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The number of people with dementia worldwide will reach 115.4 million by 2050. This accelerating crisis has sparked research on how to design neighbourhoods for those with early dementia, and how to empower them through built environment changes to remain in their community for as long as possible. There are numerous benefits for persons with dementia who continue access to their neighbourhood: physical activity, sense of dignity, social interaction, autonomy and psychological wellbeing. In this paper, I examine 17 recommendations (urban design and land use strategies) identified as ‘dementia-friendly’, within dementia design and planning literature. Each is then examined against the planning frameworks for a mid-size suburban municipality in Ontario and assessed for its financial impact on a base case subdivision using pro forma analysis. The effect on the financial return for a developer was minimal, demonstrating that establishing these recommendations as policy is viable, through regulation and incentives. [ABSTRACT FROM AUTHOR]

Background: In 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16–24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers' perceptions, practices, and recommendations on youth cannabis use. Methods: This mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16–24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis. Results: The survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services. Conclusion: Youth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms. [ABSTRACT FROM AUTHOR]

This study's goal was to determine the prevalence, temporal trends, seasonal patterns, and temporal clustering of Salmonella enterica isolated from environmental samples from Ontario's poultry breeding flocks between 2009 and 2018. Clusters of common serovars and those of human health concern were identified using a scan statistic. The period prevalence of S. enterica was 25.3% in broiler breeders, 6.4% in layer breeders, and 28.6% in turkey breeders. An overall decreasing trend in S. enterica prevalence was identified in broiler breeders (from 27.8% in 2009 to 22.1% in 2018) and layer breeders (from 15.4% to 4.9%), while an increasing trend was identified in turkey breeders (from 12.0% to 24.5%). The most common serovars varied by commodity. Among broiler breeders, S. enterica serovars Kentucky (42.4% of 682 submissions), Heidelberg (19.2%), and Typhimurium (5.4%) were the most common. Salmonella enterica serovars Thompson (20.0% of 195 submissions) and Infantis (16.4%) were most common among layer breeders, and S. enterica serovars Schwarzengrund (23.6% of 1368 submissions), Senftenberg (12.9%), and Heidelberg and Uganda (9.6% each) were most common among turkey breeders. Salmonella enterica ser. Enteritidis prevalence was highest in submissions from broiler breeders (3.7% of 682 broiler breeder submissions). Temporal clusters of S. enterica serovars were identified for all poultry commodities. Seasonal effects varied by commodity, with most peaks occurring in the fall. Our study provides information on the prevalence and temporality of S. enterica serovars within Ontario's poultry breeder flocks that might guide prevention and control programs at the breeder level. [ABSTRACT FROM AUTHOR]

Cultural safety training is a resource that healthcare institutions and staff can rely on to end anti-Indigenous racism in their organisations and to shift service providers' attitudes, beliefs, and knowledge of Indigenous people. The aim of this study was to understand the initial knowledge and interest about Indigenous Peoples that a southern Ontario public health unit's (PHU) staff hold. A cultural safety micro-credential project was developed in consultation with the PHU. An online survey was administered from January to March 2021 to those who were starting the micro-credential during this timeframe (n = 31). Thirty-one staff responded. A majority of the participants indicated that they had some knowledge of Indigenous Peoples and that this knowledge was relevant to their work. The number of interactions with Indigenous Peoples varied by role. Common themes for the open-ended responses included culture, relationships, and supports/services. Many of the open-ended responses highlighted feelings of not knowing enough and wanting to learn more about Indigenous Peoples. These results indicate a shift in attitudes, behaviours, and knowledge of Indigenous Peoples among the PHU staff. Cultural safety training can serve to address knowledge gaps and contribute to creating the systemic change needed to end anti-Indigenous racism in healthcare institutions. [ABSTRACT FROM AUTHOR]

This paper analyzes the community health of the Wikwemikong Unceded Indian Reserve (WUIR), Ontario, Canada. Results are reported from fieldwork including participant observation, key informant interviewing and self-reported data measuring health status, risk behaviour, place of residence, self-identity, and personal history extracted from 350 interviews conducted during a community-wide needs assessment. The research aimed to create a health plan for the community; however, subsequent analysis of the needs assessment results indicates that internal diversity exists in health status and needs between the seven villages that comprise WUIR. The analysis suggests variation in health status and risk-taking behaviour among community members may be related to varying colonial histories among the villages. The implications of intra-community variation in health status in First Nations are discussed in relation to influential health policy theories such as the determinants of health and health transfer policy in Canada. [Copyright &y& Elsevier]

