COVID-19 Health Precautions: Identifying Demographic and Socio-Economic Disparities and Changes over Time.

The recent coronavirus disease 2019 (COVID-19) pandemic has required the adoption of precautionary health behaviours to reduce the risk of infection. This study examines adherence, as well as changes in adherence, to four key precautionary behaviours among Canadian adults: wearing face masks, social distancing, hand washing, and avoiding large crowds. Data are drawn from Series 3 and 4 of the nationally representative Canadian Perspectives Survey Series, administered by Statistics Canada in June and July 2020. We calculate overall adherence levels as well as changes over time. Logistic regression models estimate each behaviour as a function of demographic and socio-economic characteristics to identify adherence disparities across population segments. We find a nearly universal increase in precautionary behaviours from June to July in mask wearing (67.3 percent to 83.6 percent), social distancing (82.4 percent to 89.2 percent), and avoiding crowds (84.1 percent to 88.9 percent); no significant change occurred in the frequency of hand washing. We observe significant disparities in adherence to precautionary behaviours, especially for mask wearing, in June; female, older, immigrant, urban, and highly educated adults were significantly more likely to adhere to precautionary behaviours than male, younger, Canadian-born, rural, and low-educated adults. By July 2020, these disparities persisted or were slightly attenuated; women, however, had consistently higher adherence to all behaviours at both time points. These findings have substantial implications for policy and potential public health interventions.

La pandémie de COVID-19 (la maladie à coronavirus 2019) a exigé l'adoption de comportements préventifs en matière de santé afin de réduire les risques d'infection. La présente étude est consacrée à l'examen de l'adhésion, ainsi que de son évolution, à quatre comportements préventifs principaux chez les Canadiens adultes : le port de masques antiprojections, la distanciation physique, le lavage des mains et l'évitement des foules. Les données étudiées sont tirées des enquêtes 3 et 4 de la série d'enquêtes sur les perspectives canadiennes, réalisée par Statistique Canada en juin et juillet 2020. Nous calculons les niveaux globaux d'adhésion ainsi que l'évolution de cette adhésion dans le temps. Des modèles de régression logistique permettent d'estimer chaque comportement en fonction des caractéristiques démographiques et socio-économiques, et de cerner ainsi les disparités d'adhésion dans différents segments de population. Nous observons une augmentation quasi universelle des comportements préventifs de juin à juillet pour ce qui est du port du masque (67,3 pour cent à 83,6 pour cent), de la distanciation physique (82,4 pour cent à 89,2 pour cent) et de l'évitement des foules (84,1 pour cent à 88,9 pour cent) ; aucun changement significatif ne se manifeste dans la fréquence du lavage des mains. Nous observons également d'importantes disparités d'adhésion aux comportements préventifs, en particulier pour ce qui est du port du masque, en juin ; les femmes, les aînés, les immigrants, les citadins et les adultes très scolarisés sont sensiblement plus enclins à adhérer aux comportements préventifs que les hommes, les plus jeunes, les Canadiens de naissance, les résidents des régions rurales et les adultes peu scolarisés. En juillet 2020, ces disparités persistent ou s'atténuent légèrement ; les femmes, toutefois, affichent uniformément une plus grande adhésion à tous les comportements préventifs aux deux moments. Ces observations ont d'importantes conséquences pour la politique et les interventions potentielles en santé publique.

The relationship between postsecondary education and adult health behaviors.

Nearly 80% of American adults between the ages of 33-44 have at least some postsecondary education, which ranges from vocational training to a doctorate or professional degree. However, in education-health studies, postsecondary credentials are often grouped into a limited number of categories. This is an important omission as it obscures differentiations between the various types of postsecondary credentials. This study provides the first comprehensive analysis of disparities in health behaviors across detailed levels of postsecondary education. Data comes from Wave 5 of the 2018 National Longitudinal Study of Adolescent to Adult Health (Add Health). A covariance-weighting technique is used to produce behavioral index scores that identify the full spectrum of health behaviors influenced by postsecondary educational attainment. Estimates are initially produced in aggregate for the total sample population, with interaction models subsequently being used to test differences across gender and race/ethnicity population subgroups. The aggregate results indicate that adults with at least a bachelor's degree exhibit healthier lifestyles; however, no difference is observed among adults with lower-level postsecondary credentials, compared to high school graduates. Women experience steeper gradients at higher levels of postsecondary education, compared to men. Both White and Hispanic American adults exhibit comparable health lifestyles across levels of postsecondary education; however, Black Americans were found to experience no returns except at the doctorate or professional degree level. These findings have important implications particularly as adults in their thirties and forties continue to exhibit troubling health and mortality trends.

Changes in health behaviours during early COVID-19 and socio-demographic disparities: a cross-sectional analysis.

OBJECTIVES: The COVID-19 pandemic has profoundly disrupted daily life in Canada. This study assesses changes in health behaviours during the early stages of the pandemic and examines socio-demographic disparities associated with these changes. METHODS: We analyze data on adults age 25 and older (N = 4383) from the public-use Canadian Perspectives Survey Series 1: Impacts of COVID-19 (CPSS-COVID). Multinomial regression models assess the association between demographic and socio-economic characteristics with increases or decreases in six health behaviours: alcohol, tobacco, and cannabis use, junk food consumption, and TV and internet screen time. RESULTS: While findings varied across the six behaviours, overall, there was an increase in negative health behaviours: 14% of Canadian adults reported increasing their alcohol use (95% CI = 0.12, 0.15), 25% increased their junk food consumption (95% CI = 0.23, 0.27), and over 60% increased their screen time (62%, 95% CI = 0.60, 0.65 for TV and 66%, 95% CI = 0.63, 0.68 for internet). Younger and Canada-born adults were more likely to increase negative health behaviours than older and immigrant Canadians. Adults who reported financial impact of COVID-19 were more likely to increase all negative health behaviours (e.g., for increased junk food consumption, the relative risk ratio (RRR) = 1.81, 95% CI = 1.49, 2.20 relative to group reporting no impact). CONCLUSION: Our study documents the overall deterioration of health behaviours during the early stages of the COVID-19 pandemic. To minimize long-term harm to the Canadian population's health, the results highlight the need to tailor interventions, especially for younger Canadians, and the importance of mitigating financial impacts, which are linked to negative changes in health behaviours.

