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Background: Canadian Arctic communities have experienced sustained syphilis transmission, with diagnoses rates 18-times higher than the national average. Remoteness from laboratory facilities leads to delays between syphilis screening and treatment, contributing to onward transmission. Rapid diagnostic tests can eliminate treatment delays via testing at the point-of-care. This study aims to describe syphilis diagnostic gaps and to estimate the impact of introducing rapid diagnostic tests at the point-of-care on syphilis transmission. Methods: To assess the population-level impact of deploying rapid diagnostic tests, an individual-based model was developed using detailed surveillance data, population surveys, and a prospective diagnostic accuracy field study. The model was calibrated to syphilis diagnoses (2017-2022) from a community of approximately 1,050 sexually active individuals. The impacts of implementing rapid diagnostic tests using whole blood (sensitivity: 92% for infectious and 81% for non-infectious syphilis; specificity: 99%) from 2023 onward was calculated using the annual median fraction of cumulative new syphilis infections averted over 2023-2032. Findings: The median modeled syphilis incidence among sexually active individuals was 44 per 1,000 in 2023. Males aged 16-30 years exhibited a 51% lower testing rate than that of their female counterparts. Maintaining all interventions constant at their 2022 levels, implementing rapid diagnostic tests could avert a cumulative 33% (90% credible intervals: 18-43%) and 37% (21-46%) of new syphilis infections over 5 and 10 years, respectively. Increasing testing rates and contact tracing may enhance the effect of rapid diagnostic tests. Interpretation: Implementing rapid diagnostic tests for syphilis in Arctic communities could reduce infections and enhance control of epidemics. Such effective diagnostic tools could enable rapid outbreak responses by providing same-day testing and treatment at the point-of-care. Funding: Canadian Institutes of Health Research.
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OBJECTIVES: Youth vaping is a concern in Canada. While school-level policies influence student behaviours, few studies have investigated the association between school vaping policies and student vaping. This study reviewed and scored the comprehensiveness of school vaping policies and investigated the association between school vaping policy scores and student vaping. METHODS: Online policy documents from n = 39 schools in Ontario, Alberta, and British Columbia, Canada, participating in the 2021-2022 wave of the COMPASS study were collected, reviewed, and scored for comprehensiveness (/39) using the School Tobacco Policy Index (STPI) rating form. The mean and range of scores for each domain of the STPI were calculated. School policy scores were linked to student vaping data from the COMPASS study. Multilevel logistic regression analyses identified the association between school vaping policy score and student lifetime and current (past 30-day) vaping. RESULTS: The mean total policy score was 10.2/39 (range 0â24), and 28% of schools scored 0/39. The majority of school policies did not identify enforcement approaches or available preventive or cessation resources. Increasing STPI score was not associated with the odds of student lifetime or current vaping in multilevel logistic regression analyses. CONCLUSION: The STPI quickly identified components of school vaping policies that were missing. The overall score of most school vaping policies in our sample was low and most school vaping policies lacked many important components. Future studies should explore factors associated with adolescent vaping and identify effective prevention measures.
RéSUMé: OBJECTIFS: Le vapotage des jeunes est préoccupant au Canada. Les politiques scolaires influencent les comportements des élèves, mais il y a peu d'études sur l'association entre les politiques scolaires sur le vapotage et le vapotage des élèves. Nous avons passé en revue des politiques scolaires sur le vapotage et noté leur complétude, puis étudié l'association entre les notes attribuées aux politiques scolaires sur le vapotage et le vapotage des élèves. MéTHODE: Les documents de politique accessibles en ligne de n = 39 écoles de l'Ontario, de l'Alberta et de la Colombie-Britannique, au Canada, ayant participé au cycle 2021-2022 de l'étude COMPASS ont été collectés, passés en revue et notés selon leur complétude (/39) à l'aide du formulaire de notation de l'indice School Tobacco Policy Index (STPI). La moyenne et l'intervalle des notes attribuées pour chaque élément de l'indice STPI ont été calculés. Les notes des politiques scolaires ont été maillées aux données sur le vapotage des élèves de l'étude COMPASS. Des analyses de régression logistique multiniveaux ont repéré l'association entre les notes attribuées aux politiques scolaires sur le vapotage et le vapotage des élèves à un moment de leur vie et récemment (au cours des 30 jours précédents). RéSULTATS: La note totale moyenne attribuée aux politiques a été de 10,2/39 (intervalle : 0â24), et 28 % des écoles ont obtenu une note de 0/39. La majorité des politiques scolaires ne mentionnaient pas d'approches ou de ressources de prévention et d'arrêt disponibles. Les notes STPI plus élevées n'étaient pas associées à la probabilité de vapotage récemment ou à un moment de la vie des élèves dans les analyses de régression logistique multiniveaux. CONCLUSION: L'indice STPI a rapidement repéré les lacunes dans les politiques scolaires sur le vapotage. La note globale de la plupart des politiques scolaires sur le vapotage de l'échantillon était faible, et il manquait d'importants éléments dans la plupart des politiques. Les études futures devraient explorer les facteurs associés au vapotage des adolescents et identifier des mesures de prévention efficaces.
