The Moderating Role of Health Status on the Association Between Depressive Symptoms and Cannabis Vaping.

Objective: Cannabis vaping is increasing among college students. There is little information on risk factors for vaping cannabis. Consistent with the self-medication hypothesis, experiencing depressive symptoms and having a chronic medical condition (CMC) are associated with cannabis use among young adults. Individuals who experience both risk factors may be at higher risk for cannabis vaping. This study examined cross-sectional associations between depressive symptoms, CMC status, and cannabis vaping, and identified the moderating role of CMC status on depressive symptoms and cannabis vaping. Method: College students (N = 3,742) self-reported on depressive symptoms, CMC status, and lifetime and current cannabis vaping (i.e., cannabis vaporizers; electronic nicotine devices to use cannabis). Data were collected Fall 2017 until Spring 2021. The sample was predominantly female (70.9%) and White (75.4%). Regression analyses were used. Results: Greater depressive symptoms were related to increased likelihood of cannabis vaping across outcomes. Having a CMC was related to lifetime history of cannabis vaporizing. CMC status moderated the associations between depressive symptoms and lifetime cannabis vaporizing. Depressive symptoms were only a risk factor for cannabis vaporizing among college students without a CMC, not those with a CMC. Conclusions: Interventions that teach adaptive ways of coping with depressive symptoms and the potential demands of managing a CMC in college are needed. Comprehensive programs for college students, with and without CMCs, are needed to support those with comorbid depression and cannabis vaping use.

Longitudinal Associations Between Depression and Religiosity/Spirituality Among Individuals with Asthma in the United States.

There is limited literature examining the longitudinal stability of depressive symptoms for individuals with asthma, or how religiosity/spirituality relates to depressive symptoms across time. The present study aimed to identify the stability of and the longitudinal associations between depressive symptoms and R/S across multiple developmental periods for adolesents with asthma (N = 998) within the United States. Depressive symptoms (ßrange 0.33 - 0.60) and R/S (ßrange 0.26 - 0.73) were stable across time, with some variability. A cross-lagged association demonstrated that use of R/S in young adulthood (Wave 3) was associated with decreased depressive symptoms in adulthood (ß = -0.17, p < .001, CI - 0.25 - - 0.09, SE = 0.04). Use of R/S in adolescence (Wave 2) was predictive of increased depression in adulthood (ß = 0.13, p < .001, CI 0.05 - 0.20, SE = 0.04). Results demonstrated differential relations between R/S and depressive symptoms across development, and highlight the potential importance of integrating conversations focused on R/S within healthcare settings, especially as R/S during young adulthood may buffer against or reduce depressive symptoms in adulthood.

COVID-19 Mental Health Impacts Among Parents of Color and Parents of Children with Asthma.

OBJECTIVES: This study investigated whether select social determinants of health and worries about COVID-19 resource losses mediated the relations between four parent groups: [1) non-Hispanic White (NHW) parents of children with asthma; 2) Black, Indigenous, or other Persons of Color (BIPOC) parents of healthy children; 3) BIPOC parents of children with asthma; and 4) NHW parents of healthy children (referent)] and parent anxiety and depression symptoms during COVID-19. METHODS: Parents (N = 321) completed online questionnaires about discrimination, anxiety, depression, and COVID-19 impacts on employment/income and access to food and health care. Mediation analyses were conducting using nonparametric bootstrapping procedures. RESULTS: BIPOC parents of children with and without asthma experienced greater anxiety and depression symptoms through greater discrimination compared to NHW parents of healthy children. BIPOC parents of children with asthma experienced greater anxiety symptoms, and both BIPOC groups experienced greater depression symptoms, through greater COVID-19 income losses. NHW parents of children with asthma and both BIPOC groups experienced greater anxiety and depression symptoms through greater worries about COVID-19 resource losses. CONCLUSIONS: The suffering of BIPOC parents, especially BIPOC parents of children with asthma, necessitates multi-level COVID-19 responses to address key drivers of health inequities.

An Updated Narrative Review on the Role of Alcohol Among Indigenous Communities.

