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Impact of New Rapid Transit on Physical Activity: A Meta-analysis

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-03-11
Abstract: 

New rapid transit investments have been motivated by environmental, economic, and health benefits. Given transit's potential to increase active travel, recent research leverages transit changes for natural experiment studies to examine physical activity outcomes. We aimed to quantify the association size, critically examine existing literature, and make recommendations for future studies to advance research and policies on active travel, transportation, and physical activity. Studies of physical activity impacts following transit interventions were systematically reviewed using seven health and transport databases (May–July 2017). Two investigators extracted data on sample size, intervention, pre- and post-intervention physical activity, and relevant measurement information. Inconsistency of results and estimated overall mean physical activity change post-intervention were assessed. Forest plots were created from physical activity change in each study using a general variance-based random effects model. Of 18 peer-reviewed articles examining health behaviors, 15 addressed physical activity and five were natural experiment studies with pre- and post- intervention measurements. Studies varied by intervention, duration, outcome measurement, sampling location, and spatial method. Q (201) and I2 (98%) indicated high study heterogeneity. Among these five studies, after transit interventions, total physical activity decreased (combined mean - 80.4 min/week, 95% CI - 157.9, −2.9), but transport-related physical activity increased (mean 6.7 min/week, 95% CI - 10.1, 23.5). Following new transit infrastructure, total physical activity may decline but transport-related physical activity may increase. Positive transit benefits were location, sociodemographic, or activity-specific. Future studies should address context, ensure adequate follow-up, utilize controls, and consider non-residential environments or participants.

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Predictors of Facebook User Engagement With Health-Related Content for Gay, Bisexual, and Other Men Who Have Sex With Men: Content Analysis

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-04-06
Abstract: 

Background: Social media is used by community-based organizations (CBOs) to promote the well-being of gay and bisexual men (GBM). However, few studies have quantified which factors facilitate the diffusion of health content tailored for sexual minorities.

Objective: The aim of this study was to identify post characteristics that can be leveraged to optimize the health promotion efforts of CBOs on Facebook.

Methods: The Facebook application programming interface was used to collect 5 years’ of posts shared across 10 Facebook pages administered by Vancouver-based CBOs promoting GBM health. Network analysis assessed basic indicators of network structure. Content analyses were conducted using informatics-based approaches. Hierarchical negative binomial regression of post engagement data was used to identify meaningful covariates of engagement.

Results: In total, 14,071 posts were shared and 21,537 users engaged with these posts. Most users (n=13,315) engaged only once. There was moderate correlation between the number of posts and the number of CBOs users engaged with (r=.53, P<.001). Higher user engagement was positively associated with positive sentiment, sharing multimedia, and posting about pre-exposure prophylaxis, stigma, and mental health. Engagement was negatively associated with asking questions, posting about dating, and sharing posts during or after work (versus before).

Conclusions: Results highlight the existence of a core group of Facebook users who facilitate diffusion. Factors associated with greater user engagement present CBOs with a number of strategies for improving the diffusion of health content.

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The Fundamental Association Between Mental Health and Life Satisfaction: Results from Successive Waves of a Canadian National Survey

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-03-12
Abstract: 

Background: A self-reported life satisfaction question is routinely used as an indicator of societal well-being. Several studies support that mental illness is an important determinant for life satisfaction and improvement of mental healthcare access therefore could have beneficial effects on a population’s life satisfaction. However, only a few studies report the relationship between subjective mental health and life satisfaction. Subjective mental health is a broader concept than the presence or absence of psychopathology. In this study, we examine the strength of the association between a self-reported mental health question and self-reported life satisfaction, taking into account other relevant factors.

Methods: We conducted this analysis using successive waves of the Canadian Community Health Survey (CCHS) collected between 2003 and 2012. Respondents included more than 400,000 participants aged 12 and over. We extracted information on self-reported mental health, socio-demographic and other factors and examined correlation with self-reported life satisfaction using a proportional ordered logistic regression.

Results: Life satisfaction was strongly associated with self-reported mental health, even after simultaneously considering factors such as income, general health, and gender. The poor-self-reported mental health group had a particularly low life satisfaction. In the fair-self-reported mental health category, the odds of having a higher life satisfaction were 2.35 (95% CI 2.21 to 2.50) times higher than the odds in the poor category. In contrast, for the “between 60,000 CAD and 79,999 CAD” household income category, the odds of having a higher life satisfaction were only 1.96 (95% CI 1.90 to 2.01) times higher than the odds in the “less than 19,999 CAD” category.

