Search

Objectives: This pilot project sought to seed citizen engagement processes for sustainable futures visioning with ideas, perspectives, and processes informed by Indigenous ways of knowing. Methods: Five circle dialogues were convened with students, faculty, and members of the public, in the spring of 2019, using Indigenous talking circle methodology and intentionally seeded with “disruptive” ideas to encourage reflexivity and open space for “out-of-the-box” thinking. These were complemented by a series of one-on-one dialogues with members of the pan-Canadian research team. Pre- and post-dialogue surveys, notes taken by participants, team members, and co-facilitators, as well as notes from one-on-one interviews, constituted the data drawn upon for this paper. Results: Participants were overwhelmingly positive about their experience, noting they were able to go further and deeper in their thinking and listening, and that they valued the Indigenous talking circle methodology, even if they stopped short of claiming the experience had transformed their way of seeing the world. Key points raised in the dialogues included the need for a more relational worldview, the need to repair severed relations with the land and nature, the importance of Indigenous ways of knowing, the importance of community building, and the need to question the fundamental assumptions undergirding contemporary Western societies. Conclusions: While caution must be exercised in drawing conclusions and extrapolating from this modest pilot project, our experience underscores the value of processes that intentionally catalyze critical reflexivity and openness to other ways of seeing, informed by Indigenous ways of knowing and talking circle methodology.

The volume of calls for governments and public health officials to take concerted action on climate change has become almost deafening. Public health researchers and practitioners need to look beyond what we knowabout the health impacts of climate change, to what we are doingas our part in contributing to holding global temperature rise to under 1.5°C. This commentary reflects on the common threads across the articles of a special section in this issue of the Canadian Journal of Public Health, “Moving on IPCC 1.5°C”, which sought examples of bold research and action advancing climate change mitigation and adaptation. Among the articles, there are signs that the public health community is gaining momentum in confronting the climate crisis. Three critical lessons emerged: the need for institutional change from the top of public health, the essential power of community in intersectoral action on climate change preparedness, and the importance of centring Indigenous wisdom to decolonize colonial legacy systems. We encourage readers to move public health research and practice from an instrumental relationship with nature to one of reverence and sacred reciprocity.

Objective: The Lighthouse Project (2017–2018) explored the role that faith-based organizations (FBOs) might play as resilience hubs for climate-related stresses and extreme weather emergencies in disadvantaged urban environments of three cities. This paper discusses the role that public health played in these initiatives and makes an appeal for more participatory, community-engaged public health in light of the persistent gaps in its approach to equitable climate change preparedness. Methods: Pilots were initiated in the Greater Toronto and Hamilton Area (GTHA): Brampton’s Emergency Managers offered pre-selected FBO volunteers specialized training to be part of the city’s emergency response in establishing FBO sites as emergency muster stations. An environmental organization in Hamilton explored how its existing networks could rally around a local social resilience challenge, and a community organizer in Toronto undertook network building to support mostly newcomer populations in one inner-city neighbourhood. All pilots used a mix of cold calling, workshops, municipal presentations, and participation in local programming and public events. Two convened local working groups. Results: By the end of the pilot, Brampton’s Emergency Management Office had made one contractual relationship with an FBO and its volunteers. In Hamilton, a multi-stakeholder network emerged to support the climate preparedness of agencies serving local vulnerable populations. In Toronto, a residents’ working group was established to address neighbour well-being and emergency response in one apartment tower. Work in all three communities is ongoing. Conclusion: Multi-stakeholder support for community organizations and local volunteers can enable partnerships in neighbourhood-level climate resilience—before, during and after extreme weather events. Public Health, while not typically top-of-mind as a key ally in this work, is well positioned to make a contribution. Consistent with place-based approaches, an emergent community development design enabled community animators to catalyze collaborations to suit the on-the-ground realities of each site.

Objectives: Psychosocial adaptation to climate change-related events remains understudied. We sought to assess how the psychosocial consequences of a major event were addressed via public health responses (e.g., programs, policies, and practices) that aimed to enhance, protect, and promote mental health. Methods: We report on a study of health and social service responses to the long-term mental health impacts of the 2013 Southern Alberta flood, in High River, Alberta. Qualitative research methods included (i) telephone interviews (n?=?14) with key informant health and social services leaders, (ii) four focus group sessions with front-line health and social services workers (n?=?14), and (iii) semi-structured interviews with a sample of community members (n?=?18) who experienced the flood. We conducted a descriptive thematic analysis, with a focus on participants’ perceptions and experiences. Results: Findings of this study suggest (1) the long-term psychosocial impacts of extreme weather and climate change require sustained recovery interventions rooted in local knowledge and interdisciplinary action; (2) there are unintended consequences related to psychosocial interventions that can incite complex emotions and impact psychosocial recovery; and (3) perceptions of mental health care, among people exposed to climate-related trauma, can guide climate change and mental health response and recovery interventions. Conclusion: Based on this initial exploration, policy and practice opportunities for public health to enhance psychosocial adaptation to our changing climate are highlighted.

