The Role of Scientific Research in Human Papillomavirus Vaccine Discussions on Twitter: Social Network Analysis.

BACKGROUND: Attitudes toward the human papillomavirus (HPV) vaccine and accuracy of information shared about this topic in web-based settings vary widely. As real-time, global exposure to web-based discourse about HPV immunization shapes the attitudes of people toward vaccination, the spread of misinformation and misrepresentation of scientific knowledge contribute to vaccine hesitancy. OBJECTIVE: In this study, we aimed to better understand the type and quality of scientific research shared on Twitter (recently rebranded as X) by vaccine-hesitant and vaccine-confident communities. METHODS: To analyze the use of scientific research on social media, we collected tweets and retweets using a list of keywords associated with HPV and HPV vaccines using the Academic Research Product Track application programming interface from January 2019 to May 2021. From this data set, we identified tweets referring to or sharing scientific literature through a Boolean search for any tweets with embedded links, hashtags, or keywords associated with scientific papers. First, we used social network analysis to build a retweet or reply network to identify the clusters of users belonging to either the vaccine-confident or vaccine-hesitant communities. Second, we thematically assessed all shared papers based on typology of evidence. Finally, we compared the quality of research evidence and bibliometrics between the shared papers in the vaccine-confident and vaccine-hesitant communities. RESULTS: We extracted 250 unique scientific papers (including peer-reviewed papers, preprints, and gray literature) from approximately 1 million English-language tweets. Social network maps were generated for the vaccine-confident and vaccine-hesitant communities sharing scientific research on Twitter. Vaccine-hesitant communities share fewer scientific papers; yet, these are more broadly disseminated despite being published in less prestigious journals compared to those shared by the vaccine-confident community. CONCLUSIONS: Vaccine-hesitant communities have adopted communication tools traditionally wielded by health promotion communities. Vaccine-confident communities would benefit from a more cohesive communication strategy to communicate their messages more widely and effectively.

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.

An action-oriented public health framework to reduce financial strain and promote financial wellbeing in high-income countries.

BACKGROUND: Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing. METHODS: The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires. RESULTS: The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people's financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances. CONCLUSIONS: The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives.

A Policy-Ready Public Health Guidebook of Strategies and Indicators to Promote Financial Well-Being and Address Financial Strain in Response to COVID-19.

INTRODUCTION: The COVID-19 pandemic has adversely affected the financial well-being of populations globally, escalating concerns about links with health care and overall well-being. Governments and organizations need to act quickly to protect population health relative to exacerbated financial strain. However, limited practice- and policy-relevant resources are available to guide action, particularly from a public health perspective, that is, targeting equity, social determinants of health, and health-in-all policies. Our study aimed to create a public health guidebook of strategies and indicators for multisectoral action on financial well-being and financial strain by decision makers in high-income contexts. METHODS: We used a multimethod approach to create the guidebook. We conducted a targeted review of existing theoretical and conceptual work on financial well-being and strain. By using rapid review methodology informed by principles of realist review, we collected data from academic and practice-based sources evaluating financial well-being or financial strain initiatives. We performed a critical review of these sources. We engaged our research-practice team and government and nongovernment partners and participants in Canada and Australia for guidance to strengthen the tool for policy and practice. RESULTS: The guidebook presents 62 targets, 140 evidence-informed strategies, and a sample of process and outcome indicators. CONCLUSION: The guidebook supports action on the root causes of poor financial well-being and financial strain. It addresses a gap in the academic literature around relevant public health strategies to promote financial well-being and reduce financial strain. Community organizations, nonprofit organizations, and governments in high-income countries can use the guidebook to direct initiative design, implementation, and assessment.

Fact or Fiction? The Development and Evaluation of a Tobacco Virtual Health Tool.

