Location H & eacute;lys 12-17 years old was created in response to the lack of universal-access Qu & eacute;bec programs offering support to parents of adolescents. Intervention The program provides parents with conferences, podcasts, and infographics on four themes related to adolescence (adolescence 101, digital age, love and friendships, interests and career orientation). Method The assessment of the program's initial implementation and its effects on parents was documented through focus group interviews with 12 facilitators, individual interviews with 11 parents, and questionnaires administered to 24 parents before and after the end of the program. YouTube analytics were also used to track engagement with the podcasts. Results Participants appreciated the program, particularly the opportunities for discussion and sharing. Their feedback highlights several factors that facilitated or hindered participation, including the schedule, the location, and the virtual format of the conferences. Statistically, the results show significant improvements in parents' sense of efficacy, but no changes in autonomy support or in the quality of the parent-adolescent relationship. Nonetheless, parents reported feeling valued and said they had adjusted certain practices to better communicate with their teenager and support their autonomy. Implication After evaluation, the program is considered promising, and modifications to the conference content and program modalities are being made to better meet parents' needs and encourage their participation.
Exploratory analysis conducted with the 2021/2022 age-eligible school cohorts identified lower vaccine coverage among grade 6 and 9 students of the Vancouver Coastal Health (VCH) region who were residing in neighbourhoods facing material and social deprivation. Other determinants of lower coverage included male sex, attendance in non-faith-based independent school category, and residence in rural areas. This study aimed to replicate the analysis in the 2022/2023 cohort to assess reliability across school years less affected by the pandemic and prioritise the determinants in order to implement programmatic actions to improve HPV vaccine uptake. We conducted a cross-sectional study of grade 6 and 9 students residing in the VCH region and attending VCH schools. A cross-classified multilevel model was developed to replicate and validate findings from the 2021/2022 cohort, describing associations between sociodemographic explanatory variables and underimmunisation. Public health priorities were informed by population attributable fractions (PAFs) from the final model. The final model confirmed significant associations between immunisation coverage and grade, geographic area of residence, school category, and social deprivation. Students residing in the most socially deprived areas (Q4 and Q5) had 32
To examine temporal trends in prepregnancy body mass index (BMI) from 2012 to 2022 in Ontario, Canada, and identify disparities across sociodemographic and medical condition subgroups. We conducted a population-based descriptive study using data from the Better Outcomes Registry Network (BORN) Ontario. The study included 1,170,997 singleton births between April 2012 and March 2022. Prepregnancy BMI was categorized according to World Health Organization classifications. We used generalized estimating equations to assess temporal trends in mean BMI and BMI categories, with sequential adjustments for socioeconomic and medical factors. Analyses were stratified by maternal age, parity, race/ethnicity, neighbourhood income, education, and material deprivation quantiles, smoking status, and pre-existing medical conditions. Mean prepregnancy BMI remained stable at 25.3 kg/m2 from 2012 to 2016, then increased to 26.0 kg/m2 by 2021. From 2012 to 2022, the proportion of individuals with underweight or normal weight BMI decreased (underweight 8.6
Unpaid caregiving is a vital part of Canada’s care economy, with nearly half of Canadians providing care without remuneration to individuals who are dependent. Despite its prevalence, limited Canadian research has explored the mental health impacts across different caregiving contexts. This study examined conditions of care that predict self-reported mental health consequences among unpaid caregivers across Canada and compared these across childcare and older adult care contexts. A convergent mixed methods design was used, leveraging data from two nationally representative surveys (N = 1997) and in-depth interviews with a subset of survey respondents (N = 102). Separate regression models were conducted for childcare and older adult care samples using caregiver mental health indicators. Results were merged using joint displays. Lack of leisure time and gender emerged as the strongest predictors of caregiver mental health across both datasets and care contexts, with women reporting greater mental health impacts of care than men. While paid care satisfaction and income were not significant predictors in quantitative models, qualitative data highlighted experiences of financial strain, care system challenges, and limited access to respite. Findings underscore the need for public health policies and other interventions that address caregivers’ time constraints, gender inequities, and issues of availability or access to quality care services. This study makes a unique contribution by directly comparing childcare and older adult care caregiving experiences, highlighting both shared stressors and context-specific challenges within Canada’s unpaid care landscape.