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Objective: Cannabis is frequently co-used with tobacco/nicotine products, especially among young adults. Little is known about the effects of this co-use on cannabis cessation outcomes. Within a sample of young adults using cannabis frequently (current use of ≥5 days/week in the past 3 months), this study aimed to (a) document sources of exposure to tobacco/nicotine products, whether used simultaneously with cannabis or on different occasions, (b) examine if the level of cumulated exposure to tobacco/nicotine (self-reported or from biochemical testing) could predict time to cannabis lapse during a cannabis abstinence period, and (c) explore the relationship between nicotine/tobacco exposure and time to cannabis lapse according to tobacco cigarette smoking status. Method: Urine cotinine measures and self-reported data on use of different tobacco/nicotine products, collected from 32 participants (aged 19 to 23), were analyzed to predict time to lapse during a 2-week period of attempted abstinence from cannabis, controlling for cannabis dependence and sex. Results: Half of participants (56.3%) used at least one tobacco/nicotine product. Higher urine cotinine, representing higher cumulated tobacco/nicotine exposure, was related to a higher risk of lapsing (Hazard Ratio [HR] = 1.64; 95%CI [1.04, 2.58]). The risk of lapsing was even higher ([HR] = 3.46; 95%CI [1.17, 10.25]) among heavily tobacco/nicotine exposed (>600 ng/mL, urine cotinine) participants than among unexposed (<50 ng/mL) or lightly/moderately exposed (50-600 ng/mL) participants. Among those smoking cigarettes (solely or in combination with other products), there was no relation between cotinine level and time to lapse, likely due to a reduced variability in abstinence probability and a high likelihood of lapse observed for higher cotinine levels, mainly achieved by cigarette use. Conclusions: With a rapidly changing landscape of tobacco/nicotine use, our results underscore the need to consider all sources of tobacco/nicotine exposure to fully understand the specific and cumulative contributions of tobacco/nicotine to cannabis cessation outcomes.
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This study aimed to assess associations between prenatal and postnatal exposure to lead (Pb), mercury (Hg) and polychlorinated biphenyls (PCBs) and gray matter volume of key regions of the brain reward circuit, namely the caudate nucleus, putamen, nucleus accumbens (nAcc), the amygdala, the orbitofrontal cortex (OFC) and the anterior cingulate cortex (ACC). Structural magnetic resonance imaging (MRI) was conducted in 77 Inuit adolescents (mean age = 18.39) from Nunavik, Canada, who also completed the Brief Sensation Seeking Scale (BSSS-4) and Sensation Seeking - 2 (SS-2), two self-report questionnaires evaluating the tendency toward sensation seeking, which is a proxy of reward-related behaviors. Exposures to Pb, Hg and PCBs were measured in cord blood at birth, in blood samples at 11 years old and at time of testing (18 years old). Multivariate linear regressions were corrected for multiple comparisons and adjusted for potential confounders, such as participants' sociodemographic characteristics and nutrient fish intake. Results showed that higher cord blood Pb levels predicted smaller gray matter volume in the bilateral nAcc, caudate nucleus, amygdala and OFC as well as in left ACC. A moderating effect of sex was identified, indicating that the Pb-related reduction in volume in the nAcc and caudate nucleus was more pronounced in female. Higher blood Hg levels at age 11 predicted smaller right amygdala independently of sex. No significant associations were found between blood PCBs levels at all three times of exposure. This study provides scientific support for the detrimental effects of prenatal Pb and childhood Hg blood concentrations on gray matter volume in key reward-related brain structures.
