School-based vaccination program against HPV and Hepatitis B: A longitudinal analysis of vaccine coverage between 2015 and 2021 in Quebec.

BACKGROUND: HPV vaccination prevents cancers, including 90% of cervical cancer. Since 2008, a school-based HPV vaccination program has been implemented in Quebec, but vaccine coverage is suboptimal. The COVID-19 pandemic disrupted school-based vaccination programs. This study aimed to assess variation in HPV vaccination coverage in the school-based program between 2015 and 2022 in Quebec and to identify sociodemographic characteristics associated with non-vaccination. METHODS: HPV vaccine coverage data were extracted from the Quebec Immunization Registry for students in Grade 4 and matched to the 2016 Canadian census sociodemographic data. Descriptive analysis was conducted to explore individual-level vaccine coverage according to sociodemographic data. A Generalized Estimating Equations model assessed the independent association between non-vaccination and students' sociodemographic characteristics. RESULTS: HPV vaccine coverage (at least one dose) was 84% in 2018-2019 and 85% in 2019-2020. A decrease was observed during the pandemic. In 2020-2021, the HPV vaccine coverage (at least one dose) was 52% (at the end of the school year) and rose to 84% with intense catch-up activities. In 2021-2022, the coverage was slightly lower than before the pandemic (81%). Factors in the dissemination area were statistically significantly associated with non-vaccination: material (p-value = 0.0001) and social deprivation index (p-value = 0.0048), the proportion of immigration (p-value < 0.0001), and the language spoken at home (English (p-value = 0.0318), other than French or English (p-value = 0.0001). CONCLUSION: School-based vaccination programs offer equitable access to vaccination, and our analysis showed that some groups have consistently lower vaccine acceptance and uptake. Strategies to improve HPV vaccine coverage should target children living in areas with a higher proportion of immigrants, non-French speakers, and people from underprivileged backgrounds. Although it is too early to assess the full impact of COVID-19 on school-based programs in Quebec, it remains important to ensure that catch-up strategies are implemented for missed doses.

Stakeholders' perspectives on barriers to and facilitators of school-based HPV vaccination in the context of COVID-19 pandemic-related disruption: a qualitative mixed methods study.

Despite successfully implementing the Human Papilloma Virus Vaccine (HPVV) program, Saskatchewan (SK) struggled to improve HPVV uptake rates. This suboptimal uptake of HPVV with a status quo of HPV-linked cervical cancer incidence rate is mainly because HPVV's impact on cancer prevention has not been realized adequately by vaccine providers and receivers. Further exploration of determinants of HPVV uptake is required to uncover high-resolution quality improvement targets for investment and situate contextually appropriate policies to improve its uptake. The study undertook a qualitative inquiry into understanding stakeholders' perspectives on HPVV experience through school-based programmes. It collected data through semi-structured initial interviews (N = 16) and follow-up interviews (N = 10) from across Saskatchewan's four Integrated Service Areas. Document analysis was conducted on all publicly available documents that included information on HPVV from January 2015 to July 2023. Thematic analysis of the data identified that inadequate information, awareness and education about HPV infection and HPVV among several groups, especially, parents, youth and school staff, was the main barrier to optimal HPVV uptake. Vaccine-related logistics, including the technical and text-heavy vaccine information sheet, understaffing, and time constraints, were other important factors that impeded HPVV uptake. A person-centred approach could educate parents in multiple dimensions.

Screening for poverty and related social determinants to improve knowledge of and links to resources (SPARK): development and cognitive testing of a tool for primary care.