Purpose of Review: The role of alcohol varies considerably among Indigenous Peoples and is the backdrop of persistent stereotypes despite decades of research. This paper provides an updated narrative review on the alcohol literature among Indigenous communities, highlighting recent studies published since 2017. Recent Findings: We examined published literature involving alcohol use rates, including abstinence; risk and protective factors; treatment; and recovery, as well as future directions for alcohol prevention and intervention efforts with Indigenous communities. Summary: Evidence-based alcohol use prevention, intervention, and recovery strategies with Indigenous communities are outlined. Recommendations are provided for researchers, health providers, and public policy advocates to address and better understand alcohol use, treatment, prevention, and recovery among Indigenous Peoples. Specific recommendations include using community-based participatory research strategies and harm reduction approaches to prevent and treat alcohol use problems with Indigenous communities. Future research is needed to elucidate mechanisms of resilience and recovery from Alcohol Use Disorder and possible shifts in perceptions of alcohol use for Indigenous Peoples.

The social determinants of substance use associated with deaths of despair: Individual risks and population impacts.

As the incidence of deaths from external causes including poisonings, suicide, and alcohol-related liver disease, increases in countries such as the United States and Canada, a better understanding of the fundamental social determinants of the substance use underlying these so-called "deaths of despair", at the population level, is needed. Using data from the nationally representative data from the Canadian Community Health Survey (2003, 2015-2016, 2018 cycles) (N = 30,729), the independent associations between age, sex, marital status, immigrant status, race/ethnicity, education, income, rurality, affective health and the use of illicit substances, opioids (without distinction for prescription status), problematic levels of alcohol, and combined past-year use (≥2) of substances, were explored using multivariate logistic regression, marginal risk, and population attributable fraction estimation, with propensity score-adjusted sensitivity analyses. Males, those who were under 29 years, without a partner, born in Canada, White, or had an affective disorder reported both higher use of individual substances and multiple substances in the past year. Social determinants appear to explain a substantial proportion of substance use patterns overall. Between 10% and 45% of illicit substance, problematic alcohol, and polysubstance use prevalence was attributable to non-partnered marital status, non-immigrant status, and White race/ethnicity. Of opioid use prevalence, 25% was attributable to White race/ethnicity, 13% to affective disorder status and 4% to lower-income. Though not all substance use will result in substance-related morbidity or mortality, these findings highlight the role of social determinants in shaping the intermediary behavioural outcomes that shape population-level risk of "deaths of despair".

Racial and ethnic differences in distress, discrimination, substance use coping, and nicotine use among parents during COVID-19.

This study identified contributing factors for tobacco-related inequities among parents (N = 331) during COVID-19. Compared to non-Hispanic White parents, Asian, Black, and multiracial parents experienced greater discrimination. Parents with a nicotine use history experienced greater discrimination and substance use coping relative to tobacco abstainers. Among parents who used nicotine during the pandemic (n = 45), experiencing financial loss, having COVID-19, and greater worries were positively associated with nicotine reductions during COVID-19. Being female, increased family members with COVID-19, discrimination, and substance use coping were negatively associated with nicotine reductions. Tobacco interventions that reduce substance use coping and increase alternative coping are needed.

Smoking across adolescence and adulthood with cardiovascular risk among American Indian peoples.

OBJECTIVE: American Indian peoples (AIs) have high smoking rates and cardiovascular risk factor burden. The present study aimed to (a) investigate latent smoking classes across adolescence and adulthood, (b) investigate adolescent predictors of smoking classes, and (c) assess how smoking class is related to adult cardiovascular risk in a sample of AIs. METHOD: A sample of AIs (N = 338) from the National Adolescent to Adult Health Study self-reported on smoking across four assessment waves (W1: 7th-12th grade; W2: 8th-12th grade; W3: ages 18-26; W4: ages 24-32). The socioecological framework for addressing tobacco-related disparities was used to identify potential adolescent (W1) risk and resource factors. C-reactive protein, blood pressure, and lipids were collected at W4. Growth mixture modeling and regressions were used. RESULTS: Six smoking classes were identified: light smoking (36%), nonsmoking (23%), escalating, adult daily smoking (13%), chronic heavy smoking (12%), escalating, young adult daily smoking (9%), and reducing smoking (7%). Risk factors for being in the chronic heavy smoking class included peer smoking and older age at W1. Compared with the chronic heavy smoking class, AIs in the reducing smoking class lived in in more impoverished neighborhoods during adolescence. Relative to several classes with less smoking, being in the chronic heavy smoking class was associated with higher C-reactive protein and less favorable lipid levels. W1 social support was a resource factor for adult diastolic blood pressure and some lipids. CONCLUSIONS: Socioecologically informed tobacco interventions have the potential to reduce smoking and cardiovascular risk among AIs, and bolstering social support may be important. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social determinants of ethno-racial inequalities in substance use: a decomposition of national survey data.

