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Huge advances have been made in cancer treatments over recent decades; however, significant disparities still exist in the developed world on the basis of race, socioeconomic status, education level, geographical location, and immigration status and in the United States, insurance status. Cancer disparities persist in the continuum of cancer care from risk factors, screening, diagnosis, treatment, survivorship, and end-of-life care. The causes of disparities are complex and multifactorial. The MASCC (Multinational Association of Supportive Care in Cancer) Education Study Group would like to propose a framework of cancer disparities from a social perspective utilizing "social determinants of health" as delineated by the World Health Organization and highlight an unmet need for research and policy innovations to address cancer disparities in developed world.

The objective of this study was to assess if online teaching delivery produces comparable student test performance as the traditional face-to-face approach irrespective of academic aptitude. This study involves a quasi-experimental comparison of student performance in an undergraduate health science statistics course partitioned in two ways. The first partition involves one group of students taught with a traditional face-to-face classroom approach and the other through a completely online instructional approach. The second partition of the subjects categorized the academic aptitude of the students into groups of higher and lower academically performing based on their assignment grades during the course. Controls that were placed on the study to reduce the possibility of confounding variables were: the same instructor taught both groups covering the same subject information, using the same assessment methods and delivered over the same period of time. The results of this study indicate that online teaching delivery is as effective as a traditional face-to-face approach in terms of producing comparable student test performance but only if the student is academically higher performing. For academically lower performing students, the online delivery method produced significantly poorer student test results compared to those lower performing students taught in a traditional face-to-face environment.

Background: Community-based health and social resources can help individuals with complex health and social needs achieve their health goals. However, there is often inadequate access to these resources due to a lack of physician and patient awareness of available resources and the presence of social barriers that limit an individual’s ability to reach these services. Navigation services, where a person is tasked with helping connect patients to community resources, embedded within primary care may facilitate access and strengthen the continuity of care for patients. Objective: This study aims to describe the protocol to assess whether the implementation of the Access to Resources in the Community (ARC) navigation model (an innovative approach to navigation services) is feasible, including its potential to achieve its intended outcomes, and to assess the viability of the evaluation approach. Methods: The study consists of a single-arm, prospective, explanatory, mixed-methods, pre-post design feasibility study focusing on primary care practice settings with vulnerable populations. Participants include primary care providers and patients. Results: Enrollment is closed with 82 patients. Navigation services have ended for 69 patients. Conclusions: The study of an innovative complex intervention requires an adequate assessment of the feasibility of the intended approach during which the potential challenges of the planned intervention and need for its adaptation may be uncovered. Undertaking a feasibility study of the ARC navigation model from a conceptually clear and methodologically solid protocol will inform on the practicality and acceptability of the approach, demand for the services, ease of implementation, quality of integration of the new services within primary care, and practicality and potential for efficacy prior to initiating a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT03105635; https://clinicaltrials.gov/ct2/show/NCT03105635 (Archived by WebCite at hhttp://www.webcitation.org/75FrwXORl) International Registered Report Identifier (IRRID): RR1-10.2196/11022

Objective: To explore African and Caribbean immigrants’ perceptions of a culturally tailored intervention to prevent type 2 diabetes. Methods: Using a purposive sampling scheme, 29 participants (26 women and 3 men, mean age 48 years and average length of residency of 22 years in Canada) participated in this study. The researchers used in-depth focus groups and individual surveys to collect qualitative data from participants. Following these interviews, participants individually reviewed the intervention and provided written feedback on their perceptions of the intervention. Data were analyzed using thematic analysis. Findings: Three themes emerged from the data: motivating factors to engage in physical activity and healthy eating, barriers that prohibit engaging in physical activity and increasing knowledge about food selection and modification of diet. In addition to the themes, participants had positive perceptions of the intervention. Eighty six percent rated the intervention as very useful and 83% were very satisfied with its contents. They reported that the intervention was culturally consistent with their beliefs, values and cultural practices in preventing type 2 diabetes. Conclusion: Perceptions of this culturally tailored intervention provided valuable evidence to assist the researchers in moving forward to the next level of research development such as evaluating the effectiveness of the intervention on the targeted groups’ outcomes: self-care knowledge, performance of physical activity, healthy eating practices and self-efficacy.

