How is the COVID-19 pandemic impacting our life, mental health, and well-being? Design and preliminary findings of the pan-Canadian longitudinal COHESION study.

BACKGROUND: With the advent of the COVID-19 pandemic, in-person social interactions and opportunities for accessing resources that sustain health and well-being have drastically reduced. We therefore designed the pan-Canadian prospective COVID-19: HEalth and Social Inequities across Neighbourhoods (COHESION) cohort to provide a deeper understanding of how the COVID-19 pandemic context affects mental health and well-being, key determinants of health, and health inequities. METHODS: This paper presents the design of the two-phase COHESION Study, and descriptive results from the first phase conducted between May 2020 and September 2021. During that period, the COHESION research platform collected monthly data linked to COVID-19 such as infection and vaccination status, perceptions and attitudes regarding pandemic-related measures, and information on participants' physical and mental health, well-being, sleep, loneliness, resilience, substances use, living conditions, social interactions, activities, and mobility. RESULTS: The 1,268 people enrolled in the Phase 1 COHESION Study are for the most part from Ontario (47%) and Quebec (33%), aged 48 ± 16 years [mean ± standard deviation (SD)], and mainly women (78%), White (85%), with a university degree (63%), and living in large urban centers (70%). According to the 298 ± 68 (mean ± SD) prospective questionnaires completed each month on average, the first year of follow-up reveals significant temporal variations in standardized indexes of well-being, loneliness, anxiety, depression, and psychological distress. CONCLUSIONS: The COHESION Study will allow identifying trajectories of mental health and well-being while investigating their determinants and how these may vary by subgroup, over time, and across different provinces in Canada, in varying context including the pandemic recovery period. Our findings will contribute valuable insights to the urban health field and inform future public health interventions.

Chronic health effects associated with electronic cigarette use: A systematic review.

Introduction: Over the last decade, e-cigarette use has been on the rise but with growing health concerns. The objective of this systematic review was to update findings for chronic health outcomes associated with e-cigarette use from the 2018 National Academies of Sciences, Engineering, and Medicine (NASEM) report. Methods: Three bibliographic databases were searched to identify studies comparing the chronic health effects of e-cigarette users (ECU) to non-smokers (NS), smokers, and/or dual users indexed between 31 August 2017 and 29 January 2021. Two independent reviewers screened abstracts and full texts. Data were extracted by one reviewer and verified by a second one. Outcomes were synthesized in a narrative manner using counts and based on statistical significance and direction of the association stratified by study design and exposure type. Risk of bias and certainty of evidence was assessed. The protocol was prospectively registered on Open Science Framework https://osf.io/u9btp. Results: A total of 180 articles were eligible. This review focused on 93 studies for the 11 most frequently reported outcomes and from which 59 reported on daily e-cigarette use. The certainty of evidence for all outcomes was very low because of study design (84% cross-sectional) and exposure type (27% reported on exclusive ECU, i.e., never smoked traditional cigarettes). Overall, the summary of results for nearly all outcomes, including inflammation, immune response, periodontal and peri-implant clinical parameters, lung function, respiratory symptoms, and cardiovascular disease, suggested either non-significant or mixed results when daily ECU was compared to NS. This was also observed when comparing exclusive ECU to NS. The only notable exception was related to oral health where most (11/14) studies reported significantly higher inflammation among daily ECU vs. NS. Compared to the smokers, the exclusive-ECUs had no statistically significant differences in inflammation orperiodontal clinical parameters but had mixed findings for peri-implant clinical parameters. Conclusions: This review provides an update to the 2018 NASEM report on chronic health effects of e-cigarette use. While the number of studies has grown, the certainty of evidence remains very low largely because of cross-sectional designs and lack of reporting on exclusive e-cigarette exposure. There remains a need for higher quality intervention and prospective studies to assess causality, with a focus on exclusive e-cigarette use.

Rethinking walkability and developing a conceptual definition of active living environments to guide research and practice.

