INTRODUCTION:Ten years into the most acute phase of the toxic drug crisis in Canada, trends in drug-related deaths remain poorly understood. This is hindered by delayed reporting of drug deaths in some provinces, including Alberta. We used publicly available emergency medical services (EMS) and supervised consumption site (SCS) utilization data to examine their associations with drug poisoning deaths to assess if these measures could serve as reliable proxies for fatalities to support evidence-based public health responses. METHODS:Data on Alberta-wide EMS dispatches for opioid poisoning, Alberta-wide drug deaths, and SCS drug poisoning events at the SCS in Calgary from January 2018 to March 2023 were analyzed. We used linear regression modelling to investigate the association between EMS dispatches and drug deaths (by month) and between SCS drug poisoning events and drug deaths (by month). RESULTS:Significant associations were found between drug-related deaths in Alberta and both the number of EMS dispatches (β = .06, 95% CI: 0.05-0.06) and SCS drug poisoning events (β = .73, 95% CI: 0.57-0.88), suggesting these measures mirror drug-related deaths in the province. Inverse associations were also found between drug-related deaths and SCS visits as well as visits in which drugs were consumed. CONCLUSION:Drug poisoning events recorded in EMS or SCS data may serve as a proxy for understanding trends in drug deaths. These alternative data are often publicly available and may help inform public health response to periods of increased death risk when official death data are delayed or unavailable.
INTRODUCTION:The World Health Organization (WHO) recommends implementing health-promoting interventions (HPIs) in schools to enhance student health and well-being. The repeat cross-sectional PromeSS project examines whether social inequalities are evident in perceived priority of student health concerns and in HPI availability in Quebec public schools. METHODS:We analyzed data from 171 primary (K-6) schools in PromeSS I (2016-2019) and 218 in PromeSS II (2023-2025), which updates findings post-COVID-19 and explores additional priorities. Principals or designated staff documented priority student health-related concerns and availability of related HPIs in structured interviews (PromeSS I) or online/paper questionnaires (PromeSS II). Data analysis emphasized descriptive comparisons. RESULTS:Perceived importance increased for unhealthy eating (+16%), inadequate sleep (+15%), physical inactivity (+13%), and mental health (+12%). HPI availability increased for mental health (+12%) and personal safety (+13%) but declined for physical activity (-13%) and dental health (-19%), despite government mandates. In 2023-2025, screen time was a universal concern (98%), but only three schools offered related HPIs. Sedentary behaviour was a common concern (51%), with 42% HPI availability. Three-quarters of schools implemented HPIs related to unsafe use of technology. Key challenges to HPI availability included insufficient staff (62%), funding (45%), and implementation support (35%). Few schools reported low engagement from staff, students, or families. CONCLUSION:From 2016 to 2025, concerns about student health grew, especially for mental health, inactivity, and nutrition. Yet HPI availability remains inconsistent. Increasing financial resources and implementation support is critical to align school health efforts with evolving needs.
IntroductionClimate change poses a growing threat to health in Canada through both extreme weather and climate events (e.g. wildfires, floods, extreme heat) and gradual environmental changes (e.g. shifting seasonal patterns, ecosystem degradation). While physical health impacts have been well documented, mental health consequences have only recently gained attention. This scoping review synthesizes research examining how climate-related weather events influence mental health outcomes across diverse populations and regions in Canada. MethodsFollowing Arksey and O’Malley’s five-stage scoping review framework, 72 studies published between 1990 and 2024 were analyzed. Mental health impacts were categorized by type of weather and climate event and exposure factors, population subgroup, and outcomes according to length of impact. ResultsDepression, anxiety, and posttraumatic stress disorder (PTSD) were the most commonly reported conditions, particularly following wildfires and floods. Climaterelated exposures such as property loss, displacement, and disruption of livelihoods were identified as key factors leading to psychological distress. Vulnerable populations—including Indigenous peoples, youth, women, low-income groups, and individuals with pre-existing conditions—were disproportionately affected. Emerging concerns such as eco-anxiety and grief tied to environmental change were frequently reported, especially in qualitative studies. Long-term effects of climate change on mental health were evident in more than half of the included studies, highlighting the enduring nature of these impacts. ConclusionDespite growing evidence, gaps remain in understanding region-specific exposures, gradual climate stressors, and protective interventions. This review emphasizes the need for targeted research, policy development, and mental health programming to address climate-related disparities and enhance resilience across Canada’s diverse populations.
