An Exploratory Study on the Impacts of Individual Skills and Health Information Exposure on Perceptions of Cancer Control and Expert Competence.

People's perceptions of control over their risk of cancer, and their perceptions of health experts' abilities to manage cancer risks, shape their beliefs about the effectiveness of expert-recommended cancer-preventive behaviors and actions. The aims of this exploratory study were to investigate the impact of individual skills and sources of health information on (i) internal locus of cancer control (ILOC) and (ii) perceived expert competence. Using a cross-sectional survey (n = 172), we collected data on individual health expertise, numeracy, health literacy, amounts of health information received from various sources, ILOC for cancer prevention and perceived expert competence (i.e., believing that health experts have the knowledge to correctly estimate cancer risks). Significant associations between health expertise and ILOC, and between health literacy and ILOC, were not observed in this study (OR = 2.15, 95%CI = 0.96-5.98; OR = 1.78, 95%CI = 0.97-3.63, respectively). Participants who received more health information from the news were more likely to perceive experts as competent (OR = 1.86, 95%CI = 1.06-3.57). Logistic regression analyses suggested that higher levels of health literacy among individuals with lower numeracy may promote ILOC but discourage expert competence beliefs. Analyses by gender suggested females with low educational attainment and lower numeracy may especially benefit from educational interventions to improve health literacy and promote ILOC. Our findings build off existing literature that point to a possible interaction between numeracy and health literacy. This research, with follow up work, may have practical implications for health educators aiming to promote specific cancer beliefs that lead to the uptake of expert-recommended cancer-preventive behaviors.

Negative COVID-19 Vaccine Information on Twitter: Content Analysis.

Background: Social media platforms, such as Facebook, Instagram, Twitter, and YouTube, have a role in spreading anti-vaccine opinion and misinformation. Vaccines have been an important component of managing the COVID-19 pandemic, so content that discourages vaccination is generally seen as a concern to public health. However, not all negative information about vaccines is explicitly anti-vaccine, and some of it may be an important part of open communication between public health experts and the community. Objective: This research aimed to determine the frequency of negative COVID-19 vaccine information on Twitter in the first 4 months of 2021. Methods: We manually coded 7306 tweets sampled from a large sampling frame of tweets related to COVID-19 and vaccination collected in early 2021. We also coded the geographic location and mentions of specific vaccine producers. We compared the prevalence of anti-vaccine and negative vaccine information over time by author type, geography (United States, United Kingdom, and Canada), and vaccine developer. Results: We found that 1.8% (131/7306) of tweets were anti-vaccine, but 21% (1533/7306) contained negative vaccine information. The media and government were common sources of negative vaccine information but not anti-vaccine content. Twitter users from the United States generated the plurality of negative vaccine information; however, Twitter users in the United Kingdom were more likely to generate negative vaccine information. Negative vaccine information related to the Oxford/AstraZeneca vaccine was the most common, particularly in March and April 2021. Conclusions: Overall, the volume of explicit anti-vaccine content on Twitter was small, but negative vaccine information was relatively common and authored by a breadth of Twitter users (including government, medical, and media sources). Negative vaccine information should be distinguished from anti-vaccine content, and its presence on social media could be promoted as evidence of an effective communication system that is honest about the potential negative effects of vaccines while promoting the overall health benefits. However, this content could still contribute to vaccine hesitancy if it is not properly contextualized.

Has public health messaging during the COVID-19 pandemic reflected local risks to health?: A content analysis of tweeting practices across Canadian geographies.

During the COVID-19 pandemic, public health agencies and decision-makers have used social media to disseminate information, encourage changes to behaviour and promote community supports and resources. Their communications have served to educate the public on risks and initiate the widespread adoption of public health measures to 'flatten the curve'. We conducted a content analysis of COVID-19 Tweets by Canadian public health accounts during the first 6 months of the pandemic to explore differences in Tweeting practices by geography and identify opportunities to improve risk communication. We found that Canadian public health accounts in particular geographic settings did not always apply best practices for health communication. Tweeting practices differed considerably between jurisdictions with varying burdens of COVID-19. Going forward, Tweets authored by public health accounts that promote behaviour change and community-building ought to be utilized whenever risks to health are high to reflect an increase in disease transmission requiring intervention. Our study highlights the need for public health communicators to deliver messaging that is relevant for the levels of risk that their audiences are encountering in a given geographic context.