BACKGROUND: Walkability is a popular term used to describe aspects of the built and social environment that have important population-level impacts on physical activity, energy balance, and health. Although the term is widely used by researchers, practitioners, and the general public, and multiple operational definitions and walkability measurement tools exist, there are is no agreed-upon conceptual definition of walkability. METHOD: To address this gap, researchers from Memorial University of Newfoundland hosted "The Future of Walkability Measures Workshop" in association with researchers from the Canadian Urban Environmental Health Research Consortium (CANUE) in November 2017. During the workshop, trainees, researchers, and practitioners worked together in small groups to iteratively develop and reach consensus about a conceptual definition and name for walkability. The objective of this paper was to discuss and propose a conceptual definition of walkability and related concepts. RESULTS: In discussions during the workshop, it became clear that the term walkability leads to a narrow conception of the environmental features associated with health as it inherently focuses on walking. As a result, we suggest that the term Active Living Environments, as has been previously proposed in the literature, are more appropriate. We define Active Living Environments (ALEs) as the emergent natural, built, and social properties of neighbourhoods that promote physical activity and health and allow for equitable access to health-enhancing resources. CONCLUSIONS: We believe that this broader conceptualization allows for a more comprehensive understanding of how built, natural, and social environments can contribute to improved health for all members of the population.

Recruiting Participants for Population Health Intervention Research: Effectiveness and Costs of Recruitment Methods for a Cohort Study.

BACKGROUND: Public health research studies often rely on population-based participation and draw on various recruitment methods to establish samples. Increasingly, researchers are turning to web-based recruitment tools. However, few studies detail traditional and web-based recruitment efforts in terms of costs and potential biases. OBJECTIVE: This study aims to report on and evaluate the cost-effectiveness, time effectiveness, and sociodemographic representation of diverse recruitment methods used to enroll participants in 3 cities of the Interventions, Research, and Action in Cities Team (INTERACT) study, a cohort study conducted in Canadian cities. METHODS: Over 2017 and 2018 in Vancouver, Saskatoon, and Montreal, the INTERACT study used the following recruitment methods: mailed letters, social media (including sponsored Facebook advertisements), news media, partner communications, snowball recruitment, in-person recruitment, and posters. Participation in the study involved answering web-based questionnaires (at minimum), activating a smartphone app to share sensor data, and wearing a device for mobility and physical activity monitoring. We describe sociodemographic characteristics by the recruitment method and analyze performance indicators, including cost, completion rate, and time effectiveness. Effectiveness included calculating cost per completer (ie, a participant who completed at least one questionnaire), the completion rate of a health questionnaire, and the delay between completion of eligibility and health questionnaires. Cost included producing materials (ie, printing costs), transmitting recruitment messages (ie, mailing list rental, postage, and sponsored Facebook posts charges), and staff time. In Montreal, the largest INTERACT sample, we modeled the number of daily recruits through generalized linear models accounting for the distributed lagged effects of recruitment campaigns. RESULTS: Overall, 1791 participants were recruited from 3 cities and completed at least one questionnaire: 318 in Vancouver, 315 in Saskatoon, and 1158 in Montreal. In all cities, most participants chose to participate fully (questionnaires, apps, and devices). The costs associated with a completed participant varied across recruitment methods and by city. Facebook advertisements generated the most recruits (n=687), at a cost of CAD $15.04 (US $11.57; including staff time) per completer. Mailed letters were the costliest, at CAD $108.30 (US $83.3) per completer but served to reach older participants. All methods resulted in a gender imbalance, with women participating more, specifically with social media. Partner newsletters resulted in the participation of younger adults and were cost-efficient (CAD $5.16 [US $3.97] per completer). A generalized linear model for daily Montreal recruitment identified 2-day lag effects on most recruitment methods, except for the snowball campaign (4 days), letters (15 days), and reminder cards (5 days). CONCLUSIONS: This study presents comprehensive data on the costs, effectiveness, and bias of population recruitment in a cohort study in 3 Canadian cities. More comprehensive documentation and reporting of recruitment efforts across studies are needed to improve our capacity to conduct inclusive intervention research.

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.

Causally speaking: Challenges in measuring gentrification for population health research in the United States and Canada.

