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Objective Bullying victimization among adolescents has been well-recognized as a behavior associated with adverse psychological and mental health outcomes. Most studies on bullying victimization have focused on adolescents, but research is sparse regarding school victimization among preadolescents before they transition to adolescence. This study sought to identify latent classes of different types of co-occurring bullying victimization, based on a sample of 3829 school students in grades 5–8, ages 9–14 in the year of 2011 from the Saskatoon Health Region, Saskatchewan, Canada. Results Using a latent class analysis approach, the results uncovered three groups of victimized students, including those who were aggressively victimized (7.2%), moderately victimized (34.6%) and non-victimized (58.2%). Younger age and being overweight was associated with a higher likelihood of bullying victimization. Moderately and aggressively victimized students had greater probabilities of feeling like an outsider, experiencing anxiety, depressed moods, engaging in suicidal ideation and drinking when compared to non-victimized students. Peer and parent supports had significant protective effects against being victimized. Given the negative consequences of recurrent victimization among the preadolescents, it is imperative to address bullying incidents as they occur to prevent repeated transgressions, especially for those who suffer from multiple types of victimization.

BACKGROUND We present the health inequalities analytic approach used by the Saskatoon Health Region to examine health equity. Our aim was to develop a method that will enable health regions to prioritize action on health inequalities. METHODS Data from admissions to hospital, physician billing, reportable diseases, vital statistics and childhood immunizations in the city of Saskatoon were analyzed for the years ranging from 1995 to 2011. Data were aggregated to the dissemination area level. The Pampalon deprivation index was used as the measure of socioeconomic status. We calculated annual rates per 1000 people for each outcome. Rate ratios, rate differences, area-level concentration curves and area-level concentration coefficients quantified inequality. An Inequalities Prioritization Matrix was developed to prioritize action for the outcomes showing the greatest inequality. The outcomes measured were cancer, intentional self-harm, chronic obstructive pulmonary disease, mental illness, heart disease, diabetes, injury, stroke, chlamydia, tuberculosis, gonorrhea, hepatitis C, high birth weight, low birth weight, teen abortion, teen pregnancy, infant mortality and all-cause mortality. RESULTS According to the Inequalities Prioritization Matrix, injuries and chronic obstructive pulmonary disease were the first and second priorities, respectively, that needed to be addressed related to inequalities in admissions to hospital. For physician billing, mental disorders and diabetes were high-priority areas. Differences in teen pregnancy and all-cause mortality were the most unequal in the vital statistics data. For communicable diseases, hepatitis C was the highest priority. INTERPRETATION Our findings show that health inequalities exist at the local level and that a method can be developed to prioritize action on these inequalities. Policies should consider health inequalities and adopt population-based and targeted actions to reduce inequalities.

ObjectiveThe objective of this research is to identify people with mental health and/or addiction (MHA) problems and determine characteristics that led to them becoming a superuser of health services (i.e., the most expensive 10% of all health service users). ApproachIn Saskatchewan, Canada, we used hospital and physician administrative data spanning 2005 to 2014 to identify the MHA cohort. We will calculate total health care costs for each individual and assign them to one of three groups: low cost users (

Objective We were funded by Canadian Institutes of Health Research Strategy for Patient Oriented Research (CIHR-SPOR) to use administrative data to identify people with mental health and/or addiction (MHA) problems, and determine characteristics that lead to them becoming a superuser of health services. The aim of the CIHR-SPOR is to ensure that research improves healthcare systems and practices. Their approach is to fundamentally change the ivory tower nature of research to make it more inclusive, user friendly, and timely. An essential component of the CIHR-SPOR is engaging patients as partners at all stages of the research. In this presentation we will describe the challenges, successes, and failures of engaging patients as part of the research team. Approach In Saskatchewan, Canada, we engaged with community programs to determine the ‘on-the-ground’ reality of people living with MHA problems. Our discussions revealed that First Nations and Métis People are highly overrepresented in the MHA patient population. For example, they comprise 15% of the Saskatchewan population yet 70% of patients receiving treatment at a local methadone clinic. For this reason, we are focusing our efforts on engaging with this specific patient population. Results We encountered a number of barriers to finding patient advisors. First, patient advisors available through institutional programs are not representative of our target population, being more affluent, well-educated, and Caucasian. There are currently no formal avenues to identify and invite members of the target population to join the research team and so we are using personal connections and team building to identify patients advisors. Second, complicated institutional policies on reimbursement for patient advisors impede participation by low income individuals. Third, we are concerned the socioeconomic disparities common in this vulnerable population may impede their full and honest participation as a patient advisor. Conclusions Patients and their family members are invaluable members of the research team. However, a power differential often exists between team members and patients due to socioeconomic differences, including race and education. Stigmatized health conditions such as MHA problems can exacerbate the feelings of a power differential. All of these things can prevent genuine involvement by patients. The most important step in successfully involving these untraditional team members is building trust through unconditional acceptance and respect for each individual’s lived experience. Building trust takes time and so patient engagement cannot be expected to follow a rigid schedule.

