The availability and distribution of vaping retailers across Ontario neighbourhoods, 2016-2019.

OBJECTIVES: To characterize the distribution of vaping retailers and examine the association between neighbourhood income and vaping retailer availability in Ontario prior to and after regulatory changes to the vaping market in 2018. METHODS: We quantified vaping access by number of vaping retailers for 19,964 dissemination areas (DAs) in Ontario and percentage of schools near a vaping retailer. We used mixed-effects regression models to examine the associations between vaping access and neighbourhood income in 2018 and 2019. RESULTS: Between 2016 and 2019, the number of vaping retailers in Ontario increased by 22.6% (5999 to 7355), despite a mild drop from 2016 to 2018. In 2019, 59.7% of urban neighbourhoods had one or more vaping retailers within 1000 m of their geographic centre, and 79.4% of elementary, 82.8% of secondary, and 84.2% of post-secondary schools had at least one within 1000 m. Neighbourhood income was associated with access to vaping retailers, with a greater number in low-income regions. In 2019, neighbourhoods in the lowest income quintile had over twice the number of vaping retailers per capita within 1000 m compared to the highest income quintile (adjusted incidence rate ratio 2.40; 95% CI 2.24-2.58). Increases over time in access to vaping retailers did not differ by geographic region, neighbourhood income quintile, or school type. CONCLUSION: We observed a substantial increase in access to vaping retailers in Ontario including proximity to elementary and secondary schools following the 2018 provincial marketing regulations and federal nicotine regulations. Access to vaping was greatest in low-income neighbourhoods and may contribute to established inequities in vaping-related adverse events.

RéSUMé: OBJECTIFS: Caractériser la répartition des détaillants de vapotage et examiner l'association entre le revenu du quartier et la disponibilité des détaillants de vapotage en Ontario avant et après les modifications réglementaires du marché du vapotage en 2018. MéTHODES: Nous avons quantifié l'accès au vapotage selon le nombre de détaillants de vapotage pour 19 964 aires de diffusion (DA) en Ontario et le pourcentage d'écoles à proximité d'un détaillant de vapotage. Nous avons utilisé des modèles de régression à effets mixtes pour examiner les associations entre l'accès au vapotage et le revenu du quartier en 2018 et 2019. RéSULTATS: Entre 2016 et 2019, le nombre de détaillants de vapotage en Ontario a augmenté de 22,6 % (5 999 à 7 355), malgré une légère baisse de 2016 à 2018. En 2019, 59,7 % des quartiers urbains avaient un ou plusieurs détaillants de vapotage à moins de 1 000 m de leur centre géographique, et 79,4 % des écoles élémentaires, 82,8 % des écoles secondaires et 84,2 % des écoles postsecondaires en avaient au moins un détaillant à moins de 1 000 m. Le revenu du quartier était associé à l'accès aux détaillants, avec plus de détaillants dans les régions à faible revenu. En 2019, les quartiers du quintile de revenu le plus bas comptaient plus de deux fois plus de détaillants de vapotage par habitant dans un rayon de 1 000 m par rapport au quintile le plus élevé (rapport de taux d'incidence ajusté 2,40; IC à 95 % 2,24-2,58). Les augmentations au fil du temps de l'accès aux détaillants de vapotage ne différaient pas selon la région géographique, le quintile de revenu du quartier ou le type d'école. CONCLUSION: Nous avons observé une augmentation significative de l'accès aux détaillants de vapotage en Ontario, y compris la proximité des écoles primaires et secondaires à la suite des nouvelles réglementations provinciales sur le marketing et de la réglementation fédérale sur la nicotine en 2018. L'accès au vapotage était le plus élevé dans les quartiers à faible revenu et pourrait contribuer aux inégalités par rapport aux événements indésirables lié au vapotage et tabac.

Alcohol Availability Across Neighborhoods in Ontario Following Alcohol Sales Deregulation, 2013-2017.