Examining Tweet Content and Engagement of Canadian Public Health Agencies and Decision Makers During COVID-19: Mixed Methods Analysis.

BACKGROUND: Effective communication during a health crisis can ease public concerns and promote the adoption of important risk-mitigating behaviors. Public health agencies and leaders have served as the primary communicators of information related to COVID-19, and a key part of their public outreach has taken place on social media platforms. OBJECTIVE: This study examined the content and engagement of COVID-19 tweets authored by Canadian public health agencies and decision makers. We propose ways for public health accounts to adjust their tweeting practices during public health crises to improve risk communication and maximize engagement. METHODS: We retrieved data from tweets by Canadian public health agencies and decision makers from January 1, 2020, to June 30, 2020. The Twitter accounts were categorized as belonging to either a public health agency, regional or local health department, provincial health authority, medical health officer, or minister of health. We analyzed trends in COVID-19 tweet engagement and conducted a content analysis on a stratified random sample of 485 tweets to examine the message functions and risk communication strategies used by each account type. RESULTS: We analyzed 32,737 tweets authored by 118 Canadian public health Twitter accounts, of which 6982 tweets were related to COVID-19. Medical health officers authored the largest percentage of COVID-19-related tweets (n=1337, 35%) relative to their total number of tweets and averaged the highest number of retweets per COVID-19 tweet (112 retweets per tweet). Public health agencies had the highest frequency of daily tweets about COVID-19 throughout the study period. Compared to tweets containing media and user mentions, hashtags and URLs were used in tweets more frequently by all account types, appearing in 69% (n=4798 tweets) and 68% (n=4781 tweets) of COVID-19-related tweets, respectively. Tweets containing hashtags also received the highest average retweets (47 retweets per tweet). Our content analysis revealed that of the three tweet message functions analyzed (information, action, community), tweets providing information were the most commonly used across most account types, constituting 39% (n=181) of all tweets; however, tweets promoting actions from users received higher than average retweets (55 retweets per tweet). When examining tweets that received one or more retweet (n=359), the difference between mean retweets across the message functions was statistically significant (P<.001). The risk communication strategies that we examined were not widely used by any account type, appearing in only 262 out of 485 tweets. However, when these strategies were used, these tweets received more retweets compared to tweets that did not use any risk communication strategies (P<.001) (61 retweets versus 13 retweets on average). CONCLUSIONS: Public health agencies and decision makers should examine what messaging best meets the needs of their Twitter audiences to maximize sharing of their communications. Public health accounts that do not currently employ risk communication strategies in their tweets may be missing an important opportunity to engage with users about the mitigation of health risks related to COVID-19.

Agricultural injuries among farm and non-farm children and adolescents in Alberta, Canada.

BACKGROUND: Understanding of the specific risk of agricultural injury sustained by different populations of children and adolescents is needed for effective safety intervention. OBJECTIVE: To compare the rates and patterns of agricultural injury incidence (fatal and non-fatal injury) between farm and non-farm children less than 18 years of age in Alberta, Canada. METHODS: A total of 115 378 children (five subgroups: two groups of farm children and three groups of non-farm children) in Alberta were followed from 1999 to 2010 to examine injury incidence using the linkage of three administrative health databases. A recurrent event survival analysis using Cox proportional hazards regression was carried out. RESULTS: A total of 1 849 agricultural injury episodes (1 616 emergency department visits, 225 hospitalizations, and 8 deaths) were identified from 1999 to 2010. The age- and gender-adjusted rate (per 100 000 person years) of agricultural injury was 672.3 for rural-living farm children, 369.4 for urban-living farm children, 180.2 for rural non-First Nations (FN) children, 64.4 for rural FN children, and 23.7 for urban children in descending order. CONCLUSION: Specific strategies for different children's populations to prevent agricultural injuries and to extend agricultural injury controls to non-farming populations are needed.

The effect of temperature on arson incidence in Toronto, Ontario, Canada.