This study identifies trends in abusive discourse towards public health professionals (PHPs) during the COVID-19 pandemic and explores associations between abusive digital content, case numbers, deaths, and major policy announcements. Natural language processing (NLP) and large language model (LLM) techniques were used to develop a computational model to detect abusive content on X (formerly Twitter). This model was applied to abusive posts targeting PHPs during COVID-19 by examining over 1.7 million posts from January 2020 to May 2021. Associations between spikes in abuse and the number of COVID-19 cases, deaths, and government monitoring updates were explored. Pronounced surges in abusive posts coincided with rising case and death counts and the imposition of major federal COVID-19 policies, particularly during the pandemic’s initial emergency response. Digital aggression increased at times of public health statements related to restrictions in social gatherings, testing criteria, vaccinations, and masking. However, during high-case periods, even statements providing case updates, expressing compassion, or urging collective responsibility coincided with higher numbers of abusive posts. This work provides insights into the pressures faced by health officials online and offers implications for designing resilient public communication during future crises.
Intervention The new "Passerelle" program aims to reduce socioeconomic inequalities in diet in France, by offering an untargeted cash transfer (CT) coupled with social guidance to households in precarious situations. Objectives Assess the feasibility of the program and data collection for monitoring indicators, to inform the design of a future trial to evaluate its effectiveness. Methods Single-group pre-post-test feasibility study. The program was implemented in Montreuil (France) with households in precarious situations identified by local social actors. The feasibility of the program was assessed in terms of implementation of household targeting (number and socio-economic characteristics of participants), intervention components (participation rates), and user acceptability (questionnaire and qualitative survey). The feasibility of data collection was assessed by participation in surveys before inclusion (t0) and after 3 (t1) and 6 months (t2), response rates and responsiveness of food security and well-being indicators. Results Two hundred households took part in the program, 90% were in monetary poverty, 82% in food insufficiency, 97% received the cash transfer card, 99% attended the social orientation meeting, over 95% said they were satisfied with the program, and 69% said they improved their food purchases. The qualitative survey documented the reasons for acceptability. Participation rates at t0, t1 and t2 were 93%, 76% and 73%. Non-response rates were below 5% for most indicators. Follow-up indicators ranged from + 19% to + 99% at t1. Conclusion This study demonstrates the feasibility of the program and collecting data from the target population to monitor food security and well-being indicators. It confirms the interest of a future trial to evaluate the program effectiveness, in order to contribute to reflections on policies to combat food insecurity in France. An analysis of the program theory, explaining the expected changes, mechanisms and conditions of impact would be beneficial for future research.
OBJECTIVES:An accurate understanding of expenditures on public health in Canada is necessary to assess value for money and advocate for sustainable public health systems. Our objective was to determine a consensus-based list of public health expenditure items. METHODS:We conducted a two-round, online modified Delphi study with public health physicians from across Canadian provinces. Participants rated the extent to which expenditure items in existing Canadian expenditure records should be classified as public health. In round 1, 78 expenditure items were assessed. In round 2, only items lacking consensus were reappraised considering the group's earlier ratings. RESULTS:Twenty-two public health physicians across Canada participated in round 1. Consensus was reached for 46 items, most (37 items) judged outside of public health. In round 2, the 32 items without prior consensus were returned for reassessment, and consensus was reached for 20 items, again with most (17 items) excluded from public health. Screening programs and health emergency preparedness were judged within public health expenditures, while chronic disease management and primary care services were judged outside. CONCLUSION:Public health physicians agreed that most items they rated (54 of 78) belong in funding streams other than public health. Current estimates of public health expenditures may therefore be overstated, with implications for the sustainability of public health systems in Canada.
SETTING:Amidst the global COVID-19 pandemic, Nova Scotia faced significant gaps and barriers in access to testing, particularly in underserved communities and areas experiencing outbreaks. In the fall of 2020, the Public Health Mobile Units commenced as part of Nova Scotia's provincial emergency response. INTERVENTION:Implementation involved the procurement and development of 10 vans, equipment, staffing, and processes to deliver COVID-19 testing services across the province. The Public Health Mobile Unit composes a collaborative practice model functioning as a provincial team with a focus on geographic zones. These roles include Public Health Nurses, Licensed Practical Nurses, Emergency Support Aides, Drivers, Secretaries with support from leadership, and health promoters. OUTCOMES:Embracing an equity-based approach, Public Health Mobile Units offered testing in communities not otherwise easily accessed through existing Nova Scotia Health pathways, areas experiencing COVID-19 outbreaks, and priority groups that may be at risk of severe illness. The Public Health Mobile Unit (PHMU) work expanded to include supporting public health's COVID-19 response with immunization, community rapid testing, negative results, and navigating community to COVID-19 resources. Additionally, the rapid services and flexibility of the Public Health Mobile Units supported Nova Scotia during times of need in hurricanes, wildfires, and floods. IMPLICATIONS:The successful evaluation and engagement highlighted the trust and confidence built with the community and partners throughout the pandemic response. Thus, enabling the Public Health Mobile Units to continue delivering preventative health services as the Public Health Mobile Unit has received permanent funding and has continued as a provincial public health program since the fall of 2024.
