Prevalence and characteristics of smoking cigarette and narghile among Syrian refugee parents in Ontario, Canada.

This study aimed to explore the prevalence and associated sociodemographic, migration, and health-related factors of smoking cigarettes and narghile among Syrian refugee parents resettled in Ontario, Canada since 2015. A total of 540 Syrian refugee parents, with at least one child less than 18 years of age, were interviewed. Multivariate logistic regression analysis was performed to assess the independent relationship between each of the associated sociodemographic, migration, and health-related factors and smoking cigarettes and narghile. The overall prevalence of smoking was 43% (cigarette = 22%, narghile = 25.6%). The average number of cigarettes smoked per day was 15.4 (SD = 10.1). With regard to smoking narghile, 18.2% of the sample smoked daily, while 35.5% and 52.9% smoked at least once weekly and occasionally, respectively. Results from multivariate logistic regression analysis showed that more fathers were at increased odds of smoking cigarettes than mothers OR (95% CI) = 6.6 (3.7-11.9), while no such difference was found for narghile smokers OR (95% CI) = 1.5 (0.9-2.6). Results showed that smoking cigarettes was associated with lower education levels and being Muslim, whereas smoking narghile was associated with younger age and alcohol use. Poor perceived mental health was significant/approached significance for both types of smoking. Greater understanding of smoking patterns of resettled refugees is needed to direct healthcare providers to offer targeted interventions for those who are most at risk.

Effect of food insecurity on depression, anxiety, and stress among resettled Syrian refugees in Ontario.

Food insecurity has been linked to adverse health outcomes, particularly among vulnerable populations such as refugees. The aim of this study was to assess the prevalence of food insecurity and its association with depression, anxiety, and stress among resettled Syrian refugee parents in Ontario. This was a cross-sectional study with a total of 540 Syrian refugee parents who resided in Ontario for an average of four years and had at least one child less than 18 years who were interviewed. Information about food insecurity was collected based on the question "During the past year, did you ever eat less because there was not enough food or money for food?". Levels of depression, anxiety, and stress were assessed using the Depression Anxiety Stress Scales (DASS-21). Multiple linear regression analyses were performed to evaluate the relationship between food insecurity and depression, anxiety, and stress after adjusting for sociodemographic, migration-, and health-related factors. 44.6% of respondents reported experiencing food insecurity. Of participants, 7.6%, 8.9%, and 8.5% reported severe to extremely severe levels of depression, anxiety, and stress, respectively. Results of the multiple linear regression analysis showed that food insecurity was significantly associated with higher levels of depression (Adjß = 2.00, p = 0.008), anxiety (Adjß = 1.53, p = 0.013), and stress (Adjß = 1.87, p = 0.019). Implementation of effective government interventions and frameworks are essential to reduce food insecurity among resettled Syrian refugees to ultimately improve their mental health outcomes and overall well-being.

Characteristics of Self-Rated Oral Health among Syrian Refugee Parents in Ontario.

Background: Canada has been hosting Syrian refugees since early 2015. Almost half of the Syrian refugee population lives in Ontario, with dental health being at the top of the list of important immediate needs. The objective of the study was to evaluate self-rated oral health and its associated factors among Syrian refugee parents residing in Ontario. Methods: This was a cross-sectional study where 540 Syrian refugee parents, residing in Ontario and with at least one child less than 18 years of age, were interviewed. Information about self-rated oral health was collected based on the question "In general, how would you rate the health of your teeth and mouth?" with answers ranging from 1 representing "excellent" and 5 representing "very poor." Multiple linear regression analysis was performed to assess the independent relationship between each of the sociodemographic-, migration-, health-, dental-related factors, and self-rated oral health. Results: The overall prevalence of poor and very poor self-rated oral health was 43.5%. The results showed that the presence of dental health insurance, private sponsorship, improved physical and mental health, and regular visits to the dentist were factors related to improved oral health. Discussion. To achieve better oral health outcomes among refugee populations, including Syrian refugees, efforts should be focused on improving dental care and dental insurance for vulnerable populations.

