The association of antidepressant drug usage with cognitive impairment or dementia, including Alzheimer disease: A systematic review and meta-analysis.

OBJECTIVE: To determine if antidepressant drug usage is associated with cognitive impairment or dementia, including Alzheimer disease (AD). METHOD: We conducted a systematic search of Medline, PubMed, PsycINFO, Web of Science, Embase, CINAHL, and the Cochrane Library. An initial screen by abstracts and titles was performed, and relevant full articles were then reviewed and assessed for their methodologic quality. Crude effect estimates were extracted from the included articles and a pooled estimate was obtained using a random effects model. RESULTS: Five articles were selected from an initial pool of 4,123 articles. Use of antidepressant drugs was associated with a significant twofold increase in the odds of some form of cognitive impairment or dementia (OR = 2.17). Age was identified as a likely modifier of the association between antidepressant use and some form of cognitive impairment or AD/dementia. Studies that included participants with an average age equal to or greater than 65 years showed an increased odds of some form of cognitive impairment with antidepressant drug usage (OR = 1.65), whereas those with participants less than age 65 revealed an even stronger association (OR = 3.25). CONCLUSIONS: Antidepressant drug usage is associated with AD/dementia and this is particularly evident if usage begins before age 65. This association may arise due to confounding by depression or depression severity. However, biological mechanisms potentially linking antidepressant exposure to dementia have been described, so an etiological effect of antidepressants is possible. With this confirmation that an association exists, clarification of underlying etiologic pathways requires urgent attention.

Correction to: Flipping for success: evaluating the effectiveness of a novel teaching approach in a graduate level setting.

Following publication of the original article [1], author 2 pointed out that his name has since changed from Adiba Islam to Adiba Ashrafi.

Adolescents' smoking experiences, family structure, parental smoking and socio-economic status in Ciudad Juárez, Mexico.

BACKGROUND: Cigarette smoking is the leading cause of preventable death worldwide. Tobacco use and secondhand-tobacco smoke (SHS) exposure are classified as a pediatric disease. In Mexico, the prevalence of smoking has decreased among adults but paradoxically increased among adolescents, particularly among young females. This study was designed to determine the association between adolescents' smoking experiences (smoking behaviors and second hand smoke [SHS] exposure), family structure, parental smoking and socio-economic status (SES) in Ciudad Juárez, Mexico. METHODS: This is a cross-sectional, population-based study. Data was collected from sixth-grade students (N = 506) attending school in Ciudad Juárez, Mexico. Descriptive analyses were conducted. The relationship between key outcome variables (adolescents smoking and SHS exposure) and independent variables (family structure, parental smoking, and SES level) were examined. Adjusted odds ratios were calculated. Multiple logistic regression analysis was performed while controlling for possible confounders (i.e. gender and age). RESULTS: The overall prevalence of ever/lifetime smoking and SHS exposure at home was 29.6 and 41.1 %, respectively. Results of the logistic regression analysis show that being a member of a non-intact family [(OR = 2.20; 95 % CI = 1.21-3.90) and (OR = 2.45; 95 % CI = 1.19-4.10) respectively], having parents who smoke [(OR = 4.41; 95 % CI = 2.15-5.46) and (OR = 4.95; 95 % CI = 2.25-7.12) respectively], and living in low SES setting [(OR = 1.73; 95 % CI = 1.43-3.30) and (OR = 1.99; 95 % CI = 1.16-4.00) respectively] are significantly associated with ever smoking and SHS exposure at home among sixth grade students. CONCLUSIONS: The findings of our study show that tobacco use and SHS exposure are strongly associated with adolescents living in low SES, non-intact households that have parents that smoke. To be effective, tobacco strategies specifically tailored for this particularly vulnerable group of adolescents would require a comprehensive, multi-faceted approach centered on prevention, cessation and protection.

Lean interventions in healthcare: do they actually work? A systematic literature review.