Objectives. To examine the association between neighborhood socioeconomic status (SES) and alcohol availability before and after deregulation in 2015 of the alcohol market in Ontario, Canada. Methods. We quantified alcohol access by number of alcohol outlets and hours of retail for all 19 964 neighborhoods in Ontario. We used mixed effects regression models to examine the associations between alcohol access and a validated SES index between 2013 and 2017. Results. Following deregulation, the number of alcohol outlets in Ontario increased by 15.0%. Low neighborhood SES was positively associated with increased alcohol access: lower-SES neighborhoods had more alcohol outlets within 1000 meters and were closer to the nearest alcohol outlets. Outlets located in low-SES neighborhoods kept longer hours of operation. Conclusions. We observed a substantial increase in alcohol access in Ontario following deregulation. Access to alcohol was greatest in low-SES neighborhoods and may contribute to established inequities in alcohol harms. Public Health Implications. Placing limits on number of alcohol outlets and the hours of operation in low-SES neighborhoods offers an opportunity to reduce alcohol-related health inequities.

Effectiveness of Screening and Treatment Approaches for Schistosomiasis and Strongyloidiasis in Newly-Arrived Migrants from Endemic Countries in the EU/EEA: A Systematic Review.

We aimed to evaluate the evidence on screening and treatment for two parasitic infections-schistosomiasis and strongyloidiasis-among migrants from endemic countries arriving in the European Union and European Economic Area (EU/EEA). We conducted a systematic search of multiple databases to identify systematic reviews and meta-analyses published between 1 January 1993 and 30 May 2016 presenting evidence on diagnostic and treatment efficacy and cost-effectiveness. We conducted additional systematic search for individual studies published between 2010 and 2017. We assessed the methodological quality of reviews and studies using the AMSTAR, Newcastle⁻Ottawa Scale and QUADAS-II tools. Study synthesis and assessment of the certainty of the evidence was performed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We included 28 systematic reviews and individual studies in this review. The GRADE certainty of evidence was low for the effectiveness of screening techniques and moderate to high for treatment efficacy. Antibody-detecting serological tests are the most effective screening tests for detection of both schistosomiasis and strongyloidiasis in low-endemicity settings, because they have higher sensitivity than conventional parasitological methods. Short courses of praziquantel and ivermectin were safe and highly effective and cost-effective in treating schistosomiasis and strongyloidiasis, respectively. Economic modelling suggests presumptive single-dose treatment of strongyloidiasis with ivermectin for all migrants is likely cost-effective, but feasibility of this strategy has yet to be demonstrated in clinical studies. The evidence supports screening and treatment for schistosomiasis and strongyloidiasis in migrants from endemic countries, to reduce morbidity and mortality.

The Effectiveness and Cost-Effectiveness of Screening for and Vaccination Against Hepatitis B Virus among Migrants in the EU/EEA: A Systematic Review.

Migrants from hepatitis B virus (HBV) endemic countries to the European Union/European Economic Area (EU/EEA) comprise 5.1% of the total EU/EEA population but account for 25% of total chronic Hepatitis B (CHB) infection. Migrants from high HBV prevalence regions are at the highest risk for CHB morbidity. These migrants are at risk of late detection of CHB complications; mortality and onwards transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of CHB screening and vaccination programs among migrants to the EU/EEA. We found no RCTs or direct evidence evaluating the effectiveness of CHB screening on morbidity and mortality of migrants. We therefore used a systematic evidence chain approach to identify studies relevant to screening and prevention programs; testing, treatment, and vaccination. We identified four systematic reviews and five additional studies and guidelines that reported on screening and vaccination effectiveness. Studies reported that vaccination programs were highly effective at reducing the prevalence of CHB in children (RR 0.07 95% CI 0.04 to 0.13) following vaccination. Two meta-analyses of therapy for chronic HBV infection found improvement in clinical outcomes and intermediate markers of disease. We identified nine studies examining the cost-effectiveness of screening for CHB: a strategy of screening and treating CHB compared to no screening. The median acceptance of HB screening was 87.4% (range 32.3⁻100%). Multiple studies highlighted barriers to and the absence of effective strategies to ensure linkage of treatment and care for migrants with CHB. In conclusion, screening of high-risk children and adults and vaccination of susceptible children, combined with treatment of CHB infection in migrants, are promising and cost-effective interventions, but linkage to treatment requires more attention.

Medical students' intentions to seek abortion training and to provide abortion services in future practice.