Prescription ranitidine use and population exposure in 6 Canadian provinces, 1996 to 2019: a serial cross-sectional analysis.

BACKGROUND: Ranitidine was the most prescribed histamine-2 receptor antagonist (H2RA) in Canada when recalled in 2019 because of potential carcinogenicity. We sought to compare geographic and temporal patterns in use of prescription ranitidine and 3 other HRAs and estimated population exposure to ranitidine in 6 provinces between 1996 and 2019. METHODS: This population-based serial cross-sectional study used prescription claims for H2RAs dispensed from community pharmacies in Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta and British Columbia. We estimated the period prevalence of ranitidine use per 100 population by province, age category and sex. We estimated exposure to ranitidine between 2015 and 2019 using defined daily doses (DDDs). RESULTS: Overall, 2.4 million ranitidine prescriptions were dispensed to patients aged 65 years and older, and 1.7 million were dispensed to younger adults. Among older adults, the median period prevalence of ranitidine use among females was 16% (interquartile range [IQR] 13%-27%) higher than among males. Among younger adults, the median prevalence was 50% (IQR 37%-70%) higher among females. Among older adults, between 1996 and 1999, use was highest in Nova Scotia (33%) and Ontario (30%), lower in the prairies (Manitoba [18%], Saskatchewan [26%], Alberta [17%]) and lowest in BC (11%). By 2015-2019, use of ranitidine among older adults dropped by at least 50% in all provinces except BC. We estimate that at least 142 million DDDs of prescribed ranitidine were consumed annually in 6 provinces (2015-2019). INTERPRETATION: Over the 24-year period in 6 provinces, patients aged 65 years and older were dispensed 2.4 million prescriptions of ranitidine and younger adults were dispensed 1.7 million prescriptions of ranitidine. These estimates of ranitidine exposure can be used for planning studies of cancer risk and identifying target populations for cancer surveillance.

The association between shift work exposure and cognitive impairment among middle-aged and older adults: Results from the Canadian Longitudinal Study on Aging (CLSA).

BACKGROUND: Shift work, especially rotating and night shift work, has been linked to a wide range of detrimental health outcomes. Occupational factors like shift work and their potential impact on cognitive functions have received little attention, and the evidence is inconclusive. The objective of our study is to explore associations between shift work exposure and cognitive impairment indicators based on comparisons with the normative standards from the Canadian population. METHODS: Cross-sectional analyses were performed using baseline Canadian Longitudinal Study on Aging database, including 47,811 middle-aged and older adults (45-85 years). Three derived shift work variables were utilized: ever exposed to shift work, shift work exposure in longest job, and shift work exposure in current job. Four cognitive function tests were utilized, Rey Auditory Verbal Learning Tests (immediate and delayed) representing memory domain, and Animal Fluency, and Mental Alteration, representing the executive function domain. All cognitive test scores included in study were normalized and adjusted for the participant's age, sex, education and language of test administration (English and French), which were then compared to normative data to create "cognitive impairment' variables. Unadjusted and adjusted multivariable logistic regression models were used to determine associations between shift work variables and cognitive impairment individually (memory and executive function domains), and also for overall cognitive impairment. RESULT: Overall, one in every five individuals (21%) reported having been exposed to some kind of shift work during their jobs. Exposure to night shift work (both current and longest job) was associated with overall cognitive impairment. In terms of domain-based measures, night shift work (longest job) was associated with memory function impairment, and those exposed to rotating shift work (both current and longest job) showed impairment on executive function measures, when compared to daytime workers. CONCLUSION: This study suggests disruption to the circadian rhythm, due to shift work has negative impact on cognitive function in middle-aged and older adults and this warrants further investigation.

Hydrochlorothiazide use and risk of keratinocyte carcinoma and melanoma: A multisite population-based cohort study.

