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This study investigates measles, mumps, and rubella (MMR) immunization rates during the measles outbreak in Calgary and Edmonton of 2014 stratified by four area-level socio-demographic indicators. This study also leverages this epidemiological data to assess the equity aspect of emergency measures instituted regarding immunization in those two cities.A mixed-methods comparative case study analysis methodology was employed to assess the neighbourhood-level immunization statuses before (2013), during (2014), and after (2015) an active measles outbreak in Calgary and Edmonton, Alberta, Canada. The epidemiological one-dose by age-2 MMR coverage data were stratified using four socio-demographic indicators: median household income, %-homeownership, %-Aboriginal population, and %-immigrant population. Document and content analysis was utilized to investigate the outbreak mitigation strategies deployed in each city.The measles outbreak of 2013/2014 involved the entirety of Alberta and led to both provincial and city-specific interventions in which Calgary deployed three mass immunization clinics in 2014, where Edmonton did not. The Calgary coverage data showed an increase in coverage inequalities across all indicators and the Edmonton data showed mixed results in terms of equity gains/losses. Calgary's additive intervention of three mass immunization clinics in 2014 appears to have contributed to both the higher gross immunization rates in Calgary (90.77%) and an inequitable increase in coverage rates as compared with Edmonton (88.96%), in most cases.Public health policy-makers must be cognizant that large-scale public health efforts must be optimized for accessibility across all socio-economic levels to ensure public and population health gains are realized equitably.RéSUMé: OBJECTIFS: Cette étude porte sur les taux de vaccination contre la rougeole, la rubéole et les oreillons (RRO) durant l’éclosion de rougeole de 2014 à Calgary et à Edmonton, stratifiés selon quatre indicateurs sociodémographiques régionaux. L’étude se sert aussi de ces données épidémiologiques pour évaluer l’équité des mesures de vaccination d’urgence instituées dans les deux villes. MéTHODE: À l’aide d’une analyse comparative d’études de cas à méthodes mixtes, nous avons évalué les statuts vaccinaux par quartier avant (2013), pendant (2014) et après (2015) une éclosion active de rougeole survenue à Calgary et Edmonton, en Alberta, au Canada. Les données épidémiologiques relatives à la couverture du vaccin RRO, administré en une dose avant l’âge de 2 ans, ont été stratifiées à l’aide de quatre indicateurs sociodémographiques : le revenu médian des ménages, le pourcentage d’accession à la propriété, le pourcentage de la population autochtone et le pourcentage de la population immigrante. Nous avons fait appel à l’analyse documentaire et à l’analyse de contenu pour étudier les stratégies d’atténuation de l’éclosion déployées dans chaque ville. RéSULTATS: L’éclosion de rougeole de 2013-2014 a sévi partout en Alberta et a donné lieu à des interventions à l’échelle de la province et des villes; trois cliniques de vaccination de masse ont été déployées à Calgary en 2014, mais aucune à Edmonton. Selon les données relatives à la couverture vaccinale à Calgary, il y a eu une augmentation des inégalités dans la couverture pour tous les indicateurs; selon les données pour Edmonton, les résultats en matière de gains ou de pertes d’équité ont été mitigés. L’ajout de trois cliniques de vaccination de masse à Calgary en 2014 semble avoir contribué à la fois aux taux de vaccination bruts plus élevés à Calgary (90,77 %) et à une hausse inéquitable des taux de couverture comparativement à Edmonton (88,96 %) dans la plupart des cas. CONCLUSION: Les responsables des politiques de santé publique doivent être conscients qu’il faut optimiser les efforts de santé publique à grande échelle pour que toutes les classes socioéconomiques en bénéficient, afin que les gains réalisés en santé publique et en santé des populations soient équitables.