The planet is rapidly urbanizing, the need for actionable evidence to guide the design of cities that help (not hinder) our health has never felt more urgent. One essential component of healthy city design is improving neighborhood conditions in previously disinvested areas. To ensure equitable city design, policy makers, city planners, health practitioners, and researchers are interested in understanding the complex relationship between urban change, gentrification, and population health. Yet, the causal link between gentrification and health outcomes remain unclear. Without clear and consistent gentrification measures, researchers struggle to identify populations who are exposed to gentrification, and to compare health outcomes between exposed and unexposed populations. To move the science forward, this paper summarizes the challenges related to gentrification measurement in the United States and Canada when aspiring to conduct studies to analyze causal relationships between gentrification and health. The paper concludes with a series of recommendations for studies aimed at examining both causes and consequences of gentrification and health.

A pan-Canadian measure of active living environments using open data.

BACKGROUND: Neighbourhood environments that support active living, such as walking or cycling for transportation, may decrease the burden of chronic conditions related to sedentary behaviour. Many measures exist to summarize features of communities that support active living, but few are pan-Canadian and none use open data sources that can be widely shared. This study reports the development and validation of a novel set of indicators of active living environments using open data that can be linked to national health surveys and can be used by local, regional or national governments for public health surveillance. DATA AND METHODS: A Geographic Information System (GIS) was used to calculate a variety of measures of the connectivity, density and proximity to destinations for 56,589 dissemination areas (DAs) across Canada (2016 data). Pearson correlation coefficients were calculated to assess the association between each measure and the rates of walking to work and taking active transportation to work (a combination of walking, cycling and using public transportation) from census data. The active living environment measures selected for the final database were used to classify the DAs by the favourability of their active living environment into groups by k-medians clustering. RESULTS: All measures were correlated with walking-to-work and active-transportation-to-work rates at the DA level, whether they were derived using proprietary or open data sources. Coverage of open data was consistent across Canadian regions. Three measures were selected for the Canadian Active Living Environments (Can-ALE) dataset based on the correlation analysis, but also on the principles of suitability for a variety of community sizes and openly available data: (1) three-way intersection density of roads and footpaths derived from OpenStreetMap (OSM), (2) weighted dwelling density derived from Statistics Canada dwelling counts and (3) points of interest derived from OSM. A measure of access to public transportation was added for the subset of DAs in larger urban areas and was strongly related to active-transportation-to-work rates. Active-transportation-to-work rates were graded, in steps, by the five Can-ALE groups derived from the cluster analysis, although walking-to-work rates exceeded the national average only in the most favourable active living environments. DISCUSSION: Open data may be used to derive measures that characterize the active living environments of Canadian communities.

INTERACT: A comprehensive approach to assess urban form interventions through natural experiments.

BACKGROUND: Urban form interventions can result in positive and negative impacts on physical activity, social participation, and well-being, and inequities in these outcomes. Natural experiment studies can advance our understanding of causal effects and processes related to urban form interventions. The INTErventions, Research, and Action in Cities Team (INTERACT) is a pan-Canadian collaboration of interdisciplinary scientists, urban planners, and public health decision makers advancing research on the design of healthy and sustainable cities for all. Our objectives are to use natural experiment studies to deliver timely evidence about how urban form interventions influence health, and to develop methods and tools to facilitate such studies going forward. METHODS: INTERACT will evaluate natural experiments in four Canadian cities: the Arbutus Greenway in Vancouver, British Columbia; the All Ages and Abilities Cycling Network in Victoria, BC; a new Bus Rapid Transit system in Saskatoon, Saskatchewan; and components of the Sustainable Development Plan 2016-2020 in Montreal, Quebec, a plan that includes urban form changes initiated by the city and approximately 230 partnering organizations. We will recruit a cohort of between 300 and 3000 adult participants, age 18 or older, in each city and collect data at three time points. Participants will complete health and activity space surveys and provide sensor-based location and physical activity data. We will conduct qualitative interviews with a subsample of participants in each city. Our analysis methods will combine machine learning methods for detecting transportation mode use and physical activity, use temporal Geographic Information Systems to quantify changes to urban intervention exposure, and apply analytic methods for natural experiment studies including interrupted time series analysis. DISCUSSION: INTERACT aims to advance the evidence base on population health intervention research and address challenges related to big data, knowledge mobilization and engagement, ethics, and causality. We will collect ~ 100 TB of sensor data from participants over 5 years. We will address these challenges using interdisciplinary partnerships, training of highly qualified personnel, and modern methodologies for using sensor-based data.