BACKGROUND: The association between hydrochlorothiazide (HCTZ) and skin cancer remains controversial. OBJECTIVE: To determine whether HCTZ is associated with an increased risk of skin cancer compared with angiotensin-converting enzyme inhibitors and calcium channel blockers. METHODS: Two new-user, active comparator cohorts were assembled using 6 Canadian databases. Site-specific hazard ratios (HRs) with 95% CIs were estimated using standardized morbidity ratio weighted Cox proportional hazard models and pooled using random-effects meta-analysis. RESULTS: HCTZ was not associated with an overall increased risk of keratinocyte carcinoma compared with angiotensin-converting enzyme inhibitors or calcium channel blockers, although increased risks were observed with longer durations (≥10 years; HR: 1.12; 95% CI: 1.03-1.21) and higher cumulative doses (≥100,000 mg; HR: 1.49; 95% CI: 1.27-1.76). For melanoma, there was no association with angiotensin-converting enzyme inhibitors, but a 32% increased risk with calcium channel blockers (crude incidence rates: 64.2 vs 58.4 per 100,000 person-years; HR: 1.32; 95% CI: 1.19-1.46; estimated number needed to harm at 5 years of follow-up: 1627 patients), with increased risks with longer durations and cumulative doses. LIMITATIONS: Residual confounding due to the observational design. CONCLUSIONS: Increased risks of keratinocyte carcinoma and melanoma were observed with longer durations of use and higher cumulative doses of HCTZ.

Association Between First Attempt Buffalo Concussion Treadmill Test and Days to Recovery in 855 Children With Sport-Related Concussion: A Historical Cohort Study and Prognostic Factors Analysis.

OBJECTIVE: Little is known about the prognostic value of the Buffalo Concussion Treadmill Test (BCTT) after the acute phase of sport-related concussion (SRC). We examined the added prognostic value of the BCTT performed 10 to 21 days after SRC in children, in addition to participant, injury, and clinical process characteristics on days to recovery. DESIGN: Historical clinical cohort study. SETTING: Network of approximately 150 Canadian multidisciplinary primary-care clinics. PARTICIPANTS: 855 children (mean age 14 years, range 6-17 years, 44% female) who presented between January 2016, and April 2019 with SRC. ASSESSMENT OF RISK FACTORS: Participant, injury, and clinical process characteristics, with focus on BCTT exercise intolerance assessed 10 to 21 days after injury. OUTCOME: Days to clinical recovery. RESULTS: Children who were exercise intolerant experienced an increase of 13 days to recovery (95% CI, 9-18 days). Each additional day between SRC and first BCTT was associated with a recovery delay of 1 day (95% CI, 1-2 days), and prior history of concussion was associated with a recovery delay of 3 days (95% CI, 1-5 days). Participant, injury, and clinical process characteristics, and the first attempt BCTT result explained 11% of the variation in recovery time, with 4% accounted for by the BCTT. CONCLUSION: Exercise-intolerance assessed 10 to 21 days after SRC was associated with delayed recovery. However, this was not a strong prognostic factor for days to recovery.

The association between diabetes type, age of onset, and age at natural menopause: a retrospective cohort study using the Canadian Longitudinal Study on Aging.