Multi-city investigations of how access to cycling infrastructure changes over time for equity-deserving communities have been absent in Canada and are scarce internationally. In this descriptive epidemiological study, we evaluated how area-level (ecological) access to cycling infrastructure varied by neighbourhood socio-demographic profiles in three Canadian cities (Montréal, Vancouver, and Victoria) across the 2011, 2016, and 2021 census years. For each city and year, we calculated the road network distance to the nearest cycling infrastructure from the population-representative centroids of the census dissemination area as the outcome. The independent variables were the area-level proportions of equity-deserving groups. These were Indigenous people, racialized people, recent immigrants, people in low-income households, tenants, individuals with lower educational attainment, children, and older adults. We employed linear and Bayesian spatial regression methods to examine the relationship between the tertile proportions of each population group and the outcome for each city and census year. Areas with a higher proportion of children had lower proximity to cycling infrastructure, regardless of city or census year. Similar patterns were observed for areas with a higher proportion of older adults, although to a lesser extent. The inequity across the proportion of children narrowed over time in Montréal, but not in Vancouver or Victoria. In contrast, areas with a greater proportion of low-income populations had equal or better access to cycling infrastructure across all cities and time periods. These findings on access to cycling infrastructure are concerning due to the lack of age-friendliness in the implementation of infrastructure in these cities.
While carcinogenic exposures affect half of European workers, occupational cancers remain strongly underreported. In France, the occupational diseases (OD) compensation system is ill-adapted for cancer patients, leaving work-related cancers socially and politically invisible. The identification of patients with occupational cancer and their support in compensation claims are neglected aspects of cancer care. Since 2018, GISCOPE 84 runs a two-tiered intervention: 1. A cohort-like survey with blood cancer (non-Hodgkin’s lymphoma and myeloma) patients diagnosed at the Vaucluse Regional Hospital Group, which follows four steps: (1) systematic invitation to participate to all newly diagnosed patients, (2) detailed interview-based reconstruction of participating patients’ work histories, (3) assessment of exposures to 65 carcinogens by a multidisciplinary expert group and referral of eligible patients to an OD claim, (4) provision of socio-administrative support by a hospital social worker and follow-up of patients’ OD claim procedures. 2. A strategy aimed at prompting broader change through professional training, multi-stakeholder collaboration, and proactive policy advice. The intervention generated differential effects following a concentric-circle pattern of diminishing intensity, with strong impacts on directly affected patients (notably, a stark increase in OD recognition rates), moderate impacts on directly involved institutional stakeholders, and only weak effects on the national regulatory framework and institutional practices. To prompt more structural change, GISCOPE 84 now aims to develop a transferable framework for the detection and support of patients with occupational blood cancer. This framework would be integrated into coordinated care pathways and tested in three different hospital settings to assess its transferability and potential for scale-up.
Compared to the general population, persons with intellectual disability (ID) have a similar cancer rate, but cancer is often discovered at a later stage. Adults with ID show lower participation in organized screenings for breast, cervical, and colorectal cancer. Here we tested an intervention to increase cancer screening knowledge and intention to participate among persons with ID. An open-label cluster randomized controlled trial was co-constructed with people having ID. Participants with ID underwent interventions about cancer screening or oral hygiene, using PowerPoint presentations, booklets, dice games, workshops, films, and discussions. Both groups completed a questionnaire two weeks before the intervention and at 15 min, three months, and one year after the intervention, which evaluated their knowledge gain and intention to participate in cancer screenings. At 15 min, three months, and one year after the intervention, participants in the cancer group showed significantly improved cancer screening knowledge (p < 0.001). The intention to participate in screenings was increased on the intervention date (p < 0.001), but this change was non-significant three months later, and observed as a trend at one year (p = 0.068). A steering group of persons with ID gave advice regarding participant recruitment, conducting sessions, and modifying the film scenario, PowerPoint presentation, and questionnaire. Persons with ID co-constructed the booklet on cancer screening and acted in the film. Participation of persons with ID greatly improved the study efficacy. This research provides strong evidence supporting direct interventions for people with intellectual disability to increase their participation in organized cancer screening.