PURPOSE: Lean is a widely used quality improvement methodology initially developed and used in the automotive and manufacturing industries but recently expanded to the healthcare sector. This systematic literature review seeks to independently assess the effect of Lean or Lean interventions on worker and patient satisfaction, health and process outcomes, and financial costs. DATA SOURCES: We conducted a systematic literature review of Medline, PubMed, Cochrane Library, CINAHL, Web of Science, ABI/Inform, ERIC, EMBASE and SCOPUS. STUDY SELECTION: Peer reviewed articles were included if they examined a Lean intervention and included quantitative data. Methodological quality was assessed using validated critical appraisal checklists. Publically available data collected by the Saskatchewan Health Quality Council and the Saskatchewan Union of Nurses were also analysed and reported separately. DATA EXTRACTION: Data on design, methods, interventions and key outcomes were extracted and collated. RESULTS OF DATA SYNTHESIS: Our electronic search identified 22 articles that passed methodological quality review. Among the accepted studies, 4 were exclusively concerned with health outcomes, 3 included both health and process outcomes and 15 included process outcomes. Our study found that Lean interventions have: (i) no statistically significant association with patient satisfaction and health outcomes; (ii) a negative association with financial costs and worker satisfaction and (iii) potential, yet inconsistent, benefits on process outcomes like patient flow and safety. CONCLUSION: While some may strongly believe that Lean interventions lead to quality improvements in healthcare, the evidence to date simply does not support this claim. More rigorous, higher quality and better conducted scientific research is required to definitively ascertain the impact and effectiveness of Lean in healthcare settings.

Community-based clinic volunteering: an evaluation of the direct and indirect effects on the experience of health science college students.

BACKGROUND: The present study was conducted in a multi service-learning, student managed and operated, community-based clinic. Its aim was to measure the direct and indirect effects of how proximal factors (i.e., 'management', 'support received', 'duration of involvement', and 'average time spent per month') and mediators (i.e., 'training received', 'motivation', and 'commitment') influence distal outcomes (i.e., 'performance', 'satisfaction', and 'overall experience') within a volunteer organization. METHODS: Participants were recruited through the use of an email list server. An online survey was used containing multi-item measures from validated scales. Data were collected from 170 volunteers from July to August 2013. Data analysis used a structural equation modeling (SEM) framework for the estimation of direct and indirect effects on constructs and variables of interest. Only statistically significant relationships were reported at p < 0.05. RESULTS: In this study, there are several direct effects worthy of note. First, the proximal factor of 'management' plays an important role in influencing the mediators of 'motivation' (standardized beta = 0.55) and 'training received' (0.65) by the student volunteers but has a relatively small impact on their 'commitment' (0.39) to the organization. Second, the mediator of 'motivation' proved to have the strongest impact on the distal outcome of volunteer 'performance' and 'satisfaction' levels (0.41 and 0.58 respectively), whereas 'commitment' (0.44) was the key in determining their 'overall experience' with the organization. These results in turn, help contextualize the indirect effects observed in our study. Namely, the proximal factor of 'management' played a distinctive role in influencing the distal outcomes of volunteer 'performance' (0.32) and 'overall experience' (0.66), whereas the organizational 'support received' by the volunteers was key to their 'satisfaction' (0.21). CONCLUSIONS: The findings of the present study shed light into the direct and indirect effects of how proximal factors and mediators, influence student volunteers distal outcomes within a community-based clinic. These results provide useful information and serve as a valuable tool to higher education (curriculum experts, accreditation specialists, students, faculty and administrators) and non-profit community organizations (clients, staff and managers) in their efforts to improve student volunteer satisfaction and performance outcomes.

The relationship between socioeconomic status/income and prevalence of diabetes and associated conditions: A cross-sectional population-based study in Saskatchewan, Canada.