BACKGROUND: Similar to the US, mortality due to suicide and the use of opioids, alcohol, and other substances (so-called "Deaths of Despair"), is rising in Canada and has been disproportionately observed among Whites compared to other racial and ethnic groups. This study aimed to assess the determinants of the ethno-racial differences in the use of substances that underlie these deaths. METHODS: Using nationally representative data from the Canadian Community Health Survey (2003, 2015-2016, 2018 cycles), a decomposition analysis was performed to estimate the contribution of psychosocial determinants, including age, sex, marital status, immigration, education, income, rurality, and affective health on inequalities between White and non-White populations in illicit substance, opioid, and problematic alcohol use and combined use (≥ 2) of substances. RESULTS: Overall, White respondents reported higher levels (by 5% to 10%) of substance use than non-White peers. Over 30% of the ethno-racial inequalities in illicit substance, problematic alcohol, and polysubstance use are explained by the protective role of immigration among those who are not White, whose low levels of substance use lower the prevalence in the non-White population overall. Among those born in Canada, no ethno-racial differences in substance use were observed. CONCLUSION: Social determinants, particularly immigrant status, explain a substantial proportion of ethno-racial inequalities in substance use in Canada. The jump in substance use between racialized populations who immigrated to Canada and those Canadian-born highlights the importance of exploring within-group variability in deaths of despair risk and considering how intersecting forces including systemic racism shape substance use patterns across generations.

Social inequalities in COVID-19 mortality by area and individual-level characteristics in Canada, January to July/August 2020: Results from two national data integrations.

Background: Despite early reports of social determinants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) burden, national Canadian reporting on COVID-19 inequalities has been limited. The objective of this study is to describe inequalities in COVID-19 mortality in Canada using preliminary data, as part of the Pan-Canadian Health Inequalities Reporting Initiative. Methods: Two provisional Canadian Vital Statistics Death Database integrations were used. Data concerning deaths between January 1 and July 4, 2020, among private-dwelling residents were linked to individual-level data from the 2016 short-form Census, and disaggregated by sex and low-income status, dwelling type, household type and size. Data concerning deaths between January 1 and August 31, 2020 linked to 2016 Census area data were disaggregated by sex and neighbourhood ethno-cultural composition quintiles (based on the proportion of residents who are recent immigrants, visible minorities, born outside of Canada, with no knowledge of English or French), income quintiles and urban residence. The COVID-19 age-standardized mortality rate (per 100,000 population) differences and ratios between groups were estimated. Results: As of July/August 2020, apartment dwellers, residents of urban centres, neighbourhoods with the highest ethno-cultural composition or lowest income experienced 14 to 30 more COVID-19-related deaths/100,000 compared with reference groups (residents of single-detached homes, outside of urban centres, with lowest ethno-cultural concentration or highest income, respectively). Per 100,000 population, sex/gender inequalities were also larger in these four groups (11 to 18 more male than female deaths) than in the reference groups (two to four more male than female deaths). Conclusion: These findings highlight how populations facing socioeconomic disadvantage have experienced a higher overall burden of deaths. Areas for future research are discussed to guide health equity-informed pandemic response.

Profiles of Nicotine and Cannabis Exposure among Young Adults with Asthma.

There is a paucity of data on nicotine and cannabis use among young adults (YAs) with asthma. This study aimed to do the following among YAs with asthma: (1) describe YAs' active and passive exposure to nicotine and cannabis; (2) identify latent classes of active use of nicotine and cannabis; and (3) explore predictors of class membership (i.e., demographics, parental and friend use of nicotine and cannabis, and hours of environmental exposure to tobacco smoke, e-cigarette vapor, and marijuana smoke). YAs with asthma (N = 178) self-reported on nicotine and cannabis exposure and the included covariates. Latent class analysis was used to identify latent classes of lifetime nicotine and cannabis use. High rates of nicotine and cannabis use among YAs with asthma were found: 37% reporting a lifetime history of using both nicotine and cannabis. Regarding past year use, 25% had smoked cigarettes, 40% had used e-cigarettes, and 35% had used cannabis. Five classes of lifetime use were identified. The largest class was a non-user class (53%); the other four classes indicate concerning patterns of nicotine and cannabis use. The most consistent predictor of being in a class characterized by more nicotine and cannabis exposure (versus being in the non-user class) was past week exposure to cannabis smoke. This is the first study to identify classes of lifetime nicotine and cannabis use, and examine predictors of class membership, among YAs with asthma. There is a critical need to address environmental and active tobacco and marijuana exposure among YAs with asthma.