Conclusions: Subjective mental health contributes highly to life satisfaction, being more strongly associated than other selected previously known factors. Future studies could be useful to deepen our understanding of the interplay between subjective mental health, mental illness and life satisfaction. This may be beneficial for developing public health policies that optimize mental health promotion, illness prevention and treatment of mental disorders to enhance life satisfaction in the general population.

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Low-level Lead Exposure and Mortality in US Adults: A Population-based Cohort Study

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-03-12
Abstract: 

Background: Lead exposure is a risk factor for cardiovascular disease mortality, but the number of deaths in the USA attributable to lead exposure is poorly defined. We aimed to quantify the relative contribution of environmental lead exposure to all-cause mortality, cardiovascular disease mortality, and ischaemic heart disease mortality.

Methods: Our study population comprised a nationally representative sample of adults aged 20 years or older who were enrolled in the Third National Health and Nutrition Examination Survey (NHANES-III) between 1988 and 1994 and followed up to Dec 31, 2011. Participants had completed a medical examination and home interview and had results for concentrations of lead in blood, cadmium in urine, and other relevant covariates. Individuals were linked with the National Death Index. This study presents extended follow-up of an earlier analysis.

Findings: We included 14289 adults in our study. The geometric mean concentration of lead in blood was 2·71 µg/dL (geometric SE 1·31). 3632 (20%) participants had a concentration of lead in blood of at least 5 µg/dL (≥0·24 μmol/L). During median follow-up of 19·3 years (IQR 17·6–21·0), 4422 people died, 1801 (38%) from cardiovascular disease and 988 (22%) from ischaemic heart disease. An increase in the concentration of lead in blood from 1·0 µg/dL to 6·7 µg/dL (0·048 μmol/L to 0·324 μmol/L), which represents the tenth to 90th percentiles, was associated with all-cause mortality (hazard ratio 1·37, 95% CI 1·17–1·60), cardiovascular disease mortality (1·70, 1·30–2·22), and ischaemic heart disease mortality (2·08, 1·52–2·85). The population attributable fraction of the concentration of lead in blood for all-cause mortality was 18·0% (95% CI 10·9–26·1), which is equivalent to 412000 deaths annually. Respective fractions were 28·7% (15·5–39·5) for cardiovascular disease mortality and 37·4% (23·4–48·6) for ischaemic heart disease mortality, which correspond to 256000 deaths a year from cardiovascular disease and 185000 deaths a year from ischaemic heart disease.

Interpretation: Low-level environmental lead exposure is an important, but largely overlooked, risk factor for cardiovascular disease mortality in the USA. A comprehensive strategy to prevent deaths from cardiovascular disease should include efforts to reduce lead exposure.

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Influence of Indoor Work Environments on Health, Safety, and Human Rights Among Migrant Sex Workers at the Guatemala-Mexico Border: A Call for Occupational Health and Safety Interventions.

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-02-02
Abstract: 

Background: Migrant women are over-represented in the sex industry, and migrant sex workers experience disproportionate health inequities, including those related to health access, HIV and sexually transmitted infections (STIs), and violence. Despite calls for occupational sex work interventions situated in labour rights frameworks, there remains a paucity of evidence pertaining to migrant sex workers’ needs and realities, particularly within Mexico and Central America. This study investigated migrant sex workers’ narratives regarding the ways in which structural features of work environments shape vulnerability and agency related to HIV/STI prevention and violence at the Guatemala-Mexico border. Methods: Drawing on theoretical perspectives on risk environments and structural determinants of HIV in sex work, we analyzed in-depth interviews, focus groups, and ethnographic fieldwork conducted with 39 migrant sex workers in indoor work environments between 2012 and 2015 in Tecún Umán, Guatemala. Results: Participant narratives revealed the following intersecting themes to be most closely linked to safety and agency to engage in HIV/STI prevention: physical features of indoor work environments (e.g., physical layout of venue, proximity to peers and third parties); social norms and practices for alcohol use within the workplace; the existence and nature of management practices and policies on health and safety practices; and economic influences relating to control over earnings and clients. Across work environments, health and safety were greatly shaped by human rights concerns stemming from workplace interactions with police, immigration authorities, and health authorities. Conclusions: Physical isolation, establishment norms promoting alcohol use, restricted economic agency, and human rights violations related to sex work policies and immigration enforcement were found to exacerbate risks. However, some establishment policies and practices promoted ‘enabling environments’ for health and safety, supporting HIV/STI prevention, economic agency, and protection from violence and exploitation; these practices and policies were especially crucial for recent migrants. Policy reforms and structural workplace interventions tailored to migrant sex workers’ needs are recommended to promote improved working conditions and migrant sex workers’ health, safety, and human rights.