In 2023, training in individual research interviewing was developed and implemented by social psychology researchers to enable patient researchers from the IMPAQT research group to participate in the data collection for the Ancolies project. The training was aimed at intra-individual changes (increased knowledge, sense of efficacy, and development of skills) based on interpersonal processes (sharing of experience, social support) which were part of a positive group dynamic pre-existing the training. The aim of this study was to evaluate the training. To meet the research objectives, several tools were developed : (1) an observation grid; (2) a voice recording of the second training module; and (3) a short questionnaire completed at the end of the training day. The three patient researchers who participated in the training reported that they felt capable of conducting interviews during the Ancolies project. Several learning dynamics related to the participants’ experience were highlighted : Sharing research experiences provided informational support that facilitated knowledge acquisition, while sharing illness experiences enhanced the credibility of role-playing exercises and strengthened the patient researchers’ skills in conducting interviews. A single day of training, however, proved insufficient for all the participants. The training appears to promote the commitment and skill development of patient researchers, despite being limited to a single-day format.
INTRODUCTION:Scaling up public health interventions is a major avenue for evidence-based public health policy. Many attempts have been made, but there have also been major difficulties and many failures. Scaling up is not easy; it is neither obvious nor spontaneous. OBJECTIVES:This study sets out to clarify the concept itself, distinguish the strategies on which it is based, describe the process, and identify the factors that affect it. METHODS:Semi-structured interviews were conducted with 27 scale-up experimenters from a variety of backgrounds. The interviews focused on 19 public health interventions. RESULTS:Scaling up is an active, progressive, and multidimensional process. It is based on a variety of strategies relating to territorial expansion, sustainability, and adaptation to the realities of the intervention. Four types of favourable decision could be identified: funding, support, commitment, and adoption; they emanate from multiple decision-makers. Eight essential activities emerged. In addition, scaling is based on organisations that adopt different conformations and different methods of identifying multipliers. Finally, six catalysts and six inhibitors were identified. CONCLUSION:This study has made it possible to stabilise the concept of scaling up and deepen our understanding of the process. New opportunities are emerging to support the players and decision-makers involved in scaling up public health interventions. Similarly, new research perspectives are emerging, in particular through the mobilisation of the political sociology of public action, and management and marketing sciences.
In France, participation rates in breast cancer screening have been decreasing, along with socio-territorial inequalities. To enhance women’s access to breast cancer screening, an interventional research project was implemented to assess the effectiveness, efficiency, and optimal modalities of a mobile mammography unit for women living remotely in Normandy. The randomized cluster trial was directed towards rural women. Before deploying the mobile unit, an intervention theory was developed. The principles of action to reduce inequalities, the definition and standardization of interventions, and the link to behavior change theories to establish causal mechanisms were integrated into a single model. We aimed to produce new knowledge on these mechanisms and develop intervention evaluations. Using the key function/implementation/context model, the key functions of the expected intervention were listed, linked to the behavior change technique and theoretical domain framework, and finally to the capability, opportunity, motivation–behavior model components. The mechanisms and levers that can improve access to breast cancer screening are also described. This approach also allowed the standardization of stakeholders’ implications and their corresponding actions. Concrete interventions implemented included scheduling appointments at the mobile unit and implementing a suite of measures to improve the information provided to women regarding breast cancer screening. This theoretical framework should be compared with interventions carried out during the deployment of mobile units. Various elements interact dynamically with and alter originally planned interventions. This experiential feedback may inform decisions on the transferability of mobile mammography units to other contexts. This study was registered at ClinicalTrials.gov (registration date: December 21, 2021; registration number: NCT05164874).
This research aimed to generate consensus from Canadian public health experts on organizational leadership competencies for public health governance in Canada. A three-step modified Delphi technique was used to build consensus. It included (1) identifying the list of competencies for organization leadership for public health governance based on a literature review and interviews, (2) conducting a consensus two-round modified Delphi survey with public health experts across Canada, and (3) holding an online deliberative dialogue to finalize the list of competencies and generate pathways for the uptake of competencies. Qualitative responses were analyzed using thematic analysis for Round 1. Sixty-two survey participants participated in Round 1, with a 72.58
The 2008 core competencies for the public health in Canada were used extensively however were outdated. Our objective was to determine and conduct a consultation and engagement process to update the core competencies. This study describes the approach and methods used. Feminist community-based research informed the multiple methods used to gather explicit and tacit expertise on essential knowledge, skills, and attitudes for the updated competencies. Recommendations from published literature were adapted for project governance, literature reviews, engagement, and integration of feedback on competency statements based on principles of reflection, reflexivity, equity, and transparency. More than 2300 members of the public health community contributed to updating the core competencies via in-person and virtual engagement sessions. Participants were from every province and territory and a range of public health disciplines, roles, and system levels, with a focus on integrating Indigenous and Black Health Leaders’ perspectives. Over 2200 comments and edits received informed successive competency drafts. The updated core competencies incorporate timely issues, such as climate change and planetary health, for evidence-informed public health practice and policy. They emphasize the importance of First Nations, Inuit, and Métis approaches and ways of knowing, of integrating Black Health and anti-Black racism, as well as grounding values of health equity, social justice, and accountability in public health practice and policy. This manuscript adds to the international body of knowledge on methods for modernizing core competencies for public health workforce development and training.