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Substância Cinzenta , Inuíte , Chumbo , Imageamento por Ressonância Magnética , Mercúrio , Bifenilos Policlorados , Efeitos Tardios da Exposição Pré-Natal , Recompensa , Humanos , Feminino , Substância Cinzenta/efeitos dos fármacos , Substância Cinzenta/diagnóstico por imagem , Masculino , Bifenilos Policlorados/sangue , Bifenilos Policlorados/toxicidade , Bifenilos Policlorados/efeitos adversos , Adolescente , Chumbo/sangue , Chumbo/toxicidade , Chumbo/efeitos adversos , Mercúrio/sangue , Mercúrio/toxicidade , Gravidez , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Poluentes Ambientais/sangue , Poluentes Ambientais/toxicidade , Poluentes Ambientais/efeitos adversos , Criança , Encéfalo/efeitos dos fármacos , Encéfalo/diagnóstico por imagem , Sangue Fetal/químicaRESUMO
Fusarium spp. are commonly associated with the root rot complex of soybean (Glycine max). Previous surveys identified six common Fusarium species from Manitoba, including F. oxysporum, F. redolens, F. graminearum, F. solani, F. avenaceum, and F. acuminatum. This study aimed to determine their pathogenicity, assess host resistance, and evaluate the genetic diversity of Fusarium spp. isolated from Canada. The pathogenicity of these species was tested on two soybean cultivars, 'Akras' (moderately resistant) and 'B150Y1' (susceptible), under greenhouse conditions. The aggressiveness of the fungal isolates varied, with root rot severities ranging from 1.5 to 3.3 on a 0-4 scale. Subsequently, the six species were used to screen a panel of 20 Canadian soybean cultivars for resistance in a greenhouse. Cluster and principal component analyses were conducted based on the same traits used in the pathogenicity study. Two cultivars, 'P15T46R2' and 'B150Y1', were consistently found to be tolerant to F. oxysporum, F. redolens, F. graminearum, and F. solani. To investigate the incidence and prevalence of Fusarium spp. in Canada, fungi were isolated from 106 soybean fields surveyed across Manitoba, Saskatchewan, Ontario, and Quebec. Eighty-three Fusarium isolates were evaluated based on morphology and with multiple PCR primers, and phylogenetic analyses indicated their diversity across the major soybean production regions of Canada. Overall, this study contributes valuable insights into host resistance and the pathogenicity and genetic diversity of Fusarium spp. in Canadian soybean fields.
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Sexually transmitted infections (STIs) are common among adolescents. According to the Health Belief Model, cues to action influence preventive behaviors. Cues to action can include health experiences such as being diagnosed with an STI. The impact of a history of STIs on subsequent condom use among adolescents remains largely unexamined, despite high rates of recurrence and their health impacts. This project aimed to systematically review the literature on the association between curable STIs and subsequent condom use among adolescents. The systematic review, reported following PRISMA guidelines, was conducted using the Joanna Briggs Institute method. Eligible studies, in the form of cohort studies, case-control studies, or cross-sectional studies, targeted adolescents aged 10 to 24, with or without a history of curable STIs; the outcome was subsequent condom use. MEDLINE (Ovid), Embase (Elsevier), and Web of Science were searched from January 2012 to December 2022 with the assistance of an information specialist. Two reviewers independently selected articles and extracted data. Risk of bias analysis was performed using ROBINS-E. The review explores results, with tables, based on population characteristics, exposure, and outcome, and addresses the influence of gender, ethnicity, and age. Of 3088 articles identified, seven studies were retained. Almost all the studies focused on African-American, Nigerian, or Rwandan adolescents, and several included only girls. Among girls, a history of STI increased subsequent condom use in combination with other contraceptive methods (n = 4). Among boys and older adolescents of both genders, a history of STI was associated with a decrease in condom use (n = 3). No study distinguished between different STIs. While all the studies (n = 7) presented a high risk of bias, six did not present a threat to conclusion validity. All the studies indicated that a history of STI could influence subsequent protective behaviors, possibly by acting as a cue to action, as posited by the Health Belief Model. This information enhances our understanding of factors leading to the adoption of preventive health measures among adolescents and could apply to other infectious experiences.Registration The protocol is registered in PROSPERO (CRD42023397443).
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Preservativos , Infecções Sexualmente Transmissíveis , Feminino , Adolescente , Humanos , Masculino , Estudos Transversais , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Sexo Seguro , Anticoncepção , Comportamento SexualRESUMO
OBJECTIVE: Dual use of cannabis and alcohol has increased in adolescents, but limited research has examined how it relates to impaired driving or riding with an impaired driver (IDR) compared to single substance use. This study aimed to examine the odds of alcohol- and/or cannabis-IDR among adolescents based on their use of alcohol and/or cannabis, and whether associations differed by gender and age. METHODS: Cross-sectional survey data were used from a sample of 69,621 students attending 182 Canadian secondary schools in the 2021/22 school year. Multilevel logistic regression estimated the odds of exclusive alcohol-IDR, exclusive cannabis-IDR, and both alcohol and cannabis IDR (alcohol-cannabis-IDR). Substance use interactions with gender and age were tested. RESULTS: Overall, 14.7% of participants reported IDR; 7.5% reported exclusive alcohol-IDR, 3.2% reported exclusive cannabis-IDR, 4.0% reported alcohol-cannabis-IDR, and 7.4% were unsure if they had experienced IDR. The prevalence of IDR varied across substance use groups, 8.0% among nonuse, 21.9% among alcohol-only use, 35.9% among cannabis-only use, and 49.6% among dual use groups. Gender diverse, older, and students with lower socioeconomic status exhibited a higher likelihood of reporting alcohol-cannabis-IDR. Dual use was significantly associated with 9.5 times higher odds of alcohol-cannabis-IDR compared to alcohol-only use, and 3.0 times higher odds compared to cannabis-only use. Dual use was also associated with an increased likelihood of either alcohol- or cannabis-IDR. CONCLUSIONS: This study highlights that all students, regardless of substance use, are at risk of IDR, but students engaged in dual use of alcohol and cannabis face an elevated risk compared to both peers who do not use substances and those who use only a single substance. These findings emphasize the importance of targeted interventions that address the risks associated with IDR.
