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In this paper, I discuss the process of redesigning and teaching a mandatory, academic skill building course for students on academic probation at Mount Saint Vincent University (MSVU) in Atlantic Canada. The rationale for redesigning the course was to offer an alternative curricular framework, including instructional approaches, to course instructors who taught a modular-based curriculum. The original course was designed to focus on improving students' individual self-efficacy and motivation for academic success; however, the social and relational nature of learning was not articulated as an underpinning theory in the curriculum. In the new curriculum, I draw on both Etienne Wenger's (1998) notion of communities of practice as sites for learning and Howe and Strauss' (2000; 2007) work on generational analysis as theoretical frameworks. Furthermore, I incorporate Wenger, McDermott, and Snyder's (2002) design principles for cultivating communities of practice as a framework for translating theory into practice. The initial information that I collected from students, instructors, and a thorough review of the original curriculum led to the main inquiry question: How can a curriculum, centred on building community in the classroom, help students to cultivate meaningful learning experiences that take learning beyond a "fake it 'til you make it" mentality? This question guided the curricular design process and also my experiences teaching the course at MSVU during the Fall semester of 2012.

(1) Background: ADHD is recognized as one of the most common neurodevelopmental disorders. The worldwide prevalence of ADHD is estimated at 5.3%; however, estimates vary as a function of a number of factors, including diagnostic methods, age, sex and geographical location. A review of studies is needed to clarify the epidemiology of ADHD in Canada. (2) Methods: A search strategy was created in PubMed and adapted for MEDLINE and PsycINFO. Papers were included if they examined diagnosed ADHD prevalence and/or incidence rates in any region of Canada, age group and gender. A snowball technique was used to identify additional papers from reference lists, and experts in the field were consulted. (3) Results: Ten papers included in this review reported on prevalence, and one reported on incidence. One study provided an overall prevalence estimate across provinces for adults of 2.9%, and one study provided an overall estimate across five provinces for children and youth of 8.6%. Across age groups (1 to 24 years), incidence estimates ranged from 0.4% to 1.2%, depending on province. Estimates varied by age, gender, province, region and time. (4) Conclusions: The overall Canadian ADHD prevalence estimate is similar to worldwide estimates for adults. Most studies reported on prevalence rather than incidence. Differences in estimates across provinces may reflect the varying number of practitioners available to diagnose and prescribe medication for ADHD across provinces. To achieve a more comprehensive understanding of the epidemiology of ADHD in Canada, a study is needed that includes all provinces and territories, and that considers estimates in relation to age, gender, ethnicity, geographical region, socioeconomic status and access to mental healthcare coverage. Incidence rates need further examination to be determined. [ABSTRACT FROM AUTHOR]

Climate change increases the risk of illness through rising temperature, severe precipitation and worst air pollution. This paper investigates how monthly excess mortality rate is associated with the increasing frequency and severity of extreme temperature in Canada during 2000-2020. The extreme associations were compared among four age groups across five sub-blocks of Canada based on the datasets of monthly T90 and T10, the two most representative indices of severe weather monitoring measures developed by the actuarial associations in Canada and US. We utilize a combined seasonal Auto-regressive Integrated Moving Average (ARIMA) and bivariate Peaks-Over-Threshold (POT) method to investigate the extreme association via the extreme tail index χ and Pickands dependence function plots. It turns out that it is likely (more than 10%) to occur with excess mortality if there are unusual low temperature with extreme intensity (all χ > 0.1 except Northeast Atlantic (NEA), Northern Plains (NPL) and Northwest Pacific (NWP) for age group 0-44), while extreme frequent high temperature seems not to affect health significantly (all χ ≤ 0.001 except NWP). Particular attention should be paid to NWP and Central Arctic (CAR) since population health therein is highly associated with both extreme frequent high and low temperatures (both χ = 0.3182 for all age groups). The revealed extreme dependence is expected to help stakeholders avoid significant ramifications with targeted health protection strategies from unexpected consequences of extreme weather events. The novel extremal dependence methodology is promisingly applied in further studies of the interplay between extreme meteorological exposures, social-economic factors and health outcomes. [ABSTRACT FROM AUTHOR]

This paper uses panel data for Canada from 1976 to 2018, across 10 provinces, to reassess the relationship between mortality rates and economic fluctuations. The key contribution of our paper lies in examining the extent to which this relationship is driven by the employment rate (extensive margin) versus average hours worked (intensive margin). We find evidence of procyclical mortality for females at the aggregate level; aggregate male mortality remains largely unaffected by economic fluctuations. Our findings also reveal temporal heterogeneity, as the extensive margin becomes the driving force for female mortality rates during the more recent period (1990 onwards). These findings remain robust when accounting for personal income and pollution. Finally, we find some support for a procyclical relationship for individuals in the working age groups, while mortality exhibits a countercyclical pattern for children (age 0 to 14) and the elderly (age 65 and above). [ABSTRACT FROM AUTHOR]