BackgroundHealthcare organizations are increasingly exploring ways to address the social determinants of health. Accurate data on social determinants is essential to identify opportunities for action to improve health outcomes, to identify patterns of inequity, and to help evaluate the impact of interventions. The objective of this study was to refine a standardized tool for the collection of social determinants data through cognitive testing.MethodsAn initial set of questions on social determinants for use in healthcare settings was developed by a collaboration of hospitals and a local public health organization in Toronto, Canada during 2011-2012. Subsequent research on how patients interpreted the questions, and how they performed in primary care and other settings led to revisions. We administered these questions and conducted in-depth interviews with participants from Saskatchewan, Manitoba, Ontario, and Newfoundland and Labrador. Cognitive interviewing was used, with participants invited to verbalize thoughts and feelings as they read the questions.ResultsThree hundred and seventy-five individuals responded to the study advertisements and 195 ultimately participated in the study. Although all interviews were conducted in English, participants were diverse. For many, the value of this information being collected in typical healthcare settings was unclear, and hence, we included descriptors for each question. In general, the questions were understood, but participants highlighted a number of ways the questions could be changed to be even clearer and more inclusive.ConclusionIn this work we have refined an initial set of 16 sociodemographic and social needs questions into a simple yet comprehensive 18-question tool. The changes were largely relating to wording, rather than content. These questions require validation against accepted, standardized tools. Further work is required to enable community data governance, and to ensure implementation of the tool and well as use of its data is successful in a range of organizations.

Purpose of the Program: Nîsohkamâtowak, the Cree word for Helping Each Other, is an initiative to close gaps in kidney health care for First Nations and Métis patients, their families, and communities in northern Saskatchewan. Nîsohkamâtowak emerged from a collaboration between the Kidney Health Community Program and First Nations and Métis Health Services to find ways to deliver better care and education to First Nations and Métis people living with kidney disease while acknowledging Truth and Reconciliation and the Calls to Action. Sources of Information: This article describes how traditional Indigenous protocols and storytelling were woven into the Nîsohkamâtowak events, gathering of patient and family voices in writing and video format, and how this work led to a collaborative co-designed process that incorporates the Truth and Reconciliation: Calls to Action into kidney care and the benefits we have seen so far. The teachings of the 4 Rs—respect, reciprocity, responsibility, and relevance, were critical to ensuring that Nîsohkamâtowak reports and learning were shared with participants and the communities represented in this initiative. Methods: Group discussions and sharing circles were facilitated in several locations throughout northern and central Saskatchewan. Main topics of discussion were traditional medicines, residential schools impact, community and peer supports for kidney disease patients, and cultural safety education for health care providers. Key Findings: The general themes selected for improvement were education, support within the local community, traditional practices and cultural competency, and delivery of services. To address these gaps in kidney care, the following objectives were co-created with First Nations and Métis patients, families, and communities for Kidney Health to provide culturally appropriate education and resources, to ensure appropriate follow-up support to include strengthening connections to communities and other health authorities, to incorporate traditional practices into program design, and to ensure appropriate service delivery across the spectrum of care with a focus on screening and referral, which is strongly linked to coordination of care with local health centers. Implications: As a result of this work, the Kidney Health Community Program restructured the delivery of services and continues to work with Nîsohkamâtowak advisors on safety initiatives and chronic kidney disease awareness, prevention, and management in their respective communities. The Truth and Reconciliation and Calls to Action are honored to close the gaps in kidney care. Limitations: Nîsohkamâtowak is a local Kidney Health initiative that has the good fortune of having dedicated funding and staff to carry out this work. The findings may be unique to the First Nations and Métis communities and people who shared their stories. Truth and Reconciliation is an ongoing commitment that must be nurtured. Although not part of this publication, the effects of COVID-19 have made it difficult to further advance the Calls to Action, with more limited staff resources and the inability to meet in person as in the past.

BACKGROUND Improving our understanding of social inequalities may improve prevention and treatment efforts for diabetes mellitus. We examined the association between individual- and area-level socioeconomic measures and physician-diagnosed diabetes in Saskatchewan over time. METHODS In this cross-sectional study, we linked health administrative data with individual-level socioeconomic data from the Canadian Community Health Survey and area-level data from the 2006 Canadian census. We used general linear mixed-models regression to analyze the effect of each factor, controlling for geographic and demographic measures. RESULTS Area-level deprivation was associated with medically diagnosed type 2 diabetes mellitus after adjustment for the individual-level factors of age, sex, household income and education. Individuals residing in areas ranked in the least deprived quintile had a lower likelihood of diabetes than those in the most deprived quintile (odds ratio 0.40, 95% confidence interval 0.18-0.88). However, this disparity existed only in urban areas. This result may reflect less pronounced health inequalities in rural areas, greater socioeconomic heterogeneity, larger geographic units or some combination of these factors. INTERPRETATION Individual- and area-level socioeconomic factors were associated with the likelihood of medically diagnosed diabetes; however, the strength of this association varied between urban and rural communities. Acknowledgement of area-level deprivation as a modifiable risk factor related to the prevalence of diabetes is important in the development of effective interventions for urban, but not rural, areas.