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Dirigir sob a Influência , Humanos , Masculino , Adolescente , Feminino , Estudos Transversais , Canadá/epidemiologia , Dirigir sob a Influência/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/epidemiologia , Prevalência , Fumar Maconha/epidemiologia , Estudantes/estatística & dados numéricos , Consumo de Álcool por Menores/estatística & dados numéricosRESUMO
Many indigenous cultures conceptualize health wholistically, whereby physical, mental, spiritual and relational dimensions of health are interconnected. Yet, quantitative approaches to studying Indigenous health remain anchored in western perspectives, that separate the dimensions of health. This paper aims to operationalize a wholistic indicator of health based on the IQI model of Inuit health. Variables from the 2017 Nunavik Health Survey (N = 1196) were selected based on their representativeness of IQI model. Exploratory Latent Class Analysis (LCA) was used to identify wholistic health profiles. Once participants assigned to their health profile, sociodemographic characteristics were compared across profiles, and multinomial regression models were used to examine the relationship between community-level social determinants of health and the profiles. The LCA revealed three health profiles, labelled as "excellent", "good" and "fair" based on the distribution of answers to the indicators. Nunavimmiut in "excellent" and "good" health were more likely to: rate their health positively; be over 30 years old; be in a relationship; and have participated or volunteered in community events. Nunavimmiut in "fair" health tended to report lower levels of community cohesion, family relationships, and emotional support. Intergrating culturally relevant models of health can support improved health status assessments and identify opportunities for health promotion.
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Nível de Saúde , Inuíte , Humanos , Adulto , Análise de Classes Latentes , Inquéritos Epidemiológicos , Relações FamiliaresRESUMO
PURPOSE: We quantified the joint evolution of sleep duration and screen time between 2018 and 2022 in a large sample of adolescents from Quebec, Canada, to ascertain changes that occurred during the COVID-19 pandemic. METHODS: A natural experiment design was used to compare variations from year to year and in association with the pandemic outbreak. Using structural equation modeling on data collected between 2018 and 2022 among adolescents attending 63 high schools, we analyzed the joint evolution of sleep duration and screen time while adjusting for previous year values, concurrent flourishing score, sex, age, and family level of material deprivation. RESULTS: A total of 28,307 adolescents, aged on average 14.9 years, were included in the analyses. Between 2019 and 2022, sleep duration increased by 9.6 (5.7, 13.5) minutes and screen time by 129.2 (120.5, 138.0) minutes on average. In 2022, the adolescents spent almost equal amounts of time sleeping and using screens. Lower flourishing scores were associated with shorter sleep duration and lengthier screen time. Girls' screen time became similar to boys' over time. DISCUSSION: Adolescents now spend almost equal amounts of time sleeping and using screens, a situation that calls for urgent public health actions. These findings highlight the importance of tracking changes in adolescents' behaviours over time, to design and implement interventions adapted to the changing health needs of different groups.
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COVID-19 , Masculino , Feminino , Humanos , Adolescente , Idoso , COVID-19/epidemiologia , Pandemias , Duração do Sono , Tempo de Tela , Canadá/epidemiologia , SonoRESUMO
Background: This study aimed to document recovery trajectories among adolescents with anorexia nervosa (AN) based on three markers of remission, namely changes in body weight, food restriction, and excessive exercise, and to identify predictors of these trajectories. Methods: One hundred twenty-six adolescent girls (14.7 ± 1.3 years) were recruited during initial assessment visits at specialized eating disorder (ED) programs in five University Health Centers across the province of Quebec, Canada. z-BMI and AN symptom severity (food restriction and excessive exercise) were assessed at initial assessment visits and subsequently reassessed at each quarterly follow-up over a 12-month period to identify recovery trajectories. Results: Considering the three markers of remission, three distinct trajectories emerged: Group 1, rapid responders; Group 2, gradual responders; and Group 3, unstable responders. At initial visits, a difference between groups was found regarding the type of treatment (p = 0.01) and weight suppression (p = 0.02). Group 1 had a higher number of youths hospitalized than Group 2 and Group 3, and a greater weight suppression than Group 3. Furthermore, individuals with atypical AN were more likely to belong to Group 2 than to Group 1 and Group 3 (p < 0.0001). Conclusions: This study contributes to a better understanding of the heterogeneity of recovery trajectories in adolescent girls with AN.
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Medical cannabis (MC) may offer therapeutic benefits for children with complex neurological conditions and chronic diseases. In Canada, parents, and caregivers frequently report encountering barriers when accessing MC for their children. These include negative preconceived notions about risks and benefits, challenges connecting with a knowledgeable healthcare provider (HCP), the high cost of MC products, and navigating MC product shortages. In this manuscript, we explore several of these barriers and provide recommendations to decision-makers to enable a family-centered and evidence-based approach to MC medicine and research for children.