The virtual setting is an important setting for health promotion as individuals increasingly go online for health information and support. Yet, users can have difficulty finding valid, trustworthy, and user-friendly health information online. In 2022, we launched an interactive Fact or Fiction Tobacco virtual health tool. The virtual health tool uses evidence-informed tailored content to engage users and refer them to local tobacco cessation resources. The present paper describes the development, user testing, and evaluation of this tool. The Fact or Fiction virtual health tool was designed by tobacco cessation and health marketing experts and informed by health behaviour theories of change. The tool captures data on who is seeking health information, the user's stage of readiness to quit tobacco products, and whether they act by accessing referred resources. In 2021, we conducted two phases of user testing prior to marketing the tool publicly. After 7 weeks of marketing, we collected data on user interactions with the tool and evaluated the reach of the tool. Results from user testing found the tool to be engaging, easy to use, and quick to complete. Adaptations were made to simplify and condense text and include additional animations. During the first seven weeks of the tool being live, it reached 2306 users, and 38.7% of those users were current or occasional tobacco users. Users were classified based on their intention to quit. Bivariate analysis found that the tool was successful in driving tobacco users towards action as 21.2% tobacco users who were looking to quit and 8.8% of tobacco users who were not looking to quit clicked on local tobacco cessation resources. This virtual health tool is reaching the targeted population and providing tailored information needed at each stage of the continuum of health behaviour change. Among tobacco users looking to quit, this virtual health tool acts as a quick referral to local tobacco cessation resources.

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.

Investigating the early impacts of the COVID-19 pandemic on modifiable risk factors for cancer and chronic disease: a repeated cross-sectional study in Alberta, Canada.

OBJECTIVES: This study contributes to empirical evidence by examining the impact of the first and second waves of the COVID-19 pandemic on modifiable risk factors (MRF) and whether these patterns differ according to level of material deprivation among people living in Alberta. METHODS: Using data from a repeated cross-sectional provincial health survey (Alberta Community Health Survey (ACHS): 2018-2021), we conducted logistic regression analyses examining the impacts of the COVID-19 pandemic on meeting national guidelines on four MRFs (tobacco use, physical activity, fruit and vegetable consumption, alcohol use) (n=11,249). We compared population-level changes in MRFs from one year before the COVID-19 pandemic (March 2019-February 2020) to one year during the pandemic (March 2020-February 2021) in Alberta. We also assessed whether these trends differed by a measure of material deprivation. RESULTS: Compared to the pre-COVID-19 period, the fully adjusted odds of meeting recommended guidelines for fruit and vegetable consumption (OR=0.42) decreased during the pandemic. Individuals experiencing high material deprivation had lower odds of meeting recommended guidelines for physical activity (OR=0.65) and higher odds of not being current tobacco users (OR=1.36) during the pandemic versus during the pre-pandemic period. CONCLUSION: At a population level, analyses from the ACHS showed minimal impacts of the first year of the COVID-19 pandemic on MRFs, besides fruit and vegetable consumption. Yet, stratifying results showed statistically significant differences in pandemic impacts on MRFs by level of material deprivation. Therefore, understanding the influence of material deprivation on MRFs during the pandemic is key to tailoring future public health interventions promoting health and preventing cancer and chronic disease.

RéSUMé: OBJECTIFS: Notre étude contribue aux preuves empiriques en examinant l'impact de la première et de la deuxième vague de la pandémie de COVID-19 sur les facteurs de risque modifiables (FRM) et en déterminant si ces tendances diffèrent selon le niveau de défavorisation matérielle chez les personnes vivant en Alberta. MéTHODE: À l'aide des données d'une enquête de santé transversale provinciale répétée (Alberta Community Health Survey [ACHS] : 2018-2021), nous avons mené des analyses de régression logistique pour étudier les impacts de la pandémie de COVID-19 sur le respect des directives nationales pour quatre FRM (tabagisme, activité physique, consommation de fruits et légumes, consommation d'alcool) (n = 11 249). Nous avons comparé les changements populationnels dans les FRM une année avant la pandémie de COVID-19 (mars 2019 à février 2020) et une année durant la pandémie (mars 2020 à février 2021) en Alberta. Nous avons aussi cherché à déterminer si ces tendances différaient selon un indicateur de défavorisation matérielle. RéSULTATS: Comparativement à la période ayant précédé la COVID-19, le rapport de cotes entièrement ajusté pour le respect des directives de consommation de fruits et légumes recommandées (RC = 0,42) a diminué durant la pandémie. Les personnes aux prises avec une importante défavorisation matérielle ont présenté une probabilité plus faible de respecter les directives recommandées pour l'activité physique (RC = 0,65) et une probabilité accrue de ne pas être des consommateurs actuels de produits du tabac (OR = 1,36) durant la pandémie qu'avant la pandémie. CONCLUSION: Pour l'ensemble de la population, nos analyses de l'ACHS montrent que la première année de la pandémie de COVID-19 a eu très peu d'impact sur les FRM, sauf pour la consommation de fruits et légumes. Pourtant, la stratification des résultats montre des écarts significatifs dans les impacts de la pandémie sur les FRM selon le niveau de défavorisation matérielle. Il est donc essentiel de comprendre l'influence de la défavorisation matérielle sur les FRM durant la pandémie pour adapter les futures interventions de promotion de la santé et de prévention du cancer et des maladies chroniques.