INTRODUCTION: The role that socioeconomic status/income play in accounting for the increased prevalence of type 2 diabetes has not been sufficiently studied in Canada. The primary purpose of the present study was to determine the unadjusted and adjusted effect of income on type 2 diabetes. The secondary purpose was to determine the adjusted effect of income on diabetes associated conditions such as high blood pressure and being overweight or obese, and its main behavioral factor of physical inactivity. METHODS: This is a cross-sectional, population-based study. Data was analyzed from four cycles of the Canadian Community Health Survey (CCHS). It was conducted by Statistics Canada and covered the time period of 2000-2008 in the province of Saskatchewan, Canada. In this study, four separate and distinct multivariate models were built to determine the independent effect of income on type 2 diabetes and the associated conditions of high blood pressure, being overweight or obese, and physical inactivity. RESULTS: The total sample size was comprised of 27,090 residents from Saskatchewan. After statistically controlling for age, only six covariates were independently associated with type 2 diabetes prevalence including: having high blood pressure (OR = 3.26), visible minority cultural status (OR = 2.17), being overweight or obese (OR = 1.97), being of male gender (OR = 1.76), having a household income of $29,999 per year (OR = 1.63) and being physically inactive (OR = 1.15). CONCLUSIONS: In this study, household income was strongly and independently associated with type 2 diabetes prevalence, its associated conditions of high blood pressure and being overweight or obese, and its main behavioral factor of physical inactivity. We suggest that income is an important but frequently overlooked factor for type 2 diabetes and worthy of further investigation, appropriate public debate and timely policy intervention.

Risk Indicators of Depressed Mood Among Sex-Trade Workers and Implications for HIV Risk Behaviour.

OBJECTIVES: To determine the prevalence of depressed mood among people who have traded sex for money in the Saskatoon Health Region (SHR), the adjusted risk factors for depressed mood among this sample, and if depressed mood was associated with decreased self-efficacy for safe sexual practices and injection drug use. METHODS: Two-hundred ninety-nine people who have traded sex for money were surveyed with validated instruments for measuring risk behaviours, depressed mood, and self-efficacy for safe sexual practices. RESULTS: The sample consisted primarily of low-income, poorly educated Aboriginal women, many of whom also indicated using injection drugs. Using the 16-point score cut-off for the Center for Epidemiologic Studies Depression Scale, 84.6% of participants had depressed mood. When the cut-off score was 23 points or higher, 65.9% had depressed mood. After multivariate analysis, covariates that had an independent association with depressed mood included injecting a drug in the past 4 weeks (OR 1.59; 95% CI 1.2 to 1.8), suffering the death or permanent separation from a parent before the age of 18 (OR 2.09; 95% CI 1.05 to 4.15), and physical assault or abuse by a partner in adult life (OR 2.79; 95% CI 1.38 to 5.64). Depressed mood was associated with lower self-efficacy scores for safe sexual behaviours. CONCLUSIONS: Our study suggests that high rates of depressed mood among people who have traded sex for money is associated with injection drug use and low self-efficacy for safe sexual health practices. These findings are important and may help explain the high rates of human immunodeficiency virus within the SHR.

Flipping for success: evaluating the effectiveness of a novel teaching approach in a graduate level setting.

BACKGROUND: Flipped Classroom is a model that's quickly gaining recognition as a novel teaching approach among health science curricula. The purpose of this study was four-fold and aimed to compare Flipped Classroom effectiveness ratings with: 1) student socio-demographic characteristics, 2) student final grades, 3) student overall course satisfaction, and 4) course pre-Flipped Classroom effectiveness ratings. METHODS: The participants in the study consisted of 67 Masters-level graduate students in an introductory epidemiology class. Data was collected from students who completed surveys during three time points (beginning, middle and end) in each term. The Flipped Classroom was employed for the academic year 2012-2013 (two terms) using both pre-class activities and in-class activities. RESULTS: Among the 67 Masters-level graduate students, 80% found the Flipped Classroom model to be either somewhat effective or very effective (M = 4.1/5.0). International students rated the Flipped Classroom to be significantly more effective when compared to North American students (X(2) = 11.35, p < 0.05). Students' perceived effectiveness of the Flipped Classroom had no significant association to their academic performance in the course as measured by their final grades (r s = 0.70). However, students who found the Flipped Classroom to be effective were also more likely to be satisfied with their course experience. Additionally, it was found that the SEEQ variable scores for students enrolled in the Flipped Classroom were significantly higher than the ones for students enrolled prior to the implementation of the Flipped Classroom (p = 0.003). CONCLUSIONS: Overall, the format of the Flipped Classroom provided more opportunities for students to engage in critical thinking, independently facilitate their own learning, and more effectively interact with and learn from their peers. Additionally, the instructor was given more flexibility to cover a wider range and depth of material, provide in-class applied learning opportunities based on problem-solving activities and offer timely feedback/guidance to students. Yet in our study, this teaching style had its fair share of challenges, which were largely dependent on the use and management of technology. Despite these challenges, the Flipped Classroom proved to be a novel and effective teaching approach at the graduate level setting.