INTRODUCTION:Chronic conditions are highly prevalent in Canada and are commonly examined as a single, aggregated exposure in population research on social isolation. Such approaches emphasize overall disease burden but make it difficult to distinguish the independent contributions of diagnostic category, chronic pain and disability. In this study, we examine these dimensions separately to assess how each is associated with social isolation among Canadian adults. METHODS:Using the 2022 Mental Health and Access to Care Survey (n = 9861), the association between chronic conditions, chronic pain, and disability in relation to social support was assessed, using the Social Provisions Scale (SPS-10), applying multivariable linear regression. RESULTS:More severe disability was negatively associated with social support (B = -0.09, 95% CI = -0.11, -0.08). Those with more functional impairments experienced lower social support which typically indicates greater social isolation. CONCLUSION:When examined jointly, functional disability, but not chronic disease category or chronic pain, was independently associated with lower social support. These findings indicate that social isolation among Canadian adults is more closely related to functional limitation than to diagnostic labels, underscoring the importance of function-focused approaches in research and intervention.
IntroductionConcurrent disorders, defined here as co-occurring mental health disorders (MHD) and substance use disorders (SUD), pose challenges for treatment and public health. This study examines the prevalence and characteristics associated with MHD only, SUD only, and concurrent disorders among Canadians aged 15 and older during the COVID-19 pandemic. MethodsWe analyzed data from the 2022 Mental Health and Access to Care Survey (MHACS), a cross-sectional survey of Canadians aged 15 and older living in the 10 provinces (n = 9861). MHD and SUD were assessed using the WHO Composite International Diagnostic Interview. Respondents were classified into four groups: no disorder, MHD only, SUD only, and concurrent disorders. Multinomial logistic regression identified sociodemographic, health, and pandemic-related characteristics associated with these disorder categories, using survey weights and bootstrap methods. ResultsAmong respondents, 1.6% had concurrent disorders, 12.2% had a MHD only, and 1.6% had a SUD only. Younger adults, especially those aged 20 to 24, and 2SLGBTQI+ individuals had elevated risk for concurrent disorders. Additional correlates included lower education, rural residence, weak sense of belonging, and functional impairment. Pandemic-related stressors—loneliness, financial hardship, and difficulty accessing care—were strongly associated with concurrent disorders. ConclusionThis study highlights the prevalence and key correlates for MHD, SUD, and concurrent disorders among Canadian adults during the COVID-19 pandemic. Vulnerable populations include younger individuals, sexual and gender minorities, and those facing social isolation or unmet care needs. These findings underscore the importance of ensuring integrated, accessible mental health and substance use services in Canada’s postpandemic recovery.
IntroductionThe objective of this study is to evaluate adherence to seven Canadian Lower-Risk Cannabis Use Guideline (LRCUG) recommendations among Canadian university students and identify subgroups of high-risk users. MethodsWe analyzed survey data collected across four Canadian universities under the World Mental Health-International College Student (WMH-ICS) initiative. Seven of the ten 2017 LRCUG recommendations were evaluated. Zero-inflated Poisson models were employed to examine the sociodemographic correlates of (1) any lifetime cannabis use; and (2) the number of unmet LRCUG recommendations, conditional on lifetime use. Additionally, multivariable binary logistic regression models examined the sociodemographic correlates of adherence to individual recommendations. ResultsAmong the 27 236 respondents, the prevalence of lifetime cannabis use was 33.8%. Of the seven recommendations evaluated, “choosing lower-strength cannabis products” had the lowest adherence rate (29.0%), followed by “not smoking cannabis” (36.7%). “Not using synthetic cannabis” had the highest adherence rate (96.1%), followed by “delaying cannabis use until age 16” (91.2%). Men, non-heterosexual students, students living in shared housing, and domestic students were more likely to use cannabis and, among users, reported risky use. While White students were more likely to use cannabis, among users, many non-White student groups reported riskier use. ConclusionAlthough most students did not use cannabis and many of the LRCUG recommendations had high rates of adherence, there were low rates of choosing lowerstrength cannabis products and avoiding smoking cannabis among users. Study findings highlight specific recommendations and subpopulations to inform tailoring of future interventions targeting university students.