Multisectoral partnerships to tackle complex health issues at the community level: lessons from a Healthy Communities Approach in rural Alberta, Canada.

SETTING: Health inequities exist in rural communities across Canada, as rural residents are more likely than their urban counterparts to experience injuries, chronic conditions, obesity, and shorter life expectancy. Cooperative and coordinated action across sectors is required to both understand and address these complex public health issues. INTERVENTION: The Alberta Healthy Communities Approach (AHCA) is based on the values and core building blocks of the Healthy Communities Approach, a framework centred on building community capacity to support community-led actions on the determinants of health. Adaptations within the AHCA focused on implementation mechanisms with a 5-step process and supporting implementation and assessment tools for multisectoral team building. Local measurement of change was enhanced and focused on community capacity and multisectoral action stages. Between 2016 and 2019, the AHCA was piloted with 15 rural communities across Alberta with population sizes ranging from 403 to 15,051 people. OUTCOMES: While communities piloting the AHCA ranged in the level of diversity of their coalition membership and partnerships, members' reflections demonstrate that intentional engagement with diverse citizens and sectors is pivotal to collaboratively identifying local assets and priorities and mobilizing cross-sectoral action that will sustainably improve supportive environments for cancer and chronic disease prevention. IMPLICATIONS: Engaging across sectors, building partnerships, and establishing a multisectoral team increase diversity and can catalyze community-led prioritization and actions for asset-based community development. An increase in diversity may lead to increased investment and sustainability at the community level.

RéSUMé: LIEU: Il existe des iniquités en santé dans les communautés rurales de tout le Canada, car les résidents ruraux sont plus susceptibles que leurs homologues urbains de connaître des blessures, des affections chroniques, l'obésité et une espérance de vie plus courte. Une action coopérative et coordonnée entre plusieurs secteurs est nécessaire à la fois pour comprendre ces problèmes de santé publique complexes et pour les aborder. INTERVENTION: L'approche des Communautés en santé de l'Alberta (AHCA) repose sur les valeurs et les composantes de base de l'approche des Communautés en santé, un cadre axé sur le renforcement des moyens de proximité pour soutenir des actions communautaires sur les déterminants de la santé. Les adaptations de l'AHCA ont porté sur les mécanismes de mise en œuvre de l'approche, dont un processus en cinq étapes et une aide à la création d'outils de mise en œuvre et d'évaluation pour la consolidation d'équipes multisectorielles. Les instruments de mesure du changement à l'échelle locale ont été améliorés et recentrés sur les moyens de proximité et les étapes de l'action multisectorielle. Entre 2016 et 2019, l'AHCA a été mise à l'essai dans 15 communautés rurales de l'Alberta comptant entre 403 et 15 051 habitants. RéSULTATS: Les communautés dans lesquelles l'AHCA a été mise à l'essai présentaient différents degrés de diversité dans les membres et les partenaires de leurs coalitions, mais les réflexions des membres montrent que la mobilisation intentionnelle d'une forte mixité de citoyens et de secteurs est cruciale pour définir de façon concertée les priorités et les atouts locaux et pour mobiliser une action intersectorielle qui instaure durablement des milieux favorables à la prévention du cancer et des maladies chroniques. CONSéQUENCES: L'implication de plusieurs secteurs, la création de partenariats et la formation d'une équipe multisectorielle accroissent la diversité et peuvent accélérer la définition des priorités collectives et les actions de développement de proximité fondées sur les atouts. Une augmentation de la diversité peut mener à des investissements et à une durabilité accrus à l'échelle des communautés.

Exploring Multilevel Workplace Tobacco Control Interventions: A Scoping Review.