Injuries continue to be a public health concern in Canada. National injury death data are essential for understanding the magnitude and pattern of injuries. This paper used the Vital Statistics - Death database to examine deaths associated with injuries in 2015. Injuries were ranked against causes of death, and more in-depth analysis of injury categories was conducted by sex and age. Unintentional injuries were the 6th leading causes of death overall, with different ranking by sex. Among unintentional injury deaths, leading causes included falls, poisonings, motor vehicle traffic collisions, and suffocation, which varied by age group. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Studies in Population is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Falls are a leading cause of injury-related deaths and hospitalizations among Canadians. Falls risk has been reported to be increased in individuals who are older and with certain health conditions. It is unclear whether rurality is a risk factor for falls. This study aimed to investigate: 1) fall profiles by age group e.g., 45 to 54 years, 55 to 64 years, 65 to 74 years, 75 to 85 years; and 2) falls profiles of individuals, by age group, living in rural versus urban areas of Canada. Data (N = 51,338) from the Canadian Longitudinal Study on Aging was used to examine the relationship between falls and age, rurality, chronic conditions, need for medical attention, and fall characteristics (manner, location, injury). Self-reported falls within a twelve-month period occurred in only 4.8% (single fall) and 0.8% (multiple falls) of adults. Falls were not related to rural residence or age, but those with memory impairment, multiple sclerosis, as well as other chronic conditions such as mood disorder, anxiety disorder, and hyperthyroidism not often thought to be associated with falls, were also more likely to fall. Older individuals were more likely to fall indoors or fall while standing or walking. In contrast, middle-aged individuals were more likely to fall outdoors or while exercising. Type of injury was not associated with age, but older individuals were more likely to report hospitalization after a fall. This study shows that falls occur with a similar frequency in individuals regardless of age or urban/rural residence. Age was associated with fall location and activity. A more universally applicable multi-facted approach, rather than one solely based on older age considerations, to screening, primary prevention and management may reduce the personal, social, and economic burden of falls and fall-related injuries. [ABSTRACT FROM AUTHOR]

In the era of (re)legalisation of medicinal and recreational cannabis, accidental and intentional exposure to edibles, cannabis-infused food products, has increased substantially. However, there is particular concern regarding younger age groups. Most concerning is the increase in hospitalisations. According to a study by Myran et al. (1), provinces in Canada, where the sale of edibles is permitted, saw an increase in paediatric poisonings due to unintentional consumption of edibles. Similar trends have been observed in "legalised states" in the US, such as Colorado (2). The impact of using cannabis at an early age, but particularly the impact of accidental exposure to high THC quantities, may have negative mental or physical health outcomes. Whilst regulatory restrictions vary significantly from one legalised region to another, it is difficult to identify a best practice. The aim of this study is to identify and discuss new and existing risk mitigation strategies to give guidance to policymakers. Furthermore, practical aspects, such as compliance (e.g. audits by authorities), are discussed. It is noted that edibles have been around much longer than recent political attempts to regulate them. [ABSTRACT FROM AUTHOR]

This paper provides the first analysis of the intergenerational transmission of participation in a Canadian social assistance program. Two sources of intergenerational transmission are taken into account: one that is due to a possible causal link between parents' and children's participation, and one that is due to a correlation between individual and environment specific characteristics across generations. The basic data come from the Québec government's administrative records and cover 17,203 young people who were 18 years old in 1990 and whose parents were recipients of social assistance during at least one month between 1979 and 1990. The results reveal that, on average, a one-percentage unit increase in parental participation during the youth's pre-adult years (age 7–17) raises the youth's participation rate by 0.29 percentage unit during early adulthood (age 18–21). This impact is stronger during the early stages of childhood (age 7–9) and during late adolescence (age 16–17). [ABSTRACT FROM AUTHOR]

The Health Utilities Index Mark 3 (HUI3) is a multi-dimensional, preference-based measure of health status and health-related quality of life (HRQoL). HUI3 scores correlate strongly with self-ratings of health status and functional disability and vary according to age, gender and occupation. In comparative studies relating to HRQoL, it is necessary to carry out adjusted comparison of the health status of the different groups. taking into account unbalanced distribution of confounding variables. This paper describes a stratification method to adjust the distributions of HUI3 scores. This method provides a graphical representation of adjusted distribution of HUI3, which can also be used to adjust other HRQoL scores. Cross-sectional data from the 1998/1999 National Population Health Survey (NPHS) in Canada were used to verify the proposed method. Male agriculture workers and male construction workers in Canada had quite different age distributions but similar HUI3 distributions. After adjusting the age distribution of the construction group to match the distribution of agriculture group, the mean HUI3 score of the former significantly decreased. [ABSTRACT FROM AUTHOR]