Abstract: This paper contributes to the current debates surrounding private delivery of health care services by addressing the distinctive challenges, constraints and opportunities facing for-profit and non-profit providers of long-term care in rural and small town settings. It focuses on the empirical case of Ontario, Canada where extensive restructuring of long-term care, under the rubric of managed competition, has been underway since the mid-1990s. In-depth interviews with 72 representatives from local governments, public health institutions and authorities, for-profit and non-profit organisations, and community groups during July 2003 to December 2003 form the platform for a qualitative analysis of the implications of managed competition as it relates to the provision of long-term care in the countryside. The results suggest that the introduction and implementation of managed competition has accentuated the problems of service provision in rural communities, and that the long-standing issues of caregiving in rural situations transcend the differences, perceived or otherwise, between for-profit and non-profit provision. Understanding the implications of market-oriented long-term care restructuring initiatives for providers, and their clients, in rural situations requires a re-focussing of research beyond the for- versus non-profit dichotomy. [Copyright &y& Elsevier]

Background: Since 2007, all Canadian provinces and territories have had a publicly funded program for vaccination against human papillomavirus (HPV) infection. The objective of this study was to describe the evolution of these vaccination programs. Methods: This was a targeted literature review of public HPV vaccination programs and vaccination coverage rates, based on information provided by jurisdictional public health authorities. Results: HPV vaccination of schoolgirls began in school years 2007/08 to 2010/11 with three doses of the quadrivalent HPV vaccine in all provinces except Quebec, which started with two doses. By 2018/19, all jurisdictions were vaccinating with two doses of the nonavalent vaccine in both girls and boys, except Quebec, which used a mixed vaccination schedule with one dose of the nonavalent and one dose of the bivalent vaccines. Public HPV vaccination programs in most provinces include after-school catch-up vaccination. Immunocompromised or other high-risk individuals are eligible for the HPV public vaccination program in most provinces, but policies vary by jurisdiction. In 2017/18, vaccination coverage rates in provincial HPV school-based programs varied from 62% in Ontario to 86% in Prince Edward Island in girls and from 58% in Ontario to 86% in Prince Edward Island in boys. Conclusions: Since their introduction, Canadian school-based HPV public vaccination programs have evolved from a three-dose to a two-dose schedule, from a quadrivalent to a nonavalent vaccine, and from a girls-only to a gender-neutral policy. Vaccination coverage rates have varied markedly and only Prince Edward Island and Newfoundland/Labrador have maintained rates exceeding 80%. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to pilot test the English and Urdu version of the Colon Cancer Screening Behaviours Survey among South Asians in Canada. The first objective was to evaluate feasibility of administration, data collection using computer assisted personal interviewing software on a tablet, and response burden. The second objective was to examine the prevalence of colorectal cancer screening among South Asians and evaluate the psychometric properties of sub-scales in the survey. Methods: Purposive, network and snowball sampling were used to recruit participants for this cross-sectional study. Interviewer-led administration of the Colon Cancer Screening Behaviours Survey was conducted across two cities in Ontario, Canada. Qualitative data analysis assessed feasibility; and sub-scales were evaluated through principal component analysis, item-scale correlations, and construct validity using multiple linear and logistic regression. Results: A total of 328 South Asians participated, 47% Urdu speaking, and 53% English speaking. There was a 23% refusal rate to participate. Feasibility identified: (1) successful recruitment despite reasons for refusal; (2) problematic items and response categories; and (3) computer/tablet limitations. Principal component analysis identified 14 components that explained 68.7% of total variance; 34 items were retained after factor analysis. Internal consistency of 4 scales ranged from 0.79–0.91. There were significant differences in perceived barriers scale scores (− 12.21; 95% CI, − 17.13 to - 7.28; p < 0.0001) between those who participated and those who did not participate in screening. No association was found with years of residence and uptake of screening after adjustment (OR 0.91 (0.46–1.79), p = 0.783). Conclusions: Recruitment and data collection methods are feasible among South Asians if functionality of the tablet selected is improved. The Colon Cancer Screening Behaviours Survey was finalized and retained items in sub-scales demonstrated good psychometric properties to assess behaviours for colon cancer screening among South Asians in Canada. The interviewer-led survey may be used by public health, cancer care or other health practitioners to describe or predict colorectal cancer screening behaviours among South Asians in similar settings or adapted and tested in other contexts. [ABSTRACT FROM AUTHOR]