BACKGROUND: Healthcare organizations are increasingly exploring ways to address the social determinants of health. Accurate data on social determinants is essential to identify opportunities for action to improve health outcomes, to identify patterns of inequity, and to help evaluate the impact of interventions. The objective of this study was to refine a standardized tool for the collection of social determinants data through cognitive testing. METHODS: An initial set of questions on social determinants for use in healthcare settings was developed by a collaboration of hospitals and a local public health organization in Toronto, Canada during 2011-2012. Subsequent research on how patients interpreted the questions, and how they performed in primary care and other settings led to revisions. We administered these questions and conducted in-depth cognitive interviews with all the participants, who were from Saskatchewan, Manitoba, Ontario, and Newfoundland and Labrador. Cognitive interviewing was used, with participants invited to verbalize thoughts and feelings as they read the questions. Interview notes were grouped thematically, and high frequency themes were addressed. RESULTS: Three hundred and seventy-five individuals responded to the study advertisements and 195 ultimately participated in the study. Although all interviews were conducted in English, participants were diverse. For many, the value of this information being collected in typical healthcare settings was unclear, and hence, we included descriptors for each question. In general, the questions were understood, but participants highlighted a number of ways the questions could be changed to be even clearer and more inclusive. For example, more response options were added to the question of sexual orientation and the "making ends meet" question was completely reworded in light of challenges to understand the informal phrasing cited by English as a Second Language (ESL) users of the tool. CONCLUSION: In this work we have refined an initial set of 16 sociodemographic and social needs questions into a simple yet comprehensive 18-question tool. The changes were largely related to wording, rather than content. These questions require validation against accepted, standardized tools. Further work is required to enable community data governance, and to ensure implementation of the tool as well as the use of its data is successful in a range of organizations.

Barriers to and facilitators of human papillomavirus vaccination in an ethnically diverse group of migrant parents: A qualitative mixed methods study.

A disparity in the uptake of the Human papillomavirus vaccine (HPVV) among immigrants and refugees leads to a social gradient in health. Recognizing that immigrants and refugees may encounter unique barriers to accessing prevention and care, this study seeks to determine barriers to and facilitators of HPVV among these subgroups to uncover high-resolution quality improvement targets of investment for under-immunized pockets of the population. The study undertook a qualitative inquiry into understanding immigrant and refugee parents' perspectives on HPV infection and HPVV experience through school-based programs. We collected data first through short online surveys (N = 15) followed by one-on-one interviews (N = 15) and then through detailed online surveys (N = 16) followed by focus group discussions (N = 3) with 4-6 participants per group discussion from different groups: Black, South Asian and West Asian. Analysis of surveys and interviews identified that: information, awareness, and education about HPV infection and HPVV were among the most cited barriers that impede the uptake of HPVV. Moreover, vaccine-related logistics were equally important, including not having immunization information packages in different languages and relying solely on the child to bring home packages in paper copies from school-based vaccine programs. A multi-component intervention remains instrumental in enhancing HPV immunization rates, given the inconsistent uptake of HPVV by these subgroups who voice unique barriers and facilitators. An educational campaign that involves educating parents who consent for their child(ren) for HPVV, the children receiving the vaccination, and training staff providing HPVV through school-based immunization programs would be paramount.

"The problem is not lack of information": A qualitative study of parents and school nurses' perceptions of barriers and potential solutions for HPV vaccination in schools.

BACKGROUND: HPV vaccination has been offered in school programs for over a decade in Quebec, Canada, but the vaccine coverages are not reaching the target coverage in several regions. This qualitative study aimed to describe barriers and enabling conditions of HPV vaccination as perceived by parents and school nurses and identify potential solutions to improve HPV vaccine uptake rates and acceptance in school-based programs. METHODS: Three focus group discussions were conducted with parents of children in Grades 2 or 3 who were unsure or unwilling to vaccinate. Individual interviews were conducted with 24 school nurses. A thematic content analysis was performed using N'Vivo. RESULTS: The main parental questions and concerns regarding the HPV vaccination were the children's young age, the possible side effects, the rationale behind boys' vaccination and the possible interaction with COVID-19 vaccination. Except for interaction with COVID-19 vaccination, these concerns remain similar to those identified before the pandemic. Interviews highlighted that the information on HPV vaccination provided by the public was not well understood by parents. Parents suggested different tools to access information tailored to their concerns and situation. From the nurses' perspective, HPV vaccination promotion tools such as decision-aids and social media communication campaigns were needed and could reduce their work. CONCLUSION: COVID-19 may have disrupted the acceptance of the vaccines. While strategies to catch up on missed doses and reduce access barriers to vaccines are urgently needed, our findings highlight that a shift in attitudes toward routine vaccines may pose further challenges even if HPV vaccine coverage appears to have returned to pre-pandemic levels.

Canadian SARS-CoV-2 serological survey using antenatal serum samples: a retrospective seroprevalence study.