OBJECTIVES: Foodborne illness is an important contributor to morbidity and health system costs in Canada. Using number of critical hazards as a proxy for food safety, we sought to better understand how to improve food safety in restaurants. We compared the current standard of annual inspections to twice-yearly inspections among restaurants “at risk” for food safety infractions. These were restaurants that had three or more elevated-risk inspection ratings in the preceding 36 months. METHODS: We conducted a two-arm randomized controlled trial between November 2012 and October 2014. The intervention was twice-yearly routine restaurant inspection compared to standard once-yearly routine inspection. Included were all restaurants within Saskatoon Health Region that were assessed as “at risk”, with 73 restaurants in the intervention arm and 78 in the control arm. Independent sample t -tests were conducted between groups to compare: i) average number of critical hazards per inspection; and ii) proportion of inspections resulting in a rating indicating an elevated hazard. RESULTS: Over time we noted statistically significant improvements across both study arms, in number of both critical food safety hazards (decreased by 61%) and elevated-risk inspection ratings (decreased by 45%) ( p < 0.0001). We observed no significant differences between the two groups pre- or post-intervention. CONCLUSION: Results suggest increasing the number of annual routine inspections in high-risk restaurants was not associated with a significant difference in measures of compliance with food safety regulations. Findings of this study do not provide evidence supporting increased frequency of restaurant inspection from annually to twice annually.

OBJECTIVES: To examine the prevalence and predictors associated with cybervictimization among preadolescents in a community-based sample from Canada. METHODS: Data were drawn from a cohort of 5783 students of grades 5–8, aged 9–14 from 109 elementary schools at the Saskatoon Health Region, Saskatchewan of Canada based on the Student Health Survey in the year of 2010–2011. Multivariate logistic regression with the generalized estimating equation was used to determine the individual and contextual factors associated with self-reported cybervictimization. RESULTS: Of the 5783 school children, 5611 (97.0%) responded to the question regarding cybervictimization. Among those respondents, 572 (10.2%) reported being cyberbullied at least once in the past four weeks. The students most likely to be victimized by cyberbullying were girls, students in grades 7 and 8 compared with grade 5, Aboriginal students compared to non-Aboriginal students, those who had lived part of their life outside of Canada compared with those who lived all of their life in Canada, those who reported drinking alcohol in the past, those who reported very elevated depressive symptoms, those who were traditionally bullied, those who had low self-esteem, and those who had a poor relationship with their parents. School-level variation in cyberbullying victimization is negligible. School neighbour-level deprivation is not significant after adjusting for individual-level characteristics and parent–child relationship. CONCLUSION: Our findings identified important characteristics of preadolescents with higher susceptibility to cybervictimization in a Canadian setting, which can be used to develop intervention strategies for mitigating cybervictimization among the study population.

OBJECTIVE: Our objective was to determine the effectiveness of an intervention, the Immunization Reminders Project, in terms of a) improving vaccination coverage rates for measles, mumps and rubella (MMR) among 2-year-olds and b) ameliorating geographical disparities in early childhood immunization coverage. TARGET POPULLATION: All 14-month-old and 20-month-old children in Saskatoon Health Region who were overdue for their immunizations. SETTING: Saskatoon Health Region (SHR). INTERVENTION: The intervention involved calling the parents/caregivers of the children in the target population with a reminder about immunizations. After five telephone calls and if the parent/caregiver could not be reached, a letter was mailed to the last known address. If there was no response to the letter, a reminder home visit was attempted for families residing in the low-income neighbourhoods in Saskatoon. Since January 2009, all reminders for families not residing in the low-income neighbourhoods in Saskatoon are made through mailed letters. OUTCOMES: After the introduction of the Immunization Reminders Project, coverage rates among 2-year-olds for MMR increased significantly overall and in most geographical areas examined. Disparities between geographical subgroups appeared to be declining, but not significantly. COMCLUSION: A universal approach to early childhood immunization can likely contribute to increases in coverage rates, but there is still room for improvement in SHR. These findings have prompted additional practice and policy changes.

