Exploring the contextual risk factors and characteristics of individuals who died from the acute toxic effects of opioids and other illegal substances: listening to the coroner and medical examiner voice. / Exploration des facteurs de risque contextuels et des caractéristiques des personnes décédées des effets toxiques aigus d'opioïdes et d'autres substances illégales : prise en compte de l'avis des coroners et des médecins légistes.

INTRODUCTION: Substance-related acute toxicity deaths continue to be a serious public health concern in Canada. This study explored coroner and medical examiner (C/ME)perspectives of contextual risk factors and characteristics associated with deaths from acute toxic effects of opioids and other illegal substances in Canada. METHODS: In-depth interviews were conducted with 36 C/MEs in eight provinces and territories between December 2017 and February 2018. Interview audio recordings were transcribed and coded for key themes using thematic analysis. RESULTS: Four themes described the perspectives of C/MEs: (1) Who is experiencing a substance-related acute toxicity death?; (2) Who is present at the time of death?; (3) Why are people experiencing an acute toxicity death?; (4) What are the social contextual factors contributing to deaths? Deaths crossed demographic and socioeconomic groups and included people who used substances on occasion, chronically, or for the first time. Using alone presents risk, while using in the presence of others can also contribute to risk if others are unable or unprepared to respond. People who died from a substance-related acute toxicity often had one or more contextual risk factors: contaminated substances, history of substance use, history of chronic pain and decreased tolerance. Social contextual factors contributing to deaths included diagnosed or undiagnosed mental illness, stigma, lack of support and lack of follow-up from health care. CONCLUSION: Findings revealed contextual factors and characteristics associated with substance-related acute toxicity deaths that contribute to a better understanding of the circumstances surrounding these deaths across Canada and that can inform targeted prevention and intervention efforts.

More food for thought: a follow-up qualitative study on experiences of food bank access and food insecurity in Ottawa, Canada.

BACKGROUND: Despite the widespread proliferation of food banks in high-income countries over the past several decades, there is a paucity of data regarding the long-term experiences of the people who rely on food banks. We were unable to find any other studies with follow-up interviews later than 6 months after baseline. OBJECTIVE: This study examined the changes in the lived experiences of people who accessed food banks over a period of 18 months. METHODS: Semi-structured interviews were conducted with 11 people who accessed food banks in Ottawa, Canada and who had participated in a 6-month study that ended one full year before this follow-up study was done. Transcripts of the interviews were analyzed through a general inductive approach involving repeated readings and coding of relevant segments of text with NVivo software according to themes that emerged iteratively. Code reports were then used to discuss and reach consensus on a final set of themes. RESULTS: Three main themes emerged: (1) chronic physical and mental health issues intersecting with food bank access; (2) psychosocial impact of relying on food banks; and (3) living on a low income and dealing with poverty. Chronic physical and mental health conditions were prevalent among the participants. As well, 10 of the 11 participants in this 18-month follow-up continued to rely on food banks as a regular resource - not as an emergency relief measure - to supplement their nutritional needs. While most of the participants reported that food banks helped them in some way, many shortcomings were also noted regarding food amounts, quality and choice. Overall, there was little change reported since the 6-month follow-up. CONCLUSIONS: The shortcomings reported by participants can mostly be attributed to the dependence of food banks on charitable donations; thus, despite the commendable work of food bank staff and volunteers, participants described the food assistance as inadequate. Additionally, long-term food bank usage was a common denominator in the lived experiences of all our participants; therefore, our findings reinforce the need for assistance programs that target long-term food insecurity and its underlying causes, to replace or supplement charity-based food bank programs.

The impact of novel and traditional food bank approaches on food insecurity: a longitudinal study in Ottawa, Canada.

BACKGROUND: Food insecurity is strongly associated with poor mental and physical health, especially with chronic diseases. Food banks have become the primary long-term solution to addressing food insecurity. Traditionally, food banks provide assistance in the form of pre-packed hampers based on the food supplies on hand, such that the food items often do not meet the recipients' cultural, religious or medical requirements. Recently, new approaches have been implemented by food banks, including choice models of food selection, additional onsite programming, and integrating food banks within Community Resource Centres. METHODS: This study examined changes in food security and physical and mental health, at four time points over 18 months at eleven food banks in Ottawa, Ontario, Canada. The participants - people who accessed these food banks - were surveyed using the Household Food Security Survey Module (HFSSM) and the Short-Form Health Survey Version 2 (SF-12). Statistical analyses included: pairwise paired t-tests between the mean perceived physical and mental health scores across the four waves of data collection, and longitudinal mixed effects regression models to understand how food security changed over time. RESULTS: The majority of people who were food insecure at baseline remained food insecure at the 18-month follow-up, although there was a small downward trend in the proportion of people in the severely food insecure category. Conversely, there was a small but significant increase in the mean perceived mental health score at the 18-month follow-up compared to baseline. We found significant reductions in food insecurity for people who accessed food banks that offered a Choice model of food distribution and food banks that were integrated within Community Resource Centres. CONCLUSIONS: Food banks offer some relief of food insecurity but they don't eliminate the problem. In this study, reductions in food insecurity were associated with food banks that offered a Choice model and those that were integrated within a Community Resource Centre. There was a slight improvement in perceived mental health at the 18-month time point; however, moderately and severely food insecure participants still had much lower perceived mental health than the general population.

Substance use and related harms in the context of COVID-19: a conceptual model. / Consommation de substances et méfaits connexes dans le contexte de la COVID-19 : un modèle conceptuel.