OBJECTIVES: With growing incidence of type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes, more women are expected to spend a larger proportion of their reproductive years living with a diabetes diagnosis. It is important to understand the long-term implications of premenopausal diabetes type on women's reproductive health including their age at natural menopause (ANM). METHODS: Baseline data from the Comprehensive Cohort of Canadian Longitudinal Study on Aging were used. Females who reported premenopausal diagnosis of diabetes were considered exposed. Kaplan-Meier cumulative survivorship estimates and multivariable Cox regression models were used to assess the association between diabetes types and ANM. Sociodemographic, lifestyle, and premenopausal clinical factors were adjusted in the final model as covariates. RESULTS: The sample comprised 11,436 participants, weighted to represent 1,474,412Canadian females aged 45 to 85 years. The median ANM was 52 years. After adjusting for ethnicity, education, smoking, and premenopausal clinical factors, early age of diagnosis of both T1D (<30 years) and T2D (30-39 years) were associated with earlier menopause (T1D, <30: hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.05-2.28; T2D, 30-39: HR, 1.82; 95% CI, 1.12-2.94), as compared with nondiabetics. In addition, later age of diagnosis of T2D (≥40 years) was associated with later ANM (T2D: HR, 0.63; 95% CI, 0.50-0.80). No significant association between gestational diabetes and ANM was noted. CONCLUSIONS: Our results point to early menopause among young women living with a diabetes diagnosis. These findings should allow for more focused research geared toward understanding the long-term health implications of diabetes on women's reproductive health and aging.

Patterns of Antipsychotic Dispensation to Long-Term Care Residents.

OBJECTIVES: To describe dispensing patterns of antipsychotic medications to long-term care (LTC) residents and assess factors associated with continuation of an antipsychotic after a fall-related hospitalization. DESIGN: A retrospective cohort study. SETTING AND PARTICIPANTS: Nova Scotia Seniors Pharmacare Program (NSSPP) beneficiaries age 66 years and older who resided in LTC and received at least 1 dispensation of an antipsychotic within the study period of April 1, 2009, to March 31, 2017. METHODS: Linkage of administrative claims data from the NSSPP and the Canadian Institute of Health Information Discharge Abstract Database identified LTC residents with an antipsychotic dispensation and from the subgroup of those dispensed antipsychotic medications who experienced a fall-related hospitalization. Antipsychotic dispensing patterns were reported with counts and means. Predictors of continuation of an antipsychotic after a fall-related hospitalization (sex, length of stay, days supplied, age, year of admission, rural/urban) were reported and analyzed with multiple logistic regression. RESULTS: There were 19,164 unique NSSPP beneficiaries who were dispensed at least 1 prescription for an antipsychotic medication. Of those who received at least 1 antipsychotic dispensation 90% (n = 17,201) resided in LTC. A mean of 40% (n = 2637) of LTC residents received at least 1 antipsychotic dispensation in each year. Risperidone and quetiapine were dispensed most frequently. Of the 544 beneficiaries residing in LTC who survived a fall-related hospitalization, 439 (80.7%) continued an antipsychotic after hospital discharge. Female sex [OR 1.7, 95% CI (1.013‒2.943)], age 66‒69 [OR 4.587, 95% CI (1.4‒20.8)], 75-79 [OR 2.8, 95% CI (1.3‒6.3)], and 80‒84 years [OR 3.1, 95% CI (1.6‒6.4)] (compared with age 90+ years) were associated with increased risk of antipsychotic continuation. CONCLUSIONS AND IMPLICATIONS: With 90% of antipsychotic dispensations in Nova Scotia being to LTC residents and 40% of LTC residents being dispensed antipsychotics in any year there is a need to address this level of antipsychotic dispensation to older adults.

The association of objectively and subjectively measured physical activity and sedentary time with prediabetes and type 2 diabetes in adults: a cross-sectional study in Framingham Heart Study cohorts.

The purpose of this study was to examine whether using both objectively (accelerometer) and subjectively (questionnaire) measured moderate- to vigorous-intensity physical activity (MVPA) and sedentary time (SED) improves the prediction of prediabetes and type 2 diabetes (pre/T2D) using data from the Framingham Heart Study (n = 4200). Logistic regression was used to examine the odds ratio of pre/T2D in groups cross-classified by subjective and objective MVPA and SED. Less than half of participants fell into concordant categories of MVPA and SED using subjective and objective measures, with 7.0%-9.4% of participants in the extreme discordant categories of high-low or low-high subjective-objective MVPA or SED. Low objective MVPA, regardless of subjective MVPA status, was associated with a higher prevalence of pre/T2D (P < 0.05). When cross-classifying by MVPA and SED, the majority of participants fell into concordant categories of MVPA-SED, with <4% of participants in the extreme discordant categories of MVPA-SED. Low objective MVPA, regardless of objective SED, was associated with a higher prevalence of pre/T2D (P < 0.05). These findings suggest that low objectively measured MVPA appears more closely associated with pre/T2D risk compared with subjective measures, and there does not appear to be an additive effect of SED on pre/T2D risk after accounting for MVPA.