This qualitative study explored the beliefs held by adult Caribbean immigrants regarding type 2 diabetes (T2D) and their practices in preventing it. A purposive sample of 15 immigrants living in Ontario, Canada participated in the study. Semistructured interviews were used to collect data from participants. Four themes emerged from the data: beliefs that protect participants from developing T2D, cultural practices to stay healthy, preserving culture through preparation of meals, and cultural practices determine number of servings of fruit and vegetables per day. Findings indicate how beliefs and cultural practices influence prevention of T2D and the need to design culturally tailored interventions for ethnic groups. Future research should explore health beliefs and cultural practices of other high-risk groups and use their findings to design and evaluate culturally tailored interventions to prevent T2D.

We present the results of the third phase in a three part study developing an application to reduce obesity levels in adolescents with a mobile fitness application that encourages youth to engage in fitness activity by providing social networking tools to facilitate motivation. In the first phase, we studied effecting positive attitudinal changes towards fitness. The second phase studied physical improvements with the application in our target group. This third phase tests the efficacy of the socialization tools in our application for motivating both positive attitudinal changes and physical improvements towards fitness. The application contained thirteen distinct exercises that subjects could engage in using sensors on the mobile devices to unbiasedly measure progress. The socialization tools to encourage fitness engagement allowed for such activities as friending, sharing progress and collaboratively exercising with friends either in person or remotely. The study participants were adolescents age 14 to 15 with 20 subjects in an experimental group that used the fitness application and 15 control subjects that did not. The study ran for eight weeks with the results indicating both positive attitude changes towards fitness exercises and body-mass index (BMI) improvements in fitness levels correlated to socialization interests/activities for the subjects using the application, while the control group showed no such correlation of fitness level improvement.

Objective: In Ontario, there are significant geographical disparities in colorectal cancer incidence. In particular, the northern region of Timiskaming has the highest incidence of colorectal cancer in Ontario while the southern region of Peel displays the lowest. We aimed to identify non-nutritional modifiable environmental factors in Timiskaming that may be associated with its diverging colorectal cancer incidence rates when compared to Peel. Methods: We performed a systematic review to identify established and proposed environmental factors associated with colorectal cancer incidence, created an assessment questionnaire tool regarding these environmental exposures, and applied this questionnaire among 114 participants from the communities of Timiskaming and Peel. Results: We found that tobacco smoking, alcohol consumption, residential use of organochlorine pesticides, and potential exposure to toxic metals were dominant factors among Timiskaming respondents. We found significant differences regarding active smoking, chronic alcohol use, reported indoor and outdoor household pesticide use, and gold and silver mining in the Timiskaming region. Conclusions: This study, the first to assess environmental factors in the Timiskaming community, identified higher reported exposures to tobacco, alcohol, pesticides, and mining in Timiskaming when compared with Peel. These significant findings highlight the need for specific public health assessments and interventions regarding community environmental exposures.

Purpose: The purpose of this study is to examine how demographic factors, social conditions, and health perceptions shape Diabetes Self-Efficacy (DSE) in order to enhance diabetes self-management. Methods: This article reports the results of a survey of 97 type 2 diabetes patients in a primary health care clinic located east of Toronto (Canada). Regression analyses examined the relationship between self-reported healths, self-reported A1C, social capital, social support, MD support, household income, education, gender, age, and time since diagnosis and DSE. Results: Social capital, social support, MD support, income, and age showed no significant relationship to DSE. Gender, time since diagnosis, and education showed a significant association to DSE. Perceived health variables self-reported A1C and self-reported health showed the strongest relationship to DSE. Implications: The survey results suggest a potentially fruitful line of research that might examine a feedback mechanism that appears to be at play whereby DSE affects perceived health and perceived A1C, while the latter, over time, influence DSE. The paper then suggests a follow-up protocol that future research may employ to discern the nature and strength of the feedback mechanisms implied by the results. Improved understanding of how and to what extent this feedback mechanism operates will have significant consequences for how information is delivered to patients to encourage improvements in DSE and self-management behaviours.