Income and heart disease: Neglected risk factor.

OBJECTIVE: To determine the unadjusted and adjusted effects of income on heart disease; its main disease intermediary, high blood pressure; and its main behavioural risk factors, smoking and physical inactivity. DESIGN: Random-digit dialing telephone survey collected through the Canadian Community Health Survey by Statistics Canada. SETTING: Saskatchewan. PARTICIPANTS: A total of 27 090 residents aged 20 years and older; each health region in Saskatchewan was represented. MAIN OUTCOME MEASURES: Overall, 178 variables related to demographic characteristics, socioeconomic factors, behaviour, life stress, disease intermediaries, health outcomes, and access to health care were analyzed to determine their unadjusted and adjusted effects on heart disease. RESULTS: The mean age of the sample was 52.6 years. Women represented 55.9% of the sample. Most respondents were married (52.3%) and had some postsecondary or graduate education (52.5%). The mean personal income was $23 931 and the mean household income was $37 533. All models statistically controlled for age. Five covariates independently associated with heart disease included high blood pressure, household income of $29 999 or less per year, being a daily smoker, male sex, and being physically inactive. Five covariates independently associated with high blood pressure included being overweight or obese, being a daily smoker, household income of $29 999 or less per year, male sex, and being physically inactive. Five covariates independently associated with daily smoking included being a visible minority, household income of $29 999 or less per year, not being overweight or obese, education level of less than secondary school, and male sex. Six covariates independently associated with physical inactivity included being a visible minority, being overweight or obese, education level of less than secondary school, male sex, household income of $29 999 or less per year, and being a daily smoker. CONCLUSION: Household income was strongly and independently associated with heart disease; its main disease intermediary, high blood pressure; and its main behavioural risk factors, smoking and physical inactivity. Income inequality is a neglected risk factor worthy of appropriate public debate and policy intervention.

Prevalence and risk indicators of alcohol abuse and marijuana use among on-reserve First Nations youth.

The objectives of the present study were to identify the prevalence of alcohol abuse and marijuana use among First Nations youth living on-reserve, and to identify independent risk indicators associated with these behaviours. Two hundred four students from the Saskatoon Tribal Council (Saskatchewan) who were enrolled in grades 5 through 8 were asked to complete a school health survey. The prevalence of alcohol abuse and marijuana use among First Nations on-reserve youth was 23.5% and 14.7%, respectively. Surprisingly, female First Nations youth were more likely to abuse alcohol and use marijuana than male First Nations youth. The prevalence of alcohol abuse and marijuana use among Saskatoon urban youth of the same age were only 5.4% and 2.7%, respectively. After regression analysis, five independent risk indicators were associated with alcohol abuse and marijuana use among First Nations on-reserve youth. The prevalence of alcohol abuse among First Nations on-reserve youth is higher than that in neighbouring urban youth of the same age.

La présente étude visait à déterminer la prévalence de consommation excessive d'alcool et de consommation de marijuana chez les jeunes des Premières nations qui habitent dans les réserves, ainsi que les indicateurs de risque indépendants associés à ces comportements. Deux cent quatre élèves de cinquième à huitième année du Conseil de bande de Saskatoon, au Canada, ont été invités à répondre à un sondage sur la santé en milieu scolaire. La prévalence de consommation abusive d'alcool et de consommation de marijuana chez les jeunes des Premières nations dans les réserves s'élevait à 23,5 % et 14,7 %, respectivement. Fait surprenant, les jeunes filles de ce groupe étaient plus susceptibles de consommer trop d'alcool et de consommer de la marijuana que les jeunes garçons. La prévalence de consommation excessive d'alcool et de consommation de marijuana chez les jeunes en milieu urbain de Saskatoon ne s'élevait qu'à 5,4 % et 2,7 %, respectivement. Après l'analyse de régression, cinq indicateurs de risque indépendants s'associaient à la consommation excessive d'alcool et à la consommation de marijuana chez les jeunes des Premières nations dans les réserves, dont la prévalence de consommation excessive d'alcool est plus élevée que celle des jeunes du même âge d'un milieu urbain voisin.