New permanent residents to Ontario can experience difficulties accessing health services due to the 3-month residency requirement for provincial healthcare coverage. This scoping literature review, which included peer-reviewed articles and gray literature from 1993-2013, examined the effects of the 3-month waiting period on the health of new permanent residents to Ontario, public health, and the health-care system. At the individual level, issues of affordability, pre-existing conditions, and quality of care were prominent throughout the literature. At a systems level, the policy was found to constrain various health-care settings, pose a risk to public health, and compound health-care system costs. [ABSTRACT FROM AUTHOR]

The objective of our study was to estimate direct healthcare costs incurred by a population-based sample of people with psychological distress or depression. We used the 2002 Canadian Community Health Survey on Mental Health and Well Being and categorized individuals as having psychological distress using the Kessler-6, major depressive disorder (MDD) using DSM-IV criteria and a comparison group of participants without MDD or psychological distress. Costs in 2013 USD were estimated by linking individuals to health administrative databases and following them until March 31, 2013. Our sample consisted of 9,965 individuals, of whom 651 and 409 had psychological distress and MDD, respectively. Although the age-and-sex adjusted per-capita costs were similarly high among the psychologically distressed ($3,364, 95% CI: $2,791, $3,937) and those with MDD ($3,210, 95% CI: $2,413, $4,008) compared to the comparison group ($2,629, 95% CI: $2,312, $2,945), the population-wide excess costs for psychological distress ($441 million) were more than twice that for MDD ($210 million) as there was a greater number of people with psychological distress than depression. We found substantial healthcare costs associated with psychological distress and depression, suggesting that psychological distress and MDD have a high cost burden and there may be public health intervention opportunities to relieve distress. Further research examining how individuals with these conditions use the healthcare system may provide insight into the allocation of limited healthcare resources while maintaining high quality care. [ABSTRACT FROM AUTHOR]

Background: Homicide - a lethal expression of violence - has garnered little attention from public health researchers and health policy makers, despite the fact that homicides are a cause of preventable and premature death. Identifying populations at risk and the upstream determinants of homicide are important for addressing inequalities that hinder population health. This population-based study investigates the public health significance of homicides in Ontario, Canada, over the period of 1999-2012. We quantified the relative burden of homicides by comparing the socioeconomic gradient in homicides with the leading causes of death, cardiovascular disease (CVD) and neoplasm, and estimated the potential years of life lost (PYLL) due to homicide. Methods: We linked vital statistics from the Office of the Registrar General Deaths register (ORG-D) with Census and administrative data for all Ontario residents. We extracted all homicide, neoplasm, and cardiovascular deaths from 1999 to 2012, using International Classification of Diseases codes. For socioeconomic status (SES), we used two dimensions of the Ontario Marginalization Index (ON-Marg): material deprivation and residential instability. Trends were summarized across deprivation indices using age-specific rates, rate ratios, and PYLL. Results: Young males, 15-29 years old, were the main victims of homicide with a rate of 3.85 [IC 95%: 3.56; 4.13] per 100,000 population and experienced an upward trend over the study period. The socioeconomic neighbourhood gradient was substantial and higher than the gradient for both cardiovascular and neoplasms. Finally, the PYLL due to homicide were 63,512 and 24,066 years for males and females, respectively. Conclusions: Homicides are an important cause of death among young males, and populations living in disadvantaged neighbourhoods. Our findings raise concerns about the burden of homicides in the Canadian population and the importance of addressing social determinants to address these premature deaths. [ABSTRACT FROM AUTHOR]

In Ontario, Canada, the implementation of an annual rabies control programme in wildlife that began in 1989 resulted in a marked, steady decrease in the number of animal rabies cases. The number of animal rabies cases decreased from 1870 in 1989 to 183 in 2000 (Nunan et al., 2002 Emerg Infect Dis 8, 214). In our study period, the number of animal rabies cases continued to decrease from 210 in 2001 to 28 in 2012. The marked decrease in animal rabies cases since 1989 has resulted in a decrease in the risk of human infection. A concomitant decrease in the number of rabies post-exposure prophylaxis (RPEP) administered was anticipated but failed to occur. The mean rate of RPEP, 13.9 RPEP administered per 100 000 persons, from 2001-2012 was approximately the same as the rate in the 1990s. Two possible reasons that the rate of RPEP administration has not decreased include strict adherence to RPEP recommendations and administration of RPEP when it is not recommended. A reduction in the number of RPEP administered, consistent with the decrease in the animal rabies cases, would provide some financial savings for the government. Ideally, an increased use of the risk assessment approach in keeping with recent guidelines, rather than adhering to previous prescriptive recommendations for RPEP administration, coupled with a continuing low incidence of animal rabies cases will result in decreased, and yet appropriate, use of RPEP. Consideration should be given to identify how guidelines could be revised to more effectively target high-risk exposures and reduce the administration of RPEP for instances in which the risk of rabies virus exposure is exceedingly low. [ABSTRACT FROM AUTHOR]