BACKGROUND: Insufficient data on the rate and distribution of SARS-CoV-2 infection in Canada has presented a substantial challenge to the public health response to the COVID-19 pandemic. Our objective was to assess SARS-CoV-2 seroprevalence in a representative sample of pregnant people throughout Canada, across multiple time points over 2 years of the pandemic, to describe the seroprevalence and show the ability of this process to provide prevalence estimates. METHODS: This Canadian retrospective serological surveillance study used existing serological prenatal samples across 10 provinces over multiple time periods: Feb. 3-21, 2020; Aug. 24-Sept. 11, 2020; Nov. 16-Dec. 4, 2020; Nov. 15-Dec. 3, 2021; and results from the province of British Columbia during a period in which the SARS-CoV-2 B.1.1.529 (Omicron) variant was predominant, from Nov. 15, 2021, to June 11, 2022. Age and postal code administrative data allowed for comparison with concurrent polymerase chain reactivity (PCR)-positive results collected by Statistics Canada and the Canadian Surveillance of COVID-19 in Pregnancy (CANCOVID-Preg) project. RESULTS: Seropositivity in antenatal serum as early as February 2020 indicates SARS-CoV-2 transmission before the World Health Organization's declaration of the pandemic. Seroprevalence in our sample of pregnant people was 1.84 to 8.90 times higher than the recorded concurrent PCR-positive prevalence recorded among females aged 20-49 years in November-December 2020. Overall seropositivity in our sample of pregnant people was low at the end of 2020, increasing to 15% in 1 province by the end of 2021. Seroprevalence among pregnant people in BC during the Omicron period increased from 5.8% to 43% from November 2021 to June 2022. INTERPRETATION: These results indicate widespread vulnerability to SARS-CoV-2 infection before vaccine availability in Canada. During the time periods sampled, public health tracking systems were under-reporting infections, and seroprevalence results during the Omicron period indicate extensive community spread of SARS-CoV-2 infection.

Barriers and facilitators in uptake of human papillomavirus vaccine across English Canada: A review.

Human Papillomavirus (HPV) is a highly contagious sexually transmitted infection that leads to preventable cancers of the mouth, throat, cervix, and genitalia. Despite the wide availability of HPV Vaccine (HPVV) in Canada, its uptake remains suboptimal. This review aims to identify factors (barriers and facilitators) in HPV vaccine uptake across English Canada at three levels (provider, system, and patient). We explored academic and gray literature to examine factors involved in HPVV uptake and synthesized results based on interpretive content analysis. The review identified the following factors of prime significance in the uptake of the HPV vaccine (a) at the provider level, 'acceptability' of the HPV vaccine, and 'appropriateness' of an intervention (b) at the patient level, the 'ability to perceive' and 'knowledge sufficiency' (c) at the system level, 'attitudes' of different players in vaccine programming, planning and delivery. Further research is needed to conduct population health intervention research in this area.

COVID-19 Vaccination and Public Health Countermeasures on Variants of Concern in Canada: Evidence From a Spatial Hierarchical Cluster Analysis.

BACKGROUND: There is mounting evidence that the third wave of COVID-19 incidence is declining, yet variants of concern (VOCs) continue to present public health challenges in Canada. The emergence of VOCs has sparked debate on how to effectively control their impacts on the Canadian population. OBJECTIVE: Provincial and territorial governments have implemented a wide range of policy measures to protect residents against community transmission of COVID-19, but research examining the specific impact of policy countermeasures on the VOCs in Canada is needed. Our study objective was to identify provinces with disproportionate prevalence of VOCs relative to COVID-19 mitigation efforts in provinces and territories in Canada. METHODS: We analyzed publicly available provincial- and territorial-level data on the prevalence of VOCs in relation to mitigating factors, summarized in 3 measures: (1) strength of public health countermeasures (stringency index), (2) the extent to which people moved about outside their homes (mobility index), and (3) the proportion of the provincial or territorial population that was fully vaccinated (vaccine uptake). Using spatial agglomerative hierarchical cluster analysis (unsupervised machine learning), provinces and territories were grouped into clusters by stringency index, mobility index, and full vaccine uptake. The Kruskal-Wallis test was used to compare the prevalence of VOCs (Alpha, or B.1.1.7; Beta, or B.1.351; Gamma, or P.1; and Delta, or B.1.617.2 variants) across the clusters. RESULTS: We identified 3 clusters of vaccine uptake and countermeasures. Cluster 1 consisted of the 3 Canadian territories and was characterized by a higher degree of vaccine deployment and fewer countermeasures. Cluster 2 (located in Central Canada and the Atlantic region) was typified by lower levels of vaccine deployment and moderate countermeasures. The third cluster, which consisted of provinces in the Pacific region, Central Canada, and the Prairies, exhibited moderate vaccine deployment but stronger countermeasures. The overall and variant-specific prevalences were significantly different across the clusters. CONCLUSIONS: This "up to the point" analysis found that implementation of COVID-19 public health measures, including the mass vaccination of populations, is key to controlling VOC prevalence rates in Canada. As of June 15, 2021, the third wave of COVID-19 in Canada is declining, and those provinces and territories that had implemented more comprehensive public health measures showed lower VOC prevalence. Public health authorities and governments need to continue to communicate the importance of sociobehavioural preventive measures, even as populations in Canada continue to receive their primary and booster doses of vaccines.