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BACKGROUND: We examined whether subgroups of adolescents experienced disparate changes in school connectedness-a robust predictor of multiple health outcomes-from before the COVID-19 pandemic to the first full school year following pandemic onset. METHODS: We used 2 waves of prospective survey data from 7178 students attending 41 Canadian secondary schools that participated during the 2019-2020 (T1; pre-COVID-19 onset) and 2020-2021 (T2; ongoing pandemic) school years. Fixed effects analyses tested differences in school connectedness changes by gender, race, bullying victimization, socioeconomic position, and school learning mode. RESULTS: Relatively greater declines in school connectedness were reported by students that identified as females, were bullied, perceived their family to be less financially comfortable than their classmates, and attended schools in lower income areas. Marginally greater school connectedness declines resulted among students attending schools that were fully online at T2 than those at schools using a blended model. CONCLUSION: Results point to disparate school connectedness declines during the pandemic, which may exacerbate pre-existing health inequities by gender and socioeconomic position, and among bullied youth. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Effective strategies to improve school climates for equity denied groups are critical for pandemic recovery and preparedness for future related events.
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Bullying , COVID-19 , Instituições Acadêmicas , Estudantes , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , Adolescente , Feminino , Masculino , Canadá/epidemiologia , Bullying/psicologia , Bullying/estatística & dados numéricos , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Estudos Prospectivos , SARS-CoV-2 , Fatores Socioeconômicos , PandemiasRESUMO
Bacterial canker of tomato caused by Clavibacter michiganensis (Cm) is one of the most devastating bacterial diseases affecting the tomato industry worldwide. As the result of Cm colonization of the xylem, the susceptible host shows typical symptoms of wilt, marginal leaf necrosis, stem cankers, and ultimately plant death. However, what makes Cm an even more dangerous pathogen is its ability to infect seeds and plants without causing symptoms. Unfortunately, there are no resistant cultivars or effective chemical or biological control methods available to growers against Cm. Its control relies heavily on prevention. The implementation of a rapid and accurate detection tool is imperative to monitor the presence of Cm and prevent its spread. In this study, we developed a specific and sensitive multiplex TaqMan qPCR assay to detect Cm and distinguish it from related bacterial species that affect tomato plants. Two Cm chromosomal virulence-related genes, rhuM and tomA, were used as specific targets. The plant internal control tubulin alpha-3 was included in each of the multiplexes to improve the reliability of the assay. Specificity was evaluated with 37 bacterial strains including other Clavibacter spp. and related and unrelated bacterial pathogens from different geographic locations affecting a wide variety of hosts. Results showed that the assay is able to discriminate Cm strains from other related bacteria. The assay was validated on tissue and seed samples following artificial infection, and all tested samples accurately detected the presence of Cm. The tool described here is highly specific, sensitive, and reliable for the detection of Cm and allows the quantification of Cm in seeds, roots, stems, and leaves. The diagnostic assay can also be adapted for multiple purposes such as seed certification programs, surveillance, biosafety, the effectiveness of control methods, border protection, and epidemiological studies.[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.
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OBJECTIVE: To depict the design, methods, sociodemographic characteristics of the population, and lessons learned during the Qanuilirpitaa? 2017 Nunavik Inuit Health Survey, the third major health survey to be conducted among youth and adults residing in Nunavik (Northern Quebec, Canada). METHODS: Qanuilirpitaa? 2017 is a cross-sectional survey that served to update information regarding various aspects of physical health, mental health, and general well-being of Nunavimmiut. The survey was guided by the ethics principles of Ownership, Control, Access, and Possession (OCAP®) ( https://fnigc.ca/ocap ). Questionnaires and clinical tests were administered to residents from the 14 coastal communities onboard the Canadian Coast Guard Ship Amundsen during late summer and early fall 2017. As part of the community component of the survey, qualitative interviews were performed with key respondents, and services and resources supporting health and well-being in the 14 communities were inventoried and characterized. RESULTS: A total of 1326 Nunavimmiut aged 16 and over participated in the survey. Despite difficulties encountered with the recruitment of participants, co-interpretation sessions with Inuit partners revealed that the survey had succeeded in capturing cultural, socio-economic, and lifestyle characteristics of Nunavimmiut. In all, 20 thematic reports have been published covering various aspects of health and well-being of Nunavimmiut. Regional and local reports pertaining to the community component were produced. More in-depth analyses have ensued, and results are presented in articles published in this CJPH supplement issue. CONCLUSION: Information from this survey is being used to update health services and programs in the region and for the development of health policies and public health interventions to tackle key health-related issues faced by Nunavimmiut. Drawing lessons from challenges and successes encountered in Qanuilirpitaa? 2017, this survey paved the way to the upcoming Inuit-led Qanuippitaa? National Inuit Health Survey to be conducted every 5 years throughout Inuit Nunangat.
