The Core Competencies for Public Health in Canada: Opportunities and Recommendations for Modernization.

CONTEXT: The 2008 Public Health Agency of Canada's (PHAC's) "Core Competencies for Public Health in Canada" (the "Canadian core competencies") outline the skills, attitudes, and knowledge essential for the practice of public health. The core competencies represent an important part of public health practice, workforce development, and education in Canada and internationally. However, the core competencies are considered outdated and are facing calls for review, expansion, and revision. OBJECTIVE: To examine the literature on public health competencies to identify opportunities and recommendations for consideration when reviewing and updating the Canadian core competencies. METHODS: This narrative literature review included 4 components: 3 literature searches conducted between 2021 and 2022 using similar search strategies, as well as an analysis of competency frameworks from comparable jurisdictions. The 3 searches were conducted in collaboration with the Health Library to identify core competency-relevant scholarly and gray literature published in English since 2007. Reference lists of sources identified were also reviewed. During the data extraction process, one researcher screened each source, extracted competency-relevant information, and categorized these data into key findings. RESULTS: After identifying 2392 scholarly and gray literature sources, 166 competency-relevant sources were included in the review. Findings from these sources were synthesized into 3 main areas: (1) competency framework methodology and structure; (2) competencies to add; and (3) competencies to modify. DISCUSSION: These findings demonstrate that updates to Canada's core competencies are needed and overdue. Recommendations to support this process include establishing a formal governance structure for the competencies' regular review, revision, and implementation, as well as ensuring that priority topics applicable across all competency categories are integrated as overarching themes. Limitations of the evidence include the potential lack of applicability and generalizability to the Canadian context, as well as biases associated with the narrative literature review methodology.

Factors Associated with Initiating Cannabis Use After Legalization in Canada: A Cross-Sectional Study.

Background: Cannabis use has increased since the Government of Canada legalized nonmedical use in October 2018. We investigated demographic factors associated with initiating cannabis use after legalization. Materials and Methods: We used data from the 2018 and 2019 National Cannabis Survey and constructed multivariable regression models. Respondents' data were weighted and bootstrapped. We report relative measures of association as adjusted odds ratios (ORs) and absolute measures of association as adjusted risk increases (RIs). Results: Among the 58,195 households surveyed, 28,566 provided complete data (49%) and our weighted analysis represented 27,904,258 Canadians aged ≥ 15 years. Approximately one in five Canadians endorsed use of cannabis (19.8%), predominantly for nonmedical (9.5%) or combined medical and nonmedical (5.8%) reasons. Those who initiated cannabis use in the past 3 months (1.9%) were more likely to be younger (25-34 years vs. ≥ 65 years; adjusted OR 1.7, 95% confidence interval [CI] 1.1-2.8; adjusted RI 1.1%, 95% CI 0.1-2.0%), endorse poor to fair versus good to excellent physical health (adjusted OR 2.0, 95% CI 1.3-3.1; adjusted RI 1.7%, 95% CI 0.3-3.1%), and reside outside of Quebec (adjusted OR 1.4, 95% CI 1.1-2.0; adjusted RI 0.1%, 95% CI 0.6-1.1%). The 1% of Canadians who endorsed initiating use of cannabis due to legalization were more likely to reside outside of Quebec (adjusted OR 1.9, 95% CI 1.1-3.2; adjusted RI 0.5%, 95% CI 0.2-0.9%). Conclusion: Canadians initiating cannabis use after nonmedical legalization were likely to be younger and endorse worse physical health, and half of those using cannabis reported therapeutic use. Stricter policies, lower social acceptance, and less availability of cannabis in Quebec appear to have curtailed initiation of use after legalization.

Early Impacts of the COVID-19 Pandemic on Public Health Systems and Practice in 3 Canadian Provinces From the Perspective of Public Health Leaders: A Qualitative Study.