OBJECTIVES: Legislation to ban smoking in public places is currently a major area of interest across Canada. The main objectives of the study were to 1) determine the effect of the smoking ban on incidence of acute myocardial infarction, 2) determine if the new legislation altered population-based smoking prevalence, and 3) measure public support for the public smoking ban. METHODS: The city of Saskatoon initiated a public smoking ban on July 1, 2004. We retrospectively reviewed all hospital discharges for acute MI from July 2000 to June 2005. We reviewed CCHS survey information on smoking prevalence for Saskatoon, Saskatchewan and Canada from 2003 to 2005. We prospectively contacted 1,255 Saskatoon residents by telephone to determine support for the public smoking ban. RESULTS: The age-standardized incidence rate of acute MI fell from 176.1 (95% CI 165.3–186.8) cases per 100,000 population (July 1, 2000 to June 30, 2004) to 152.4 (95% CI 135.3–169.3) cases per 100,000 population (July 1, 2004 to June 30, 2005). Smoking prevalence in Saskatoon fell from 24.1% in 2003 (95% CI 20.4–27.7) to 18.2% in 2005 (95% CI 15.7–20.9) while smoking prevalence in Saskatchewan remained unchanged at 23.8% (95% CI 22.6–25.3) and Canada reduced from 22.9% (95% CI 22.5–23.3) to 21.3% (95% CI 20.8–21.8). Seventy-nine percent of Saskatoon residents believed the smoking ban was a good idea. INTERPRETATION: The public smoking ban in Saskatoon, Canada, is associated with reduced incidence rates of acute MI, lower smoking prevalence and high levels of public support.

BACKGROUND: Incomplete immunization coverage is common in low-income families and Aboriginal children in Canada. OBJECTIVE: To determine whether child immunization coverage rates at two years of age were lower in low-income neighbourhoods of Saskatoon, Saskatchewan. METHODS: Parents who were and were not behind in child immunization coverage were contacted to determine differences in knowledge, beliefs and opinions on barriers and solutions. A multivariate regression model was designed to determine whether Aboriginal cultural status was associated with being behind in childhood immunizations after controlling for low-income status. RESULTS: Reviewing the past five years in Saskatoon, the six low-income neighbourhoods had complete child immunization coverage rates of 43.7% (95% CI 41.2 to 45.9) for measles-mumps-rubella, and 42.6% (95% CI 40.1 to 45.1) for diphtheria, pertussis, tetanus, polio and Haemophilus influenzae type B. The five affluent neighbourhoods had 90.6% (95% CI 88.9 to 92.3) immunization coverage rates for measles-mumps-rubella, and 78.6% (95% CI 76.2 to 81.0) for diphtheria, pertussis, tetanus, polio and H influenzae type B. Parents who were behind in immunization coverage for their children were more likely to be single, of Aboriginal or other (non-Caucasian or non-Aboriginal) cultural status, have lower family income and have significant differences in reported beliefs, barriers and potential solutions. In the final regression model, Aboriginal cultural status was no longer associated with lower immunization status. INTERPRETATION: Child immunization coverage rates in Saskatoon's six low-income neighbourhoods were approximately one-half the rate of the affluent neighbourhoods. The covariates with the strongest independent association with complete childhood immunization status were low income and other cultural status. Aboriginal cultural status was not associated with low child immunization rates after controlling for income status

Objective: Smoking prevalence in the Saskatoon Health Region (SHR) went from 23.9% in 2003 to 23.3% in 2005 to 26.2% in 2007. The prevalence of smoking within the SHR Aboriginal population is substantially higher than the rest of the population. The purpose of the current study was to determine the independent effects of Aboriginal cultural status and income status on daily smoking status. Methods: Data from three cycles of the Canadian Community Health Survey (2001, 2003, 2005) were merged with identical data collected by the SHR in 2007. All four cycles were random telephone survey samples. Results: 5948 participants (81.1% response rate) completed the survey. After cross-tabulation, Aboriginal cultural status and income were strongly associated with daily smoking status. Using logistic regression, the odds of daily smoking for residents of Aboriginal cultural status was reduced substantially from the initial odds of 3.43 to 2.26 after adjusting for income alone, and reduced further to 1.57 after full multivariate adjustment. Conclusion: Given the association between smoking status and income status, future policies to reduce smoking prevalence should include generic policies to reduce income disparity as well as targeted strategies to improve the social conditions of Aboriginal people. Key words: Ethnology; social class; income; smoking Resume Objectif : La prevalence du tabagisme dans la region sanitaire de Saskatoon (RSS) a recule de 23,9 % en 2003 a 23,3 % en 2005, puis augmente a 26,2 % en 2007. La prevalence du tabagisme dans la population autochtone de la RSS est considerablement plus elevee que dans le reste de la population. Notre etude visait a determiner les effets independants du statut culturel autochtone et du revenu sur l'usage quotidien du tabac. Methode : Nous avons fusionne les donnees de trois cycles de l'Enquete sur la sante dans les collectivites canadiennes (2001, 2003, 2005) avec des donnees identiques recueillies par la RSS en 2007. Les quatre cycles utilisaient des echantillons aleatoires d'enquetes telephoniques. Resultats : 5 948 participants ont repondu aux enquetes (taux de reponse de 81,1 %). Une tabulation en croix a mis au jour de fortes correlations entre le statut culturel autochtone et le revenu et l'usage quotidien du tabac. L'analyse de regression logistique a toutefois considerablement reduit la probabilite pour les residents de statut culturel autochtone d'etre des fumeurs quotidiens : cette probabilite est passee de 3,43 (initialement) a 2,26 apres rajustement selon le revenu, et a 1,57 apres rajustement multivarie. Conclusion : Etant donne l'association entre l'usage du tabac et le revenu, les futures politiques de reduction de la prevalence du tabagisme devraient inclure des politiques generales pour reduire l'ecart dans les revenus, ainsi que des strategies ciblees pour ameliorer les conditions sociales des Autochtones. Mots cles : ethnologie; classe sociale; revenu; tabagisme