Program Report: Nîsohkamâtowak-Helping Patients and Families Living With Kidney Disease in Northern Saskatchewan.

PURPOSE OF THE PROGRAM: Nîsohkamâtowak, the Cree word for Helping Each Other, is an initiative to close gaps in kidney health care for First Nations and Métis patients, their families, and communities in northern Saskatchewan. Nîsohkamâtowak emerged from a collaboration between the Kidney Health Community Program and First Nations and Métis Health Services to find ways to deliver better care and education to First Nations and Métis people living with kidney disease while acknowledging Truth and Reconciliation and the Calls to Action. SOURCES OF INFORMATION: This article describes how traditional Indigenous protocols and storytelling were woven into the Nîsohkamâtowak events, gathering of patient and family voices in writing and video format, and how this work led to a collaborative co-designed process that incorporates the Truth and Reconciliation: Calls to Action into kidney care and the benefits we have seen so far. The teachings of the 4 Rs-respect, reciprocity, responsibility, and relevance, were critical to ensuring that Nîsohkamâtowak reports and learning were shared with participants and the communities represented in this initiative. METHODS: Group discussions and sharing circles were facilitated in several locations throughout northern and central Saskatchewan. Main topics of discussion were traditional medicines, residential schools impact, community and peer supports for kidney disease patients, and cultural safety education for health care providers. KEY FINDINGS: The general themes selected for improvement were education, support within the local community, traditional practices and cultural competency, and delivery of services. To address these gaps in kidney care, the following objectives were co-created with First Nations and Métis patients, families, and communities for Kidney Health to provide culturally appropriate education and resources, to ensure appropriate follow-up support to include strengthening connections to communities and other health authorities, to incorporate traditional practices into program design, and to ensure appropriate service delivery across the spectrum of care with a focus on screening and referral, which is strongly linked to coordination of care with local health centers. IMPLICATIONS: As a result of this work, the Kidney Health Community Program restructured the delivery of services and continues to work with Nîsohkamâtowak advisors on safety initiatives and chronic kidney disease awareness, prevention, and management in their respective communities. The Truth and Reconciliation and Calls to Action are honored to close the gaps in kidney care. LIMITATIONS: Nîsohkamâtowak is a local Kidney Health initiative that has the good fortune of having dedicated funding and staff to carry out this work. The findings may be unique to the First Nations and Métis communities and people who shared their stories. Truth and Reconciliation is an ongoing commitment that must be nurtured. Although not part of this publication, the effects of COVID-19 have made it difficult to further advance the Calls to Action, with more limited staff resources and the inability to meet in person as in the past.