Background: The incidence of hospitalizations for acute respiratory infections (ARI) among young Indigenous children from Northern Canada is consistently high. ARIs requiring urgent air transfer can be life-threatening and costly. We aimed to describe their epidemiology, estimate age-specific incidences, and explore factors associated with level of care required. Methods: We undertook a retrospective cohort study of children <5 years old from Northern Canada transferred by urgent air transport for ARI from 2005 through 2014 to 5 pediatric tertiary care centers in Vancouver, Edmonton, Winnipeg, Ottawa and Montreal. Admissions were identified via ARI-related ICD-9/10 coding and forward sortation area. Descriptive statistics and univariable analyses were performed. Results: Among 650 urgent air transfers, the majority were from Nunavut (n = 349, 53.7%) or Nunavik (n = 166, 25.5%), <6 months old (n = 372, 57.2%), and without underlying comorbidity (n = 458; 70.5%). Estimated annual tertiary care ARI admission rates in infants <1 year old from Nunavut (40.7/1000) and Nunavik (44.5/1000) were tenfold higher than in children aged 1 to 4 years. Bronchiolitis (n = 333, 51.2%) and pneumonia (n = 208, 32.0%) were the most common primary discharge diagnoses. Nearly half required critical care (n = 316, 48.6%); mechanical ventilation rates ranged from 7.2% to 55.9% across centres. The most common primary pathogen was respiratory syncytial virus (n = 196, 30.1%). Influenza A or B was identified in 35 cases (5.4%) and vaccine-preventable bacterial infections in 27 (4.1%) cases. Interpretation: Urgent air transfers for ARI from Northern Canada are associated with high acuity. Variations in levels of care were seen across referral centers, age groups and pathogens. [ABSTRACT FROM AUTHOR]

Setting e-flows (instream, environmental or ecological flow regimes) for existing or new hydroelectric and other projects is a key worldwide consideration. A Canadian perspective and experience in arriving at e-flow regimes for ice-free or ice-covered rivers, with emphasis on small and large hydroelectric projects, is presented through general concepts and modeling approaches. Rather than a single standard approach, several methodologies are used throughout Canada, although in some regions preferred techniques may be favoured. Methods range from relatively simple desktop calculations based primarily on hydrological data to sophisticated hydrodynamic and habitat modeling followed by time series analyses. Method complexity usually depends on impact severity, particularly on fish and fish habitat. Multi-jurisdictional, legislative, climatic (e.g. ice regimes) and geographic landscapes present unique challenges for methods, data availability, and tools used to set e-flow regimes. Nature-mimicking approaches are also employed to enhance the ecological integrity of estimated flow regimes by imitating key elements of natural hydrographs and geomorphic features. More holistic approaches and scientific reviews may supplement studies, particularly when complex technical and societal issues are involved. Plans for new or modified hydroelectric projects strive to balance power generation with social and economic considerations, as well as river flow regimes for ecological needs, including fish and fish habitat. [ABSTRACT FROM AUTHOR]

A continuum of ages exists at school entry due to the use of a single school cutoff date-making the “oldest” children approximately 20 percent older than the “youngest” children. We provide substantial evidence that these initial maturity differences have long-lasting effects on student performance across OECD countries. In particular, the youngest members of each cohort score 4-12 percentiles lower than the oldest members in grade four and 2-9 percentiles lower in grade eight. In fact, data from Canada and the United States show that the youngest members of each cohort are even less likely to attend university. [ABSTRACT FROM AUTHOR]