Social inequalities in protective behaviour uptake at the start of the COVID-19 pandemic: results from a national survey.

OBJECTIVES: We aimed to assess social patterns of handwashing, social distancing, and working from home at the start of the COVID-19 pandemic in Canada, and determine what proportions of the overall prevalence and social inequalities in handwashing and social distancing are related to inequalities in the opportunity to work from home, to guide pandemic preparedness and response. METHODS: Using cross-sectional data from the Canadian Perspectives Survey Series, collected between March 29 and April 3, 2020, among Canadian adults (N=4455), we assessed prevalence of not working from home, social distancing in public, or practicing frequent handwashing, according to age, sex, marital status, immigration, education, chronic disease presence, and source of COVID-19 information. Multivariate regression, population attributable fraction estimation, and generalized product mediation analysis were applied. RESULTS: Absence of frequent handwashing and distancing was more common among those working outside than within the home (prevalence differences of 7% (95% CI: 4, 10) and 7% (95% CI: 3, 10), respectively). Inequalities in handwashing and distancing were observed across education and immigration status. Over 40% of the prevalence of non-uptake of handwashing and distancing was attributable to populations not being able to work from home. If all worked from home, over 40% (95% CI: 8, 70) of education-based inequalities in handwashing and distancing could be eliminated, but differences by immigration status would likely remain. CONCLUSION: For pandemic response, both workplace safety initiatives and mechanisms to address the inequitable distribution of health risks across socio-economic groups are needed to reduce broader inequalities in transmission risk.

RéSUMé: OBJECTIFS: Nous avons cherché à évaluer les habitudes sociales en matière d'hygiène des mains, de distanciation physique et de travail à domicile au début de la pandémie de la COVID-19 au Canada, et à déterminer quelles proportions de la prévalence globale et des inégalités sociales en matière d'hygiène des mains et de distanciation physique sont liées aux inégalités dans la possibilité de travailler à domicile (le télétravail), afin de guider la préparation et la réponse à la pandémie. MéTHODES: À l'aide des données transversales de la Série d'enquêtes sur les perspectives canadiennes 1, recueillies entre le 29 mars et le 3 avril 2020 auprès d'adultes canadiens (N=4 455), nous avons évalué la prévalence du travail hors du domicile, de la non-distanciation physique en public et de l'absence de lavage fréquent des mains, en fonction de l'âge, du sexe, de l'état civil, de l'immigration, de l'éducation, de la présence de maladies chroniques et de la principale source déclarée d'information sur la COVID-19. Une régression multivariée, une estimation de la fraction attribuable dans la population et une analyse de médiation par produit généralisé ont été appliquées. RéSULTATS: L'absence de lavage fréquent des mains et de distanciation physique étaient déclarées plus fréquemment chez les personnes travaillant à l'extérieur qu'à l'intérieur du domicile (différences de prévalence de 7 % (IC 95 % : 4, 10) et 7 % (IC 95 % : 3, 10), respectivement). Des inégalités en matière de lavage fréquent des mains et de la pratique de distanciation physique ont été observées en fonction du niveau d'éducation et du statut d'immigration. Plus de 40 % de la prévalence de la non-pratique du lavage fréquent des mains et de la distanciation physique était attribuable au fait que les populations ne pouvaient pas travailler à domicile. Si toutes les personnes travaillaient à domicile, plus de 40 % (IC 95 % : 8, 70) des inégalités liées au niveau d'éducation en matière de lavage des mains et distanciation physique pourraient être éliminées, mais les inégalités au niveau du statut d'immigration en matière de ces deux comportements subsisteraient probablement. CONCLUSION: Pour la répondre à la pandémie, il faut à la fois des initiatives de sécurité au travail, ainsi que des mécanismes visant à remédier à la répartition inéquitable des risques sanitaires entre les groupes socio-économiques pour réduire les inégalités plus larges en matière de risque de transmission.