As a collective organized to address the education implications of calls for public health engagement on the ecological determinants of health, we, the Ecological Determinants Group on Education (cpha.ca/EDGE), urge the health community to properly understand and address the importance of the ecological determinants of the public’s health, consistent with long-standing calls from many quarters—including Indigenous communities—and as part of an eco-social approach to public health education, research and practice. Educational approaches will determine how well we will be equipped to understand and respond to the rapid changes occurring for the living systems on which all life—including human life—depends. We revisit findings from the Canadian Public Health Association’s discussion paper on ‘Global Change and Public Health: Addressing the Ecological Determinants of Health’, and argue that an intentionally eco-social approach to education is needed to better support the health sector’s role in protecting and promoting health, preventing disease and injury, and reducing health inequities. We call for a proactive approach, ensuring that the ecological determinants of health become integral to public health education, practice, policy, and research, as a key part of wider societal shifts required to foster a healthy, just, and ecologically sustainable future.

Objectives:To examine the congruence in perceptions and attitudes of legislators and the public regarding tobacco and tobacco control policies. Methods:Two cross-sectional surveys were used, one of elected federal and provincial legislators and one of adult residents in Ontario, Canada. Perceptions and attitudes were analyzed as dependent variables using multiple logistic regression, and adjusted for age, sex, educational attainment, and smoking status. Findings:Congruence was found in most instances, however, some differences were found. Legislators were more likely than the public to agree that most smokers are addicted and were more supportive of a smoking ban in workplaces, but these differences disappeared after controlling for socio-demographic characteristics. Legislators were also more aware than the public of the magnitude of deaths due to tobacco compared to alcohol, whereas the public was more supportive of strong penalties against stores that sell cigarettes to minors. Conclusions:Our findings provide considerable evidence for congruence in the “real-world” (unadjusted) perceptions and attitudes of Ontario legislators and the Ontario public toward tobacco control policies. Such findings are positive for tobacco control advocates and should be leveraged to bring forward strong tobacco policies in the political arena. Objectifs:Examiner la concordance dans les perceptions et les attitudes des législateurs et de la population en ce qui a trait au tabac et aux politiques de lutte contre le tabagisme. Méthode:À l’aide de deux enquêtes transversales (l’une auprès des législateurs fédéraux et provinciaux élus et l’autre auprès des résidents adultes de l’Ontario), on a analysé les perceptions et les attitudes des répondants en tant que variables dépendantes, par régression logistique multiple. On les a ensuite ajustées selon l’âge, le sexe, le niveau d’instruction et le statut de fumeur ou de non-fumeur. Constatations:Dans la plupart des cas, on observe une concordance. Les législateurs sont proportionellement plus nombreux que l’ensemble de la population à convenir que la plupart des fumeurs sont dépendants et à approuver l’interdiction du tabagisme sur les lieux de travail, mais cette différence disparaît lorsqu’on tient compte de l’effet de la variable socio-démographique. Les législateurs sont aussi plus sensibles que l’ensemble de la population à l’ampleur des décès dus au tabac (par comparaison avec les décès dus à l’alcool). Dans l’ensemble de la population, on approuve davantage l’imposition de lourdes sanctions aux magasins qui vendent des cigarettes à des mineurs. Conclusions:Ces constatations témoignent d’une forte concordance entre les perceptions et les attitudes (non ajustées) des législateurs ontariens „ dans le monde réel ” et celles de la population ontarienne en ce qui a trait aux politiques de lutte contre le tabagisme. C’est une bonne nouvelle pour les porte-parole de la lutte contre le tabagisme, qui devraient s’en servir pour promulguer le renforcement des politiques en ce domaine.