Studies evaluating the outcomes of flavoured vaping product sales bans on adolescent vaping remain scarce, often inconclusive, and of limited generalizability, as they rely predominantly on US data. This study examines the short-term outcomes of such legislation implemented in Quebec (Canada) in October 2023. A pretest-posttest design with a nonequivalent control group was used, drawing on data from the 2022, 2023 (pre-intervention), and 2024 (post-intervention) waves of the COMPASS study. The exposed group included 4540 adolescents from 68 Quebec schools, and the comparison group included 1491 adolescents from 39 Ontario schools. Indicators derived from self-reported current vaping (past-30-days) were analysed: non-use, daily use, initiation, reduction, mean magnitude of reduction, and cessation. Between 2023 and 2024, difference-in-differences analyses revealed no significant between-group differences across all six outcomes examined: non-use (−0.7 percentage point; 95
Considering growing food insecurity and diet-related inequalities, Canada has introduced a national school food program (SFP). International studies have shown the benefits of SFPs for student diets, but their potential to reduce differences in dietary intake and diet quality (dietary inequalities) has not been studied. This study examines the associations of existing SFPs with dietary intake and inequalities among elementary students in Canada. Data from 1442 grade 4–6 students (9–12 years of age) from 26 schools in underserved communities reported foods and beverages consumed in the past 24 h and whether these were provided as part of an SFP, brought from home, or obtained elsewhere. Inequalities in dietary intake (vegetables and fruit, milk and alternatives, free sugars, sodium) and overall diet quality of students who accessed vs. did not access SFPs were quantified using Gini coefficients. Students who accessed SFPs (n = 181) reported consuming more vegetables and fruit, more milk and alternatives, and diets of better quality, compared to their peers who did not access SFPs (n = 1261). These differences were especially pronounced among students from less affluent households. Lower inequalities in the consumption of vegetables and fruit (difference in Gini coefficients = 0.072, 95
This quantitative study examines the factors predicting changes in trust in governments (federal and provincial/territorial), public health authorities, health scientists, and medical care providers from before the COVID-19 pandemic to May 2024. A cross-sectional online survey was conducted among Canadian adults in May 2024. Trust levels before and during the pandemic were assessed using tested and validated items across five domains—provincial and federal governments, public health authorities, health scientists, and medical care providers using Likert scales. A weighted multinomial logistic regression was used to identify factors associated with changes in trust (trust increased, trust decreased). Models were evaluated for goodness-of-fit of predicted versus observed estimates. Adults aged 34–54 were less likely to increase trust in provincial government (RRR = 0.78), and older adults (≥ 55 years) were less likely to increase trust in medical care providers (RRR = 0.36) and more likely to decrease trust in health scientists (RRR = 1.44). Respondents who declared their gender as non-binary or chose not to disclose were less likely to increase trust in provincial governments (RRR = 0.24). However, individuals with a strong interest in science were more likely to report increased trust in public health authorities (RRR = 1.39) and in health scientists (RRR = 1.69). Vaccine-trusting individuals were more likely to report increased trust across all trust domains. The COVID-19 pandemic significantly impacted public trust in health institutions, with disparities across sociodemographic groups and regions. Trust levels were closely tied to vaccination-attitudes, underscoring the need for transparent, science-based communication and targeted interventions to rebuild trust, particularly among vaccine-hesitant populations.
In 2018, Canada legalized and regulated the production and sale of cannabis for non-medical purposes. This paper examined the prevalence of ‘higher risk’ cannabis use outcomes across Canadian provinces and territories (PTs), with rates hypothesized to be lower in Quebec and higher in the territories. Past 12-month cannabis consumers from the 2023 and 2024 cycles of the Canadian Cannabis Survey were included (n = 7238). A previous study identified 16 higher risk cannabis use outcomes. Logistic regression models tested differences in each outcome by PT (10 provinces; three territories combined) or region (Western Canada, Ontario, Quebec, Atlantic Canada, territories). Newfoundland and the territories had the highest rates of frequent cannabis use, and Alberta had the highest rate of inhalable cannabis extract use. Consumers in Quebec reported among the lowest rates of five ‘higher risk’ outcomes (including frequent cannabis use, past 12-month use of inhalable cannabis extracts, and use of extracts containing > 30