Introduction: Mood and anxiety disorders frequently cooccur, but few studies have differentiated their unique and shared risk factors. This study examines factors associ ated with mood disorders alone, anxiety disorders alone and comorbid mood and anxi ety disorders among Canadians using 2019-2020 Canadian Community Health Survey data. Methods: The analytic sample included 107 859 respondents, weighted to represent the Canadian population. Multinomial logistic regression with survey and bootstrap weights estimated adjusted relative risk ratios (aRRRs) for sociodemographic, socioeconomic, health related and psychosocial factors. Results: Prevalence was 4.17% for mood disorders alone, 4.99% for anxiety disorders alone and 4.85% for comorbid mood and anxiety disorders. Females had significantly higher risks across all categories (comorbidity aRRR = 2.284; 95% confidence interval [CI]: 1.951-2.673). Younger adults (18-34 years) had greater risks for anxiety disorders alone (aRRR = 3.036; 95% CI: 2.441-3.776) and comorbid disorders (9.311; 7.134-12.153) compared with those aged 65 years and older. Lower household income and poor perceived health were consistently associated with increased risks, with comorbid disorders showing the strongest associations (poor perceived health aRRR = 14.688; 95% CI: 9.908-21.775). Psychosocial factors, including low life satisfaction and a weak sense of community belonging, were also linked to higher risks, particularly for comor bid disorders. Conclusion: Distinct and overlapping factors contribute to mood and/or anxiety disor ders. Targeted prevention and intervention efforts addressing health status, socioeco nomic disadvantage and psychosocial stressors-especially among younger people and females-are critical to reducing the burden of these mental health conditions in Canada.
INTRODUCTION:Use of administrative health data to identify chronic disease cases can cause misclassification bias. Reclassification-based exit rules may reduce misclassification bias. METHODS:Manitoban administrative health data (1995-2022) were used to ascertain multiple sclerosis (MS) and "juvenile diabetes" (JD) prevalence. We constructed multivariable logistic regression model-based algorithms and used a model-predicted probability exit rule to reclassify JD and MS case status annually. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and reclassification rates were estimated. Linear regression tested for differences in prevalence estimates for the model-based algorithm with an exit rule and an existing Canadian Chronic Disease Surveillance System (CCDSS) algorithm without an exit rule. RESULTS:The MS cohort included 60 228 individuals (608 cases, 59 620 non-cases) and the JD cohort 44 125 individuals (2506 cases, 41 619 non-cases). Model-based algorithm sensitivity was 0.62 to 0.85 for MS and 0.87 to 0.95 for JD. PPV for MS was 0.21 to 0.60 and for JD was 0.92 to 0.95. Specificity and NPV were consistently high (0.98-1.00). Non-cases were frequently misclassified; reclassification rates for non-cases were higher than for cases for MS (0.22-0.33 vs. 0.14-0.28) and JD (0.18-0.65 vs. 0.13-0.15). The model-based algorithm with an exit rule for MS, but not for JD, had a slower increase in prevalence than the CCDSS algorithm. CONCLUSION:Case ascertainment algorithms with an exit rule can address misclassification bias when estimating chronic disease prevalence using administrative health data. Improvements are disease dependent.
IntroductionPublic health organizations in Canada play a central role in chronic disease prevention (CDP) but face persistent challenges, including system restructuring, persistent underfunding and shifting policy priorities. The growing complexity of these issues warrants qualitative insight to complement quantitative reports capturing CDP organizations’ perspectives. MethodsThe Public Health Organizational Capacity Study (PHORCAST) is a repeat Canada-wide census of public health organizations engaged in primary CDP at national, provincial, territorial and regional population levels. In 2023, senior managers and staff with in-depth knowledge of their organizations’ CDP activities completed a questionnaire that requested optional comments via an open-ended question. The responses were analyzed using qualitative descriptive methods and inductive content analysis to identify and organize recurring issues. Theme frequencies are reported descriptively to indicate prominence across organizations and not to quantify meaning. ResultsAcross the 55 organizations, 125 coded references to barriers to CDP were synthesized into five key themes: organizational capacity and program delivery challenges (n = 38), including chronic underfunding, workforce shortages and limited infrastructure; COVID-19 pandemic disruptions causing staff redeployment and prolonged service interruptions (n = 30); policy and systemic barriers (n = 28), including political interference and poor interjurisdictional coordination; fragile partnerships and the need for stronger intersectoral collaboration (n = 16); and difficulties engaging diverse communities, digital access issues and lack of culturally responsive programming (n = 13). ConclusionCDP efforts in Canada are constrained by structural, operational and contextual barriers. Addressing these challenges requires sustained investment, coherent policies and stronger cross-sector partnerships.