Objectives:To describe and discuss the challenges in evaluation of a participatory action research with street-involved youth. Methods:A combination of quantitative and qualitative methods were utilized for both process and outcome evaluations. Process evaluation methods included in-depth individual interviews, focus groups, participant observation, and session debriefing forms. Summative evaluation research included focus testing of the harm reduction video and a survey of video users. Findings:Members of the youth team reported favourably on the experience, citing friendship, skills development, fun, and pride of accomplishment among the key benefits of participation. Political tensions arose because of the focus on reducing harm from drug use rather than encouraging abstension. The heavy demands of participatory research and development, resource constraints and the priority given to product development in these kinds of projects necessarily precludes extensive youth participation in the design, implementation and analysis of additional evaluation research. Even when resources are directed towards evaluation, there is a tendency to focus on data collection, which may limit time and resources for data analysis. Finally, there is an inclination to focus on the product development rather than dissemination and impact of the product. Interpretation:Despite the challenges inherent in participatory action research and its evaluation, this project was regarded as an empowering experience by the street youth who participated in it. It is worthwhile to direct resources to evaluation which optimally gives proportional attention to data collection as well as data analysis, and focusses not only on product development but also on its dissemination and impact. Objectifs:Décrire et expliquer les défis de l’évaluation d’un projet de recherche active auprès de jeunes de la rue. Méthode:Nous avons combiné des méthodes quantitatives et qualitatives pour évaluer tant le processus que les résultats du projet. Pour l’évaluation du processus, nous avons utilisé des entrevues individuelles approfondies, des groupes de discussion, l’observation des participants et des questionnaires récapitulatifs après les séances. Pour l’évaluation sommative, nous avons fait visionner à des groupes cibles une vidéocassette traitant de réduction des méfaits en sollicitant leurs commentaires. Constatations:Les jeunes ont dit avoir apprécié l’expérience, qui leur a permis entre autres de se faire des amis, d’acquérir des compétences tout en s’amusant et de retirer une certaine fierté de leurs accomplissements. Des tensions politiques se sont manifestées lorsque les jeunes de la rue se sont concentrés sur la réduction des méfaits de la consommation de drogues plutôt que sur l’abstention. En recherche active, il est souvent difficile de doser le temps et les ressources consacrés au projet proprement dit et à son évaluation. Même lorsqu’on dispose de ressources d’évaluation, on a tendance à mettre l’accent sur la collecte des données en négligeant leur analyse. On tend aussi à s’attacher à l’élaboration du produit plutôt qu’à sa diffusion et à l’analyse de ses effets. Interprétation:Malgré les défis inhérents à la recherche active et à son évaluation, les jeunes qui ont participé au projet considèrent qu’il leur a permis de renforcer leur autonomie. Il vaut la peine de consacrer des ressources à l’évaluation, car cela incite à se pencher autant sur la collecte des données que sur leur analyse et à ne pas en rester à l’élaboration d’un produit, mais à travailler à sa diffusion et à l’analyse de ses effets.

The Community Action and Public Health study explored how Ontario public health practitioners interpret and implement guidance in community action. In-depth interviews were conducted with 107 public health professionals and community members in 6 Ontario health units. This report briefly describes the study methods and presents results pertaining to the measurement of success based on interviews with 67 public health professionals. Data substantiate the view that evaluation methodologies employing quantitative measures of epidemiological outcomes inadequately capture “success” in community action, possibly attributable to an unproductive dichotomization of “process” and “outcome”. Results suggest two kinds of “success”: a) changes related to stated goals and targets; and b) more iterative and process-oriented changes, including necessary but often undocumented shifts in relationships, structures, social conditions and processes. In order to legitimize and validate results that might otherwise pass unrecognized, we suggest a methodology that records project “milestones” as successes in their own right. Dans notre étude sur les initiatives communautaires et la santé publique, nous avons cherché à savoir comment les praticiens de la santé publique de l’Ontario interprètent et appliquent les orientations en matière d’initiatives communautaires. Nous avons mené des entrevues approfondies auprès de 107 professionnels de la santé publique et membres de communautés relevant de six services de santé de l’Ontario. Le rapport décrit brièvement la méthode de l’étude et en présente les résultats qui ont trait aux mesures de réussite, tirés d’entrevues auprès de 67 professionnels de la santé publique. Les résultats confirment que les méthodes d’évaluation fondées sur la mesure quantitative des résultats épidémiologiques sont insuffisantes lorsqu’il s’agit d’évaluer la « réussite » d’une initiative communautaire, peut-être parce qu’elles opèrent une dichotomie stérile entre le « processus » et le « résultat ». Il semble y avoir deux genres de réussite: a) les changements obtenus par rapport aux buts fixés et aux cibles visées; et b) les changements itératifs, davantage axés sur le processus, notamment les changements nécessaires, mais souvent mal documentés, dans les rapports humains, les structures et les conditions sociales. Pour confirmer et valider des résultats qui autrement passeraient inaperçus, nous suggérons d’employer une méthode qui considère les « jalons » d’un projet comme des réussites à part entière.