The association between shift work exposure and the variations in age at natural menopause among adult Canadian workers: results from the Canadian Longitudinal Study on Aging (CLSA).

OBJECTIVE: A wide range of negative health outcomes have been associated with shift work (SW) particularly night and rotating SW. However, little is known about effects of SW exposure on reproductive health outcomes. The objective of our study is to prospectively investigate the association between SW exposure and the variations in age at natural menopause among adult Canadian workers. METHODS: Secondary data analyses were performed using the Canadian Longitudinal Study on Aging database. Premenopausal women (N = 3,688) at baseline were followed prospectively for 3 years. Three derived variables were used to measure SW primary exposure: 1) ever exposed to SW, 2) SW exposure in current job, and 3) SW exposure in the longest job. Cox proportional hazard regression models were used to evaluate risk of variations in age at natural menopause after adjusting for potential confounders. RESULT: One out of five women (20%) reported to be ever exposed to SW during their jobs. Overall, women who were ever exposed to SW were significantly associated with a delayed onset of menopause compared with daytime workers (hazard ratios [HR] = 0.77, 95% CI, 0.61-0.98). Particularly, when compared with daytime workers, rotating shift worker in the current and longest job were significantly related to delayed onset of menopause (HR = 0.64, 95% CI, 0.46-0.89 and HR = 0.65, 95% CI, 0.49-0.86), respectively. CONCLUSION: Our results suggest a relationship between rotating shift and delayed onset of menopause. We speculate that disruptive circadian stimuli may play a role in menopausal onset and this warrants further investigation.Video Summary:http://links.lww.com/MENO/A940 .

Fear of COVID-19 and depression, anxiety, stress, and PTSD among Syrian refugee parents in Canada.

INTRODUCTION: The high frequency of COVID-19 has had an impact on the psychological health of all countries and socioeconomic groups around the world, with refugees suffering the brunt of the burden. The aim was to assess the relationship between fear of COVID-19 and depression, anxiety, stress, and PTSD among Syrian refugee parents residing in the Greater Toronto Area. METHODS: A convenience sample of 274 Syrian refugee parents residing in Ontario was recruited. Fear of COVID-19 was measured using the Fear of COVID-19 Scale (FCV-19S). Levels of depression, anxiety, stress and PTSD were assessed using the Depression Anxiety Stress Scales (DASS-21), and Primary Care PTSD screen (PC-PTSD). Multiple Linear Regression analyses were performed to assess the relationship between FCV-19S and the DASS-21 subscales and PC-PTSD. RESULTS: Severe levels of depression, anxiety, and stress were reported by 12.2%, 26.8%, and 9.7% of participants respectively, and 24.1% screened positive for PTSD. FCV-19S was associated with higher levels of stress (ß = 0.27, p = 0.006), anxiety (ß = 0.40, p <0.001), depression (ß = 0.32, p = 0.001) and PTSD (ß = 0.04, p = 0.015). DISCUSSION: Government initiatives should consider tackling fear concerning pandemics among Syrian refugee parents to help enhance their mental well-being.

Variations in perceived stress among Syrian refugee parents resettled through different sponsorship programs in Canada.