INTRODUCTION:The COVID-19 pandemic caused unprecedented and inequitably distributed adverse health impacts, which varied across socioeconomic circumstances. We investigated differences in incident depression among individuals aged 50 years and older according to various employment factors during the early stages of the pandemic. METHODS:We included 16 719 Canadian Longitudinal Study on Aging participants who provided data at Follow-up one (2015-2018) (FUP1) and twice during the pandemic (Spring and Autumn 2020). The Center for Epidemiologic Studies Depression Scale (CESD-10) was used to classify individuals with depression (CESD-10 score ≥ 10). Logistic regression, adjusted for possible confounders, estimated the odds of incident depression in Autumn 2020. RESULTS:We found depression scores worsened from pre-pandemic (FUP1) to Autumn 2020; this pattern was evident across different employment features. Individuals who were newly unemployed in Spring 2020 had over double the odds of depression in Autumn 2020 (odds ratio [OR] = 2.22; 95% confidence interval [CI]: 1.51-3.28) compared to those who remained retired. Higher odds of depression were also observed among those with employment disruptions in Spring 2020 relative to those who did not (OR = 1.65; 95% CI: 1.28-2.12), and individuals primarily working in non-home-based settings in Autumn 2020 had 21% lower odds of depression (OR = 0.79; 95% CI: 0.63-0.98) than those who worked remotely. CONCLUSION:Our findings suggest that employment status was an important predictor of depression among Canadians during the early phases of the pandemic.
IntroductionMental health stigma has been a long-standing issue in public safety professions and can deter public safety personnel (PSP) from accessing mental health support. This is concerning as PSP experience higher rates of post-traumatic stress injuries (PTSI) than the general population. Public safety employers play an important role in stigma reduction. However, there is little research on Ontario public safety employers’ perspectives on mental health stigma in their organization and the accompanying organizational challenges they face in addressing stigma and supporting PSPs’ mental health. MethodsA thematic analysis of 28 semi-structured interviews with 33 public safety employer representatives from fire services, paramedics, police, and provincial corrections within Ontario was conducted. ResultsEmployer representatives recognized mental health stigma existed historically. They described that stigma is reducing due to sociopolitical changes that restructured PTSI as a common occupational injury. Participants shared ways they are adjusting organizational practices and policies to further reduce stigma and support PSP. They also highlighted accompanying organizational challenges, including ongoing historic stigma, uncertainty in how to support PSP with PTSI, and difficulty finding meaningful accommodations. ConclusionParticipants perceived mental health stigma to be decreasing in their public safety organizations. However, ongoing stigma, organizational factors and uncertainty around how to support those experiencing PTSI can pose challenges to return-to-work and accommodation. While in various stages of implementing initiatives to support mental health, organizations need to continue to build PTSI awareness, take accountability for their role in reducing mental health stigma, and build trauma-informed practices and policies.
IntroductionThe Canadian Diabetes Risk Questionnaire (CANRISK) is a validated tool for diabetes risk screening, but the extent of its uptake and implementation by Canadian pharmacists has not been assessed. We aimed to describe the current use of the CANRISK tool and user guide among pharmacists, identify facilitators and barriers, and provide solutions to improve uptake. MethodsWe used a mixed-methods approach comprising an initial quantitative online survey followed by qualitative interviews with pharmacists to allow for a deeper understanding of their experiences. Descriptive statistics were used to analyze the survey data and thematic analysis was used to analyze the interview data. ResultsWe found that 89% of pharmacists surveyed provided diabetes counselling on a daily or weekly basis, but more than half (55%) were not aware of CANRISK and its user guide. Of those who were aware, 60% indicated that they rarely or never used CANRISK. Five overarching themes were identified in the qualitative component. The facilitators to CANRISK uptake included pharmacist’s interest, diabetes clinic days/awareness campaigns, and patient-provider relationship. However, there are barriers to its implementation, including time constraints, competing priorities, financial pressures, staff shortages, and limited understanding of the tool’s usefulness. ConclusionThis paper found that CANRISK use was limited, and that support is needed to address the barriers for the successful implementation of CANRISK in pharmacies.