BACKGROUND: The workplace provides a unique opportunity to intervene on tobacco use, by implementing multilevel interventions engaging diverse employees. Using the social ecological model (SEM), this scoping review aimed to synthesize descriptions of multilevel workplace tobacco control programs to create a health equity informed framework for intervention planning. METHODS: Multiple databases were searched for articles published from January 2010 to December 2020 meeting inclusion criteria (i.e., discussed multilevel tobacco cessation interventions that intervene, target, or incorporate two or more levels of influence, and one of the levels must be the workplace). Articles were screened by two independent researchers and included if they discussed multilevel tobacco cessation interventions that intervened, targeted, or incorporated two or more levels of influence. To integrate the extracted information into the SEM, we utilized the McLeroy et al. model and definitions to describe potential multilevel interventions and their determinants. RESULTS: Nine articles were included in this review. No studies intervened across all five levels (individual, interpersonal, institutional, community, and policy), and the most common levels of intervention were individual (e.g., individual counseling), interpersonal (e.g., group therapy), and institutional (e.g., interventions during work hours). Participation rates varied by key social determinants of health (SDOHs) such as age, gender, education and income. Barriers including cost and sustainability influenced successful implementation, while leadership endorsement and accessibility facilitated successful implementation. DISCUSSION/APPLICATION TO PRACTICE: Multilevel interventions targeting at least two SEM levels may reduce persistent health inequities if they address how SDOHs influence individual health behaviors. Employee characteristics impacted the success of tobacco cessation interventions, but more research is needed to understand the barriers and facilitators related to workplace characteristics.

Community intervention strategies to reduce the impact of financial strain and promote financial well-being: a comprehensive rapid review.

Financial well-being describes when people feel able to meet their financial obligations, feel financially secure and are able to make choices that benefit their quality of life. Financial strain occurs when people are unable to pay their bills, feel stressed about money and experience negative impacts on their quality of life and health. In the face of the global economic repercussions of the COVID-19 pandemic, community-led approaches are required to address the setting-specific needs of residents and reduce the adverse impacts of widespread financial strain. To encourage evidence-informed best practices, a provincial health authority and community-engaged research centre collaborated to conduct a rapid review. We augmented the rapid review with an environmental scan and interviews. Our data focused on Western Canada and was collected prior to the pandemic (May-September 2019). We identified eight categories of community-led strategies to promote financial well-being: systems navigation and access; financial literacy and skills; emergency financial assistance; asset building; events and attractions; employment and educational support; transportation; and housing. We noted significant gaps in the evidence, including methodological limitations of the included studies (e.g. generalisability, small sample size), a lack of reporting on the mechanisms leading to the outcomes and evaluation of long-term impacts, sparse practice-based data on evaluation methods and outcomes, and limited intervention details in the published literature. Critically, few of the included interventions specifically targeted financial strain and/or well-being. We discuss the implications of these gaps in addition to possibilities and priorities for future research and practice. We also consider the results in relation to the COVID-19 pandemic and its economic consequences.

Understanding the decision to immunize: insights into the information needs and priorities of people who have utilized an online human papillomavirus (HPV) vaccine decision aid tool.

SETTING: People in Alberta are more likely to seek information about cancer prevention online than they are to have this conversation with their primary care provider. As people turn to the internet to support health decision-making, it is critical that we improve the supportiveness of the virtual health setting for cancer prevention. INTERVENTION: In 2014, the Alberta Cancer Prevention Legacy Fund launched an online HPV Decision Aid Tool to support evidence-informed decision-making in response to suboptimal uptake of the HPV (human papillomavirus) vaccine. Google Analytics data from approximately 2000 recent interactions with this tool have yielded insights into the concerns that impact people's decision-making about the vaccine. OUTCOMES: Most users of this tool are adults interested in the vaccine for themselves (69%), rather than parents considering immunizing their children (31%). No differences were found in the information-seeking behaviour of parents of girls compared with parents of boys, suggesting that mental models among those who are considering the HPV vaccine may have shifted in recent years. Concerns differed by respondent; cost was the most important concern among adults (62.0%), while parents were most concerned about vaccine safety (61.5%). Only 23% of users asked "what is HPV", suggesting that many people in Alberta now have basic knowledge about the virus. IMPLICATIONS: Results provide a real-time "pulse" on knowledge and attitudes towards HPV immunization, which informs our approach to tailoring messaging with the aim of increasing vaccine uptake in Alberta. Outcomes will provide evidence needed to inform new interventions aimed at increasing HPV immunization rates.