BACKGROUND: Little is known about the perceived stress level of Syrian Refugee (SR) parents residing in Canada specifically in relation to different sponsorship programs. This study aims to assess the relationship between the different sponsorship programs [Government-Assisted Refugees (GAR), Privately Sponsored Refugees (PSR) and Blended Visa Office-Referred refugees (BVOR)] and perceived stress among SR parents, with at least one child under the age of four, who resettled in the Greater Toronto area after 2015. METHODS: A convenience sample of 155 Syrian Refugee (SR) parents was recruited. Perceived levels of stress were measured using the Perceived Stress Scale (PSS-10). Multiple linear regression analysis was performed to assess the independent relation between several types of sponsorship programs and PSS adjusting for demographic, economic and social factors. RESULTS: The overall average PSS score was found to be 12.5 ± 7.2 with BVORs presenting the highest level of moderate stress when compared to GARs and PSRs (75.0% compared to 39.5% and 35.2% respectively). Multivariate analysis showed that the mean PSS was significantly higher among BVORs when compared with GARs (Adj ß = 4.8; 95% CI 0.4, 9.2). No significant difference in PSS levels was reported when PSRs were compered to GARs. Increased PSS scores were found to be associated with worse family functioning (Adj ß = 4.2; 95% CI 1.0, 7.4), while decreased PSS scores were associated with increased age (Adj ß = -0.4; 95% CI -0.6, -0.1). CONCLUSION: A better understanding of the various underlying factors associated with elevated stress is essential for improving the quality of life for SRs in Canada. Results of the study may help tailor more effective preventative measures or government interventions dedicated to reducing stress levels among this population.

Impact of using concomitant conventional DMARDs on adherence to biologic DMARD treatment in rheumatoid arthritis: Multi-centre, population-based cohort study.

PURPOSE: To evaluate the impact of concomitant use of conventional synthetic DMARDs (csCMARD) on adherence, switching and dose of biologic disease modifying antirheumatic drugs (bDMARD) in rheumatoid arthritis (RA) patients treated with bDMARDs. PATIENTS AND METHODS: This was a population-based cohort study conducted in five provinces of Canada (Alberta, Manitoba, Ontario, Quebec, and Saskatchewan), and one American database (IBM® MarketScan® Databases). Adult RA patients entered the study after a 3-month initiation period of bDMARDs between 1 January 2007, and 30 March 2014. Concomitant csDMARD exposure was compared to non-csDMARD exposure on the following outcomes: discontinuation of bDMARD therapy, switching of bDMARDs, and percent change in dose of bDMARD compared to initial dose. The effect of the time-varying changes in csDMARD exposure was analyzed using marginal structural models. Dose change was analyzed using linear regression. Results from each participating site were combined using likelihood ratio meta-analysis. RESULTS: The study population comprised 20,221 new users of bDMARDs: adalimumab (7609), etanercept (9809), abatacept (1024), infliximab (1779). Concomitant use of csDMARD therapy was not significantly associated with reduced discontinuation of bDMARD treatment (hazard ratio 0.90, 95% intrinsic confidence interval 0.79 to 1.02) or reduced switching of bDMARDs (hazard ratio 0.95, 95% intrinsic confidence interval 0.80 to 1.11), but was associated with a small increase in bDMARD dose compared to the mean dose over the first three months of treatment (mean percentage change in dose +0.56% mg/day, 95% intrinsic confidence interval +0.14% to +0.97%). CONCLUSION: In this large study of RA patients using bDMARDs in Canada and the United States, we found no clear evidence that patients who received concomitant csDMARD therapy were less likely to discontinue, switch or increase their dose of bDMARD.

Effects of Exercise on Resting Metabolic Rate in Adolescents with Overweight and Obesity.