Risk indicators of suicide ideation among on-reserve First Nations youth.

BACKGROUND: Despite the known disparity in suicide rates in Canada, there is limited information on the independent risk indicators of suicide ideation among First Nations youth living on reserve. OBJECTIVE: To determine the prevalence and adjusted risk indicators for suicide ideation among on-reserve First Nations youth. METHODS: Saskatoon Tribal Council (Saskatchewan) First Nations students enrolled in grades 5 through 8 who were living on reserve were asked to complete a health survey using validated questionnaires. In total, 75.3% of the students completed the survey. The study was led by the Saskatoon Tribal Council with assistance from three departments at the University of Saskatchewan (Saskatoon, Saskatchewan). RESULTS: Among on-reserve First Nations youth, 23% experienced suicide ideation within the past 12 months. In comparison, 8.5% of Saskatoon urban youth and 19% of Saskatoon urban Aboriginal youth within the same grades experienced suicide ideation. Wanting to leave home (OR 13.91 [95% CI 3.05 to 63.42]), having depressed mood (OR 2.98 [95% CI 1.16 to 7.67]) and not feeling loved (OR 3.85 [95% CI 1.49 to 9.93]) were independently associated with suicide ideation among on-reserve youth. None of the children with a father who was professionally employed reported suicide ideation. CONCLUSIONS: Understanding the independent risk indicators associated with suicide ideation among First Nations youth living on reserve will hopefully aid in appropriate interventions.

HISTORIQUE: Malgré la disparité connue des taux de suicide au Canada, l'information sur les indicateurs de risque indépendants d'idéation suicidaire chez les jeunes des Premières nations qui habitent dans les réserves est limitée. OBJECTIF: Déterminer la prévalence et les indicateurs de risque rajustés d'idéation suicidaire chez les jeunes des Premières nations dans les réserves. MÉTHODOLOGIE: Les élèves de cinquième à huitième année des Premières nations du Conseil de bande de Saskatoon qui habitaient dans les réserves ont été invités à remplir un sondage sur la santé au moyen de questionnaires validés. Au total, 75,3 % des élèves ont répondu au sondage mené par le Conseil de bande de Saskatoon avec l'aide de trois départements de l'université de Saskatchewan, à Saskatoon. RÉSULTATS: Chez les jeunes des Premières nations de la réserve, 23 % avaient eu des idéations suicidaires au cours des 12 mois précédents. En comparaison, en milieu urbain de Saskatoon, 8,5 % des jeunes et 19 % des jeunes autochtones des mêmes années scolaires avaient eu des idéations suicidaires. Vouloir quitter la maison (RR 13,91 [95 % IC 3,05 à 63,42]), une humeur dépressive (RR 2,98 [95 % IC 1,16 à 7,67]) et le sentiment de ne pas être aimé (RR 3,85 [95 % IC 1,49 à 9,93]) s'associaient de manière indépendante aux idéations suicidaires chez les jeunes dans les réserves. Aucun des enfants dont le père occupait un emploi professionnel ne faisait état d'idéations suicidaires. CONCLUSIONS: On espère que le fait de comprendre les indicateurs de risque indépendants associés aux idéations suicidaires chez les jeunes des Premières nations qui habitent dans les réserves contribuera à la mise en œuvre d'interventions pertinentes.

Risk indicators associated with injection drug use in the Aboriginal population.