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Cohort Profile: The Comparative Outcomes and Service Utilization Trends (COAST) Study Among People Living With and Without HIV in British Columbia, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-01-13
Abstract: 

Purpose The Comparative Outcomes And Service Utilization Trends (COAST) Study in British Columbia (BC), Canada, was designed to evaluate the determinants of health outcomes and health care services use among people living with HIV (PLHIV) as they age in the period following the introduction of combination antiretroviral therapy (cART). The study also assesses how age-associated comorbidities and health care use among PLHIV may differ from those observed in the general population.

Participants COAST was established through a data linkage between two provincial data sources: The BC Centre for Excellence in HIV/AIDS Drug Treatment Program, which centrally manages cART dispensation across BC and contains prospectively collected data on demographic, immunological, virological, cART use and other clinical information for all known PLHIV in BC; and Population Data BC, a provincial data repository that holds individual event-level, longitudinal data for all 4.6 million BC residents. COAST participants include 13 907 HIV-positive adults (≥19 years of age) and a 10% random sample inclusive of 516 340 adults from the general population followed from 1996 to 2013.

Findings to date For all participants, linked individual-level data include information on demographics, health service use (eg, inpatient care, outpatient care and prescription medication dispensations), mortality, and HIV diagnostic and clinical data. Publications from COAST have demonstrated the significant mortality reductions and dramatic changes in the causes of death among PLHIV from 1996 to 2012, differences in the amount of time spent in a healthy state by HIV status, and high levels of injury and mood disorder diagnosis among PLHIV compared with the general population.

Future plans To capture the dynamic nature of population health parameters, regular data updates and a refresh of the data linkage are planned to occur every 2 years, providing the basis for planned analysis to examine age-associated comorbidities and patterns of health service use over time.

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“All Weather Friends”: How China Transformed Zimbabwe’s Tobacco Sector

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-01-22
Abstract: 

Recent research documents the globalization strategy of the Chinese tobacco industry since the early 2000s and risks posed to global health. There are limited analyses to date of how this strategy is playing out in specific countries. This paper analyses the expansion of the China National Tobacco Company (CNTC) in Zimbabwe, the largest producer of tobacco leaf globally, since the early 2000s, through document analysis. It applies a political economy framework—identifying material, ideational and institutional forces—to demonstrate how CNTC capitalized on the unique features of China-Africa development cooperation to pursue its expansion goals, which threaten global public health efforts to reduce tobacco supply. In a context of economic crisis, CNTC offered substantial resources to revive Zimbabwe’s tobacco industry, promoting a shift to contract farming of its preferred leaf. It benefited from perceptions of state friendship, which it fostered through corporate social responsibility initiatives. Through ties with the Chinese embassy and economic actors, CNTC embedded its interests in development institutions. While contributing to improved foreign exchange earnings and some farmers’ livelihoods, CNTC’s expansion has increased the dependence on China as a development partner and tobacco as a crop, benefitting its “go global” strategy, while contributing to public health and environmental challenges locally and globally. The expansion of the Chinese tobacco industry interests in Zimbabwe offers lessons for global tobacco control and efforts to support alternatives to tobacco growing.

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“A Two Glass of Wine Shift”: Dominant Discourses and the Social Organization of Nurses’ Substance Use

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-11-19
Abstract: 

We undertook an institutional ethnography utilizing the expert knowledge of nurses who have experienced substance-use problems to discover: (a) What are the discourses embedded in the talk among nurses in their everyday work worlds that socially organize their substance-use practices and (b) how do those discourses manage these activities? Data collection included interviews, researcher reflexivity, and texts that were critically analyzed with a focus on institutional features. Analysis revealed dominant moralistic and individuated discourses in nurses’ workplace talk that socially organized their substance-use practices, subordinated and silenced experiences of work stress, and erased employers’ roles in managing working conditions. Conclusions included that nurses used substances in ways that enabled them to remain silent and keep working. Nurses’ education did not prepare them regarding nurses’ substance-use problems or managing emotional labor. Nurses viewed alcohol as an acceptable and encouraged coping strategy for nurses to manage emotional distress.

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An Exploratory Study on Police Oversight in British Columbia: The Dynamics of Accountability for Royal Canadian Mounted Police and Municipal Police

Author: 
Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2020-01-09
Abstract: 

Independent oversight of Canadian police has increased over the past decade in response to a number of high-profile cases of police misconduct and public dissatisfaction with internal police investigations. To date, however, the dynamics of the oversight process have not been subjected to critical analysis. This study examines the benefits and challenges of the oversight systems for the Royal Canadian Mounted Police (RCMP) and municipal police in British Columbia, Canada, as well as the role of oversight in increasing police accountability, improving public confidence, and modifying police behavior. Drawing on semi-structured interviews with persons (n = 13) from oversight agencies, police unions, special interest groups, and professional standards units, the study found that despite having one of the most progressive oversight models in Canada, the system faces major challenges. These include slow processing of complaints, the administrative burden of minor complaints, the difficulty in determining return on investment, and the two-tier complaint model.