Place matters: A longitudinal analysis measuring the association between neighbourhood walkability and walking by age group and population center size in Canada.

This study examined the influence of walkability on walking behaviour and assessed whether associations varied according to life-stage and population center (PC) size. Walkability scores were obtained for the six-digit postal codes of residential neighbourhoods of 11,200 Canadians, who participated in biennial assessments of the National Population Health Survey from 1994 to 2010. Participants were stratified by age-group. Mixed-effects logistic regression models were used to estimate the influence of cumulative exposure to neighborhood walkability on utilitarian and exercise walking by PC size and life-stage. Associations of neighbourhood walkability with utilitarian and exercise walking varied according to age-group and PC size. Exposure to high walkable neighborhoods was associated with utilitarian walking in younger and older adults in all PC sizes, except for older adults living in a medium PC. Living in a highly walkable neighborhood in a large PC was associated with walking for exercise in younger (OR: 1.42; 95%CI: 1.20-1.67) and older adults (OR: 2.09; 95%CI: 1.51-2.89). Living in highly walkable neighbourhood in a medium PC was associated with walking for exercise in older adults (OR: 1.62; 95%CI: 1.15-2.29). These results emphasize the need to consider the size and nature of every community, and the age-group of a population when implementing strategies to promote walking.

Is gentrification all bad? Positive association between gentrification and individual's perceived neighborhood collective efficacy in Montreal, Canada.

BACKGROUND: Collective efficacy has been associated with many health benefits at the neighborhood level. Therefore, understanding why some communities have greater collective efficacy than others is important from a public health perspective. This study examined the relationship between gentrification and collective efficacy, in Montreal Canada. METHODS: A gentrification index was created using tract level median household income, proportion of the population with a bachelor's degree, average rent, proportion of the population with low income, and proportion of the population aged 30-44. Multilevel linear regression analyses were conducted to measure the association between gentrification and individual level collective efficacy. RESULTS: Gentrification was positively associated with collective efficacy. Gentrifiers (individuals moving into gentrifying neighborhoods) had higher collective efficacy than individuals that lived in a neighborhood that did not gentrify. Perceptions of collective efficacy of the original residents of gentrifying neighborhoods were not significantly different from the perceptions of neighborhood collective efficacy of gentrifiers. CONCLUSIONS: Our results indicate that gentrification was positively associated with perceived collective efficacy. This implies that gentrification could have beneficial health effects for individuals living in gentrifying neighborhoods.

"Contextualizing Context": Reconciling Environmental Exposures, Social Networks, and Location Preferences in Health Research.

PURPOSE OF REVIEW: The aim of this paper is to review the recent advances in health and place research and discuss concepts useful to explore how context affects health. More specifically, it reviews measures and tools used to account for place; concepts relating to daily mobility and multiple exposure to places, and further points to the intertwining between social and spatial networks to help further our understanding of how context translates into health profiles. RECENT FINDINGS: Significant advances in environmental or neighborhood effects have been made in the last decades. Specifically, conceptual and methodological developments have improved our consideration of spatial processes, shifting from a residential-based view of context to a more dynamic activity space and daily mobility paradigm. Yet, such advances have led to overlooking other potentially important aspects related to social networks and decision-making processes. With an increasing capacity to collect high-precision data on daily mobility and behavior, new possibilities in understanding how environments relate to behavior and health inequalities arise. Two overlooked aspects need to be addressed: the questions of "with or for whom", and "why". While the former calls for a better consideration of social networks and social interactions, the latter calls for refining our understanding of place preference and decision-making leading to daily mobility and multiple exposures.

Measuring the transportation needs of people with developmental disabilities: A means to social inclusion.