As the effects of COVID-19 have been unfolding, growing attention has been paid to the intersection of COVID-19 and substance use and the related harms. However, there are few theories and little empirical evidence to guide investigations in this area. To advance this emerging area of inquiry, we present a conceptual model that synthesizes evidence, information and knowledge on substance use and related harms in the context of the pandemic. The conceptual model offers a visual representation of the connections between the pandemic and substance use and related harms, and can be used to identify areas for future research.

As of June 2020, substance use and related harms in the context of a pandemic remained largely uninvestigated. The COVID-19 pandemic may impact how Canadians use substances and may present specific challenges and harms among people who use substances. The conceptual model in this paper offers a synthesis of evidence, information and knowledge of the concepts and associations relevant to substance use and harms in the context of the pandemic. Relevant concepts were synthesized into five interrelated domains that can be used to identify areas for future research into substance use and related harms in the context of COVID-19: substance use as a means of coping; changes in social support and networks; availability and accessibility of services; increased risk of COVID-19 transmission among people who use substances; and increased risk of severe outcomes.

En juin 2020, la consommation de substances et les méfaits connexes dans le contexte de la pandémie restaient largement inexplorés. La pandémie de COVID-19 peut avoir une incidence sur la façon dont les Canadiens consomment des substances, ce qui pourrait entraîner des défis et des méfaits particuliers chez ces personnes. Le modèle conceptuel présenté dans le présent document offre une synthèse des données probantes, de l'information et des connaissances sur les concepts et les associations relatifs à la consommation de substances et aux méfaits dans le contexte de la pandémie. Les concepts pertinents ont été synthétisés en cinq domaines interreliés qui peuvent être utilisés pour déterminer les futurs domaines de recherche sur la consommation de substances et les méfaits connexes dans le contexte de la COVID-19, soit la consommation de substances comme stratégie d'adaptation, les changements relatifs au soutien social et aux réseaux; la disponibilité et l'accessibilité des services; le risque accru de transmission de la COVID-19 chez les personnes qui consomment des substances; et le risque accru de conséquences graves.

Autonomy, competence and relatedness and cannabis and alcohol use among youth in Canada: a cross-sectional analysis. / Autonomie, compétence et appartenance sociale et consommation de cannabis et d'alcool chez les jeunes au Canada : une analyse transversale.

INTRODUCTION: There has been increasing attention on preventing problematic youth substance use in light of concerns about rates of use and policy changes in Canada. Strengths-based approaches that emphasize protective factors, including positive mental health, are at the forefront of current prevention recommendations. However, there is a dearth of research on the association between positive mental health and substance use among youth. This study examines the associations between cannabis and alcohol use among youth and positive mental health as measured through the lens of self-determination theory. METHODS: Secondary analyses of the 2014/2015 Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS) were conducted. Participating Grade 7 to 12 students residing in Canada completed the Children's Intrinsic Needs Satisfaction Scale (CINSS), which measures autonomy, competence and relatedness, and answered questions that measure past 30-day and more frequent cannabis use, alcohol use and binge-drinking. The associations between autonomy, competence and relatedness and substance use, stratified by sex, were examined using logistic regression. RESULTS: Fully adjusted models revealed that relatedness and competence were associated with lower odds of 30-day and more frequent cannabis use, alcohol use and binge-drinking. Higher autonomy was associated with higher odds of these behaviours. All associations were significant with the exception of competence and more frequent cannabis use among boys, and autonomy and more frequent alcohol use among girls. CONCLUSION: The findings offer new evidence on the associations between positive mental health and substance use among youth, specifically how autonomy, competence and relatedness are associated with cannabis use, alcohol use and binge-drinking. This evidence can be used to inform health promotion and substance use prevention programs.

Perceived stress, coping strategies, and emotional intelligence: A cross-sectional study of university students in helping disciplines.

BACKGROUND: Post-secondary students in training for helping profession disciplines, including nursing, may be at elevated risk for high stress levels. Stress among students has been linked with adverse physical and psychological health. In addition to the common stressors associated with post-secondary education, sources of stress for students in the helping professions include balancing academic and clinical demands. Previous research indicates perceived stress levels are correlated with emotional intelligence (EI) and with the coping strategies employed by students. OBJECTIVES: The aim of this study was to examine (1) the relationship between EI and perceived stress, and (2) the potential mediating role of coping responses. DESIGN: A cross-sectional survey design was employed. SETTING: Participants were recruited from a public university in the United States. PARTICIPANTS: A sample of 203 undergraduate and graduate students majoring in psychology, nursing, and social work was recruited. METHOD: Participants were recruited on-campus and through campus online resources and completed an online survey or a paper-and-pencil version of the survey. Descriptive statistics and mediation analyses were used to test the study hypotheses. RESULTS: Higher EI was associated with lower perceived stress, and this association was partially mediated by both adaptive and maladaptive coping responses. Higher EI was associated with greater use of adaptive coping and lower use of maladaptive coping, and these, in turn, were negatively and positively (respectively) associated with perceived stress. CONCLUSION: The findings suggest that interventions aimed at increasing emotional intelligence may help to reduce perceived stress for students in the helping disciplines.

Risk factors for continuous distress over a 12-month period in newly diagnosed cancer outpatients.

This analysis examined demographic and medical factors associated with continuous distress in the year following cancer diagnosis. Patients completed the Distress Thermometer, Fatigue and Pain Thermometers, and anxiety and depression measures, at baseline, 3-, 6-, and 12 months. A total of 480 patients were grouped into three trajectories for distress, pain, fatigue, anxiety, and depression. Logistic regression analyses were conducted to determine risk factors associated with each symptom pattern. Females were more likely to report continuous distress. Predictors of the remaining outcomes included younger age; a diagnosis of head and neck, gastrointestinal, or prostate cancer; and receipt of chemotherapy and radiation therapy. By identifying risk factors for continuous distress, interventions can be implemented more efficiently and targeted to those who are at an elevated risk.