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Projected Local Rain Events Due To Climate Change and the Impacts on Waterborne Diseases in Vancouver, British Columbia, Canada

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-12-30
Abstract: 

Background

Climate change is increasing the number and intensity of extreme weather events in many parts of the world. Precipitation extremes have been linked to both outbreaks and sporadic cases of waterborne illness. We have previously shown a link between heavy rain and turbidity to population-level risk of sporadic cryptosporidiosis and giardiasis in a major Canadian urban population. The risk increased with 30 or more dry days in the 60 days preceding the week of extreme rain. The goal of this study was to investigate the change in cryptosporidiosis and giardiasis risk due to climate change, primarily change in extreme precipitation.

Methods

Cases of cryptosporidiosis and giardiasis were extracted from a reportable disease system (1997–2009). We used distributed lag non-linear Poisson regression models and projections of the exposure-outcome relationship to estimate future illness (2020–2099). The climate projections are derived from twelve statistically downscaled regional climate models. Relative Concentration Pathway 8.5 was used to project precipitation derived from daily gridded weather observation data (~ 6 × 10 km resolution) covering the central of three adjacent watersheds serving metropolitan Vancouver for the 2020s, 2040s, 2060s and 2080s.

Results

Precipitation is predicted to steadily increase in these watersheds during the wet season (Oct. -Mar.) and decrease in other parts of the year up through the 2080s. More weeks with extreme rain (>90th percentile) are expected. These weeks are predicted to increase the annual rates of cryptosporidiosis and giardiasis by approximately 16% by the 2080s corresponding to an increase of 55–136 additional cases per year depending upon the climate model used. The predicted increase in the number of waterborne illness cases are during the wet months. The range in future projections compared to historical monthly case counts typically differed by 10–20% across climate models but the direction of change was consistent for all models.

Discussion

If new water filtration measures had not been implemented in our study area in 2010–2015, the risk of cryptosporidiosis and giardiasis would have been expected to increase with climate change, particularly precipitation changes. In addition to the predicted increase in the frequency and intensity of extreme precipitation events, the frequency and length of wet and dry spells could also affect the risk of waterborne diseases as we observed in the historical period. These findings add to the growing evidence regarding the need to prepare water systems to manage and become resilient to climate change-related health risks.

Background

Climate change is increasing the number and intensity of extreme weather events in many parts of the world. Precipitation extremes have been linked to both outbreaks and sporadic cases of waterborne illness. We have previously shown a link between heavy rain and turbidity to population-level risk of sporadic cryptosporidiosis and giardiasis in a major Canadian urban population. The risk increased with 30 or more dry days in the 60 days preceding the week of extreme rain. The goal of this study was to investigate the change in cryptosporidiosis and giardiasis risk due to climate change, primarily change in extreme precipitation.

Methods

Cases of cryptosporidiosis and giardiasis were extracted from a reportable disease system (1997–2009). We used distributed lag non-linear Poisson regression models and projections of the exposure-outcome relationship to estimate future illness (2020–2099). The climate projections are derived from twelve statistically downscaled regional climate models. Relative Concentration Pathway 8.5 was used to project precipitation derived from daily gridded weather observation data (~ 6 × 10 km resolution) covering the central of three adjacent watersheds serving metropolitan Vancouver for the 2020s, 2040s, 2060s and 2080s.

Results

Precipitation is predicted to steadily increase in these watersheds during the wet season (Oct. -Mar.) and decrease in other parts of the year up through the 2080s. More weeks with extreme rain (>90th percentile) are expected. These weeks are predicted to increase the annual rates of cryptosporidiosis and giardiasis by approximately 16% by the 2080s corresponding to an increase of 55–136 additional cases per year depending upon the climate model used. The predicted increase in the number of waterborne illness cases are during the wet months. The range in future projections compared to historical monthly case counts typically differed by 10–20% across climate models but the direction of change was consistent for all models.

Discussion

If new water filtration measures had not been implemented in our study area in 2010–2015, the risk of cryptosporidiosis and giardiasis would have been expected to increase with climate change, particularly precipitation changes. In addition to the predicted increase in the frequency and intensity of extreme precipitation events, the frequency and length of wet and dry spells could also affect the risk of waterborne diseases as we observed in the historical period. These findings add to the growing evidence regarding the need to prepare water systems to manage and become resilient to climate change-related health risks.

 

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