CONTEXT: The COVID-19 pandemic has impacted health systems worldwide. Studies to date have largely focused on the health care system with less attention to the impact on public health systems and practice. OBJECTIVE: To describe the early impacts of COVID-19 on public health systems and practice in 3 Canadian provinces from the perspective of public health system leaders and synthesize lessons learned. DESIGN: A qualitative study using semistructured virtual interviews with public health leaders between October 2020 and April 2021. The World Health Organization's essential public health operations framework guided data collection and analysis. SETTING: This study involved the Canadian provinces of Alberta, Ontario, and Québec. These provinces were chosen for their large populations, relatively high COVID-19 burden, and variation in public health systems. PARTICIPANTS: Public health leaders from Alberta (n = 21), Ontario (n = 18), and Québec (n = 19) in organizations with a primary mandate of stewardship and/or administration of essential public health operations (total n = 58). RESULTS: We found that the COVID-19 pandemic led to intensified collaboration in public health systems and a change in workforce capacity to respond to the pandemic. This came with opportunities but also challenges of burnout and disruption of non-COVID-19 services. Information systems and digital technologies were increasingly used and there was greater proximity between public health leaders and other health system leaders. A renewed recognition for public health work was also highlighted. CONCLUSIONS: The COVID-19 pandemic impacted several aspects of public health systems in the provinces studied. Our findings can help public health leaders and policy makers identify areas for further investment (eg, intersectoral collaboration, information systems) and develop plans to address challenges (eg, disrupted services, workforce burnout) that have surfaced.

Correlates of explicit and implicit stigmatizing attitudes of Canadian undergraduate university students toward mental illness: A cross-sectional study.

OBJECTIVE: To assess explicit and implicit attitudes toward mental illness of undergraduate students and explore associated variables. Participants: Year 1-4 undergraduate students from a large Canadian university (n = 382). Methods: Participants completed demographics, the Opening Minds Scale for Healthcare Providers, and an Implicit Association Test. Two-tailed independent and paired-samples t-tests, and ANOVA were performed with significance level at p < .05. Results: About 67.5% self-reported having experienced a mental illness and 31.2% had been diagnosed. Lower explicit stigma was associated with females, those with a history of mental illness diagnosis, and those who have had a close relationship with someone experiencing a mental illness. Faculty of Social Sciences students had significantly lower explicit stigma scores than Faculty of Engineering students. Implicit stigma did not show significant associations with any factors. Conclusions: A high proportion of undergraduate students experience mental illness. Increased exposure and experience were associated with reduced explicit stigma.

Correction to: The Potential Effect of the Psychiatric Clerkship and Contact-Based Hypothesis on Explicit and Implicit Stigmatizing Attitudes of Canadian Medical Students Towards Mental Illness.

The authors would like to correct the footnote of Table 2.

The Potential Effect of the Psychiatric Clerkship and Contact-Based Hypothesis on Explicit and Implicit Stigmatizing Attitudes of Canadian Medical Students Towards Mental Illness.

OBJECTIVE: The purpose of this study was to assess if having completed a psychiatric clerkship or having increased exposure to mental illness in general was associated with reduced explicit and implicit stigmatizing attitudes towards mental illness in undergraduate medical students. METHODS: A secondary analysis of data specific to medical students from McMaster University was completed. Data were obtained through a cross-sectional survey administered electronically. It consisted of a demographic questionnaire, the Opening Minds Scale for Healthcare Providers (OMS-HC) 12-item survey, and an Implicit Association Test (IAT). The OMS-HC was used as a measure of explicit stigmatizing attitudes, whereas the IAT was used as a measure of implicit bias. All analyses were completed using Stata/IC 15 and were two-tailed with significance defined as p < 0.05. RESULTS: Individuals that self-reported either having had a mental illness or diagnosis by a health care professional had significantly lower levels of explicit stigma. Final-year medical students had significantly lower levels of implicit stigmatizing attitudes than first-year medical students. Neither having completed a psychiatric clerkship nor having a close relationship with someone experiencing a mental illness was significantly associated with the explicit or implicit stigmatizing attitudes of medical students. CONCLUSION: More years in medical school and self-identifying or receiving a diagnosis of mental illness are associated with reduced stigmatizing attitudes, whereas having completed the psychiatric clerkship and having a close relationship with an individual experiencing mental illness were not. This study suggests that the psychiatric clerkship may have limited impact on the stigmatizing attitudes of medical students.