RéSUMé: OBJECTIFS: La pandémie de COVID-19 perturbe profondément la vie quotidienne au Canada. Notre étude évalue les changements survenus dans les comportements de santé aux premiers stades de la pandémie et examine les disparités sociodémographiques associées à ces changements. MéTHODE: Nous analysons les données sur les adultes de 25 ans et plus (N = 4 383) tirées de la Série d'enquêtes sur les perspectives canadiennes 1 : Répercussions de la COVID-19 (SEPC-COVID) d'usage public. Des modèles de régression multinomiale permettent d'évaluer l'association entre les caractéristiques démographiques et socioéconomiques et les augmentations ou les diminutions de six comportements de santé : usage de l'alcool, du tabac et du cannabis, consommation d'aliments vides et temps passé devant la télévision et sur Internet. RéSULTATS: Nos constatations varient entre ces six comportements, mais dans l'ensemble, il y a eu une augmentation des comportements de santé négatifs : 14 % des Canadiens adultes ont dit avoir accru leur usage de l'alcool (IC de 95 % = 0,12, 0,15), 25 % ont accru leur consommation d'aliments vides (IC de 95 % = 0,23, 0,27), et plus de 60 % ont accru leur temps d'écran (62 %, IC de 95 % = 0,60, 0,65 pour la télévision et 66 %, IC de 95 % = 0,63, 0,68 pour Internet). Les jeunes adultes et les adultes nés au Canada étaient plus susceptibles d'avoir accru leurs comportements de santé négatifs que les adultes âgés et ceux ayant immigré au Canada. Les adultes ayant dit subir des contrecoups financiers de la COVID-19 étaient plus susceptibles d'avoir accru tous leurs comportements de santé négatifs (p. ex., pour la consommation accrue d'aliments vides, le rapport de risque relatif [RRR] = 1,81, IC de 95 % = 1,49, 2,20, comparativement au groupe n'ayant pas subi de contrecoups financiers). CONCLUSION: Notre étude décrit la détérioration globale des comportements de santé aux premiers stades de la pandémie de COVID-19. Pour réduire les torts que cela peut causer à long terme à la santé de la population canadienne, il faut, selon les résultats, adapter les interventions, surtout aux jeunes Canadiens, et atténuer les contrecoups financiers de la pandémie, qui sont liés à des changements négatifs dans les comportements de santé.

Mental health and economic concerns from March to May during the COVID-19 pandemic in Canada: Insights from an analysis of repeated cross-sectional surveys.

BACKGROUND: The COVID-19 pandemic impacted the psychological wellbeing of populations worldwide. In this study, we assess changes in mental health during the early months of the pandemic in Canada and examine its relationship with another prominent problem during this time, economic concerns. METHODS: Analyses were based on two cycles of the nationally representative repeated cross-sectional Canadian Perspectives Survey Series (N=4627 in March and 4600 in May). We described the changes in mental health and economic concerns between March and May, and assessed the relationship between the two characteristics. RESULTS: Mental health declined significantly during the early months of the COVID-19 pandemic: the proportion of Canadian adults who reported only good/fair/poor mental health grew from 46% to 52% from March to May. Economic concerns including food insecurity were an important correlate of 'bad' mental health, as was younger age, female gender, and Canada-born status. Contrary to expectations, however, economic concerns lessened during this time frame. CONCLUSIONS: These findings suggest that policies to mitigate economic stress, such as Canada's Emergency Response Benefit, may have eased mental health deterioration in early pandemic months through a reduction in financial hardship. Interventions to increase the economic security of the population will have far-reaching consequences in terms of improved mental health, and should be continued throughout the pandemic.

Disability trends in Canada: 2001-2014 population estimates and correlates.

OBJECTIVES: Disability is a major concern for the health of midlife and older Canadians. Understanding disability trends is critical for detecting socio-economic and health precursors that could be amenable to policy interventions. The purpose of this study is to assess trends in rates of disability among Canadian adults age 40-64 and 65+. We also examine the impact of changing socio-demographic and health factors over time on the trends. METHODS: Data from the 2001-2014 Canadian Community Health Survey (CCHS), a repeated cross-sectional nationally representative study, are used to estimate age- and gender-stratified logistic regression models of disability as a function of the year of interview to assess trends. Disability is defined as experiencing difficulties with a variety of individual functions, such as seeing, walking, climbing stairs, and bending. RESULTS: Among men and women 65 and older, disability has declined since 2001 in most subgroups and regardless of changing socio-economic and health characteristics. Adults 40-64 years of age, in contrast, have experienced stagnating disability over the observation period. If it were not for changes in the distribution of education and household income, the disability rate would be increasing significantly. CONCLUSION: Older Canadian adults are experiencing mild but systemic improvements in disability. More worrisome is the stagnating trend among midlife cohorts, which could portend greater disability burden in the future as Canada's population ages. Preventive efforts need to be targeted at vulnerable groups at earlier ages in order to prevent future increases in disability-related financial, caregiving, and medical burden.