OBJECTIFS DU PROGRAMME: Nîsohkamâtowak, un terme cri signifiant « s'aider les uns les autres ¼, est une initiative qui vise à combler les lacunes dans les soins de santé rénaux pour les patients des Premières Nations et Métis, leurs familles et leurs collectivités du nord de la Saskatchewan. Nîsohkamâtowak est née d'une collaboration entre le Kidney Health Community Program et First Nations and Métis Health Services pour trouver des moyens d'offrir de meilleurs soins et une meilleure éducation aux membres des Premières Nations et aux Métis qui vivent avec une néphropathie, tout en reconnaissant les appels à l'action de la Commission de vérité et réconciliation du Canada. SOURCES: Cet article décrit comment les protocoles et récits autochtones traditionnels ont été intégrés aux événements de Nîsohkamâtowak, comment les voix des patients et des familles ont été recueillies par écrit et sous forme de vidéos, et comment ces travaux ont mené à un processus collaboratif de conception conjointe qui intègre les recommandations de Vérité et réconciliation : Appels à l'action dans les soins rénaux et qui a mené aux avantages constatés jusqu'à présent. L'enseignement des quatre grands principes ­ respect, réciprocité, responsabilité et pertinence ­ était essentiel pour assurer que les rapports et les apprentissages de Nîsohkamâtowak soient partagés avec les participants et les communautés représentées par cette initiative. PRINCIPAUX RÉSULTATS: Les thèmes généraux suivants ont été retenus pour amélioration : l'éducation, le soutien dans la communauté locale, les pratiques traditionnelles et les compétences culturelles, et la prestation des services. Pour combler ces lacunes dans les soins rénaux, les objectifs suivants liés à la santé rénale ont été développés conjointement avec les patients, les familles et les communautés des Premières Nations et des Métis: offrir une éducation et des ressources adaptées à la culture; assurer un soutien de suivi approprié, notamment en renforçant les liens avec les communautés et avec les autres autorités sanitaires; intégrer les pratiques traditionnelles dans la conception des programmes; et garantir la prestation appropriée des services dans tout l'éventail des soins, en mettant l'accent sur le dépistage et l'aiguillage, qui sont fortement liés à la coordination des soins avec les centres de santé locaux. RÉSULTATS: À la suite de ces travaux, le Kidney Health Community Program a restructuré la prestation des services et continue à ce jour de travailler avec les conseillers de Nîsohkamâtowak sur des initiatives de sécurité, ainsi que sur la sensibilisation, la prévention et la prise en charge de l'insuffisance rénale chronique dans leurs collectivités respectives. La Commission de vérité et réconciliation du Canada : appel à l'action est honorée de combler les lacunes dans les soins rénaux. LIMITES: Nîsohkamâtowak est une initiative locale de santé rénale qui bénéficie d'un financement et d'un personnel dédiés pour accomplir ce travail. Les résultats pourraient être propres aux communautés des Premières Nations et des Métis et aux personnes qui ont partagé leurs histoires. La Commission de vérité et réconciliation est un engagement permanent qui doit être soutenu. Bien que cela ne soit pas souligné dans cette publication, la pandémie de COVID-19 a rendu difficile l'avancement des appels à l'action en raison des ressources humaines plus limitées et de l'incapacité de se rencontrer en personne comme auparavant.

An equity-based assessment of immunization-related responses in urban Alberta during the 2014 measles outbreak: a comparative analysis between Calgary and Edmonton.

OBJECTIVES: This study investigates measles, mumps, and rubella (MMR) immunization rates during the measles outbreak in Calgary and Edmonton of 2014 stratified by four area-level socio-demographic indicators. This study also leverages this epidemiological data to assess the equity aspect of emergency measures instituted regarding immunization in those two cities. METHODS: A mixed-methods comparative case study analysis methodology was employed to assess the neighbourhood-level immunization statuses before (2013), during (2014), and after (2015) an active measles outbreak in Calgary and Edmonton, Alberta, Canada. The epidemiological one-dose by age-2 MMR coverage data were stratified using four socio-demographic indicators: median household income, %-homeownership, %-Aboriginal population, and %-immigrant population. Document and content analysis was utilized to investigate the outbreak mitigation strategies deployed in each city. RESULTS: The measles outbreak of 2013/2014 involved the entirety of Alberta and led to both provincial and city-specific interventions in which Calgary deployed three mass immunization clinics in 2014, where Edmonton did not. The Calgary coverage data showed an increase in coverage inequalities across all indicators and the Edmonton data showed mixed results in terms of equity gains/losses. Calgary's additive intervention of three mass immunization clinics in 2014 appears to have contributed to both the higher gross immunization rates in Calgary (90.77%) and an inequitable increase in coverage rates as compared with Edmonton (88.96%), in most cases. CONCLUSION: Public health policy-makers must be cognizant that large-scale public health efforts must be optimized for accessibility across all socio-economic levels to ensure public and population health gains are realized equitably.

