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Background: The COVID-19 pandemic has had adverse impacts on mental health and substance use worldwide. Systematic reviews suggest eHealth interventions can be effective at addressing these problems. However, strong positive eHealth outcomes are often tied to the intensity of web-based therapist guidance, which has time and cost implications that can make the population scale-up of more effective interventions difficult. A way to offset cost while maintaining the intensity of therapist guidance is to offer eHealth programs to groups rather than more standard one-on-one formats. Objective: This systematic review aims to assess experimental evidence for the effectiveness of live health professional–led group eHealth interventions on mental health, substance use, or bereavement among community-dwelling adults. Within the articles selected for our primary aim, we also seek to examine the impact of interventions that encourage physical activity compared with those that do not. Methods: Overall, 4 databases (MEDLINE, CINAHL, PsycINFO, and the Cochrane Library) were searched in July 2020. Eligible studies were randomized controlled trials (RCTs) of eHealth interventions led by health professionals and delivered entirely to adult groups by videoconference, teleconference, or webchat. Eligible studies reported mental health, substance use, or bereavement as primary outcomes. The results were examined by outcome, eHealth platform, and intervention length. Postintervention data were used to calculate effect size by study. The findings were summarized using the Synthesis Without Meta-Analysis guidelines. Risk of bias was assessed using the Cochrane Collaboration Tool. Results: Of the 4099 identified studies, 21 (0.51%) RCTs representing 20 interventions met the inclusion criteria. These studies examined mental health outcomes among 2438 participants (sample size range: 47-361 participants per study) across 7 countries. When effect sizes were pooled, live health professional–led

The primary focus of this thesis was to investigate the impact of maternal adverse childhood experiences (ACEs) on two pregnancy outcomes: 1) anxiety symptoms and 2) smoking status. The second objective was to determine whether partner support moderated these associations. Secondary statistical analyses were performed using All Our Families (AOF) study data collected between 2008-2010 in Calgary, Alberta (N = 3,362). Thesis results were non-significant, illustrating that maternal ACEs had no effect on anxiety symptoms and smoking status in pregnancy among a moderate to high socioeconomic status sample. Given that neither of the focal associations under study show statistical significance, partner support as a moderator could not be investigated. It is likely that the moderate to high socioeconomic characteristics of the AOF sample were health protective and ameliorated the negative effects of maternal ACEs on anxiety symptoms and smoking in pregnancy.

Childhood stress has been linked to an increase in cancer-risk behaviours and cancer rates. Addressing health-risk behaviours in adolescence can create healthy lifelong habits. Mindfulness focuses on cultivating present-moment awareness and may offer a healthy coping strategy to youth. This thesis focused on process evaluation of a mindfulness intervention delivered to 17 junior high students attending an alternative school. The main objectives were to assess program adaptation, youth engagement, and youth experience. Technology was successfully integrated into the program. Results were inconclusive on whether adaptations to increase participant safety were successful. Youth were engaged in sessions, though some facilitation improvements were suggested. Participants experienced mindfulness as a quiet time, novel to typical busyness. Youth understandings of mindfulness increased post-intervention, with youth describing it as a tool for relaxation and coping. Findings can be used to strengthen the delivery of mindfulness interventions to youth within alternative schools.

Racial discrimination has been associated with a number of adverse health outcomes. There is limited information regarding racially-motivated housing discrimination and health. This thesis included two studies. Study 1 was a scoping review that examined the impacts of housing discrimination on physical and mental health, and educational pursuits across various ethnic minorities. Study 2 examined the impacts of housing discrimination on PTSD symptomology and university stress among Canadian Indigenous students. Results indicate racially-motivated housing discrimination was associated with reduced physical health outcomes (Study 1); and reduced mental health including increased depression (Study 1) and PTSD symptomology (Study 2). Racially motivated housing discrimination was also associated qualitatively with reduced motivation at university (Study 1), and quantitatively with increased perceptions of stress while at university (Study 2). The results highlight the need for greater policies and program supports to address this problem.

Objective: Examine associations between residential school experiences, adverse childhood experiences, and allostatic load scores among Indigenous students (n = 90) at the University of Lethbridge. Methods: Data for this cross-sectional study were collected through in-person surveys and physical measurements. Results: Participants who had a mother attend residential school evidenced higher allostatic load scores. Having a mother attend residential school was significantly associated with higher adverse childhood experiences. There was no association between feeling the way they were parented was influenced by residential school and higher allostatic load scores. There were also no association between adverse childhood experiences and allostatic load scores. Conclusion: Participants who had a mother attend residential school were significantly more likely to have an allostatic load score in the mid-range rather than a low-range, compared to individuals who did not have a mother attend. Results provide biological evidence for the multigenerational transmission of trauma.