Background: The International Circumpolar Surveillance (ICS) program conducts surveillance on five invasive bacterial diseases: pneumococcal disease (IPD), group A streptococcus (iGAS), Haemophilus influenzae (Hi), meningococcal disease (IMD) and group B streptococcus (GBS). Invasive bacterial diseases have a higher burden of disease in northern populations than the rest of Canada.Methods: To describe the epidemiology of invasive bacterial diseases in northern Canada from 1999 to 2018, data for IPD, iGAS, Hi, IMD and GBS were extracted from the ICS program and the Canadian Notifiable Diseases Surveillance System (CNDSS) and analyzed.Results: The annualized incidence rates for IPD, iGAS, Hi, GBS and IMD were 23.3, 10.5, 8.9, 1.9 and 1.1 per 100,000 population, respectively. The incidence of IPD, iGAS and Hi serotype b were 2.8, 3.2 and 8.8 times higher, respectively, in northern Canada than in the rest of Canada. Rates of disease decreased statistically significantly for IPD (β=-0.02) and increased statistically for iGAS (β=0.08) and Hi serotype a (β=0.04) during the study period. In Northern Canada, the annualized incidence rates for IPD, iGAS and Hi were statistically higher for Indigenous residents than for non-Indigenous residents. The highest incidence rates were among the very young and older age groups.Conclusion: Invasive bacterial diseases represent a high burden of disease in Canada's northern populations. Indigenous peoples, children and seniors are particularly at risk. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Studies in Population is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction and objective: The United States (US) has the highest rate of firearm suicides in the world. The US and Canada are comparable countries with markedly different rates of firearm ownership, providing an opportunity to estimate suicide fatalities that could be averted in the US with a lower rate of firearm ownership. Methods: We compared 2016 US suicide fatality rates–standardized within fourteen sex-specific age groups to reflect the ethnic composition of Canada–to 2016 Canadian suicide rates. We then calculated the number and proportion of suicides that could be averted in the US if the US had the same rates of suicide as in Canada. Results: If the US had the same suicide rates as in Canada, we estimate there would be approximately 25.9% fewer US suicide fatalities, equivalent to 11,630 suicide fatalities averted each year. This decline would be driven by a 79.3% lower rate of firearm-specific suicide fatalities. The male suicide fatality rate would be 28.8% lower and equivalent to 9,992 fewer suicide fatalities each year. The female suicide fatality rate would be 16.0% lower and equivalent to 1,638 fewer suicide fatalities each year. While 36% of firearm suicide fatalities could be replaced by non-firearm suicide fatalities, 64% of firearm fatalities could be averted entirely. Conclusions: US policymakers may wish to consider policies that would reduce rates of firearm ownership, given that that about 26% of US suicide fatalities might be averted if the US had the same suicide rates as in Canada, a country with drastically lower firearm ownership rates. [ABSTRACT FROM AUTHOR]

The number of individuals reporting an Aboriginal Identity in the Census of Population has increased in each census by more than the number of births (minus deaths) of the Aboriginal Identity population. The number reporting an Aboriginal Identity has shown a consistent pattern of increase in each inter-censal period in each age group -- with one exception. As individuals move from the age group of 15-19 years of age to 20-24 years of age, the pattern of increase does not appear for individuals with a First Nations Aboriginal Identity in Canada's four western provinces and in the northern territories. Age matters in the reporting of an Aboriginal Identity. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to: (i) evaluate changes in Canadian children's dietary quality during school hours and on school days between 2004 and 2015; and (ii) explore whether changes in dietary quality over time were moderated by sociodemographic characteristics.Design: Nationally representative 24 h dietary recall data were obtained from the 2004 (n 4827) and 2015 (n 2447) Canadian Community Health Surveys. Dietary quality was measured using the Canadian Healthy Eating Index (C-HEI) which evaluates respondents' compliance with 2007 national dietary recommendations, and the school-HEI which assesses respondents' dietary quality during school hours. Multivariable regression models compared differences in dietary quality between 2004 and 2015. Interaction effects were used to test whether changes over time were moderated by sociodemographic characteristics (sex, age group, ethnicity, residential location, province of residence, parental education, food security status).Setting: Canada.Participants: Children aged 6-17 years.Results: Mean school-HEI score rose from 51.3 to 58.0 points (maximum = 100) from 2004 to 2015 (P < 0.001). School-HEI sub-scores for total vegetables and fruit, whole fruit, dark green and orange vegetables, milk and alternatives, and meat and alternatives improved over time, but remained well below recommendations. Decreased energy from minimally nutritious foods accounted for 39 % of the improvement in mean school-HEI scores. Mean whole day C-HEI scores also improved (60.8 to 66.4 points, P < 0.001). There was no evidence of a moderating effect for any of the sociodemographic variables examined.Conclusions: Mean dietary quality of Canadian children during school hours and on school days improved modestly for all age and sex groups but remained below 2007 national dietary recommendations. [ABSTRACT FROM AUTHOR]

The kindergarten program, Tools of the Mind (Tools), has been shown to improve executive functions (as assessed by laboratory measures) and academic performance. The objective here was to see if Tools can improve executive functions in the real world (in the classroom), academic outcomes not previously investigated, reduce bullying and peer ostracism, and increase teachers’ and students’ joy in being in the classroom. This first randomized controlled trial of Tools in Canada included 351 kindergarten children (mean age 5.2 years at entry; 51% female) in 18 public schools. Stratified randomization resulted in teachers and students in both groups being closely matched. Teachers in both groups received the same number of training hours and same funds for new materials. Outcome measures were pre and post standardized academic skill assessments and teacher online survey responses. This study replicated that Tools improves reading and shows for the first time that it improves writing (far exceeding levels the school districts had seen before), self-control and attention-regulation in the real world (e.g., time on task without supervision), reduces teacher burnout and children being ostracized or excluded, and increases the joy students and teachers experience in school. By Spring, Tools teachers were still enthusiastic about teaching; control teachers were exhausted. These results were not only better than the control group but also better than Tools teachers experienced the year before Tools. Thus, children in a kindergarten curriculum that emphasized play, improving self-regulation, working together and helping one another, and hands-on learning performed better academically, showed less bullying and peer ostracism and more kindness and helping behavior than students in more traditional classes, and teacher enthusiasm for teaching soared. Tools reduced initial disparities separating children, schools, and teachers. [ABSTRACT FROM AUTHOR]