Using data from a 1996 random-digit-dialling computer-assisted telephone survey of Ontario adults, 424 smokers and 1,340 non-smokers were compared regarding knowledge about the health effects of tobacco use, attitudes toward restrictions on smoking and other tobacco control measures, and predictions of compliance with more restrictions. The response rate was 65%. Smokers were less knowledgeable than nonsmokers. Smokers were also less likely to support bans on smoking in specific locations, but majorities of both groups supported some restriction in most settings. Smokers were more likely than nonsmokers to predict that most smokers would comply with more restrictions, and more than three quarters indicated that they, themselves, would comply. Sizable proportions of both groups, especially smokers, failed to appreciate the effectiveness of taxation in reducing smoking. Support for other control measures also differed by smoking status. Both knowledge and smoking status were independently associated with support for more restrictions and other tobacco control policy measures. À partir de données recueillies en 1996 lors d’un sondage téléphonique à numéros aléatoires assisté par ordinateur et mené auprès d’adultes de l’Ontario, nous avons comparé les réponses de 424 fumeurs et de 1 340 non-fumeurs concernant les effets du tabagisme sur la santé, les attitudes à l’égard de restrictions et d’autres mesures de contrôle de l’usage du tabac et les prédictions quant au respect de restrictions plus nombreuses. Le taux de réponse au sondage a été de 65 %. Les fumeurs avaient moins de connaissances que les non-fumeurs. Les fumeurs étaient également moins portés à appuyer l’interdiction de fumer à certains endroits précis, mais la majorité des répondants des deux groupes appuyaient l’idée d’imposer certaines restrictions dans la plupart des endroits. Les fumeurs étaient plus portés que les non-fumeurs à prédire que la plupart des fumeurs se conformeraient à un plus grand nombre de restrictions; plus des trois-quarts d’entre eux ont indiqué qu’eux-mêmes s’y conformeraient. Une grande proportion des deux groupes, surtout parmi les fumeurs, ne croyait pas que les taxes étaient un moyen efficace de réduire l’usage du tabac. Les deux groupes ne donnaient pas le même appui à d’autres mesures de contrôle du tabagisme. La connaissance et le statut de fumeur ou de non-fumeur étaient associés de façon indépendante à l’appui donné à des restrictions plus nombreuses et à d’autres mesures de contrôle de l’usage du tabac.

Few studies have employed a qualitative approach to better understand how both smokers and non-smokers experience and make sense of no-smoking restrictions in their daily lives. We describe qualitative research involving an examination of self-reported interpersonal interactions between smokers and non-smokers in public places regarding exposure to environmental tobacco smoke (ETS). Five focus group discussions and twenty individual in-depth interviews were conducted with smokers and non-smokers in the Metropolitan Toronto region as a complement to a quantitative survey of the adult population of Ontario. Strategies used by non-smokers in responding to ETS exposures included verbal confrontations, non-verbal cues, use of a third party, and moving away. The perceived consequences of such actions, as described by both smokers and non-smokers, are discussed, together with implications for tobacco control policy and practice. Peu d’études ont utilisé l’approche qualitative pour mieux comprendre comment les fumeurs et les non fumeurs font l’expérience — dans la vie quotidienne — des restrictions face à l’usage du tabac. Nous décrivons des recherches qualitatives qui impliquent un examen des relations interpersonnelles entre fumeurs et non fumeurs dans les endroits publiques; principalement en ce qui concerne l’exposition à la fumée de tabac dans l’environnement. Cinq groupes de discussion et vingt interviews d’individus en profondeur, ont été réalisés avec des fumeurs et non fumeurs dans la région métropolitaine de Toronto, comme complément à une enquête auprès de la population adulte ontarienne. Les stratégies employées par les non fumeurs pour répondre à l’exposition à la fumée ont inclus la confrontation verbale, des signes non verbaux, l’emploi d’une tierce personne et le retrait. Les conséquences perçues de ces actions, décrites par les fumeurs et non fumeurs, sont discutées; ainsi que l’implication pour les pratiques et politiques de lutte contre le tabac.