BACKGROUND: One of the major causes of social exclusion for people with developmental disability (PDD) is the inability to access different activities due to inadequate transportation services. OBJECTIVE: This research paper identifies transportation needs, and reasons for unmet, but desired untaken trips of adults with developmental disabilities in Hennepin County, Minnesota. We hypothesize that PDD cannot make trips they want to make due to personal and neighborhood characteristics. METHODS: A survey measuring existing travel behavior and unmet transportation needs of PDD (N = 114) was conducted. The survey included both demographic and attitudinal questions as well as a travel diary to record both actual and desired but untaken trips. Logistic regression analyses were conducted to determine reasons associated with their inability to make desired, but untaken trips. RESULTS: Most respondents did not live independently. More than half of the surveyed population worked every day and recreation trips occurred at least once a week for about two-thirds of the population. About 46% were unable to make trips they needed to make. Public transit posed physical and intellectual difficulties, however the presence of public transit in neighborhoods decreased odds of not making trips. Concerns about Paratransit services were also reported. CONCLUSION: Findings from this study can be of value to transportation engineers and planners interested in shedding light on the needs of a marginalized group that is rarely studied and have special transport needs that should be met to ensure their social inclusion in society.

Understanding the role of contrasting urban contexts in healthy aging: an international cohort study using wearable sensor devices (the CURHA study protocol).

BACKGROUND: Given the challenges of aging populations, calls have been issued for more sustainable urban re-development and implementation of local solutions to address global environmental and healthy aging issues. However, few studies have considered older adults' daily mobility to better understand how local built and social environments may contribute to healthy aging. Meanwhile, wearable sensors and interactive map-based applications offer novel means for gathering information on people's mobility, levels of physical activity, or social network structure. Combining such data with classical questionnaires on well-being, physical activity, perceived environments and qualitative assessment of experience of places opens new opportunities to assess the complex interplay between individuals and environments. In line with current gaps and novel analytical capabilities, this research proposes an international research agenda to collect and analyse detailed data on daily mobility, social networks and health outcomes among older adults using interactive web-based questionnaires and wearable sensors. METHODS/DESIGN: Our study resorts to a battery of innovative data collection methods including use of a novel multisensor device for collection of location and physical activity, interactive map-based questionnaires on regular destinations and social networks, and qualitative assessment of experience of places. This rich data will allow advanced quantitative and qualitative analyses in the aim to disentangle the complex people-environment interactions linking urban local contexts to healthy aging, with a focus on active living, social networks and participation, and well-being. DISCUSSION: This project will generate evidence about what characteristics of urban environments relate to active mobility, social participation, and well-being, three important dimensions of healthy aging. It also sets the basis for an international research agenda on built environment and healthy aging based on a shared and comprehensive data collection protocol.

Neighborhood Walkability and Body Mass Index Trajectories: Longitudinal Study of Canadians.

OBJECTIVES: To assess the impact of neighborhood walkability on body mass index (BMI) trajectories of urban Canadians. METHODS: Data are from Canada's National Population Health Survey (n = 2935; biannual assessments 1994-2006). We measured walkability with the Walk Score. We modeled body mass index (BMI, defined as weight in kilograms divided by the square of height in meters [kg/m(2)]) trajectories as a function of Walk Score and sociodemographic and behavioral covariates with growth curve models and fixed-effects regression models. RESULTS: In men, BMI increased annually by an average of 0.13 kg/m(2) (95% confidence interval [CI] = 0.11, 0.14) over the 12 years of follow-up. Moving to a high-walkable neighborhood (2 or more Walk Score quartiles higher) decreased BMI trajectories for men by approximately 1 kg/m(2) (95% CI = -1.16, -0.17). Moving to a low-walkable neighborhood increased BMI for men by approximately 0.45 kg/m(2) (95% CI = 0.01, 0.89). There was no detectable influence of neighborhood walkability on body weight for women. CONCLUSIONS: Our study of a large sample of urban Canadians followed for 12 years confirms that neighborhood walkability influences BMI trajectories for men, and may be influential in curtailing male age-related weight gain.

Achieving recommended daily physical activity levels through commuting by public transportation: unpacking individual and contextual influences.

This paper estimates the amount of daily walking associated with using public transportation in a large metropolitan area and examines individual and contextual characteristics associated with walking distances. Total walking distance to and from transit was calculated from a travel diary survey for 6913 individuals. Multilevel regression modelling was used to examine the underlying factors associated with walking to public transportation. The physical activity benefits of public transportation varied along gender and socio-economic lines. Recommended minutes of daily physical activity can be achieved for public transportation users, especially train users living in affluent suburbs.