Introduction: La Maison Bleue is a community-based perinatal health and social centre in Montreal that provides services during pregnancy up to age five to families living in vulnerable contexts. The study aimed to describe: 1) the challenges and protective factors that affect the well-being of migrant families receiving care at La Maison Bleue; and 2) how La Maison Bleue strengthens resilience among these families. Methods: We conducted a focused ethnography. Immigrants, refugees, asylum seekers and undocumented migrants were invited to participate. We collected data from November to December 2017 via semi-structured interviews and participant observation during group activities at La Maison Bleue. Data were thematically analysed. Results: Twenty-four mothers participated (9 interviewed, 17 observed). Challenges to well-being included family separation, isolation, loss of support, the immigration process, an unfamiliar culture and environment, and language barriers. Key protective factors were women’s intrinsic drive to overcome difficulties, their positive outlook and ability to find meaning in their adversity, their faith, culture and traditions, and supportive relationships, both locally and transnationally. La Maison Bleue strengthened resilience by providing a safe space, offering holistic care that responded to both medical and psychosocial needs, and empowering women to achieve their full potential towards better health for themselves and their families. Conclusion: Migrant mothers have many strengths and centres like La Maison Bleue can offer a safe space and be an empowering community resource to assist mothers in overcoming the multiple challenges that they face while resettling and raising their young children in a new country. [ABSTRACT FROM AUTHOR]

This study examined profiles of participation in extracurricular activities (ECAs) in 4th grade children (N = 27,121; Mean age = 9.20 years; SD = .54; 51% male) in British Columbia, Canada. Latent class analyses were used to establish activity profiles and determine class membership; ANCOVA was used to investigate differences in mental wellbeing (optimism, life satisfaction, self-concept) and perceived overall health between groups. Data came from a cross-sectional, population-level child self-report survey (i.e., the Middle Years Development Instrument) implemented with 4th grade children in public schools. We found four distinct ECA profiles: participation in “All Activities”, “No activities”, “Sports” (i.e., individual and team sports), and “Individual activities” (i.e., educational programs, arts/music, individual sports). Wellbeing and health scores were highest for children in the “All Activities” and the “Sports” clusters, and lowest for those in “No Activities” and the cluster reflecting individual activities (i.e., “Individual activities”). Results are discussed in the context of previous research, and with respect to practical relevance. [ABSTRACT FROM AUTHOR]

Background: Attention to research and planning are increasingly being devoted to newcomer health, but the needs of newcomers with disabilities remain largely unknown. This information is difficult to determine since population-level data are rarely available on newcomers or on people with intellectual and developmental disabilities (IDD), although in Ontario, Canada these databases are accessible. This study compared the prevalence of IDD among first generation adult newcomers to adult non-newcomers in Ontario, and assessed how having IDD affected the health profile and health service use of newcomers. Methods: This population-based retrospective cohort study of adults aged 19–65 in 2010 used linked health and social services administrative data. Prevalence of IDD among newcomers (n = 1,649,633) and non-newcomers (n = 6,880,196) was compared. Among newcomers, those with IDD (n = 2,830) and without IDD (n = 1,646,803) were compared in terms of health conditions, and community and hospital service use. Results: Prevalence of IDD was lower in newcomers than non-newcomers (171.6 versus 898.3 per 100,000 adults, p<0.0001). Among newcomers, those with IDD were more likely than those without IDD to have comorbid physical health disorders, non-psychotic, psychotic and substance use disorders. Newcomers with IDD were also more likely to have psychiatry visits, and frequent emergency department visits and hospitalizations. Conclusion: First generation adult newcomers have lower rates of IDD than non-newcomers. How much of this difference is attributable to admission policies that exclude people expected to be high health service users versus how much is attributable to our methodological approach is unknown. Finding more medical and psychiatric comorbidity, and more health service use among newcomers with IDD compared to newcomers without IDD is consistent with patterns observed in adults with IDD more generally. To inform polices that support newcomers with IDD future research should investigate reasons for the prevalence finding, barriers and facilitators to timely health care access, and pathways to care. [ABSTRACT FROM AUTHOR]