RéSUMé: OBJECTIFS: Cette étude porte sur les taux de vaccination contre la rougeole, la rubéole et les oreillons (RRO) durant l'éclosion de rougeole de 2014 à Calgary et à Edmonton, stratifiés selon quatre indicateurs sociodémographiques régionaux. L'étude se sert aussi de ces données épidémiologiques pour évaluer l'équité des mesures de vaccination d'urgence instituées dans les deux villes. MéTHODE: À l'aide d'une analyse comparative d'études de cas à méthodes mixtes, nous avons évalué les statuts vaccinaux par quartier avant (2013), pendant (2014) et après (2015) une éclosion active de rougeole survenue à Calgary et Edmonton, en Alberta, au Canada. Les données épidémiologiques relatives à la couverture du vaccin RRO, administré en une dose avant l'âge de 2 ans, ont été stratifiées à l'aide de quatre indicateurs sociodémographiques : le revenu médian des ménages, le pourcentage d'accession à la propriété, le pourcentage de la population autochtone et le pourcentage de la population immigrante. Nous avons fait appel à l'analyse documentaire et à l'analyse de contenu pour étudier les stratégies d'atténuation de l'éclosion déployées dans chaque ville. RéSULTATS: L'éclosion de rougeole de 2013-2014 a sévi partout en Alberta et a donné lieu à des interventions à l'échelle de la province et des villes; trois cliniques de vaccination de masse ont été déployées à Calgary en 2014, mais aucune à Edmonton. Selon les données relatives à la couverture vaccinale à Calgary, il y a eu une augmentation des inégalités dans la couverture pour tous les indicateurs; selon les données pour Edmonton, les résultats en matière de gains ou de pertes d'équité ont été mitigés. L'ajout de trois cliniques de vaccination de masse à Calgary en 2014 semble avoir contribué à la fois aux taux de vaccination bruts plus élevés à Calgary (90,77 %) et à une hausse inéquitable des taux de couverture comparativement à Edmonton (88,96 %) dans la plupart des cas. CONCLUSION: Les responsables des politiques de santé publique doivent être conscients qu'il faut optimiser les efforts de santé publique à grande échelle pour que toutes les classes socioéconomiques en bénéficient, afin que les gains réalisés en santé publique et en santé des populations soient équitables.

Surveying the local public health response to COVID-19 in Canada: Study protocol.

BACKGROUND: Public health services and systems research is under-developed in Canada and this is particularly the case with respect to research on local public health unit operational functioning and capacity. The purpose of this paper is to report on a study that will collect retrospective information on the local public health response to COVID-19 throughout Canada between 2020 and 2021. METHODS/DESIGN: The goal of the study is to develop and implement a study framework that will collect retrospective information on the local public health system response to the COVID-19 pandemic in Canada. This study will involve administering a mixed-method survey to Medical Health Officers/Medical Officers of Health in every local and regional public health unit across the country, followed by a process of coding and grouping these responses in a consistent and comparable way. Coded responses will be assessed for patterns of divergent or convergent roles and approaches of local public health across the country with respect to interventions in their response to COVID-19. The Framework Method of thematic analysis will be applied to assess the qualitative answers to the open-ended questions that speak to public health policy features. DISCUSSION: The strengths of the study protocol include the engagement of Medical Health Officers/Medical Officers of Health as research partners and a robust integrated knowledge translation approach to further public health services and systems research in Canada.

Diverse Approaches to Creating and Using Causal Loop Diagrams in Public Health Research: Recommendations From a Scoping Review.

Objectives: Complex systems thinking methods are increasingly called for and used as analytical lenses in public health research. The use of qualitative system mapping and in particular, causal loop diagrams (CLDs) is described as one promising method or tool. To our knowledge there are no published literature reviews that synthesize public health research regarding how CLDs are created and used. Methods: We conducted a scoping review to address this gap in the public health literature. Inclusion criteria included: 1) focused on public health research, 2) peer reviewed journal article, 3) described and/or created a CLD, and 4) published in English from January 2018 to March 2021. Twenty-three articles were selected from the search strategy. Results: CLDs were described as a new tool and were based upon primary and secondary data, researcher driven and group processes, and numerous data analysis methods and frameworks. Intended uses of CLDs ranged from illustrating complexity to informing policy and practice. Conclusion: From our learnings we propose nine recommendations for building knowledge and skill in creating and using CLDs for future public health research.

Bullying victimization among preadolescents in a community-based sample in Canada: a latent class analysis.