The focus of this thesis was to better understand the link between social environments: namely, the school and workplace; and addictive behaviour among Indigenous youth and adults in Canada. Secondary datasets were accessed and analyzed. Data derived from the 2012 Aboriginal Peoples Survey was used to examine the impacts of the school environment, extracurricular activity, and peer risk behaviour on binge drinking among First Nations and Métis youth aged 15 to 24 living in urban environments. Results indicate that peer risk behaviour was the strongest determinant of binge drinking, but that the school environment both positively and negatively influenced peer behaviour making it an important target for interventions to reduce binge drinking. Results suggest increased opportunities for extracurricular activities at school may also reduce binge drinking among Indigenous youth, particularly among those disengaged from school. Data derived from the Quinte Longitudinal Study was used to examine the role of trauma and changes in job satisfaction and stressful life events on at-risk gambling behaviour among employed Indigenous adults. Overall, results indicate that those who were more satisfied in their work were less likely to engage in at-risk gambling. Among Indigenous women, those who experienced more stressful life events were more likely to engage in at-risk gambling. These findings highlight the need for policies and programs aimed upstream to improve work and school environments and reduce structural inequalities.

Sedentary behaviour is associated with an increased incidence of cardiovascular disease, diabetes, obesity, cancer, depression, and all-cause mortality. In Canada, little is known regarding the prevalence and correlates of sedentary time during leisure. The purpose of this study was to identify sociodemographic, behavioural, community, and health-related factors associated with low sedentary time. Using epidemiological data from the Canadian Community Health Survey, prevalence and correlates of sedentary time were identified among adults in the general population, First Nations adults, and Métis adults living outside Aboriginal communities. Findings indicate a strong association between sense of belonging to community and low sedentary time, and that low income is an important determinant of sedentary behaviour regardless of ethnic group. Use of intersectionality theory highlighted the complexity of this association, particularly among First Nations and Métis adults, and the need to consider the role of social inequities in health behaviour and intervention ideas.

Objective: Exposure to green space is correlated with positive mental health outcomes; however, there is a lack of qualitative studies focusing on experiences of this phenomenon. Therefore, the research objective was to examine individual’s experiences of mental restoration after spending time in urban parks. Methods: A phenomenological approach was used. Fifteen participants in Lethbridge, Alberta, were interviewed, all of whom used parks and believed it benefitted their mental health. Results: Analysis revealed four main themes highlighted by participants, including connections to nature, connections to community, connections to themselves, and built environment features. These themes may be important aspects of the experience of mental restoration and may factor in the relationship between green space and mental health. Conclusion: The results support ongoing development of a variety of urban green spaces. Further, they suggest the need for more research into the complex relationship between green space and mental health and moderating factors.

Objective: Exposure to green space is correlated with positive mental health outcomes; however, there is a lack of qualitative studies focusing on experiences of this phenomenon. Therefore, the research objective was to examine individual’s experiences of mental restoration after spending time in urban parks. Methods: A phenomenological approach was used. Fifteen participants in Lethbridge, Alberta, were interviewed, all of whom used parks and believed it benefitted their mental health. Results: Analysis revealed four main themes highlighted by participants, including connections to nature, connections to community, connections to themselves, and built environment features. These themes may be important aspects of the experience of mental restoration and may factor in the relationship between green space and mental health. Conclusion: The results support ongoing development of a variety of urban green spaces. Further, they suggest the need for more research into the complex relationship between green space and mental health and moderating factors.

Objective: We examined the prevalence and correlates of prescription drug misuse (PDM) in a population-based sample of adults from Alberta. Methods: Data were collected from 3511 adults in Alberta aged 18 years and older in 2002 using a computer-aided telephone survey; the survey response rate was 57.4%. Results: The prevalence of 12-month PDM in Alberta was 8.2% in 2002. Opiates were the most frequently misused drug class, followed by sedatives, stimulants, and tranquilizers. Current disability was particularly associated with PDM. Odds of PDM were also elevated among adult students and adults with a high school diploma relative to adults with a post-secondary degree. Past-year problem gambling, illicit drug use, and alcohol use and dependence were each associated with PDM, while past-year binge drinking and daily smoking were not. Conclusions: Findings suggest PDM was an important public health concern in Alberta in 2002. Estimates suggest prescription use and misuse have increased substantially in Canada since that time. There is an urgent need for an ongoing assessment of this evolving problem so that effective prevention and therapeutic strategies can be developed.

Objective: To examine associations between Aboriginal enculturation, Canadian acculturation, and alcohol problems among Aboriginal university students living in an urban area in Canada. Methods: Data for this mixed methods study were collected through in-person surveys with a convenience sample of Aboriginal university students (n = 60) in 2008/2009. Results: Students evidenced high levels of Aboriginal enculturation and Canadian acculturation. Aboriginal enculturation was significantly associated with reduced alcohol problems for Aboriginal university students. There was no association between Canadian acculturation and alcohol problems. Qualitative findings suggest Aboriginal cultural practices helped students cope with problems in their daily lives and provided them with both personal and social rewards. Conclusions: This study found Aboriginal enculturation was significantly associated with reduced alcohol problems among Aboriginal university students. Results support the growth of programs and services that encourage Aboriginal students to maintain their cultural identity within the university setting. Can J Psychiatry. 2011;56(12)