OBJECTIVES: Lack of providers is a barrier to accessing abortion in Canada. The factors influencing the number of abortion providers are poorly understood. In this study, we assessed the attitudes and intentions of medical students towards abortion training and provision to gain insight into the future supply of abortion providers. METHODS: We surveyed first, second, and third year medical students at an Ontario university to determine their intentions to train in and provide abortion services during different stages of training and in future practice. We assessed students' attitudes and intentions towards training in and providing abortions, their perceptions of social support, their perceived ability to receive training in and to provide abortion services, and their attitudes towards the legality of abortion. RESULTS: Surveys were completed by 337 of 508 potential respondents (66.7%). The responses indicated that the students in the survey held relatively positive attitudes towards the legality and availability of abortion in Canada. Respondents had significantly more positive attitudes towards first trimester medical abortions (and a greater intention to provide them) than towards second trimester surgical abortions. Thirty-five percent of students planned to enter a specialty in which they could perform abortions, but fewer than 30% of these students planned to provide any type of abortion. Intentions to provide abortions were correlated with positive attitudes toward abortion in general and greater perceived social support for abortion provision. CONCLUSION: A small proportion of students sampled intended both to enter a specialty in which abortion would be within the scope of practice and to provide abortion services. Lack of perceived social support for providing abortions and the perceived inability to obtain abortion training or to logistically provide abortions were identified as two potentially modifiable barriers to abortion provision. We propose increasing education on abortion provision and creating policies to promote medical abortion as a method of improving access to abortion across Canada.

Objectifs : Au Canada, l'accès à des services d'avortement est entravé par le manque de fournisseurs de soins étant en mesure d'offrir de tels services. Les facteurs qui influencent le nombre de fournisseurs de services d'avortement sont mal compris. Dans le cadre de cette étude, nous avons évalué les attitudes et les intentions des étudiants de médecine en ce qui concerne la formation en matière d'avortement et l'offre de tels services dans le cadre de leur future pratique, et ce, pour en connaître davantage au sujet de nos futurs effectifs dans ce domaine. Méthodes : Nous avons sondé les étudiants de médecine de première, de deuxième et de troisième année d'une université ontarienne, à différents stades de leur formation (et en leur demandant de remplir un questionnaire traitant de la future pratique qu'ils envisageaient), en vue de déterminer leurs intentions en ce qui concerne l'obtention d'une formation en matière d'avortement et l'offre de services d'avortement. Nous avons évalué les attitudes et les intentions de ces étudiants en ce qui concerne l'obtention d'une formation en matière d'avortement et l'offre de services d'avortement, leurs perceptions en ce qui a trait au soutien social, leur capacité subjective de recevoir une formation en matière d'avortement et d'offrir des services d'avortement, et leurs attitudes envers la légalité de l'avortement. Résultats : Trois cent trente-sept des 508 répondants potentiels (66,7 %) ont répondu aux questionnaires. Les réponses indiquent que les répondants adoptaient des attitudes relativement positives envers la légalité et la disponibilité de l'avortement au Canada. Les répondants adoptaient des attitudes considérablement plus positives envers les avortements médicaux au premier trimestre (et un plus grand nombre d'entre eux avaient l'intention d'offrir de tels services) qu'envers les avortements chirurgicaux menés au deuxième trimestre. Trente-cinq pour cent des étudiants avaient l'intention de choisir une spécialité dans le cadre de laquelle latenue d'avortements serait possible; toutefois, moins de 30 % de ces étudiants avaient l'intention d'offrir quelque type de services d'avortement que ce soit. Les intentions d'offrir des services d'avortement étaient en corrélation avec les attitudes positives envers l'avortement en général et avec la perception d'un soutien social accru envers l'offre de services d'avortement. Conclusion : Une faible proportion de l'échantillon d'étudiants analysé avait l'intention de choisir une spécialité dont le champ d'activité englobe la tenue d'avortements et d'offrir des services d'avortement. L'absence subjective de soutien social envers l'offre de services d'avortement et l'incapacité subjective d'obtenir une formation en matière d'avortement ou d'offrir des services d'avortement au plan logistique ont été identifiés comme étant deux obstacles potentiellement modifiables pour ce qui est de l'offre de services d'avortement. Pour assurer l'amélioration de l'accès à l'avortement d'un bout à l'autre du Canada, nous proposons l'augmentation des efforts d'éducation au sujet de l'offre de services d'avortement et la création de politiques visant la promotion de l'avortement médical.