RéSUMé: LIEU: Les gens de l'Alberta ont plus tendance à chercher des informations sur la prévention du cancer en ligne que d'en parler avec leur fournisseur de soins de premier recours. Comme les gens se tournent de plus en plus vers Internet pour éclairer leurs décisions en matière de santé, il est essentiel d'améliorer notre soutien aux milieux de soins virtuels de prévention du cancer. INTERVENTION: En 2014, le fonds spécial de l'Alberta pour la prévention du cancer (Alberta Cancer Prevention Legacy Fund) lançait un outil en ligne d'aide à la décision axé sur le VPH (virus du papillome humain) pour favoriser la prise de décisions éclairées par les données probantes, vu le recours sous-optimal au vaccin anti-VPH. Les données sur environ 2 000 interactions récentes avec cet outil, extraites au moyen de Google Analytics, ont offert un aperçu des préoccupations qui comptent dans les décisions des gens au sujet du vaccin. RéSULTATS: La plupart des utilisateurs de l'outil sont des adultes que le vaccin intéresse pour eux-mêmes (69 %) plutôt que des parents qui songent à faire vacciner leurs enfants (31 %). Aucune différence n'a été constatée dans le comportement de recherche d'informations des parents de filles et des parents de garçons, ce qui indique que les modèles mentaux des personnes qui envisagent le vaccin anti-VPH pourraient avoir changé ces dernières années. Les préoccupations différaient selon les répondants; le coût était la préoccupation la plus importante chez les adultes en général (62 %), tandis que les parents s'inquiétaient surtout de l'innocuité du vaccin (61,5 %). Seulement 23 % des utilisateurs ont cherché « qu'est-ce que le VPH? ¼, ce qui donne à penser que beaucoup de gens en Alberta ont maintenant des connaissances de base sur le virus. CONSéQUENCES: Nos résultats permettent de prendre le « pouls ¼ en temps réel des connaissances et des attitudes à l'égard de l'immunisation contre le VPH, ce qui éclaire notre stratégie d'adaptation de nos messages en vue d'accroître le recours au vaccin en Alberta. Les résultats finaux fourniront les données probantes nécessaires pour éclairer de nouvelles interventions visant à accroître les taux d'immunisation contre le VPH.

Size Matters: A Latent Class Analysis of Workplace Health Promotion Knowledge, Attitudes, Practices and Likelihood of Action in Small Workplaces.

Workplace health programs (WHPs) have been shown to improve employee health behaviours and outcomes, increase productivity, and decrease work-related costs over time. Nonetheless, organizational characteristics, including size, prevent certain workplaces from implementing these programs. Past research has examined the differences between small and large organizations. However, these studies have typically used a cut-off better suited to large countries such as the USA. Generalizing such studies to countries that differ based on population size, scale of economies, and health systems is problematic. We investigated differences in WHP knowledge, attitudes, and practices between organizations with under 20 employees, 20-99 employees, and more than 100 employees. In 2017-2018, a random sample of employers from 528 workplaces in Alberta, Canada, were contacted for participation in a cross-sectional survey. Latent Class Analysis (LCA) was used to identify underlying response pattern and to group clusters of similar responses to categorical variables focused on WHP knowledge, attitudes, practices and likelihood of action. Compared to large organizations, organizations with fewer than 20 employees were more likely to be members of the Medium-Low Knowledge of WHP latent class (p = 0.01), the Low Practices for WHP latent class (p < 0.001), and more likely to be members of Low Likelihood of Action in place latent class (p = 0.033). While the majority of workplaces, regardless of size, recognized the importance and benefits of workplace health, capacity challenges limited small employers' ability to plan and implement WHP programs. The differences in capacity to implement WHP in small organizations are masked in the absence of a meaningful cut-off that reflects the legal and demographic reality of the region of study.

Academic Institutions and One Health: Building Capacity for Transdisciplinary Research Approaches to Address Complex Health Issues at the Animal-Human-Ecosystem Interface.

To improve health at the human, animal, and ecosystem interface, defined as One Health, training of researchers must transcend individual disciplines to develop a new process of collaboration. The transdisciplinary research approach integrates frameworks and methodologies beyond academic disciplines and includes involvement of and input from policy makers and members of the community. The authors argue that there should be a significant shift in academic institutions' research capacity to achieve the added value of a transdisciplinary approach for addressing One Health problems. This Perspective is a call to action for academic institutions to provide the foundations for this salient shift. The authors begin by describing the transdisciplinary approach, propose methods for building transdisciplinary research capacity, and highlight three value propositions that support the case. Examples are provided to illustrate how the transdisciplinary approach to research adds value through improved sustainability of impact, increased cost-effectiveness, and enhanced abilities to mitigate potentially harmful unintended consequences. The authors conclude with three key recommendations for academic institutions: (1) a focus on creating enabling environments for One Health and transdisciplinary research, (2) the development of novel funding structures for transdisciplinary research, and (3) training of "transmitters" using real-world-oriented educational programs that break down research silos through collaboration across disciplines.