Structural determinants of stigma across health and social conditions: a rapid review and conceptual framework to guide future research and intervention. / Déterminants structurels de la stigmatisation touchant les conditions sanitaires et sociales : revue rapide et cadre conceptuel visant à guider la recherche et les interventions.

INTRODUCTION: Stigma has been identified as a key determinant of health and health inequities because of its effects on access to health-enabling resources and stress exposure. Though existing reports offer in-depth summaries of the mechanisms through which stigma influences health, a review of evidence on the upstream drivers of stigma across health and social conditions has been missing. The objective of this review is to summarize known structural determinants of stigma experienced across health and social conditions in developed country settings. METHODS: We conducted a rapid review of the literature. English- and French-language peer-reviewed and grey literature works published after 2008 were identified using MEDLINE, Embase, PsycINFO, Google and Google Scholar. Titles and abstracts were independently screened by two reviewers. Information from relevant publications was extracted, and a thematic analysis of identified determinants was conducted to identify broad domains of structural determinants. A narrative synthesis of study characteristics and identified determinants was conducted. RESULTS: Of 657 publications identified, 53 were included. Ten domains of structural determinants of stigma were identified: legal frameworks, welfare policies, economic policies, social and built environments, media and marketing, pedagogical factors, health care policies and practices, biomedical technology, diagnostic frameworks and public health interventions. Each domain is defined and summarized, and a conceptual framework for how the identified domains relate to the stigma process is proposed. CONCLUSION: At least 10 domains of structural factors influence the occurrence of stigma across health and social conditions. These domains can be used to structure policy discussions centred on ways to reduce stigma at the population level.

A time-series analysis of testing and COVID-19 outbreaks in Canadian federal prisons to inform prevention and surveillance efforts.

BACKGROUND: Approximately 14,000 adults are currently incarcerated in federal prisons in Canada. These facilities are vulnerable to disease outbreaks and an assessment of coronavirus disease 2019 (COVID-19) testing and outcomes is needed. The objective of this study was to examine outcomes of COVID-19 testing, prevalence, case recovery and death within federal prisons and to contrast these data with those of the general population. METHODS: Public time-series outcome data for prisoners and the general population were obtained on-line from the Correctional Service of Canada and the Public Health Agency of Canada, respectively, from March 30 to May 27, 2020. Prison, province and sex-specific frequency statistics for each outcome were calculated. A total of 50 facilities were included in this study. RESULTS: Of these 50 facilities, 64% reported fewer individuals tested per 1,000 population than observed in the general population and 12% reported zero tests in the study period. Testing tended to be reactive, increasing only once prisons had recorded positive tests. Six prisons reported viral outbreaks, with three recording over 20% cumulative COVID-19 prevalence among prisoners. Cumulatively, in prisons, 29% of individuals tested received a positive result, compared to 6% in the general population. Two of the 360 cases died (0.6% fatality). Four outbreaks appeared to be under control (more than 80% of cases recovered); however, sizeable susceptible populations remain at risk of infection. Female prisoners (5% of the total prisoner population) were over-represented among cases (17% of cases overall). CONCLUSION: Findings suggest that prison environments are vulnerable to widespread severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Gaps in testing merit public health attention. Symptom-based testing alone may not be optimal in prisons, given observations of widespread transmission. Increased sentinel or universal testing may be appropriate. Increased testing, along with rigorous infection prevention practices and the potential release of prisoners, will be needed to curb future outbreaks.

COVID-19 Impacts on Families of Color and Families of Children With Asthma.

