of illicit opioid users in five Canadian cities (OPICAN), this paper explores the prevalence and predictors of HCV status in this high-risk population. HCV status of cohort participants was assessed by salivary antibody test. Univariate relationships of HCV status with select variables were examined on the basis of cohort baseline data, and subsequently multivariate models using logistic regression to determine independent predictors of HCV status were generated. 54.6% of the analysis sample (n=482) was HCV positive. Significant differences in terms of HCV prevalence existed across the sites. Significant variables in the final stepwise logistic regression model included age, site (Toronto), unprotected sex, injecting drug use, drug treatment and incarceration in past year, in addition to opioid use in combination with non-opioids. Besides drug injecting, various other socio-behavioural factors were associated with HCV status in our cohort. On this basis, interventions focusing solely on injection risks are overly limited in scope to prevent HCV transmission in the high-risk population of illicit drug users and need to be broadened. Prevention efforts should also target young injectors as a priority.

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. 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. 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. 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.

OBJECTIVES: Previous studies have shown that children who spend more time outdoors are more active and spend less time sedentary, but these studies were limited by the use of small convenience samples. We examined the relationship between outdoor time and measures of physical activity (PA), screen time and sedentary time in a nationally-representative sample of young children. METHODS: Parental reports of outdoor time were obtained for 594 children aged 3–6 years (47.8% girls) who participated in the 2012–2013 Canadian Health Measures Survey. Participants were asked to wear an Actical accelerometer for seven consecutive days. Outdoor time and screen time were assessed by parent reports. The relationships between outdoor time and measures of PA, screen time and sedentary time were examined with linear regression models. Adherence to PA guidelines was estimated based on a betabinomial distribution, and adherence with the screen time guidelines was assessed through logistic regression models. All analyses were stratified by age group (3–4 and 5–6 year olds) and adjusted for sex, parental education and household income. RESULTS: Among 5–6 year olds, each additional hour spent outdoors was associated with an additional 10 minutes of moderate-to-vigorous PA (95% CI: 6–14), 27,455 more accelerometer counts/day (95% CI: 11,929–42,980) and an increased likelihood of meeting the PA guidelines (OR = 2.53; 95% CI: 1.68–3.82). No significant relationships were observed among 3–4 year olds. CONCLUSION: Outdoor time has a large effect on PA among 5–6 year olds at a population level. Future studies should examine the correlates of outdoor time to inform novel PA promotion interventions.

In Ontario, Public Health is mandated to work with municipal partners to inform and collaborate on built environment initiatives. For the Healthy Community Design (HCD) Baseline project, Public Health partnered with three communities (approximately 132,000, 29,000 and 22,000 residents, respectively). The HCD Baseline Project created a baseline of HCD indicators containing spatial data and self-reported behaviour and perception data. Tailored indicators were determined collaboratively between Public Health and municipal planning staff. Physical HCD indicator data were collected and mapped spatially, while primary data collected from a Neighbourhood Design Survey provided residents’ perceptions of HCD and reported behaviour. The HCD Baseline Project produced a data monitoring system to: track progress of HCD indicators as communities grow; measure current community design to identify municipal and public health priorities, including public policy and supportive environments; and assess the impact of future HCD interventions on the community. By compiling spatial and perception data, areas of strength and opportunity guided the collaborative development of tailored recommendations for each community. Findings from the HCD Baseline Project have created a stronger position for Public Health to support local municipalities. Recommendations are guiding collaborative, evidence-informed initiatives and informing local land use planning and related supportive environment policy. Data collection will be repeated in 5, 10 and 15 years to monitor trends and impact on community design.

As the world prepares for the next influenza pandemic, governments have made significant funding commitments to vaccine development and antiviral stockpiling. While these are essential components to pandemic response, rapid and accurate diagnostic testing remains an often neglected cornerstone of pandemic influenza preparedness. Clinicians and Public Health Practitioners need to understand the benefits and drawbacks of different influenza tests in both seasonal and pandemic settings. Culture has been the traditional gold standard for influenza diagnosis but requires from 1–10 days to generate a positive result, compared to nucleic acid detection methods such as real time reverse transcriptase polymerase chain reaction (RT-PCR). Although the currently available rapid antigen detection kits can generate results in less than 30 minutes, their sensitivity is suboptimal and they are not recommended for the detection of novel influenza viruses. Until point-of-care (POC) tests are improved, PILPN recommends that the best option for pandemic influenza preparation is the enhancement of nucleic acid-based testing capabilities across Canada.