Background: We examined the effects of exercise training on resting metabolic rate (RMR), and whether changes in body composition are associated with changes in RMR in adolescents with overweight and obesity. Methods: One hundred forty adolescents (12-18 years, BMI ≥85th percentile) participated in randomized exercise trials (3-6 months) at UPMC Children's Hospital of Pittsburgh (18 control, 51 aerobic, 50 resistance, and 21 combined aerobic and resistance exercise). All participants had RMR assessments by indirect calorimetry after a 10-12 hour overnight fast, and body composition by magnetic resonance imaging and dual-energy X-ray absorptiometry. Results: There were no significant changes in RMR (kcal/day) between exercise groups vs. controls (p > 0.05). All exercise groups decreased visceral fat (-0.2 ± 0.02 kg; p < 0.05) compared to control. Increases in fat-free mass (FFM) were only seen in the combined group (2.3 ± 0.4 kg; p < 0.05), whereas increases in skeletal muscle mass were observed in both resistance (1.2 ± 0.2 kg; p < 0.05) and combined (1.5 ± 0.3 kg; p < 0.05) groups vs. control. Change in FFM, but not fat mass (FM), visceral fat, or skeletal muscle mass (p > 0.05), was a significant determinant of changes in RMR, independent of exercise modality (p = 0.04). Conclusion: Although exercise modality was not associated with changes in RMR, change in FFM, but not skeletal muscle or FM, was a significant correlate of changes in RMR in adolescents with overweight and obesity. Clinicaltrials.gov registration numbers: NCT00739180, NCT01323088, NCT01938950.

Cannabis use and patterns among middle and older aged Canadians prior to legalization: a sex-specific analysis of the Canadian Tobacco, Alcohol and Drugs Survey.

BACKGROUND: The recreational use of cannabis was legalized across Canada in October 2018. While many people use cannabis without harm, adverse outcomes have been noted in a few populations, including middle-aged and older adults. Given that the current literature has neglected to study cannabis use among this population and between sexes, the objective of our study was to identify the prevalence, characteristics, and patterns of cannabis use among middle and older aged males and females prior to legalization in Canada. METHODS: Secondary analysis was conducted on the Canadian Tobacco, Alcohol and Drugs Survey 2017, with the sample restricted to adults ages 40 and above. The main outcome was defined as past-year cannabis use and statistical analysis was conducted separately for males and females. Bivariate and multivariable logistic regression was performed to identify associations between the main outcome and various sociodemographic, health, and substance use variables. Explanatory supplementary variables were also explored. RESULTS: In 2017, 5.9% of females and 9.0% of males over the age of 40 reported past-year cannabis use. Almost 62% of males who used cannabis in the past-year reported a failed attempt at reducing or stopping their cannabis use. Over half (56%) of older females, self-reported using cannabis for medical purposes. Additionally, over one in five older adults reported using a vaporizer or e-cigarette as a delivery method for cannabis. Significant characteristics of male cannabis use included having no marital partner, cigarette smoking, and illegal drug use. Furthermore, significant predictors of past-year cannabis use in females included residing in an urban community, Eastern- Atlantic provinces or British Columbia, having fair/poor mental health, smoking cigarettes, use of other tobacco products, and illegal drugs. CONCLUSION: To our such knowledge, this is the first nationally representative study to outline the prevalence, characteristics, and patterns of past-year cannabis use prior to Canadian legalization, among middle and older aged Canadians. Results from this study are expected to be used to reliably to track changes in usage, behaviours, and related disorders in the years to come.

Supporting sexual adjustment from the perspective of men living with spinal cord injury.