In 2009, the incidence of positive HIV tests in the Saskatoon Health Region, Canada, was 31.3 per 100,000 population when the national average was only 9.3 per 100,000 population. A majority of the positive HIV tests were of Aboriginal cultural status with a majority of those associated with injection drug use (IDU). The main objective of the study was to determine the risk indicators independently associated with higher rates of IDU in the Aboriginal population in comparison to other cultural groups. It appears that there is no another study with a similar analysis. From September 2009 to April 2010, 603 current IDUs were interviewed; which represents 76.6% of the known Saskatoon IDUs. In our study population, 88.1% of the current IDUs were of Aboriginal cultural status despite making up only 9.2% of the general population. Comparing Aboriginal IDUs to non-Aboriginal IDUs, our study found that Aboriginal injection users were more likely to be female and younger, less likely to receive paid income and were more likely to attend a Residential School or had a parent or grandparent attend a Residential School. If exposure to Residential Schools is ignored, Aboriginal IDUs were also more likely to use sex trading as a source of income and witness death or experience permanent separation from a parent during youth. Our study has identified a limited number of risk indicators independently associated with higher rates of IDU in the Aboriginal population. More specifically, Residential Schools are having a significant generational impact on current IDU, which might explain higher HIV incidence rates within the Aboriginal population.

Risk indicators and outcomes associated with bullying in youth aged 9-15 years.

OBJECTIVES: Bullying is a form of aggression in which children are intentionally intimidated, harassed or harmed. The main objective of our study was to determine the unadjusted and adjusted risk indicators associated with physical bullying. The second objective was to clarify the impact of repeated physical bullying on health outcomes - namely depressed mood. METHODS: Every student attending school in the city of Saskatoon, Canada, between grades 5-8 was asked to complete the Saskatoon School Health Survey. RESULTS: In total, 4,197 youth completed the questionnaire; of these, 23% reported being physically bullied at least once or twice in the previous four weeks. After multivariate adjustment, the covariates independently associated with being physically bullied included being male (OR=1.39), attending a school in a low-income neighbourhood (OR=1.41), not having a happy home life (OR=1.19), having a lot of arguments with parents (OR=1.16) and feeling like leaving home (OR=1.23). Children who were repeatedly physically bullied were more likely to have poor health outcomes. For example, 37.3% of children who were physically bullied many times per week had depressed mood in comparison to only 8.1% of children who were never bullied. After regression analysis, children who were ever physically bullied were 80% more likely to have depressed mood. CONCLUSION: Most of the independent risk indicators associated with physical bullying are preventable through appropriate social policy implementation and family support. It also appears that preventing repeated bullying should be the main focus of intervention in comparison to preventing more infrequent bullying.

Physical activity in youth: prevalence, risk indicators, and solutions.

OBJECTIVE: To determine the unadjusted and adjusted associations between developmental, environmental, psychological, social, or demographic factors and meeting the Health Canada physical activity standard. DESIGN: Survey. SETTING: Saskatoon, Sask. PARTICIPANTS: Every student in grades 5 to 8 in Saskatoon was asked to complete the Saskatoon School Health Survey; 4197 students did so. MAIN OUTCOME MEASURES: Whether students met the Health Canada standard for daily physical activity and associated risk factors for not meeting the standard. RESULTS: Among the 4197 youth who participated in the survey, only 7% met the Health Canada standard of daily physical activity longer than 1 hour of somewhat hard intensity or higher. Although there were 23 unadjusted factors associated with youth meeting the Health Canada standard, only 5 were significant after multivariate adjustment: 1) their fathers were employed (odds ratio [OR] 2.29, P = .027), 2) their parents watched them participate in physical activities or sports every day (OR 1.23, P < .001), 3) their friends encouraged them to do physical activities or sports every day (OR 1.19, P < .001), 4) their friends or classmates did not tease them for not doing well at physical activities or sports every day (OR 1.20, P = .001), and 5) they played sports or physical activities with coaches or instructors more than 4 times a week (OR 1.44, P < .001). CONCLUSION: Given the low rates of physical activity among youth, we believe that a reduced list of independent risk indicators is required to focus our limited human and financial resources for successful intervention in the community.

Risk indicators of depressive symptomatology among injection drug users and increased HIV risk behaviour.