Studies of crime and weather have largely excluded arson from empirical and theoretical consideration, yet weather could influence arson frequency over short time frames, influencing the motivation and activity of potential arsonists, as well as the physical possibility of fire ignition. This study aims to understand the role of weather on urban arson in order to determine its role in explaining short-term variations in arson frequency. We use data reported to the Ontario Fire Marshall's office of arson events in the City of Toronto between 1996 and 2007 to estimate the effect of temperature, precipitation, wind conditions and air pressure on arson events while controlling for the effects of holidays, weekends and other calendar-related events. We find that temperature has an independent association with daily arson frequency, as do precipitation and air pressure. In this study area, cold weather has a larger influence on arson frequency than hot weather. There is also some evidence that extremely hot and cold temperatures may be associated with lower day-time arson frequency, while night-time arson seems to have a simpler positive linear association with temperature.

Genetic susceptibility to beryllium: a case-referent study of men and women of working age with sarcoidosis or other chronic lung disease.

OBJECTIVE: The study was designed to investigate whether beryllium exposure was related to illness diagnosed as sarcoidosis. Chronic beryllium disease (CBD) and sarcoidosis are clinically and pathologically indistinguishable, with only the presence of beryllium-specific T-lymphocytes identifying CBD. Testing for such cells is not feasible in community studies of sarcoidosis but a second characteristic of CBD, its much greater incidence in those with a glutamic acid residue at position 69 of the HLA-DPB1 gene (Glu69), provides an alternative approach to answering this question. METHODS: Cases of sarcoidosis aged 18-60 years diagnosed in Alberta, Canada, from 1999 to 2005 were approached through their specialist physician, together with age-matched and sex-matched referents with other chronic lung disease. Referents were grouped into chronic obstructive pulmonary disease (COPD), asthma and other lung disease. Participants completed a telephone questionnaire, including industry-specific questionnaires. DNA was extracted from mailed-in mouthwash samples and genotyped for Glu69. Duration of employment in types of work with independently documented beryllium exposure was calculated. RESULTS: DNA was extracted for 655 cases (270 Glu69 positive) and 1382 referents (561 positive). No increase in sarcoidosis was seen with either Glu69 or beryllium exposure (none, <10, ≥10 years) as main effects: longer duration in possible beryllium jobs was related to COPD. In Glu69 positive men with exposure ≥10 years, the trend towards increasing rate of COPD was reversed, and a significant interaction of duration of exposure and Glu69 was detected (OR=4.51 95% CI 1.17 to 17.48). CONCLUSIONS: The gene-environment interaction supports the hypothesis that some cases diagnosed as sarcoidosis result from occupational beryllium exposure.

A geography of moral hazard: sources and sinks of motor-vehicle commuting externalities.

Motor-vehicles are responsible for harms to health that are not directly experienced by individual drivers - such as air pollution and risk of injury to pedestrians. In addition to their direct effects on health, these harms also represent a moral hazard since drivers are not required to consider their effects as part of their decision to drive. We describe an approach for estimating sources of motor-vehicle commuter externalities as a means of understanding the geography of moral hazard, and in particular, the spatial displacement of negative health externalities associated with motor-vehicle commuting. This approach models motor-vehicle commuter traffic flow by trip origin for small geographic areas within the City of Toronto, Ontario. We find that most health-related externalities associated with motor-vehicle commuters are not locally generated, with a large share coming from outside Toronto. Low income is associated with externalities originating outside the municipal boundary, but not with locally sourced externalities. We discuss the impact of geographical moral hazard on the agency of citizens as well as policy options aimed at addressing motor-vehicle externalities.

Representations of disability in the Canadian news media: a decade of change?