RéSUMé: OBJECTIF: Décrire la conception, les méthodes, les caractéristiques sociodémographiques de la population et les leçons tirées de l'Enquête sur la santé des Inuits du Nunavik Qanuilirpitaa? 2017, la troisième grande enquête de santé menée auprès de jeunes et d'adultes résidant au Nunavik (Nord du Québec, Canada). MéTHODES: Qanuilirpitaa? 2017 est une enquête transversale qui a permis la mise à jour des informations concernant divers aspects de la santé physique, de la santé mentale et du bien-être général des Nunavimmiut. L'enquête a été guidée par les principes de propriété, de contrôle, d'accès et de possession (OCAP®) ( https://fnigc.ca/ocap ). Des questionnaires et des tests cliniques ont été administrés à des résidents des 14 communautés côtières, à bord du navire Amundsen de la Garde côtière canadienne, à la fin de l'été et au début de l'automne 2017. Des entrevues qualitatives ont également été réalisées avec des répondants clé dans le cadre de la composante communautaire. RéSULTATS: Au total, 1 326 Nunavimmiut âgés de 16 ans et plus ont été recrutés. Malgré les difficultés rencontrées lors du recrutement des participants, les rencontres de co-interprétation ont permis de vérifier que l'enquête avait réussi à capturer les caractéristiques culturelles, socioéconomiques et les habitudes de vie de la population. Au total, 20 rapports thématiques ont été publiés, lesquels couvrent différents aspects de la santé et du bien-être des Nunavimmiut. Un rapport régional et des rapports locaux liés à la composante communautaire ont également été produits. Des analyses plus approfondies ont également été réalisées, dont les résultats sont présentés dans les articles publiés dans ce numéro supplémentaire de la Revue canadienne de santé publique. CONCLUSION: Les informations issues de cette enquête sont utilisées pour la mise à jour des services de santé dans la région et pour le développement de politiques de santé et d'interventions de santé publique, ayant pour cibles les principaux défis auxquels les Nunavimmiut sont confrontés. Grâce aux leçons apprises lors de sa réalisation, cette enquête a pavé la voie aux prochaines enquêtes Qanuippitaa ? qui seront menées tous les 5 ans dans tout l'Inuit Nunangat.
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Estudos Transversais , Adulto , Adolescente , Humanos , Canadá , Quebeque/epidemiologia , Inquéritos Epidemiológicos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Stemming from historical traumas and changes in the Inuit way of life, substance use and its intertwined problems are a major cause of concern for Nunavimmiut. This study's objective is to investigate sociocultural determinants of substance use and misuse to inform culturally appropriate public health programs. METHODS: The 2017 Qanuilirpitaa? survey was conducted among a sample intended to be representative of Nunavimmiut aged 16 and over (total n = 1326). Sociocultural factors included cultural identity, land-based activities, involvement in community activities, social support, and family and community cohesion. The frequency of binge drinking (5 or more drinks on one occasion), cannabis use, and problematic substance use (CAGE and DAST-10) were documented. Data were analyzed using weighted multivariate logistic regressions. Inuit partners were involved from the planning of analyses to the co-interpretation of results. RESULTS: Nearly a third of Nunavimmiut aged 16 and over reported binge drinking at least once a week (29.3%), and 68.6% of drinkers were at risk of potential drinking problems. Forty-five percent (45%) reported using cannabis at least once a week, and 30% of drug users were at risk of potential drug abuse problems. Volunteering and participation in community activities were associated with lower odds of cannabis use, as was frequently going on the land with weekly binge drinking, potential drinking problems, and weekly cannabis use. Social support and community cohesion were associated with higher odds of weekly binge drinking, as was cultural identity (centrality scale) with potential drinking problems. CONCLUSION: Key determinants of substance use relevant to Inuit culture were identified. Results are in line with our Inuit partners' experience in their communities and are coherent with current land-based interventions implemented in Nunavik. A thorough understanding of substance use contexts and related stressors should guide the content and implementation of substance use programs in Nunavik.