Introduction: Increases in life expectancy and the underlying age structure of the Canadian population have contributed to dramatic increases in the number of seniors who are caregivers. While caregiving is associated with several adverse health impacts, there is a need to better understand how these impacts might be different among older caregivers, and whether those impacts are modified by socioeconomic status. Methods: We sought to address these research gaps by using cross-sectional data provided by participants of the 2012 Canadian General Social Survey (GSS). Descriptive analyses were performed to compare the self-reported health impacts that participants attributed to caregiving, and how these varied by age and income. Logistic regression analyses were performed to identify which factors were associated with self-reported impacts on overall health among caregivers 65 years of age and older. Results: The demographic characteristics of the care-providers varied substantially by age with older caregivers having lower incomes and devoting more time to caregiving relative to those who were younger. The self-reported impacts of caregiving on overall health were greatest among those between the ages of 35 and 64, and this pattern was evident across all income groups. Feelings of loneliness and social isolation as a result of caregiving responsibilities appeared to be mitigated by both greater age and income. However, across all age groups, caregiving was more likely to adversely impact exercise habits, healthy eating, and alcohol consumption than to promote more positive behaviours. Conclusion: Providing care impacts health behaviours and mental health regardless of age and income. However, our findings suggest that older caregivers (who are most often women)--who provide the most hours of care and on reduced incomes relative to younger caregivers--appear less impacted in terms of health behaviours, perhaps as a result of fewer competing demands relative to younger caregivers. Taken together, these findings suggest that support systems must consider caregiver impacts that vary in complex ways across age, sex, and income. [ABSTRACT FROM AUTHOR]

Objectives: The Healthy Kids Community Challenge is a large-scale, centrally-coordinated, community-based intervention in Ontario, Canada that promotes healthy behaviours towards improving healthy weights among children. With the goal of exploring tools available to evaluators, we leveraged electronic medical records from primary care physicians to assess child weights prior to launch of the Healthy Kids Community Challenge. This study compares the baseline (i.e. pre-intervention) prevalence of overweight and obesity in children 1–12 years of age living within and outside Healthy Kids Community Challenge communities. Design: Cross-sectional analysis of a primary care patient cohort. Setting: Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada. Participants: A cohort of 19 920 Ontario children who are rostered to an EMRALD physician. Children were 1–12 years of age at a primary care visit with recorded measured height and weight, between January 1, 2014 and December 31, 2015. Outcome measure: Overweight and obesity as determined by age- and sex-standardized body mass index using World Health Organization’s Growth Standards. Results: In Healthy Kids Community Challenge communities, 25.6% (95% CI 24.6–26.6%) of children had zBMI above normal (i.e. >1) compared to 26.7% (95% CI 25.9–27.5%) for children living outside of Healthy Kids Community Challenge communities. Conclusions: Despite some differences in sociodemographic characteristics, zBMI of children aged 1–12 years were similar inside and outside of Healthy Kids Community Challenge community boundaries prior to program launch. [ABSTRACT FROM AUTHOR]

Background: Food insecurity is associated with a wide array of negative health outcomes and higher health care costs but there has been no population-based study of the association of food insecurity and mortality in high-income countries. Methods: We use cross-sectional population surveys linked to encoded health administrative data. The sample is 90,368 adults, living in Ontario and respondents in the Canadian Community Health Survey (CCHS). The outcome of interest is all-cause mortality at any time after the interview and within four years of the interview. The primary variable of interest is food insecurity status, with individuals classed as “food secure”, “marginally food insecure”, “moderately food insecure”, or “severely food insecure”. We use logistic regression models to determine the association of mortality with food insecurity status, adjusting for other social determinants of health. Results: Using a full set of covariates, in comparison to food secure individuals, the odds of death at any point after the interview are 1.28 (CI = 1.08, 1.52) for marginally food insecure individuals, 1.49 (CI = 1.29, 1.73) for moderately food insecure individuals, and 2.60 (CI = 2.17, 3.12) for severely food insecure individuals. When mortality within four years of the interview is considered, the odds are, respectively, 1.19 (CI = 0.95, 1.50), 1.65 (CI = 1.37, 1.98), and 2.31 (CI = 1.81, 2.93). Interpretation: These findings demonstrate that food insecurity is associated with higher mortality rates and these higher rates are especially large for the most severe food insecurity category. Efforts to reduce food insecurity should be incorporated into broader public health initiatives to reduce mortality. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the current study was to understand the added effects of having a sensory impairment (vision and/or hearing impairment) in combination with cognitive impairment with respect to health-related outcomes among older adults (65+ years old) receiving home care or residing in a long-term care (LTC) facility in Ontario, Canada. Methods: Cross-sectional analyses were conducted using existing data collected with one of two interRAI assessments, one for home care (n = 291,824) and one for LTC (n = 110,578). Items in the assessments were used to identify clients with single sensory impairments (e.g., vision only [VI], hearing only [HI]), dual sensory impairment (DSI; i.e., vision and hearing) and those with cognitive impairment (CI). We defined seven mutually exclusive groups based on the presence of single or combined impairments. Results: The rate of people having all three impairments (i.e., CI+DSI) was 21.3% in home care and 29.2% in LTC. Across the seven groups, individuals with all three impairments were the most likely to report loneliness, to have a reduction in social engagement, and to experience reduced independence in their activities of daily living (ADLs) and instrumental ADLs (IADLs). Communication challenges were highly prevalent in this group, at 38.0% in home care and 49.2% in LTC. In both care settings, communication difficulties were more common in the CI+DSI group versus the CI-alone group. Conclusions: The presence of combined sensory and cognitive impairments is high among older adults in these two care settings and having all three impairments is associated with higher rates of negative outcomes than the rates for those having CI alone. There is a rising imperative for all health care professionals to recognize the potential presence of hearing, vision and cognitive impairments in those for whom they provide care, to ensure that basic screening occurs and to use those results to inform care plans. [ABSTRACT FROM AUTHOR]