PURPOSE: To assess stability and change in representations of disability and persons with disability in the Canadian news media between 1998 and 2008. METHOD: The study replicated research conducted in 1998 that assessed the representation of disability in the Canadian news media. Following the earlier study, three newspapers were selected (Globe and Mail, Toronto Star and Toronto Sun) and all articles from a three-month period in 1998 and 2008 were assessed for disability content. In total, 362 articles were found in the two time periods. These were coded for structure and content using a schema developed in the earlier research. RESULTS: Between 1998 and 2008, there was a significant increase in the proportion of stories using "person first" language, and a significant increase in the proportion of "progressively" themed articles (e.g. dealing with barriers to participation, or disability awareness and inclusion). At the same time, there were significant differences between newspapers, with the Toronto Sun (a tabloid) maintaining a strong focus on "traditional" themes (e.g. special education, charitable provision). CONCLUSIONS: The differences in news media representations between 1998 and 2008 suggest a positive change in the way people with disabilities are represented, with greater attention to the complexity of their identity and their multiple social roles. IMPLICATIONS FOR REHABILITATION: The participation of persons with disabilities in society continues to be limited by negative attitudes. Media reporting has a significant influence on public attitudes toward disability. In a content analysis of three Canadian newspapers, this study found several significant changes in the language and content of disability-related articles. Together, these changes provide some evidence of more favorable media representations of disability. Further research in rehabilitation is needed to understand how such changes may both reflect and facilitate ongoing efforts to enhance people with disabilties' participation in social life.

Understanding identifiability in secondary health data.

Secondary health data are becoming important sources of information for health research. Unfortunately, there are few national guidelines outlining clear criteria for data custodians when adjudicating requests for access to these data. This presents a particular challenge to researchers and even public health officials interested in multi-jurisdictional analysis of health data. While some of the problem in developing consistent national standards may stem from differences in provincial privacy law, it may also be the result of imprecise terminology, particularly around the concept of identifiability. This commentary discusses the differences between identifiability and self-identification with the hope of contributing to a broader discussion establishing national guidelines for the use of secondary health data in research.

Locating irregularly shaped clusters of infection intensity.

Patterns of disease may take on irregular geographic shapes, especially when features of the physical environment influence risk. Identifying these patterns can be important for planning, and also identifying new environmental or social factors associated with high or low risk of illness. Until recently, cluster detection methods were limited in their ability to detect irregular spatial patterns, and limited to finding clusters that were roughly circular in shape. This approach has less power to detect irregularly-shaped, yet important spatial anomalies, particularly at high spatial resolutions. We employ a new method of finding irregularly-shaped spatial clusters at micro-geographical scales using both simulated and real data on Schistosoma mansoni and hookworm infection intensities. This method, which we refer to as the "greedy growth scan", is a modification of the spatial scan method for cluster detection. Real data are based on samples of hookworm and S. mansoni from Kitengei, Makueni district, Kenya. Our analysis of simulated data shows how methods able to find irregular shapes are more likely to identify clusters along rivers than methods constrained to fixed geometries. Our analysis of infection intensity identifies two small areas within the study region in which infection intensity is elevated, possibly due to local features of the physical or social environment. Collectively, our results show that the "greedy growth scan" is a suitable method for exploratory geographical analysis of infection intensity data when irregular shapes are suspected, especially at micro-geographical scales.

Direct health care costs after traumatic spinal cord injury.

BACKGROUND: The objective was to quantify direct health care costs attributable to traumatic spinal cord injury (SCI). METHODS: This population-based cohort study followed individuals with SCI from date of injury to 6 years postinjury. SCI cases were matched to a comparison group randomly selected from the general population. Administrative data from a Canadian province with a universal publicly funded health care system and centralized health databases were used. Costs included hospitalizations, physician services, home care, and long-term care. RESULTS: Attributable costs in the first year were $121,600 (2002 $CDN) per person with a complete SCI, and $42,100 per person with an incomplete injury. In the subsequent 5 years, annual costs were $5,400 and $2,800 for persons with complete and incomplete SCIs, respectively. CONCLUSION: Direct costs in the first year after SCI are substantial. In the subsequent 5 years, individuals with SCI will continue to accrue greater costs than the general public.

Depression following traumatic spinal cord injury.

OBJECTIVES: To describe the epidemiology of depression following traumatic spinal cord injury (SCI) and identify risk factors associated with depression. METHODS: This population-based cohort study followed individuals from date of SCI to 6 years after injury. Administrative data from a Canadian province with a universal publicly funded health care system and centralized databases were used. A Cox proportional hazards model was developed to identify risk factors. RESULTS: Of 201 patients with SCI, 58 (28.9%) were treated for depression. Individuals at highest risk were those with a pre-injury history of depression [hazard rate ratio (HRR) 1.6; 95% CI: 1.1-2.3], a history of substance abuse (HRR 1.6; 95% CI: 1.2-2.3) or permanent neurological deficit (HRR 1.6; 95% CI: 1.2-2.1). CONCLUSION: Depression occurs commonly and early in persons who sustain an SCI. Both patient and injury factors are associated with the development of depression. These should be used to target patients for mental health assessment and services during initial hospitalization and following discharge into the community.