Introduction: Canadian youth report some of the highest rates of cannabis use globally, raising concerns about child and youth poisonings from unintentional exposures and recreational use following legalization. This study examines and compares trends in cannabis poisonings among children and youth aged 16 years or younger treated in the emergency department (ED) of a Canadian pediatric hospital before and after the legalization of nonmedical cannabis. Methods: Cannabis related ED visits at BC Children's Hospital (BCCH) (2016-2021) were identified from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database using injury codes and keyword searches. Key variables included age, sex, intent, method of cannabis use, poisoning intent, season, peer use, and mode of ED arrival. Chisquare tests were used to assess associations between characteristics, and interrupted time series analysis evaluated legalization impact. Results: There were 304 pediatric related cannabis poisoning ED visits to BCCH between 2016 and 2021, increasing 55.5% from pre legalization (n = 119) to post legalization (n = 185). Unintentional poisonings rose from 4% to 12%, mainly involving the ingestion of edibles among children with a median age of 3 years. Ninety percent of cases involved intentional use, with co consumption with other substances more common than cannabis use only. Interrupted time series analysis showed an upward trend in poisonings from 2016 to 2018, an immediate 48% increase in ED visits following legalization, followed by a decline. Conclusion: Findings highlight the need for strengthened substance use prevention efforts, education programs, and continued surveillance to reduce harm among children and youth from intentional use and unintentional cannabis exposures, particularly involving edibles.
Introduction: Few studies have analyzed the impact of public investments in indoor and outdoor recreational spaces, and even fewer have assessed this impact longitudi nally. This hinders informed decision making about returns on investments made with limited public budgets. We assessed the impact of a 2008 municipal plan to revitalize existing urban and rural public indoor facilities and outdoor spaces by evaluating changes in usage levels before and after implementation of Phase 1 (2009-2013) of the revitalization plan. Methods: A quasi experimental study involving a telephone survey of 750 participants was conducted before and after Phase 1. A region with similar demographics and public recreational indoor and outdoor infrastructure was used for comparison. Results: Our analysis found no changes in usage of recreational venues over time whether indoor (e.g. multipurpose recreational facilities, community halls) or outdoor (e.g. golf courses, off leash dog parks, multiuse trails), in either the intervention or comparison region. Only one rural multipurpose indoor recreational facility showed a statistically significant increase in usage during Phase 1. Conclusion: Strategies targeting only physical infrastructure may not result in increased usage across a municipal population. To address existing inequities in access to publicly funded community resources that support health, both the built and social environ ments must be considered.
IntroductionThe built environment supports physical activity (PA) by providing opportunities to be active in daily life. Natural experiments are valuable for assessing how real-world changes to the built environment affect PA and are critical for guiding policies to improve population-level PA. The objective of this review was to summarize the evidence from natural experiments that investigated the impacts of built environment changes on PA in Canada. MethodsSearches were conducted in MEDLINE, Embase, PsycINFO, ProQuest Public Health and SportDISCUS, from inception to 27 November 2024. Natural experiment evaluations that included a comparator or historical control group and assessed changes in PA associated with changes in the built environment were eligible. A narrative synthesis summarizes the evidence and the certainty of the evidence. ResultsResults from the included natural experiments (n = 25) suggest positive effects, with low to moderate certainty, of increased walkability, new cycling and pedestrian infrastructure, bike share (bike rental) programs and new trails. However, there was very low to low certainty of no significant effects for bus rapid transit, school building and yard improvements and school zone improvements. Some evidence suggests negative effects of off-leash dog park areas on children’s park-based PA and of daycare yard improvements on moderate-to-vigorous intensity PA. ConclusionFew Canadian studies have evaluated the impact of built environment changes on PA, with most emerging in the last decade. Future studies should include larger and more diverse samples and all regions, control for confounders including seasonal variation in outdoor PA, use well-matched control groups and incorporate objective PA measures.