This study examined the influence of walkability on walking behaviour and assessed whether associations varied according to life-stage and population center (PC) size. Walkability scores were obtained for the six-digit postal codes of residential neighbourhoods of 11,200 Canadians, who participated in biennial assessments of the National Population Health Survey from 1994 to 2010. Participants were stratified by age-group. Mixed-effects logistic regression models were used to estimate the influence of cumulative exposure to neighborhood walkability on utilitarian and exercise walking by PC size and life-stage. Associations of neighbourhood walkability with utilitarian and exercise walking varied according to age-group and PC size. Exposure to high walkable neighborhoods was associated with utilitarian walking in younger and older adults in all PC sizes, except for older adults living in a medium PC. Living in a highly walkable neighborhood in a large PC was associated with walking for exercise in younger (OR: 1.42; 95%CI: 1.20–1.67) and older adults (OR: 2.09; 95%CI: 1.51–2.89). Living in highly walkable neighbourhood in a medium PC was associated with walking for exercise in older adults (OR: 1.62; 95%CI: 1.15–2.29). These results emphasize the need to consider the size and nature of every community, and the age-group of a population when implementing strategies to promote walking. [ABSTRACT FROM AUTHOR]

Uncertainty remains regarding the magnitude of effectiveness of influenza vaccines for preventing serious outcomes, especially among young children. We estimated vaccine effectiveness (VE) against laboratory-confirmed influenza hospitalizations among children aged 6–59 months. We used the test-negative design in hospitalized children in Ontario, Canada during the 2010–11 to 2013–14 influenza seasons. We used logistic regression models adjusted for age, season, and time within season to calculate VE estimates by vaccination status (full vs. partial), age group, and influenza season. We also assessed VE incorporating prior history of influenza vaccination. We included specimens from 9,982 patient hospitalization episodes over four seasons, with 12.8% testing positive for influenza. We observed variation in VE by vaccination status, age group, and influenza season. For the four seasons combined, VE was 60% (95%CI, 44%-72%) for full vaccination and 39% (95%CI, 17%-56%) for partial vaccination. VE for full vaccination was 67% (95%CI, 48%-79%) for children aged 24–59 months, 48% (95%CI, 12%-69%) for children aged 6–23 months, 77% (95%CI, 47%-90%) for 2010–11, 59% (95%CI, 13%-81%) for 2011–12, 33% (95%CI, –18% to 62%) for 2012–13, and 72% (95%CI, 42%-86%) for 2013–14. VE in children aged 24–59 months appeared similar between those vaccinated in both the current and previous seasons and those vaccinated in the current season only, with the exception of 2012–13, when VE was lower for those vaccinated in the current season only. Influenza vaccination is effective in preventing pediatric laboratory-confirmed influenza hospitalizations during most seasons. [ABSTRACT FROM AUTHOR]

Introduction: Numerous data sources suggest a decline in child sexual abuse (CSA) in the United States since the early 1990s. Some evidence also indicates that an earlier period of higher CSA incidence began following World War II. This study examines prevalence estimates of sexual abuse reported retrospectively as having occurred in childhood (ChSA) in two nationally representative surveys of the Canadian population. Methods: Data are from 13 931 respondents aged 18 to 76 years from the 2004/2005 Canadian Gender, Alcohol, and Culture: An International Study (GENACIS), and from 22 169 household residents aged 18 years or older who participated in the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). We present inter- and intrasurvey comparisons of ChSA prevalence specific to sex and age groups. Results: Findings from both surveys suggest a decline in CSA since 1993, consistent with declines observed in the United States. Results also suggest that 1946 to 1992 was a period of higher risk of CSA, relative to the period before 1946. The evidence was more robust for women. Conclusion: Evidence of a decline in CSA in Canada since the early 1990s is encouraging, given the long-term debilitating effects with which it is associated. Continued monitoring is critical. The long-term negative effects associated with CSA underscore the importance of continuing to move from lower risk to zero risk. [ABSTRACT FROM AUTHOR]