OBJECTIVE: Bullying victimization among adolescents has been well-recognized as a behavior associated with adverse psychological and mental health outcomes. Most studies on bullying victimization have focused on adolescents, but research is sparse regarding school victimization among preadolescents before they transition to adolescence. This study sought to identify latent classes of different types of co-occurring bullying victimization, based on a sample of 3829 school students in grades 5-8, ages 9-14 in the year of 2011 from the Saskatoon Health Region, Saskatchewan, Canada. RESULTS: Using a latent class analysis approach, the results uncovered three groups of victimized students, including those who were aggressively victimized (7.2%), moderately victimized (34.6%) and non-victimized (58.2%). Younger age and being overweight was associated with a higher likelihood of bullying victimization. Moderately and aggressively victimized students had greater probabilities of feeling like an outsider, experiencing anxiety, depressed moods, engaging in suicidal ideation and drinking when compared to non-victimized students. Peer and parent supports had significant protective effects against being victimized. Given the negative consequences of recurrent victimization among the preadolescents, it is imperative to address bullying incidents as they occur to prevent repeated transgressions, especially for those who suffer from multiple types of victimization.

Individual- and area-level socioeconomic inequalities in diabetes mellitus in Saskatchewan between 2007 and 2012: a cross-sectional analysis.

BACKGROUND: Improving our understanding of social inequalities may improve prevention and treatment efforts for diabetes mellitus. We examined the association between individual- and area-level socioeconomic measures and physician-diagnosed diabetes in Saskatchewan over time. METHODS: In this cross-sectional study, we linked health administrative data with individual-level socioeconomic data from the Canadian Community Health Survey and area-level data from the 2006 Canadian census. We used general linear mixed-models regression to analyze the effect of each factor, controlling for geographic and demographic measures. RESULTS: Area-level deprivation was associated with medically diagnosed type 2 diabetes mellitus after adjustment for the individual-level factors of age, sex, household income and education. Individuals residing in areas ranked in the least deprived quintile had a lower likelihood of diabetes than those in the most deprived quintile (odds ratio 0.40, 95% confidence interval 0.18-0.88). However, this disparity existed only in urban areas. This result may reflect less pronounced health inequalities in rural areas, greater socioeconomic heterogeneity, larger geographic units or some combination of these factors. INTERPRETATION: Individual- and area-level socioeconomic factors were associated with the likelihood of medically diagnosed diabetes; however, the strength of this association varied between urban and rural communities. Acknowledgement of area-level deprivation as a modifiable risk factor related to the prevalence of diabetes is important in the development of effective interventions for urban, but not rural, areas.

Quality improvement as a population health promotion opportunity to reorient the healthcare system.

BACKGROUND: A quality improvement (QI) focus in systems strategically investing resources to achieve the Quadruple Aim (i.e., better population health, lower system costs, improved patient care, and an engaged and productive workforce) presents an opportunity to reorient health services towards population health promotion. SETTING: An interdisciplinary team linked across a large regionalized healthcare system engaged in a (Saskatoon) Region-wide 90-day QI initiative focused on patient safety. INTERVENTION: The team worked directly with healthcare teams to link cultural safety, patient-centeredness, and health equity to other dimensions of healthcare quality. The team provided data from health status reports, equity analyses of healthcare utilization, and stakeholder consultations and adapted QI methods, including A3 thinking and Plan-Do-Check-Act (PDCA) cycles. OUTCOMES: Throughout the 90 days, use of the terms "health equity" and "cultural safety" increased among healthcare teams and in region-wide communications. Within the year following the initiative, the Region made public and ongoing commitments to address health inequities. IMPLICATIONS: System-wide QI initiatives present opportunities to promote population health approaches, shift perspectives and language, and ultimately influence organizational culture. Learnings are relevant to health promotion practitioners attempting to engage healthcare partners, and for health systems strategically investing for improved population health.

Facilitators and barriers of sociodemographic data collection in Canadian health care settings: a multisite case study evaluation.