OBJECTIVES: A majority of population-based studies suggest prevalence of depressed mood and anxiety is most common during late adolescence to early adulthood. Mental health status has been linked previously to socio-economic status in adults. The purpose of this systematic literature review is to clarify if socio-economic status (SES) is a risk indicator of depressed mood or anxiety in youth between the ages of 10 to 15 years old. METHODS: We performed a systematic literature review to identify published or unpublished papers between January 1, 1980 and October 31, 2006 that reviewed depressed mood or anxiety by SES in youth aged 10-15 years. SYNTHESIS: We found nine studies that fulfilled our inclusion criteria and passed the methodological quality review. The prevalence of depressed mood or anxiety was 2.49 times higher (95% CI 2.33-2.67) in youth with low SES in comparison to youth with higher SES. DISCUSSION: The evidence suggests that low SES has an inverse association with the prevalence of depressed mood and anxiety in youth between the ages of 10 to 15 years old. Higher rates of depressed mood and anxiety among lower socio-economic status youth may impact emotional development and limit future educational and occupational achievement. CONCLUSION: Lower socio-economic status is associated with higher rates of depressed mood and anxiety in youth. Language: en

OBJECTIVES: A majority of population-based studies suggest prevalence of drug and alcohol risk behaviour increases during late adolescence to early adulthood. The purpose of this systematic literature review is to clarify if socio-economic status (SES) is a determinant of marijuana and alcohol risk behaviour in adolescents between the ages of 10–15 years. METHODS: We performed a meta-analysis to identify published or unpublished papers between January 1, 1980 and February 9, 2007 that reviewed marijuana and alcohol risk behaviour by SES in adolescents aged 10–15 years. SYNTHESIS: We found nine studies that fulfilled our inclusion criteria and passed the methodological quality review. The prevalence of marijuana and alcohol risk behaviour was 22% higher (RR = 1.22; 95% CI 1.14-1.31) in adolescents with low SES in comparison to adolescents with higher SES. Stratification by country of origin revealed that American and New Zealand studies had statistically significant variability in the reported effects as compared to European and UK studies. DISCUSSION: The evidence suggests that low SES has an inverse association with the prevalence of marijuana and alcohol risk behaviour in adolescents between the ages of 10–15 years. Higher rates of marijuana and alcohol risk behaviour among lower SES adolescents may impact emotional development, limit future educational and occupational achievement, and increase the likelihood for adult marijuana and alcohol addiction. CONCLUSION: Lower SES adolescents have higher rates of marijuana and alcohol risk behaviour than higher SES adolescents.

BACKGROUND: Canadian cities are becoming more segregated by income. As such, investigation is required into the magnitude of health disparity between low-, average- and high-income neighbourhoods in order to quantify the level of health disparity at the scale of an urban city. METHODS: A cross-sectional ecological study design was used to review all hospital discharges, physician visits, medication utilization, public health information and vital statistics for an entire city by neighbourhood income status. Postal code information was used to identify six existing contiguous residential neighbourhoods in the city of Saskatoon that were defined as low-income cut-off neighbourhoods (N=18,228). There were two comparison groups: all other Saskatoon residents (N=184,284) and the five most affluent neighbourhoods in Saskatoon (N=16,683). FINDINGS: Statistically significant differences in health care utilization by neighbourhood income status were observed for suicide attempts, mental disorders, injuries and poisonings, diabetes, chronic obstructive pulmonary disease, coronary heart disease, chlamydia, gonorrhea, |hepatitis C, teen birth, low birthweight, infant mortality and all-cause mortality. The rate ratios increased in size when comparing low-income neighbourhoods to high-income neighbourhoods. No clear trend was observed for stroke or cancer. INTERPRETATION: The findings suggest that low-income neighbourhoods are associated with increased health care utilization in Saskatoon.