OBJECTIVE: This cross-sectional study quantified differences in (a) social determinants of health (SDOH) and perceived changes in SDOH during the 2019 novel coronavirus (COVID-19) pandemic and (b) COVID-19 psychosocial impacts across four groups: (a) non-Hispanic White (NHW) parents of children with asthma, (b) Black, Indigenous, or other People of Color (BIPOC) parents of healthy children, (c) BIPOC parents of children with asthma, and (d) NHW parents of healthy children (referent). The NIMHD Framework was used to identify SDOHs that may change for families during COVID-19. METHODS: Parents were recruited via Prolific (N = 321) and completed questions about COVID-19 family impacts on employment, income, access to food and healthcare, and psychosocial functioning, including discrimination. It was hypothesized that NHW families of children with asthma and BIPOC families would endorse greater negative outcomes relative to NHW parents of healthy children. RESULTS: BIPOC families experienced greater food insecurity and discrimination relative to NHW parents of healthy children. When compared with the NHW healthy group, COVID-19 resulted in greater parent-reported resource losses for both BIPOC groups and greater reductions in healthcare access for both asthma groups. Children with asthma and BIPOC children had greater distress surrounding COVID-19. BIPOC and NHW parents of children with asthma reported greater worries about resource losses due to COVID-19. CONCLUSIONS: The pandemic is widening inequities for BIPOC families, especially for families of children with asthma. These results highlight the need for interventions that address the needs of underserved communities, providing the infrastructure, policies, and supports needed to reduce health inequities during and after COVID-19.

Identifying gaps in COVID-19 health equity data reporting in Canada using a scorecard approach.

OBJECTIVE: To assess health equity-oriented COVID-19 reporting across Canadian provinces and territories, using a scorecard approach. METHODS: A scan was performed of provincial and territorial reporting of five data elements (cumulative totals of tests, cases, hospitalizations, deaths, and population size) across three units of aggregation (province or territory level, health regions, and local areas) (15 "overall" indicators), and for four vulnerable settings (long-term care and detention facilities, schools, and homeless shelters) and eight social markers (age, sex, immigration status, race/ethnicity, healthcare worker status, occupational sector, income, and education) (180 "equity-related" indicators) as of December 31, 2020. Per indicator, one point was awarded if case-delimited data were released, 0.7 points if only summary statistics were reported, and 0 if neither was provided. Results were presented using a scorecard approach. RESULTS: Overall, information was more complete for cases and deaths than for tests, hospitalizations, and population size denominators needed for rate estimation. Information provided on jurisdictions and their regions, overall, tended to be more available (average score of 58%, "D") than that for equity-related indicators (average score of 17%, "F"). Only British Columbia, Alberta, and Ontario provided case-delimited data, with Ontario and Alberta providing case information for local areas. No jurisdiction reported on outcomes according to patients' immigration status, race/ethnicity, income, or education. Though several provinces reported on cases in long-term care facilities, only Ontario and Quebec provided detailed information for detention facilities and schools, and only Ontario reported on cases within homeless shelters and across occupational sectors. CONCLUSION: One year into the pandemic, socially stratified reporting for COVID-19 outcomes remains sparse in Canada. However, several "best practices" in health equity-oriented reporting were observed and set a relevant precedent for all jurisdictions to follow for this pandemic and future ones.

RéSUMé: OBJECTIF: Évaluer les pratiques de déclaration des données de surveillance de la COVID-19 axée sur l'équité en matière de santé dans les provinces et territoires canadiens, en utilisant une fiche de pointage. MéTHODES: Les sites webs et rapports officiels des provinces et territoires ont été analysés pour identifier la présence de cinq éléments de données sur la COVID-19 (totaux cumulatifs des tests, cas, hospitalisations et décès ainsi que la taille de la population évaluée, nécessaire pour l'estimation de taux), déclarées au niveau de trois unités d'agrégation populationnelle (de la province/du territoire, des régions socio-sanitaires, et des localités/quartiers) (15 indicateurs de données « globales ¼); ainsi qu'au niveau de quatre milieux à risque d'éclosions (les établissements de soins de longue durée et de détention, les écoles, et les refuges pour personnes en situation d'itinérance) et de huit marqueurs sociaux (l'âge, le sexe, le statut d'immigration, la race/ethnicité, le statut de travailleur de santé, le revenu, le niveau d'éducation, et le secteur de travail) (180 indicateurs d'équité en matière de santé) à compter du 31 décembre 2020. Pour chaque indicateur, un point a été attribué si des données délimitées par cas ont été publiées, 0,7 points si seules les statistiques sommaires ont été communiquées, et 0 si aucune information n'a été fournie. Les résultats sont présentés sous la forme d'une fiche de pointage. RéSULTATS: Dans l'ensemble, les informations sur les cas et les décès étaient plus complètes que celles pour les tests, les hospitalisations et les tailles de population. Les éléments de données étaient plus disponibles au niveau global des provinces et territoires et de leurs régions socio-sanitaires (note moyenne de 58 % ou « D ¼) que pour les indicateurs liés à l'équité en matière de santé (note moyenne de 17 % ou « F ¼). Seuls la Colombie-Britannique, l'Alberta et l'Ontario ont fourni des données délimitées par cas, et seuls l'Alberta et l'Ontario ont fourni des données au niveau local. Aucune juridiction n'a fait état de données en fonction du statut d'immigration, de la race/l'ethnicité, du revenu ou du niveau d'éducation des patients. Plusieurs juridictions ont fourni des informations au sujet des cas au sein des établissements de soins de longue durée, mais seuls l'Ontario et le Québec ont fourni des informations détaillées au sujet des établissements de détention et des écoles. L'Ontario était unique en rapportant sur les cas par secteur occupationnel et pour les refuges pour les personnes en situation d'itinérance. CONCLUSION: Un an après le début de la pandémie, la disponibilité des données sur la COVID-19, stratifiées par marqueurs sociaux, reste très limitée au Canada. Cependant, plusieurs « bonnes pratiques ¼ en matière de déclaration axée sur l'équité en matière de santé ont été observées, ce qui constitue un précédent pertinent que les juridictions pourront suivre pendant cette pandémie et celles à venir.

