Individual and Geospatial Determinants of Health Associated With School-Based Human Papillomavirus Immunization in Alberta: Population-Based Cohort Study.

BACKGROUND: Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions. OBJECTIVE: The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada. METHODS: Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results. RESULTS: The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95% CI 1.006-1.185) and 1.831 (95% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95% CI 1.200-1.381) and 1.099 (95% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots. CONCLUSIONS: Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions.

Factors influencing human papillomavirus school-based immunization in Alberta: A mixed-methods study protocol.

More than 1,300 Canadians are diagnosed with cervical cancer annually, which is nearly preventable through human papillomavirus (HPV) immunization. Across Canada, coverage rates remain below the 90% target set out by the Action Plan for the Elimination of Cervical Cancer in Canada (2020-2030). To support this Plan, the Canadian Partnership Against Cancer has commissioned the Urban Public Health Network (UPHN) to coordinate a quality improvement project with Canada's school-based HPV immunization programs. In Alberta, the UPHN partnered with Alberta Health Services (AHS) for this work. This study has one overarching research question: what are parent/guardian and program stakeholder perceived barriers, enablers and opportunities to immunization for youth as part of the school-based HPV immunization program in Alberta? This study uses a mixed-methods sequential explanatory design. A survey will be emailed to a sample of Albertans with children aged 11-17 years. Questions will be based on a Conceptual Framework of Access to Health Care. Subsequent qualitative work will explore the survey's findings. Parents/guardians identifying as vaccine hesitant in the survey will be invited to participate in virtual, semi-structured, in-depth interviews. Stakeholders of the school-based immunization program will be purposively sampled from AHS' five health zones for virtual focus groups. Quantitative data will be analyzed using SAS Studio 3.6 to carry out descriptive statistics and, using logistic regression, investigate if Framework constructs are associated with parents'/guardians' decision to immunize their children. Qualitative data will be analyzed using NVivo 12 to conduct template thematic analysis guided by the Framework. Study results will provide insights for Alberta's public health practitioners to make evidence-informed decisions when tailoring the school-based HPV immunization program to increase uptake in vaccine hesitant populations. Findings will contribute to the national study, which will culminate in recommendations to increase HPV immunization uptake nationally and progress towards the 90% coverage target.

Long-Haul Truck Driver Training Does Not Meet Driver Needs in Canada.

INTRODUCTION: Training standards for long-haul truck drivers (LHTD) are rapidly evolving in Canada, yet the opinions of the drivers themselves have not been adequately considered. The purpose was to survey LHTD on their work training history and to examine LHTD perceptions of driver training and licensing protocols. METHODS: LHTD were recruited across two Western Canadian provinces from seven different truck stops. The sample completed 207 surveys and 67 semi-structured interviews. RESULTS: The average age of the participants was 52.5 ± 11.5 years (range 24-79); 96% were men. Approximately 33% of the LHTD had at least one crash. Those who did not receive formal driver training were significantly more likely to crash than those who had received training. Participants stated that current training standards are inadequate for the industry, particularly for new drivers. According to participants, entry-level curriculums should consist of both classroom and practical training, as well as on-road observation with a senior mentor. LHTD reported that many new drivers are not equipped to drive in various contexts and settings (e.g., mountains, slippery roads). CONCLUSIONS: LHTD are not confident in the current training guidelines for novice truck drivers. Revisions to the training curriculum and standardization across Canada should be considered. PRACTICAL APPLICATION: A federal mandatory entry-level training program is needed in Canada to ensure that all new LHTD ascertain the necessary skills to drive safely. Such a program requires government involvement and input from LHTD to facilitate appropriate licensure and consistent training for all drivers.

Impact of limited rest areas on truck driver crashes in Saskatchewan: a mixed-methods approach.

BACKGROUND: Long-haul truck drivers (LHTDs) suffer from long work hours often resulting in fatigue. Although several studies have reported that fatigue can contribute to crashes, no study has identified the location and patterns of fatigue-related crashes and solicited truck driver feedback on potential mitigation strategies. The purpose of this study is 1) to map the location of fatigue-related crashes and 2) examine the perceptions of truck drivers concerning fatigue-related crashes. METHODS: Using databases from the Saskatchewan Government Insurance, information on LHTD demographics, crashes and their causes, as well as crash location was analyzed. All fatigue-related crashes were then documented and mapped. Additionally, we interviewed 67 LHTDs (mean age = 53.0 ± 12.9; range 23-89; 95% were men) asking questions about fatigue, access to truck stops/rest areas, and provided recommendations for improvement. All interviews were subsequently analyzed using thematic analyses. RESULTS: On average, there were 20 fatigue-related crashes per year over the 10-year period. Fatigue-related crashes were common across Saskatchewan, however, there was a concentration of crashes along major roadways between major cities. There was a significant association between crashes with age and experience. Despite many LHTDs being fatigued, there was a lack of truck stops/rest areas along highway routes. LHTDs suggested having access to truck stops/rest areas 250-400 km apart with running water and washrooms available. CONCLUSIONS: Additional truck stops and rest areas are needed in Saskatchewan to ensure LHTDs have more opportunities for rest to reduce fatigue in general, as well as to reduce the risk of fatigue-related crashes.

Risk Factors for Depressive Symptoms in Long-Haul Truck Drivers.

Work-related stress is a salient risk factor for depression. While long-haul truck drivers (LHTDs) face a myriad of occupational pressures and demands, little research has examined predictors of depressive symptoms in this occupational group. The purpose of this study was to identify predictors of depressive symptoms in LHTDs. A cross-sectional study was used to examine depressive symptoms, health and working conditions in a sample of 107 LHTDs (mean age of 50.7 ± 12.3; 95.6% were men) at truck stops from five Western Canadian cities. The findings show that 44% of LHTDs reported symptoms of depression in the past 12 months. Severe work-related stress, the use of psychiatric medications and broken sleep were significant predictors of depressive symptomology accounting for 41% of the variance. The findings suggest that LHTDs experience a host of occupational stressors that are embedded within the transportation industry that may increase the risk for depressive symptoms. Mental health promotion efforts that improve sleep quality, decrease work-related demands and pressures, and increase the use of psychiatric medication may reduce rates of depressive symptoms among LHTDs.