OBJECTIVES: In 2009, the annual incidence of positive human immunodeficiency virus (HIV) test reports for people in the Saskatoon Health Region (SHR) was 31.3 per 100,000, when the national average was only 9.3 per 100 000. The first objective was to determine the prevalence of depressive symptomatology among injection drug users (IDUs) in the SHR. The second objective was to determine the unadjusted and adjusted risk indicators associated with depressive symptomatology among IDUs. The third objective was to determine if depressive symptomatology was associated with HIV risk behaviours. METHODS: From September 2009 to April 2010, 603 current IDUs were surveyed with validated instruments; this sample represents 76.6% of known IDUs in the SHR. RESULTS: Among the respondents, 81.4% reported depressive symptomatology, whereas 57.7% reported more severe depressive symptomatology. After multivariate analysis, the 4 covariates that had an independent association with depressive symptomatology included sexual assault as an adult, sexual assault as a child, attending a residential school, and having an annual income of less than $10,000 Depressive symptomatology was initially associated with 7 HIV risk behaviours. After multivariate analysis, depressive symptomatology was associated with giving sex to get money, giving drugs to get sex, and with more frequently sharing injecting equipment. CONCLUSIONS: This study found that depressive symptomatology was strongly associated with injection drug use.

Prevalence, risk indicators and outcomes of bullying among on-reserve First Nations youth.

OBJECTIVE: Bullying is common and multifaceted. There is no published literature focusing on bullying in First Nations youth on-reserve in Canada. The purpose of this paper is to examine the prevalence, risk indicators and impact of bullying within a First Nations youth population currently living on-reserve. METHODS: Students in grades 5 through 8 (age 10 to 16 years) within the Saskatoon Tribal Council were asked to complete a youth health survey. Among the seven schools, 271 students were eligible to participate. RESULTS: 204 youth completed the eight-stage consent protocol and the school survey for a response rate of 75.3%. Overall, 35.8% of youth reported being physically bullied, 59.3% verbally bullied, 47.5% socially bullied and 30.3% electronically bullied at least once or twice in the previous four weeks. After regression analysis, having a father who works in a professional occupation, doing well in school, and having the perception that parents expect too much from them were found to be independent risk indicators of being bullied. Irrespective of the type of bullying, youth who were bullied were at least twice as likely to suffer from depressed mood. DISCUSSION: We have found that bullying is more common for First Nations youth living on-reserve, compared to other Canadian youth. Given that the independent risk indicators also appear to be different, we hope that this new information can aid in the design of effective bullying strategies.

Prevalence and risk indicators of depressed mood in on-reserve first nations youth.

OBJECTIVES: The first objective was to determine the prevalence of depressive mood in First Nations youth in school grades 5 through 8 in seven on-reserve communities. The second objective was to determine the unadjusted and adjusted risk indicators associated with depressed mood in these youth. METHODS: Students in grades 5 through 8 in the seven reserve communities of the Saskatoon Tribal Council were asked to complete a paper and pencil, comprehensive youth health survey in May 2010. An eight-stage consent protocol was followed prior to participation. RESULTS: Out of 271 students eligible to participate, 204 youth completed the survey for a response rate of 75.3%. Using the Center for Epidemiological Studies of Depression scale, 25% of the youth had moderate depressive symptoms. After cross-tabulation, 1 socioeconomic variable, 10 social variables, 3 social support variables, 1 self-esteem variable, 5 parental relationship variables and 3 bullying variables were associated with depressed mood. Logistic regression was used to determine four independent risk indicators associated with having depressed mood in First Nations youth, including: 1) not having worked through things that happened during childhood, 2) not having someone who shows love and affection, 3) having a lot of arguments with parents and 4) being physically bullied at least once per week. CONCLUSIONS: Our study found high rates of depressed mood in on-reserve First Nations youth. These youth are now at increased risk for problems later in life unless successful interventions can be implemented.

Impact and Effectiveness of Legislative Smoking Bans and Anti-Tobacco Media Campaigns in Reducing Smoking among Women in the US: A Systematic Review and Meta-Analysis.