Longitudinal smoking patterns and adult cardiometabolic risk among African Americans.

OBJECTIVE: To better understand mechanisms influencing health in African Americans (AAs), the aims of this study were (a) to identify longitudinal cigarette smoking classes among AAs across adolescence and into young adulthood; (b) to identify risk factors for smoking and how cardiometabolic health in adulthood differs by smoking class; and (c) to investigate whether smoking mediates the relation between adolescent risk factors and adult cardiometabolic health. METHOD: This study used 4 waves of nationally representative data, restricted to an AA subsample (N = 2,009). Participants self-reported on multilevel risk factors in adolescence and smoking across adolescence and young adulthood; cardiometabolic risk was assessed in adulthood. Growth mixture modeling and structural equation modeling were conducted. RESULTS: Five classes emerged: nonsmoker; early onset, heavier smoking; later onset; early onset, light smoking; and maturing out or declining smoking. Predictors of class membership included living with individuals who smoke, having friends who smoke, and limited access to medical care. The early onset, light smoking class had the greatest cardiometabolic risk. Smoking class mediated the relation between living with people who smoke in adolescence and adult cardiometabolic risk. CONCLUSIONS: Nuanced smoking patterns among AAs were identified, and 23% fell into classes characterized by an early onset and persistent smoking trajectory. The early onset, light smoking class had the greatest cardiometabolic risk in adulthood. The results suggest unique protective factors may be present for youth who remain nonsmokers even when their family smokes. Results have implications for health promotion and tobacco prevention efforts among AA families. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Associations between area-level deprivation, rural residence, physician density, screening policy and late-stage colorectal cancer in Canada.

BACKGROUND: Important social disparities in colorectal screening exist in Canada. Few studies have assessed disparities further along the cancer control continuum. Here we assess the associations between social and material deprivation, physician density, rural residence, and the absence of provincial mail-based screening programs and colorectal cancer (CRC) stage at diagnosis. METHODS: Colorectal cancer cases and stage data ("local or regional" if stage 0, I, or II, "late" if stage III or IV) were obtained through the Canadian Cancer Registry (2011-2015, N = 54,745). Cases were linked to 2006 Canadian Census Dissemination Area-level data on rural/urban status, exposure to a provincial mail-based screening program, and social and material deprivation (Pampalon Index quintile groups); and to Scott's Medical Database 2011 physician density data (<7 vs. ≥ 7/10,000). Age, sex, and predictor-adjusted Generalized estimating equation (GEE) Poisson models were used to determine independent associations between predictors and late-stage at diagnosis. RESULTS: Half of CRC cases are diagnosed at stage III or IV (51 %), with younger age groups experiencing higher late-stage prevalence (57 % among those aged 18-49). The covariate-adjusted late-stage prevalence was 2-percentage points higher in most materially- and socially-deprived areas (95 % CI: 1 %, 4 %, in both, respectively) and in provinces with no mail-based screening programs (95 % CI: 1 %, 2 %). No significant differences were observed according to rural residence or physician density. CONCLUSIONS: Social disparities in late-stage CRC diagnosis are modest. Continued surveillance of these disparities may be warranted as provinces continue to promote early cancer detection through screening, and stage distributions may change overtime.