STUDY DESIGN: Descriptive phenomenological approach. OBJECTIVES: This study explored the lived experience of sexuality for men after spinal cord injury (SCI) and described the current state of tools and resources available to assist with sexual adjustment from the perspective of men living with SCI. SETTING: Men living in the community in Ontario, Canada. METHODS: Six men (age 24-49 years) with complete or incomplete SCI (C4-T12; <1-29 years post injury) participated in one individual, in-depth, standardized, open-ended interview (68-101 min). Analysis was conducted using Giorgi's method, and involved within case analysis followed by cross-case analysis. RESULTS: All participants reported that resources available to support sexual adjustment after SCI were inadequate, and the majority of men felt their healthcare providers lacked knowledge regarding, and comfort discussing sexuality after SCI. Men reported sexuality was not a priority of the rehabilitation centers and felt that healthcare providers did not understand the importance of addressing sexuality. Existing resources were described as too clinical and not necessarily relevant given changes in sensation and mobility post injury. Participants provided recommendations for the effective delivery of relevant sexual education information. CONCLUSIONS: To improve quality of life for men after SCI, suitable resources must be available to support sexual rehabilitation post injury. Future research should focus on developing strategies to facilitate discussions about sexuality between individuals with SCI and healthcare providers, and on developing resources that are effective and relevant for these men.

Prevalence and Factors Associated with Visiting the Dentist Only for Emergency Care Among Indigenous People in Ontario.

Ontario has the largest Indigenous population in Canada. This study aims to examine the prevalence and factors associated with poor dental care use amongst the Indigenous in Ontario. Data from the 2014 cycle of the Canadian Community Health Survey was used. The main outcome was defined as visiting the dentist only for emergency care. Stepwise multivariable logistic regression was performed to assess the association between socio-demographic, socio-economic, and the health related factors and emergency dental care use. 28% of the participants reported visiting the dentist only for emergencies. First Nations people were at increased odds of having poor dental care (OR 2.01, CI 1.12-3.95). Additionally, being male, a smoker, having fair/poor health and lacking dental insurance puts the Indigenous Ontarians at increased odds of having the outcome. Improvements to the current social benefit programs could help better cater to the needs of this population.

The association between alcohol, marijuana, illegal drug use and current use of E-cigarette among youth and young adults in Canada: results from Canadian Tobacco, Alcohol and Drugs Survey 2017.

BACKGROUND: E-cigarettes have grown in popularity around the world since 2003. Although marketed as a smoking cessation tool, e-cigarettes can lead to tobacco cigarette smoking in youth. In Canada, among all age groups, youth and young adults have the highest prevalence of e-cigarette use. The objective of this study was to assess the factors associated with e-cigarette use among youth and young adults in Canada, and to specifically examine the association between alcohol, marijuana and illicit drug use. METHODS: Data from the 2017 Canadian Tobacco, Alcohol and Drugs Survey were used. The sample was restricted to those aged 15-24 years (n = 10,322), and main outcome defined as 'E-cigarette use in the past 30-days'. Multivariable logistic regression was performed to assess the association between the main outcome and substance use variables (illicit drug, marijuana and alcohol use), tobacco exposure variables, and demographic and health-related factors. RESULTS: 6.2% Canadians aged 15-24 reported using e-cigarettes in the past 30-days, while 23.9% reported having ever tried e-cigarettes. Twenty-three percent of the past 30-day users reported using e-cigarettes every day and 72.5% of the past 30-day users reported having nicotine in their last e-cigarette. Additionally, youth aged 15-17 were 4.95 times more likely to be e-cigarette users as compared to those aged 22-24 (OR: 4.95, 95% CI: 3.1-7.9). Moreover, e-cigarette use was significantly associated with marijuana use (OR:4.17, 95% CI: 2.6-6.7) and alcohol use (OR: 5.08, 95% CI: 2.9-9.0), and approached significance with illicit drug use (OR: 1.68, 95% CI: 1.0-2.9). Furthermore, being a current smoker (OR: 2.93, 95% CI: 1.8-4.7) and male (OR: 2.28, 95% CI: 1.5-3.4) was significantly associated with the outcome. CONCLUSION: This study is nationally representative and provides insight into e-cigarette use among youth and young adults aged 15-24 years. Given that e-cigarettes can be used as illicit drug delivery systems, more studies are needed to understand how Canadian youth and young adults are using e-cigarettes. Stricter restrictions on public e-cigarette smoking, and awareness campaigns informing youth of risks of e-cigarette smoking should be implemented.