Characteristics of Canadians likely to try or increase cannabis use following legalization for nonmedical purposes: a cross-sectional study.

BACKGROUND: The Government of Canada legalized nonmedical use of cannabis in October 2018. Our objectives were to determine the percentage of Canadians intending to try or increase their cannabis use following legalization and to explore characteristics associated with this intent. METHODS: We used data from the 2018 National Cannabis Survey and constructed multivariable regression models. Respondents' data were weighted and bootstrapped. We report relative measures of association as adjusted odds ratios (ORs) and absolute measures of association as adjusted risk increases (RIs). RESULTS: Among the 39 000 households selected for recruitment for the survey, 17 089 respondents provided complete data (43.8%) and our weighted analysis represented 27 808 081 Canadians aged 15 years and older. An estimated 18.5% of respondents (95% confidence interval [CI] 17.6%-19.5%) indicated they intended to try or increase cannabis use following legalization. Being more likely to try or increase cannabis use was associated with younger age (15-24 yr v. ≥ 65 yr; adjusted OR 3.8, 95% CI 2.6-5.6; adjusted RI 20.1%, 95% CI 13.9%-26.2%), cannabis use in the past 3 months versus no use (adjusted OR 3.3, 95% CI 2.8-3.9; adjusted RI 20.4%, 95% CI 17.1%-23.6%), higher income (≥ $80 000 v. < $40 000; adjusted OR 1.5, 95% CI 1.3-1.9; adjusted RI 6.1%, 95% CI 3.2%-9.0%) and poor or fair mental health versus good to excellent mental health (adjusted OR 2.0, 95% CI 1.6-2.6; adjusted RI 11.5%, 95% CI 6.7%-16.2%). INTERPRETATION: Nearly 1 in 5 respondents reported that they intended to try or increase cannabis use after legalization; however, intention may not translate into behaviour. Continued monitoring should help to establish rates and patterns of cannabis use among Canadians following legalization.

Mental Health Stigma: Explicit and Implicit Attitudes of Canadian Undergraduate Students, Medical School Students, and Psychiatrists.

OBJECTIVES: To compare explicit and implicit stigmatizing attitudes towards mental illness among undergraduate students, medical school students, and psychiatrists, and to assess whether attitudes are associated with education level, exposure to, and personal experience with mental illness. METHODS: Participants from McMaster University were recruited through email. Participants completed a web-based survey consisting of demographics; the Opening Minds Scale for Healthcare Providers (OMS-HC) 12-item survey, which measures explicit stigma; and an Implicit Association Test (IAT), measuring implicit bias toward physical illness (diabetes mellitus) or mental illness (schizophrenia). RESULTS: A total of 538 people participated: undergraduate students ( n = 382), medical school students ( n = 118), and psychiatrists ( n = 38). Psychiatrists had significantly lower explicit and implicit stigma than undergraduate students and medical school students. Having been diagnosed with mental illness or having had a relationship with someone experiencing one was significantly associated with lower explicit stigma. Mean scores on the OMS-HC "disclosure/help-seeking" subscale were higher compared with the "attitudes towards people with mental illness" subscale. There was no correlation between the OMS-HC and IAT. CONCLUSIONS: These findings support the theory that increased education and experience with mental illness are associated with reduced stigma. Attitudes regarding disclosure/help-seeking were more stigmatizing than attitudes towards people with mental illness. The groups identified in this study can potentially benefit from anti-stigma campaigns that focus on reducing specific components of explicit, implicit, public and self-stigma.