RéSUMé: OBJECTIF: Suite aux traumas historiques et changements au mode de vie, l'usage de substance et les problèmes associés sont une source d'inquiétude majeure pour les Nunavimmiut. L'objectif de cette étude est d'investiguer les déterminants socioculturels de l'usage de substances pour adapter les programmes de santé publique à la culture Inuit. MéTHODES: L'enquête Qanuilirpitaa? 2017 repose sur un échantillon sélectionné pour être représentatif des Nunavimmiut (16 ans et plus; n = 1 326). Les déterminants socioculturels incluent : identité culturelle, activités sur le territoire, activités communautaires, support social, cohésion familiale et communautaire. La fréquence de consommation excessive d'alcool (5 consommations ou plus), l'usage du cannabis et l'usage problématique (CAGE et DAST-10) ont été documentés. Données analysées par régression multiple pondérée. Nos partenaires Inuit ont été impliqués de la planification des analyses à la co-interprétation des résultats. RéSULTATS: Près du tiers des Nunavimmiut de 16 ans et plus ont rapporté une consommation hebdomadaire excessive d'alcool (29,3 %) et 68,6 % de ceux consommant de l'alcool étaient potentiellement à risque de consommation problématique. Quarante-cinq pourcent (45 %) ont rapporté consommer du cannabis au moins une fois par semaine et 30 % des consommateurs de drogue étaient à risque de consommation potentiellement problématique. Le bénévolat et la participation aux activités communautaires étaient associés à une cote plus faible d'usage de cannabis, tout comme la pratique fréquente d'activités sur le territoire avec la consommation hebdomadaire excessive d'alcool, d'usage potentiellement problématique d'alcool et d'usage hebdomadaire de cannabis. Le support social et la cohésion communautaire étaient associés à une cote plus élevée de consommation excessive hebdomadaire d'alcool, tout comme l'identité culturelle (centralité) avec l'usage potentiellement problématique d'alcool. CONCLUSION: Des déterminants clés de l'usage de substance spécifiques aux Inuit ont été identifiés. Les résultats concordent avec le vécu de nos partenaires dans leurs communautés et le cadre théorique d'interventions déjà implémentées impliquant des activités sur le territoire et de guérison. Les contextes de consommation et les stresseurs associés devraient guider l'élaboration des programmes au Nunavik.
Assuntos
Alcoolismo , Consumo Excessivo de Bebidas Alcoólicas , Cannabis , Transtornos Relacionados ao Uso de Substâncias , Humanos , Etanol , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologiaRESUMO
OBJECTIVES: Distress and associated health problems reported by Nunavik Inuit emanate from heterogeneous roots, including adverse childhood experiences. This study aims to (1) identify distinct childhood adversity profiles and (2) examine associations between these profiles and sex, socioeconomic characteristics, social support, and community involvement among Nunavimmiut. METHODS: In a sample of 1109 adult Nunavimmiut, sex, socioeconomic characteristics, support, community involvement, residential school attendance, and 10 forms of adverse childhood experiences (ACEs) were documented using questionnaires. Latent class analyses and weighted comparisons were performed for three subgroups: 18-49 years; 50 years and above with experience of residential school; and 50 years and above without experience of residential school. The analysis design, the manuscript drafts, and the key findings were discussed and co-interpreted with the collaboration of community representatives, taking into consideration Inuit culture and needs. RESULTS: A total of 77.6% of Nunavimmiut reported having experienced at least one form of childhood adversity. Three ACE profiles were identified among the 18-49-year-olds: low ACEs (43.0%), household stressors (30.7%), and multiple ACEs (26.3%). Two profiles characterized ACEs experienced among the 50-year-olds and over with and without history of residential schooling: low ACEs (80.1% and 77.2%, respectively) and multiple ACEs (19.9% and 22.8%, respectively). Among the group of 18-49-year-olds, as compared to the low ACE profile, the profile with household stressors included proportionally more women (odds ratio [OR] = 1.5) and was associated with lower involvement in volunteering and community activities (mean score reduced by 0.29 standard deviation [SD]) and lower family cohesion (SD = - 0.11), while the multiple ACE profile was related to a lower rate of employment (OR = 0.62), lower family cohesion (SD = - 0.28), and lower satisfaction with ability to practice traditional activities (SD = - 0.26). CONCLUSION: Childhood adversities among Nunavimmiut do not occur in isolation and experiencing multiple forms of childhood adversities predicts lower socioeconomic status, support, and community involvement in adulthood. Implications for the planning of health and community services in Nunavik are discussed.