The public health system in the province of Ontario in Canada is a publicly funded system that is responsible for addressing the health status of the population. Public health involves the combined effort of all levels of government (federal, provincial, municipal) in the country to strengthen the health system and promote the health of Canadians. The federal Canada Health Act guides the delivery of health services, with the administration of the health system a provincial responsibility. There are multiple organizations involved in public health including the Ontario Ministry of Health and Long-Term Care, Local Health Integration Networks, local Boards of Health, Public Health Ontario, and the Ontario Public Health Association. Public health program costs at Ontario's 36 public health units are shared between municipal and provincial governments. Public health initiatives undertaken by public health units and governmental agencies are aimed at addressing and improving the population's determinants of health. [ABSTRACT FROM AUTHOR]

Background: Addressing the social determinants of health (SDH) is identified as a role for local public health units (PHUs) in the province of Ontario. Despite this authorization to do so there is wide variation in PHU practice. In this article we consider the factors that shape local PHU action on the SDH through a critical realist analysis. Methods: Interviews with Medical Officers of Health (MOHs) and lead staff from nine PHUs in Ontario identify the structures and powers that allow PHUs to address the SDH as well as the many factors that either activate or inhibit these structures and powers. Results: We found that personal backgrounds and attitudes of MOHs and leading staff people as well as local jurisdictional characteristics shape whether and how PHUs carry out SDH-related activities. Conclusions: Action on the SDH is a result of a complex interplay of micro-, meso- and macro-level factors that requires recognition of the contested nature of public health, presence of Ministry of Health mandates, local jurisdictional characteristics, and politics. The most effective way to assure PHU action on the SDH is for the Ministry of Health and Long-Term Care to mandate such activities and develop accountability mechanisms that assure implementation. [ABSTRACT FROM AUTHOR]

The province of Ontario hosts nearly a half of Canada's temporary foreign migrant farm workers (MFWs). Despite the essential role played by MFWs in the economic prosperity of the region, a growing body of research suggests that the workers' occupational safety and health are substandard, and often neglected by employers. This study thus explores farm owners' perceptions about MFWs occupational safety and general health, and their attitudes towards health promotion for their employees. Methods Using modified grounded theory approach, we collected data through in-depth individual interviews with farm owners employing MFWs in southern Ontario, Canada. Data were analyzed following three steps (open, axial, and selective coding) to identify thematic patterns and relationships. Nine employers or their representatives were interviewed. Results Four major overarching categories were identified: employers' dependence on MFWs; their fragmented view of occupational safety and health; their blurring of the boundaries between the work and personal lives of the MFWs on their farms; and their reluctance to implement health promotion programs. The interaction of these categories suggests the complex social processes through which employers come to hold these paradoxical attitudes towards workers' safety and health. There is a fundamental contradiction between what employers considered public versus personal. Despite employers' preference to separate MFWs' workplace safety from personal health issues, due to the fact that workers live within their employers' property, workers' private life becomes public making their personal health a business-related concern. Farmers' conflicting views, combined with a lack of support from governing bodies, hold back timely implementation of health promotion activities in the workplace. Conclusions In order to address the needs of MFWs in a more integrated manner, an ecological view of health, which includes the social and psychological determinants of health, by employers is necessary. Employers and other stakeholders should work collaboratively to find a common ground, harnessing expertise and resources to develop more community-based approaches. Further research and continuous dialogue are needed. [ABSTRACT FROM AUTHOR]

Cannabis use and driving (CUD) is a growing public health concern. This study's main objective was to identify distinguishing characteristics associated with high-frequency CUD (HFCUD) activity (i.e., CUD &nvgt; 12 times) in a multi-site sample of university students who had self-identified as having driven a car within 4 hours of cannabis use in the past year. Participants for the study (n = 248; age 18-28 years) were recruited by mass advertising at five universities in Ontario. Participants were screened for eligibility and assessed by an anonymous interview between April 2005 and March 2006. Bivariate analyses determined factors associated with HFCUD (i.e., &nvgt; 12 times) vs. a low frequency of CUD (LFCUD); significant factors were subsequently entered into a discriminant function analysis model. HFCUD was associated with several variables, including frequent (i.e., at least weekly) cannabis use; daily driving; perception of own ability to drive not being impaired by cannabis use; and expectation of CUD in the next 12 months (all p < 0.0001). CUD among young drivers is an important health and safety risk requiring effective interventions. Given the strong association of HFCUD with frequent cannabis use, these phenomena need to be addressed conjointly. Furthermore, preventive interventions responsive to the specific socio-cultural contexts of possible CUD need to be developed and implemented. [ABSTRACT FROM AUTHOR]