There is a shortage of registered nurses in developed countries, and this shortage is due to the aging nursing workforce, demand for healthcare services, and shortage of nursing professors to teach students. In order to increase the number of clinical placements for nursing students, the authors developed and implemented a collaborative preceptorship model between a Canadian University and Public Health Department to facilitate the clinical experiences of Bachelor of Science of Nursing (BScN) students. This paper describes the Team Preceptorship Model which guided the clinical experience of nine students and 14 preceptors. It also highlights the model's evaluation, strengths, and limitations.

Colorectal cancer is the third most diagnosed cancer and second leading cause of cancer related deaths in Canada. As Ontario has the largest population in Canada, it also has great disparities in colorectal cancer incidence. The region of Timiskaming has the highest incidence for colorectal cancer, while the region of Peel has the lowest incidence for colorectal cancer in Ontario. There are no previously published studies regarding cancer or environmental risk factors performed in the Timiskaming region. The purpose of this study was to identify the dominant non-nutritional modifiable environmental risk factors in the region of Timiskaming compared to the reference region of Peel that may be associated with diverging colorectal cancer incidence rates. After reviewing the available published literature, a questionnaire assessment tool regarding environmental exposures was created. This questionnaire tool was created by combining standardized questionnaire tools available in the published literature that assessed environmental exposures. The questionnaire assessment tool was then utilized within a pilot study group followed by the Timiskaming and Peel participant communities. The tool assessed the exposures of tobacco smoking, alcohol use, pesticides/organochlorines, metal toxins, occupational exposures, and medical ionizing radiation. A total of 53 participants completed the questionnaire tool in Timiskaming, and a total of 61 participants completed the questionnaire tool in Peel. Findings indicate that there are dominant non-nutritional modifiable environmental risk factors in the region of Timiskaming that may be associated with colorectal cancer when compared to the region of Peel. The significant dominant environmental factors identified by Timiskaming participants were tobacco smoking, alcohol use, pesticides/organochlorines, and metal toxins. The findings also indicate that the Peel community may have important community health initiatives that can be used in the Timiskaming community to reduce the present colorectal cancer disparities. Following this study, it is imperative that recommendations are directed at a community level and relate to the assessment of potential non-nutritional modifiable environmental risk factors. While colorectal cancer disparities are evident, future research should help to understand the relationship between cancer disparities and environmental risk factors. Citation Format: Jeavana Sritharan, Rishikesan Kamaleswaran, Ken McFarlan, Manon Lemonde, Clemon George, Otto Sanchez. Assessing the environmental factors in two Ontario communities with diverging colorectal cancer incidence rates . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4819. doi:10.1158/1538-7445.AM2013-4819

Caroline Andrew, Lyne Bouchard, Denyse Culligan, Denise Lemire, Natalie Beausoleil, Helene Gendron, Denise Merkle, Gaetane Pharand, Danielle Fournier, Lucie Massicotte, France Gelinas, Mary Carter, Helene Dallaire, Lucie Plante, Colette Prevost, Lorraine LeBlanc, Manon Lemonde, Eva Mazerolle, Celine Simard, Anne Hodge, Diane Dupont, Marie-Beatrice Ngaba, Anne-Marie Mboma, Denyse Cote, Lise Ladouceur et Michelle Bernier-Wilson Reflets : revue d'intervention sociale et communautaire, vol. 3, n° 2, 1997, p. 312-328.