RéSUMé: OBJECTIFS: La détresse et les problèmes de santé associés rapportés par les Inuits du Nunavik émanent de racines hétérogènes, notamment des expériences négatives durant l'enfance. Cette étude vise à : 1) identifier des profils distincts d'adversités vécues durant l'enfance; et 2) examiner les associations entre ces profils et le sexe, les caractéristiques socioéconomiques, le soutien social et l'engagement communautaire des Nunavimmiut. MéTHODES: Dans un échantillon de 1 109 adultes Nunavimmiut, le sexe, les caractéristiques socioéconomiques, le soutien, l'engagement communautaire, la fréquentation des pensionnats et 10 formes d'expériences négatives durant l'enfance (ENE) ont été documentés à l'aide de questionnaires. Des analyses de classes latentes et des comparaisons pondérées ont été réalisées pour trois sous-groupes : 1849 ans; 50 ans et plus avec et sans expérience de pensionnat. Le plan d'analyses, les ébauches de manuscrit et les principaux résultats ont été discutés et co-interprétés avec la collaboration de représentants des communautés, en tenant compte de la culture et des besoins inuits. RéSULTATS: Un total de 77,6 % des Nunavimmiut ont déclaré avoir vécu au moins une forme d'adversité durant l'enfance. Trois profils d'ENE ont été identifiés chez les 1849 ans : ENE faibles (43,0 %), facteurs de stress domestiques (30,7 %) et ENE multiples (26,3 %). Deux profils caractérisaient les ENE vécus chez les 50 ans et plus avec et sans antécédents de pensionnat : faibles ENE (80,1 % et 77,2 %, respectivement) et ENE multiples (19,9 % et 22,8 %, respectivement). Parmi le groupe des 1849 ans, par rapport au profil des ENE faibles, le profil avec facteurs de stress domestiques incluait proportionnellement plus de femmes (rapport de cotes [RC] = 1,5) et était associé à une plus faible implication dans le bénévolat et les activités communautaires (score moyen réduit de 0,29 écart-type [ET]) et une cohésion familiale plus faible (ET = -0,11), tandis que le profil d'ENE multiples était lié à un taux d'emploi plus faible (RC = 0,62), à une cohésion familiale plus faible (ET = -0,28) et à une plus faible satisfaction à l'égard de la capacité à pratiquer des activités traditionnelles (ET = -0,26). CONCLUSION: Les adversités vécues en enfance par les Nunavimmiut ne surviennent pas de manière isolée et le fait de vivre de multiples formes d'ENE prédit un statut socio-économique, un soutien et une implication communautaire inférieurs à l'âge adulte. Les implications pour la planification des services de santé et communautaires au Nunavik sont discutées.
Assuntos
Experiências Adversas da Infância , Fatores Socioeconômicos , Adulto , Criança , Feminino , Humanos , Participação da Comunidade , Inuíte , Inquéritos e Questionários , Masculino , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Apoio SocialRESUMO
PURPOSE: There is concern over the potentially detrimental impact of the COVID-19 pandemic on adolescents' mental health. We examined changes in depression and anxiety symptoms from before (2018-19) to the early (2019-20) and ongoing pandemic (2020-21) responses among Canadian adolescents in the context of a natural experiment. METHODS: We used linked survey data from 5,368 Canadian secondary school students who participated in three consecutive waves of the cannabis use, obesity, mental health, physical activity, alcohol use, smoking, and sedentary behaviour study during the 2018-19, 2019-20, and 2020-21 school year. Separate fixed effects models examined whether changes in depression (Center for Epidemiologic Studies Depression Scale Revised-10) and anxiety (General Anxiety Disorder-7) symptoms differed between two cohorts. The cohorts differed in the timing of their second data collection wave; one cohort participated before the pandemic and the other cohort participated in the early pandemic (spring 2020). RESULTS: Depression and anxiety symptoms increased during the early and ongoing pandemic periods in the overall sample and both cohorts. The two cohorts experienced similar elevations in their symptoms. Females and younger respondents presented greater elevations over time. The proportion of adolescents with significant depressive (29.4%) and moderate-to-severe anxiety (17.6%) symptoms at baseline increased by 1.5 times, reaching 44.8% and 29.8% in the ongoing pandemic period, respectively. DISCUSSION: Findings suggest that internalizing symptoms have consistently increased since before the onset of COVID-19, particularly in the ongoing pandemic period; however, we found no evidence of the increase being due to the pandemic in the early COVID-19 period when comparing the two cohorts. Ongoing evaluation of adolescents' mental health is necessary to capture potentially dynamic impacts over time.
Assuntos
COVID-19 , Feminino , Humanos , Adolescente , Pandemias , Depressão/epidemiologia , Canadá/epidemiologia , Ansiedade/epidemiologiaRESUMO
PURPOSE: Considerable debate centered on the impact of school closures and shifts to virtual learning on adolescent mental health during the COVID-19 pandemic. We evaluated whether mental health changes differed by school learning modes during the pandemic response among Canadian adolescents and whether associations varied by gender and perceived home life. METHODS: We used prospective survey data from 7270 adolescents attending 41 Canadian secondary schools. Conditional change linear mixed effects models were used to examine learning mode (virtual optional, virtual mandated, in-person, and blended) as a predictor of change in mental health scores (depression [Centre for Epidemiologic Studies - Depression], anxiety [Generalized Anxiety Disorder-7], and psychosocial well-being [Flourishing scale]), adjusting for baseline mental health and covariates. Gender and home life happiness were tested as moderators. Least square means were calculated across interaction groups. RESULTS: Students learning in a blended learning mode had greater anxiety increases relative to their peers in other learning modes. Females learning fully in-person and males learning virtually when optional reported less of an increase in depression scores relative to their gender counterparts in other learning modes. Learning virtually when optional was associated with greater declines in psychosocial well-being in students without happy home lives relative to other learning modes. CONCLUSION: Findings demonstrate the importance of considering gender and home environments as determinants of mental health over the pandemic response and when considering alternative learning modes. Further research is advised before implementing virtual and blended learning modes. Potential risks and benefits must be weighed in the context of a pandemic.