RESUMO
BACKGROUND: While increasingly referenced in the literature and policy discussions, a "public health approach" (PHA) to substance use has been inconsistently defined or remained undefined. As part of a larger project on building the capacity to implement a PHA to substance use, we aimed to understand how professionals and practitioners across Canada who work with or whose work directly impacts the lives of people who use substances conceptualize a PHA. METHODS: We conducted a cross-sectional national online survey of public health professionals, public safety professionals, health and social service providers, and other relevant professionals and practitioners. The survey contained closed- and open-ended questions designed to gauge familiarity and comfort with application of a PHA to substance use, and perspectives on an organizational definition of such an approach. Survey recruitment was active between May and July 2021. Data analysis included descriptive statistics and thematic analysis. RESULTS: A total of 1041 surveys were completed. Most respondents (76 %) reported having heard of a PHA to substance use, as it was defined. Over half (54 %) indicated a high level of comfort with applying such an approach within their work. In relation to defining a PHA to substance use, the following thematic suggestions emerged from respondent's open-ended answers: explicitly recognize people with lived/living experience of substance use; incorporate trauma-informed understanding and acknowledge the varied underlying reasons for substance use; decolonize approaches to substance use and empower communities; and consider a more critical appraisal of a PHA and the terminology in its definition. CONCLUSION: Empirically unpacking multi-stakeholder understandings of a PHA to substance use can help to inform a more cohesive definition and build the consensus needed for more effective, coordinated, and community-led responses to substance use. Future work, especially qualitative research, will provide richer and more practical understandings of a PHA to substance use.
RESUMO
BACKGROUND: The association between belonging to a disadvantaged socio-economic status or social class and health outcomes has been consistently documented during recent decades. However, a meta-analysis quantifying the association between belonging to a lower social class and the risk of dementia has yet to be performed. In the present work, we sought to summarise the results of prospective, longitudinal studies on this topic. METHODS: We conducted a systematic review and meta-analysis of prospective, longitudinal studies measuring the association between indicators of social class and the risk of all-cause/Alzheimer's dementia. The search was conducted in four databases (Medline, Embase, Web of Science and PsychInfo). Inclusion criteria for this systematic review and meta-analysis were: (a) longitudinal prospective study, (b) aged ⩾60 years at baseline, (c) issued from the general population, (d) no dementia at baseline and (e) mention of social class as exposure. Exclusion criteria were: (a) study of rare dementia types (e.g. frontotemporal dementia), (b) abstract-only papers and (c) articles without full text available. The Newcastle-Ottawa scale was used to assess the risk of bias in individual studies. We calculated the overall pooled relative risk of dementia for different social class indicators, both crude and adjusted for sex, age and the year of the cohort start. RESULTS: Out of 4548 screened abstracts, 15 were included in the final analysis (76,561 participants, mean follow-up 6.7 years (2.4-25 years), mean age at baseline 75.1 years (70.6-82.1 years), mean percentage of women 58%). Social class was operationalised as levels of education, occupational class, income level, neighbourhood disadvantage and wealth. Education (relative risk (RR)=2.48; confidence interval (CI) 1.71-3.59) and occupational class (RR=2.09; CI 1.18-3.69) but not income (RR=1.28; CI 0.81-2.04) were significantly associated with the risk of dementia in the adjusted model. Some of the limitations of this study are the inclusion of studies predominantly conducted in high-income countries and the exclusion of social mobility in our analysis. CONCLUSIONS: We conclude that there is a significant association between belonging to a social class and the risk of dementia, with education and occupation being the most relevant indicators of social class regarding this risk. Studying the relationship between belonging to a disadvantaged social class and dementia risk might be a fruitful path to diminishing the incidence of dementia over time. However, a narrow operationalisation of social class that only includes education, occupation and income may reduce the potential for such studies to inform social policies.