Population-based study of medically treated self-inflicted injuries.

OBJECTIVE: Self-inflicted injury is commonly seen in emergency departments (EDs). It may be a pre-cursor to death by suicide. The objective of this study was to examine the epidemiology of self-inflicted injury presentations to EDs in the province of Alberta. METHODS: Self-inflicted injury records for the 3 fiscal years 1998/99 to 2000/01 were accessed from the Ambulatory Care Classification System, a database that captures all ED encounters in the province of Alberta. Available data for each case included demographic details, location and time of visit, diagnoses and procedures. RESULTS: There were 22 396 self-inflicted injury presentations to Alberta EDs during the study period. Self-inflicted injury rates were higher in females, younger patients, those on social services and those with Aboriginal treaty status. There were higher rates of return visits in the year following the self-inflicted injury than in other patient groups. Data showed regional variation. Trends could be seen in the timing of self-inflicted injury presentations by hour of day, day of week, and month of year. CONCLUSIONS: Self-inflicted injury is common, with particularly high rates demonstrated among marginalized populations. This study provides comprehensive data on those who present with self-inflicted injuries, and can be used to guide further treatment, research and evaluation for this population.

The epidemiology of traumatic spinal cord injury in Alberta, Canada.

OBJECTIVES: To describe the incidence and pattern of traumatic spinal cord injury and cauda equina injury (SCI) in a geographically defined region of Canada. METHODS: The study period was April 1, 1997 to March 31, 2000. Data were gathered from three provincial sources: administrative data from the Alberta Ministry of Health and Wellness, records from the Alberta Trauma Registry, and death certificates from the Office of the Medical Examiner. RESULTS: From all three data sources, 450 cases of SCI were identified. Of these, 71 (15.8%) died prior to hospitalization. The annual incidence rate was 52.5/million population (95% CI: 47.7, 57.4). For those who survived to hospital admission, the incidence rate was 44.3/million/year (95% CI: 39.8, 48.7). The incidence rates for males were consistently higher than for females for all age groups. Motor vehicle collisions accounted for 56.4% of injuries, followed by falls (19.1%). The highest incidence of motor vehicle-related SCI occurred to those between 15 and 29 years (60/million/year). Fall-related injuries primarily occurred to those older than 60 years (45/million/year). Rural residents were 2.5 times as likely to be injured as urban residents. CONCLUSION: Prevention strategies for SCI should target males of all ages, adolescents and young adults of both sexes, rural residents, motor vehicle collisions, and fall prevention for those older than 60 years.

The spatial and temporal dimensions of child pedestrian injury in Edmonton.

OBJECTIVES: This paper describes the temporal and spatial distribution of child pedestrian injury within Edmonton, Alberta for four fiscal years (1995-96 through 1998-99), and compares this pattern to temporal and spatial data on traffic volume. METHODS: We used injury data obtained through an ongoing emergency department (ED) surveillance system involving all hospitals in Alberta's Capital Health Region. We identified peak times of injury occurrence and the location of high injury incidence as indicated by census tract of residence. Empirical Bayes estimation procedures were used to calculate stable injury incidence ratios. Cartographic and correlation analyses identified the relationship between traffic volume and injury incidence. RESULTS: Child pedestrian injury occurred most frequently during morning (0700-0900 hrs) and late afternoon (1500-1800 hrs) which corresponds with peak periods of vehicular traffic flow. The highest incidence rates occurred in or near areas of high traffic volume, notably in the central and west-central parts of Edmonton. DISCUSSION: These findings emphasize the importance of considering spatial and temporal patterns in pedestrian injury research, as well as the need to incorporate these patterns in prevention strategies. Changing the times that children attend school may reduce the convergence of pedestrian and vehicular traffic.