BACKGROUND: Despite growing awareness of the importance of social determinants of health, research remains limited about the implementation of sociodemographic data collection in Canadian health care settings. Little is known about the salient contextual factors that enable or hinder collection and use of social information to improve quality of care in clinical settings. This study examines the perceptions and experiences of managers and care providers to better understand how to support organizational efforts to collect and use sociodemographic data to provide equity-oriented care. METHODS: Case studies of three diverse urban health care settings employed semi-structured individual and group interviews with managers and care providers respectively to explore their experiences with implementation. Data was analyzed separately and in context for each site as part of an individual case study. A thematic analysis of interview transcripts was performed with an inductive approach to coding of segments of the text. Constructs of the Consolidated Framework for Implementation Research (CFIR) were used as an analytical framework to structure the data to support cross case comparisons of facilitators and barriers to implementation across settings. RESULTS: Several perceived facilitators and barriers to implementation were identified that clustered around three CFIR domains: intervention, inner setting and characteristics of individuals. Macro level (outer setting) factors were relatively unexplored. Sites were motivated by their recognition of need for social information to improve quality of care. Organizational readiness for implementation was demonstrated by priorities that reflected concern for equity in care, leadership support and commitment to an inclusive process for stakeholder engagement. Barriers included perceived relevance of only a subset of sociodemographic questions to service delivery, staff capacity and comfort with data collection as well as adequate resources (funding and time). CONCLUSION: Although system level mandates were underexplored, they may accelerate adoption and implementation of sociodemographic data collection in the presence of organizational readiness. Standardized tools integrated into information systems and workflows would support adequately trained personnel. More research is needed to understand important factors in rural health settings and with clinical application to inform care delivery pathways.

Cybervictimization among preadolescents in a community-based sample in Canada: Prevalence and predictors.

OBJECTIVES: To examine the prevalence and predictors associated with cybervictimization among preadolescents in a community-based sample from Canada. METHODS: Data were drawn from a cohort of 5783 students of grades 5-8, aged 9-14 from 109 elementary schools at the Saskatoon Health Region, Saskatchewan of Canada based on the Student Health Survey in the year of 2010-2011. Multivariate logistic regression with the generalized estimating equation was used to determine the individual and contextual factors associated with self-reported cybervictimization. RESULTS: Of the 5783 school children, 5611 (97.0%) responded to the question regarding cybervictimization. Among those respondents, 572 (10.2%) reported being cyberbullied at least once in the past four weeks. The students most likely to be victimized by cyberbullying were girls, students in grades 7 and 8 compared with grade 5, Aboriginal students compared to non-Aboriginal students, those who had lived part of their life outside of Canada compared with those who lived all of their life in Canada, those who reported drinking alcohol in the past, those who reported very elevated depressive symptoms, those who were traditionally bullied, those who had low self-esteem, and those who had a poor relationship with their parents. School-level variation in cyberbullying victimization is negligible. School neighbour-level deprivation is not significant after adjusting for individual-level characteristics and parent-child relationship. CONCLUSION: Our findings identified important characteristics of preadolescents with higher susceptibility to cybervictimization in a Canadian setting, which can be used to develop intervention strategies for mitigating cybervictimization among the study population.

Restaurant inspection frequency: The RestoFreq Study.

OBJECTIVES: Foodborne illness is an important contributor to morbidity and health system costs in Canada. Using number of critical hazards as a proxy for food safety, we sought to better understand how to improve food safety in restaurants. We compared the current standard of annual inspections to twice-yearly inspections among restaurants "at risk" for food safety infractions. These were restaurants that had three or more elevated-risk inspection ratings in the preceding 36 months. METHODS: We conducted a two-arm randomized controlled trial between November 2012 and October 2014. The intervention was twice-yearly routine restaurant inspection compared to standard once-yearly routine inspection. Included were all restaurants within Saskatoon Health Region that were assessed as "at risk", with 73 restaurants in the intervention arm and 78 in the control arm. Independent sample t-tests were conducted between groups to compare: i) average number of critical hazards per inspection; and ii) proportion of inspections resulting in a rating indicating an elevated hazard. RESULTS: Over time we noted statistically significant improvements across both study arms, in number of both critical food safety hazards (decreased by 61%) and elevated-risk inspection ratings (decreased by 45%) (p < 0.0001). We observed no significant differences between the two groups pre- or post-intervention. CONCLUSION: Results suggest increasing the number of annual routine inspections in high-risk restaurants was not associated with a significant difference in measures of compliance with food safety regulations. Findings of this study do not provide evidence supporting increased frequency of restaurant inspection from annually to twice annually.