How community resources mitigate the association between household poverty and the incidence of adverse childhood experiences.

OBJECTIVES: To assess what proportion of the association between household low income and incidence of adverse childhood experiences (ACE) would be eliminated if all households had access to housing, transportation and childcare services, breastfeeding counselling, and parks. METHODS: Using Growing Up in Scotland birth cohort data (N = 2816), an inverse probability-weighted regression-based mediation technique was applied to assess associations between low-income status (< £11,000 in 2004/5), resource access, and cumulative 8-year ACE incidence (≥ 1, ≥ 3 ACEs). Resource access was measured based on households' self-reported difficulties (yes/no) in accessing housing, transportation, childcare, and breastfeeding counselling, and park proximity (within 10 min from the residence). RESULTS: The protective effects of resources were heterogeneous. Only access to transportation was associated with lower ACE incidence in both low- and higher-income households. If all had access to transportation, 21% (95% CI 3%, 41%) of the income-based inequality in incidence of 3 or more ACEs could be eliminated. CONCLUSIONS: While second best to the elimination of child poverty, measures to improve families' access to community resources such as transportation may mitigate the effects of poverty on ACE incidence.

The Role of Access to a Regular Primary Care Physician in Mediating Immigration-Based Disparities in Colorectal Screening: Application of Multiple Mediation Methods.

BACKGROUND: Colorectal cancer screening participation is lower among recent immigrants than among Canadian-born individuals. We assessed whether this screening disparity is mediated by access to regular primary care physicians (PCP). METHODS: Pooling years 2003 to 2014 of the Canadian Community Health Survey, lifetime screening in respondents aged 50 to 75 years of age who immigrated in the previous 10 years (n = 1,067) was compared with Canadian-born respondents (N = 102,366). Regression- and inverse probability weighting-based methods were used to estimate the total effect (TE) and controlled direct effect (CDE) of recent immigration on never having received either a stool- or endoscopic-based screening test. The proportion of the TE that would be eliminated if all had a PCP was computed using these estimates [proportion eliminated (PE) = (TE - CDE)/(TE - 1)]. Analyses were stratified by visible minority status and adjusted for income, rurality, age, sex, marital status, education, and exposure to a provincially organized colorectal screening program. RESULTS: The prevalence of never having been screened was 71% and 57% in visible minority and white recent immigrants, respectively, and 46% in white Canadian-born respondents. If all had regular PCPs, there would be no reduction in the screening inequality between white recent immigrants and Canadian-born (null PE), and the inequality between visible minority immigrants and white Canadian-born may increase by 6% to 13%. CONCLUSIONS: Ensuring all have regular PCPs may lead to greater screening gains among Canadian-born than recent immigrants. IMPACT: Improving access to PCPs may increase colorectal screening overall, but not reduce immigration-based disparities screening. Alternative interventions to reduce this disparity should be explored.

Canadian report card on health equity across the life-course: Analysis of time trends and cross-national comparisons with the United Kingdom.

Addressing social determinants of health (SDoH) has been acknowledged as an essential objective for the promotion of both population health and health equity. Extant literature has identified seven potential areas of investment to address SDoH: investments in sexual and reproductive health and family planning, early learning and child care, education, universal health care, as well as investments to reduce child poverty, ensure sustainable economic development, and control health hazards. The aim of this paper is to produce a 'report card' on Canada's success in reducing socioeconomic and health inequities pertaining to these seven policy domains, and to assess how Canadian trends compare to those in the United Kingdom (UK), a country with a similar health and welfare system. Summarising evidence from published studies and national statistics, we found that Canada's best successes were in reducing socioeconomic inequalities in early learning and child care and reproductive health-specifically in improving equity in maternal employment and infant mortality. Comparative data suggest that Canada's outcomes in the latter areas were like those in the UK. In contrast, Canada's least promising equity outcomes were in relation to health hazard control (specifically, tobacco) and child poverty. Though Canada and the UK observed similar inequities in smoking, Canada's slow upward trend in child poverty prevalence is distinct from the UK's small but steady reduction of child poverty. This divergence from the UK's trends indicates that alternative investment types and levels may be needed in Canada to achieve similar outcomes to those in the UK.