The UV Index was introduced in Canada in 1992 in response to growing concerns about the potential increase of ultraviolet (UV) radiation due to ozone depletion. The index was adopted as a standard indicator of UV levels by the World Meteorological Organization and World Health Organization in 1994. This survey article gives an overview of the UV Index and the main features of its geographical distribution. UV index values are determined from measurements made by ground-based spectrometers, broad-band filter radiometers and multi-filter radiometers. Radiative transfer models are used to estimate UV Index values from other types of geophysical observations, primarily column ozone and cloud thickness. UV Index values can also be retrieved from satellite measurements of atmospheric ozone and cloud cover. Forecasts of UV Index values are now widely available and are intended to be used by the public as a guide to avoid excessive exposure to UV radiation. Over the UV and Canada, mean noontime UV Index values in summer range from 1.5 in the Arctic to 11.5 over southern Texas and can be as high as 20 at high elevations in Hawaii. The UV Index is also often used to quantify UV levels in studies investigating the impact of UV on other biological and photochemical processes. Factors affecting the UV Index, such as the sun elevation, total amount of ozone in the atmosphere, cloud cover, reflection from snow and local pollution, are also discussed. Since its introduction in 1992, the UV Index has become a widely used parameter to characterize solar UV. Information about it can be useful for helping people avoid excessive levels of UV radiation.

Karasek’s demand-control model and Siegrist’s effort-reward imbalance model have accumulated solid evidence regarding the associations between exposure to psychosocial risk at work (PSRW) and mental health of workers. However, there is scarce such evidence with regard to its associations with alcohol consumption. This study proposed to estimate the associations between exposure to PSRW and hazardous alcohol consumption (HAC) in Chile’s working adult population. The study was cross-sectional and a nationally representative survey was applied to 3,010 workers (65% male and 35% female, ages 20 to 65). The analysis included prevalences and logistic regression controlling for covariables. The adjusted analyses show that male workers exposed to low social support (OR=1.47; 95% CI:1.14–1.89), low reward (OR=1.38; 95% CI:1.07–1.78) and effort-reward imbalance (OR=1.34; 95% CI:1.04–1.73) have a higher chance of presenting with HAC compared to those who are not exposed. Female workers exposed to effort-reward imbalance (OR=2.34; 95% CI:1.10–5.58) have twice the risk of HAC compared with their reference group. This study shows evidence of the associations between HAC and exposure to a set of psychosocial risk factors from the Karasek and Siegrist models. For future research, it is recommended that HAC and PSRW factors be examined in a longitudinal study in order to control for possible confounding effects on these associations.

OBJECTIVES: Although timely access to health care is a top priority, a burgeoning body of research highlights the important role of neighbourhood environments on unmet health care needs. This study aimed to examine an association between perceptions of neighbourhood availability of health care services and experience of unmet health care needs by gender in an urban city setting. METHODS: A total of 2338 participants from the Neighbourhood Effects on Health and Well-being (NEHW) study, between 25 and 64 years of age and dwelling in the City of Toronto, Ontario, Canada, were included in the analyses. Four different logistic regression models stratified by gender were used to examine the relationship between neighbourhood health care availability and unmet health care need as well as the impact of neighbourhood perception of health care availability on the three different types of unmet needs. RESULTS: Perceived health care availability was associated with higher likelihood of experiencing unmet health care needs in both women and men (women = OR: 1.58, 95% CI: 1.09–2.28; men = OR: 1.92, 95% CI: 1.23–2.99). In addition, perceived health care availability was associated with barrier-and wait times-related unmet health care need among women (OR: 1.83, 95% CI: 1.13–2.97; OR: 1.93, 95% CI: 1.10–3.40 respectively), and personal choice- and wait times-related unmet need among men (OR: 1.99, 95% CI: 1.10–3.58). CONCLUSION: Individuals’ perception of health care availability plays a crucial role in the experience of unmet health care needs, suggesting the importance of community-based policy development for improving physical conditions and the social aspect of health care services.