IntroductionBuilt environment initiatives that change the physical places in which people live, work and play offer an approach to preventing cancer and chronic diseases. The purpose of this study was to evaluate the effectiveness of the Alberta Healthy Communities Approach Phase II (AHCA II), a community-based approach to creating healthy environments within and across rural communities and addressing modifiable health behaviours to prevent and reduce cancer and chronic disease. MethodsNineteen rural communities participated in AHCA II. Data collected with and by community members included two pre- and postimplementation assessment tools and postimplementation focus groups and surveys. Qualitative and quantitative data sources were triangulated to determine community-level outcomes and impacts. ResultsThe evaluation found three key outcomes and impacts of the AHCA: supportive (built) environments for health; community wellness culture; and community capacity. These intersecting categories demonstrate the positive effects of healthy community initiatives on improving the built environment and supporting health behaviours such as healthy eating, physical activity, ultraviolet radiation protection and tobacco reduction. ConclusionIn addition to improving supportive environments for health, the AHCA facilitated cultural changes and improved community capacity within and across rural communities in Alberta. Each of these components is required to support long-term behaviour changes that promote health and prevent cancer and chronic disease. While these results are encouraging, time and additional evaluations are required to determine whether behavioural changes are sustained and result in reduced rates of cancer and chronic disease.
This study presents the first Canadian self reported estimates of child maltreatment (CM) from youth using data from 5256 participants aged 15 to 17 years in the 2023 Canadian Health Survey on Children and Youth. CM prevalence was high, particularly for emotional abuse (44.9%) and exposure to caregiver emotional intimate partner vio lence (39.4%). Females reported higher prevalence of sexual abuse (8.1% vs. 1.5%) and emotional abuse (52.2% vs. 35.4%) than males. Youth identifying as nonbinary or with a gender different from their sex assigned at birth reported the highest prevalence across all CM types, including 22.4% for sexual abuse and 83.7% for emotional abuse. These finding underscore the need for targeted research and policies that address struc tural determinants of gender based disparities.
A gap in Canadian public health surveillance is the monitoring of childhood positive mental health (PMH). We used available data from the first six cycles of the Canadian Health Measures Survey to examine how two potential PMH indicators are distributed across time and populations of children aged 6 to 11 years. The prevalence of normative parent rated prosocial behaviour and perceived happiness was high and relatively stable across time. Normative parent rated prosocial behaviour was more common among females (vs. males) and 8 to 9year olds (vs. 6 to 7year olds), while perceived happi ness was higher among 6 to 7year olds (vs. 10 to 11year olds).
INTRODUCTION:This study examined physical activity (PA) levels among youth (12-17 years) and adults (18 years and older) living in Canada by subgroups including gender, sexual orientation, population groups, education, and income. METHODS:Data from the 2021 Canadian Community Health Survey (N = 44 239), a large national, cross-sectional survey, was used to examine self-reported daily PA time spent in active transportation, recreation, school/camp, occupational/household, and adherence to PA recommendations (≥ 60 minutes/day and ≥ 150 minutes/week of moderate-to-vigorous intensity PA for youth and adults, respectively) by population subgroups. Significant differences within subgroups were assessed with chi-square and Tukey-Kramer analyses. RESULTS:Among youth, boys were more likely to meet the PA recommendation than girls (54.9% vs. 36.5%). Boys engaged in more recreational (36.0 vs. 24.0 min/day) and school/camp (24.0 vs. 15.9 min/day) PA than girls. Youth from households in the highest income quintile reported more recreational PA compared to those in the lowest income quintile (35.8 vs. 22.1 min/day). Among adults, there was a significant gender difference in PA recommendation adherence (men: 57.4% vs. women: 51.7%). Men engaged in more recreational (18.0 vs. 15.1 min/day) and occupational/household (26.4 vs. 15.4 min/day) PA than women. Recreational PA was significantly higher in households with the highest income (22.8 min/day) and education (17.4 min/day) compared to lowest income (10.4 min/day) and education (6.9 min/day), respectively. Few sub-group differences were observed for active transportation. CONCLUSION:PA inequalities persist in Canada. Future research should explore why these inequalities exist to help inform interventions.
This corrigendum is being published to add a clarification on page 361 of the following article: Gariépy G, Prowse RKM, Plouffe R, Graham E. Supervised consumption sites and population-level overdose mortality: a systematic review of recent evidence, 2016-2024. Health Promot Chronic Dis Prev Can. 2025;45(9):357-66. https://doi.org/10.24095/hpcdp.45.9.02 Text has been added to highlight an important precision about the Rammohan et al. study. Bold has been used to identify the added text. The authors thank Dr. Daniel Werb for raising this concern.