BACKGROUND: The purpose of this study is to systematically review the literature addressing the effectiveness of legislative smoking bans and anti-tobacco media campaigns in reducing smoking among women. METHODS: MEDLINE, PubMed, CINAHL, and ABI/INFORM were searched for studies published from 2005 onwards. Meta-analysis was conducted using a random effects model and subgroup analysis on pre-selected characteristics. RESULTS: In total, 652 articles were identified, and five studies satisfied the inclusion criteria. The studies varied from school-based to workplace settings and had a total of 800,573 women participants, aged 12 to 64 years old. Three studies used legislative bans, one study used anti-tobacco campaigns and another one used both as their intervention. The overall pooled effect of the five studies yielded an odds ratio (OR) = 1.137 (C.I. = 0.976-1.298 and I2 = 85.6%). Subgroup analysis by intervention revealed a significant pooled estimate for studies using legislative smoking bans OR = 1.280 (C.I. = 1.172-1.389 and I2 = 0%). CONCLUSION: Legislative smoking bans were found to be associated with a reduction in the smoking rates among women compared to anti-tobacco media campaigns. Further research in this area is needed.

Preference in the use of full childhood immunizations in Ethiopia: the role of maternal health services.

BACKGROUND: Immunizations represent a successful and cost-effective public health strategy in preventing common childhood diseases. Ethiopia has made remarkable progress in increasing its full immunization coverage, but significant gaps remain. This study aims to measure the preference in the use of full immunizations for children aged 12-23 months in Ethiopia and examine the role of key maternal health services. METHODS: This is a cross-sectional study and uses data from a nationally generalizable survey, the Ethiopian Demographic and Health Survey, 2016. It includes a representative sample of 2,168 children aged 12-23 months. The main outcome was full immunization, measured based on the WHO guidelines (Bacillus Calmette-Guérin [BCG], diphtheria, tetanus, and pertussis [DPT], polio, and measles vaccines). The main exposure variables were provision of three key maternal health services (antenatal care, delivery services, and tetanus vaccine) as well as other sociodemographic factors. Descriptive statistics and multivariate logistic regression analyses were conducted. RESULTS: This study found the overall full immunization coverage in Ethiopia to be much lower (39%) than the WHO-recommended rate (≥90%). There were distinctive differences in the preference in the use of full immunization coverage for various vaccines (BCG 70.0%, polio 56.5%, measles 55.3%, and DPT 53.9%). The maternal health service variables (antenatal care, delivery services, and tetanus vaccine) were significantly associated with the full immunization of children aged 12-23 months (P<0.001). In the full model, the maternal health service variables remained significant, along with other socioeconomic predictors of full immunization, including sex of the household head (P<0.001), maternal education (P<0.05), wealth index (P<0.01), and religion (P<0.001). CONCLUSION: Full immunization coverage has been identified as a critical factor in the prevention of morbidity and mortality from childhood diseases. Future progress in the provision of key maternal health services can have a positive impact in narrowing the gap in immunization coverage.

Risk Factors Associated with Self-reported Sexually Transmitted Infections among Postsecondary Students in Canada.

BACKGROUND: Despite major public health efforts in addressing the burden of disease caused by sexually transmitted infections (STIs), rates among young adults continue to rise in Canada. The purpose of the study was to examine the prevalence and risk factors associated with acquiring STIs among postsecondary students in Canada. METHODS: A secondary analysis of the American College Health Association-National College Health Assessment II-C Spring 2016 survey data (n = 43,780) was conducted. Sexually active participants (n = 28,831) were examined for their demographics, sexual behavior, alcohol and marijuana use, testing for human immunodeficiency virus (HIV), and human papillomavirus vaccination history. These factors were analyzed to help identify their possible association with acquiring an STI using logistic regression and multivariate modeling. RESULTS: Among the study participants, 3.88% had an STI, with the highest rates observed among females and individuals aged 21-24 years old. Multivariate logistic analysis showed that participants who engaged in anal intercourse within the past 30 days (odds ratio [OR] = 1.634; 95% confidence interval [CI], 1.343-1.988), had four or more sexual partners in the last 12 months (OR = 4.223; 95% CI, 3.595-4.962), used marijuana within the past 30 days (OR = 1.641; 95% CI, 1.387-1.941), and had ever been tested for HIV (OR = 3.008; 95% CI, 2.607-3.471) had greater odds of acquiring an STI. CONCLUSIONS: The findings of this study highlight certain high-risk behaviors that are strongly associated with acquiring an STI among postsecondary students. Thus, efforts to design and deliver relevant educational programming and health promotion initiatives for this particular population are of utmost importance.