Introduction: Injuries are a leading cause of death and morbidity. While individual Aboriginal identifiers are not routinely available on national administrative databases, this study examines unintentional injury hospitalization, by cause, in areas with a high percentage of Aboriginal-identity residents. Methods: Age-standardized hospitalization rates (ASHRs) and rate ratios were calculated based on 2004/2005-2009/2010 data from the Discharge Abstract Database. Results: Falls were the most frequent cause of injury. For both sexes, ASHRs were highest in high-percentage First Nations-identity areas; high-percentage Métis-identity areas presented the highest overall ASHR among men aged 20-29 years, and highpercentage Inuit-identity areas presented the lowest ASHRs among men of all age groups. Some causes, such as falls, presented a high ASHR but a rate ratio similar to that for all causes combined; other causes, such as firearm injuries among men in highpercentage First Nations-identity areas, presented a relatively low ASHR but a high rate ratio. Residents of high-percentage Aboriginal-identity areas have a higher ASHR for hospitalization for injuries than residents of low-percentage Aboriginal-identity areas. Conclusion: Residents of high-percentage Aboriginal-identity areas also live in areas of lower socio-economic conditions, suggesting that the causes for rate differences among areas require further investigation. [ABSTRACT FROM AUTHOR]

Objectives. The objective of this article is to measure the contributions of age groups and causes of death to differences in mortality and life expectancy between residents of Inuit Nunangat and the rest of Canada. Study design. The geographic area of coverage includes communities within Inuit Nunangat, with the addition of Inuvik in the Northwest Territories. Deaths were compiled for 2 5-year periods, 1994 through 1998 and 1999 through 2003, with the mid-year centred on the 1996 and 2001 censuses. Methods. Abridged life tables were constructed according to the revised Chiang method. Age decomposition of differences in life expectancy and cause-deleted life tables were calculated using a discrete approach. The age groups and causes contributing to differences in life expectancy between Inuit Nunangat and the rest of Canada were calculated. Results. Specific age groups contribute more to the difference in life expectancy between Inuit Nunangat and the rest of Canada. For males, over 50% of the difference in life expectancy is due to excess mortality before 25 years of age, while for females nearly 65% is due to excess mortality after the age of 60. Conclusions. Cancer is a major contributor to the difference in life expectancy between residents of Inuit Nunangat and the rest of Canada; reduction in cancer rates would make the greatest contribution to gains in life expectancy. There are clear gender differences in life expectancy and mortality, with the total effect of mortality being greatest for males between 15 and 25 years of age and for females over the age of 60. [ABSTRACT FROM AUTHOR]

Background: Alcohol exposure in pregnancy is a common and modifiable risk factor for poor pregnancy and child outcomes. Alcohol exposure in pregnancy can cause a range of physical and neurodevelopmental problems in the child including the Fetal Alcohol Spectrum Disorders (FASD). In order to improve prevention strategies, we sought to describe the knowledge and attitudes of women of childbearing age regarding alcohol consumption during pregnancy and its effects on the fetus. Methods: We conducted a national cross-sectional survey via computer assisted telephone interview of 1103 Australian women aged 18 to 45 years. Participants were randomly selected from the Electronic White Pages. Pregnant women were not eligible to participate. Quotas were set for age groups and a minimum of 100 participants per state to ensure a national sample reflecting the population. The questionnaire was based on a Health Canada survey with additional questions constructed by the investigators. Descriptive statistics were calculated and logistic regression analyses were used to assess associations with participants' knowledge and attitudes. Results: Of women surveyed, 61.5% had heard about effects of alcohol on the fetus and 55.3% had heard of Fetal Alcohol Syndrome. Although 92.7% agreed alcohol can affect the unborn child, 16.2% did not agree that the disabilities could be lifelong. Most women agreed that pregnant women should not drink alcohol (80.2%) and 79.2% reported having negative feelings towards pregnant women drinking alcohol. Women with higher education levels were more likely to know the effects of alcohol consumption in pregnancy (adjusted OR 5.62; 95% CI 3.20 to 9.87) but education level and knowledge were not associated with attitude. Conclusions: There was a disjunction between knowledge and attitudes towards alcohol consumption in pregnancy. These findings will assist in developing effective health promotion campaigns to reduce fetal alcohol exposure and subsequent fetal damage. [ABSTRACT FROM AUTHOR]