Post-North American Free Trade Agreement (NAFTA) trade liberalisation combined with post-9/11 border securitisation means North America increasingly relies on pools of temporary foreign labour, particularly in the agricultural and service sectors. Despite being temporary, these workers often spend most of their years on foreign soil, living and working in isolated rural communities, far from their own families and communities. Migrants' mental and physical health suffers due to hazardous and stressful working conditions, sub-standard housing, lack of social support and limited access to health and social welfare services. Assuming access to health is a basic human right, who is responsible for the health of temporary foreign migrant workers? Is it the nation-state? or the Employers and/or unions? or Civil society? Research and practice show that a combined multisector approach is best; however, such initiatives are often uneven due to questions of sovereignty and citizenship rights. Community-based organisations (CBOs) have emerged to advocate for and serve migrants' social and welfare needs; analysis of CBO projects reveals an uneven application of rights to migrants. Using a comparative case study from Canada, this project contributes to understanding how civil-society helps to activate different types of health care rights for migrants, and to create an informed policy that provides migrant workers with access to a wider range of human and health rights. [ABSTRACT FROM PUBLISHER]

Background: Food insecurity is a serious public health issue for Aboriginal people (First Nations [FN], Métis, and Inuit) living in Canada. Food security challenges faced by FN people are unique, especially for those living in remote and isolated communities. Conceptualizations of food insecurity by FN people are poorly understood. The purpose of this study was to explore the perceptions of food insecurity by FN adults living in a remote, on-reserve community in northern Ontario known to have a high prevalence of moderate to severe food insecurity. Methods: A trained community research assistant conducted semi-directed interviews, and one adult from each household in the community was invited to participate. Questions addressed traditional food, coping strategies, and suggestions to improve community food security and were informed by the literature and a community advisory committee. Thematic data analyses were carried out and followed an inductive, data-driven approach. Results: Fifty-one individuals participated, representing 67% of eligible households. The thematic analysis revealed that food sharing, especially with family, was regarded as one of the most significant ways to adapt to food shortages. The majority of participants reported consuming traditional food (wild meats) and suggested that hunting, preserving and storing traditional food has remained very important. However, numerous barriers to traditional food acquisition were mentioned. Other coping strategies included dietary change, rationing and changing food purchasing patterns. In order to improve access to healthy foods, improving income and food affordability, building community capacity and engagement, and community-level initiatives were suggested. Conclusions: Findings point to the continued importance of traditional food acquisition and food sharing, as well as community solutions for food systems change. These data highlight that traditional and store-bought food are both part of the strategies and solutions participants suggested for coping with food insecurity. Public health policies to improve food security for FN populations are urgently needed. [ABSTRACT FROM AUTHOR]

Background: Climate change is among the major challenges for health this century, and adaptation to manage adverse health outcomes will be unavoidable. The risks in Ontario - Canada's most populous province - include increasing temperatures, more frequent and intense extreme weather events, and alterations to precipitation regimes. Socio-economic-demographic patterns could magnify the implications climate change has for Ontario, including the presence of rapidly growing vulnerable populations, exacerbation of warming trends by heat-islands in large urban areas, and connectedness to global transportation networks. This study examines climate change adaptation in the public health sector in Ontario using information from interviews with government officials. Methods: Fifty-three semi-structured interviews were conducted, four with provincial and federal health officials and 49 with actors in public health and health relevant sectors at the municipal level. We identify adaptation efforts, barriers and opportunities for current and future intervention. Results: Results indicate recognition that climate change will affect the health of Ontarians. Health officials are concerned about how a changing climate could exacerbate existing health issues or create new health burdens, specifically extreme heat (71%), severe weather (68%) and poor air-quality (57%). Adaptation is currently taking the form of mainstreaming climate change into existing public health programs. While adaptive progress has relied on local leadership, federal support, political will, and inter-agency efforts, a lack of resources constrains the sustainability of long-term adaptation programs and the acquisition of data necessary to support effective policies. Conclusions: This study provides a snapshot of climate change adaptation and needs in the public health sector in Ontario. Public health departments will need to capitalize on opportunities to integrate climate change into policies and programs, while higher levels of government must improve efforts to support local adaptation and provide the capacity through which local adaptation can succeed. [ABSTRACT FROM AUTHOR]