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.

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.

Aims: The purpose of this systematic review was to determine if school-based marijuana and alcohol prevention programs are effective in preventing marijuana and alcohol use in adolescents between t...

The prevalence of risk behaviours, such as marijuana use and alcohol abuse, among youth in North America has been steadily increasing since the 1980s, with sharp inclines since the early 1990s (1–11). Alcohol is the drug of choice among North American adolescents, and it is used by more young people than tobacco or illicit drugs (12–14). A review of American population-based studies (5,15) suggests that drug and alcohol risk behaviours start at approximately 10 years of age, and peak between 14 and 15 years of age. A national study (4) suggests that for Canadian youth who are 15 years of age, the prevalence of alcohol use is 25% for boys and 19% for girls. The prevalence of alcohol use for Canadian youth who are between 11 and 13 years of age is 12% for boys and 8% for girls (4). A Canadian addiction survey (16) indicated that 61.4% of youth between 15 and 17 years of age had used marijuana in their lifetime, and 37% had used it at least once in the past 12 months. In 2004, The Centre for Addictions and Mental Health (Toronto, Ontario) reported that Aboriginal youth are two to six times at a higher risk for every alcohol-related problem compared with other youth (17). Results from the 2002 Alberta Youth Experience Survey (18) indicated that a higher percentage of Aboriginal youth compared with non-Aboriginal youth reported signs of alcohol abuse (34.5% and 12.3%, respectively), and twice as many Aboriginal youth between grades 7 and 9 had used marijuana compared with non-Aboriginal youth (52.1% and 26.8%, respectively). These data suggest that being of Aboriginal ethnicity increases the risk of marijuana use or alcohol abuse among adolescents. Through an extensive literature search, the authors found no studies that reviewed the independent association between Aboriginal cultural status and marijuana use after multivariate adjustment. Only one American study (19) was found by the authors that reviewed the independent association of Aboriginal cultural status with alcohol use after multivariate adjustment for variables, such as socioeconomic status (SES). In this study, initial differences in alcohol use by cultural status were no longer statistically significant in the final multivariate model (19). The primary purpose of the present paper was to determine whether Aboriginal cultural status is independently associated with the risk behaviours of marijuana use and alcohol abuse (being drunk) among youth after multivariate adjustment for other factors, such as SES.

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

BACKGROUND: The incidence rates of Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (GC) in Saskatoon Health Region are approximately double the national average. A descriptive study was designed to try to determine why. METHODS: The objectives of the study were: 1) to determine whether or not the introduction of a new detection method that is less invasive and more sensitive led to more tests being ordered and a higher percentage of positive cases; 2) to determine what percentage of physicians and STI clinic nurses notified Public Health within 72 hours of suspected Ct or GC; 3) to determine what percentage of physicians and STI clinic nurses listed sexual contact information; and 4) to compare recurrence rates between patients treated by physicians and STI clinic nurses. RESULTS: The number of tests ordered for Ct and GC increased substantially from 10,425 in 1998 to 28,885 in 2003, while the percentage of positive cases decreased from 7.2% to 3.6%. Only 1.3% of physicians and 9.1% of STI clinic nurses notified Public Health within 72 hours of a suspected case. 51.2% of physicians listed sexual contact information in comparison to 85.4% of STI clinic nurses. Recurrence rates of Ct or GC within one year of initial treatment were 26% lower for patients treated by STI clinic nurses (5.7%) than for physicians (7.2%). CONCLUSIONS: There is a need for additional education for health care providers in the management of sexually transmitted infections in Saskatoon Health Region.

Objectives:The population health approach is increasingly recognized for its role in health system reform; however, its broad scope and definition have been criticized for being a barrier to clear communication. This qualitative study examined the way senior healthcare leaders in Canada conceptualize and operationalize the population health approach in planning and decision-making.Findings:Core elements of the population health approach included focusing on health and wellness rather than illness, taking a population rather than individual orientation, understanding needs and solutions through community outreach, addressing health disparities/health in vulnerable groups, addressing the social determinants of health and inter-sectoral action and partnerships.Conclusion:The population health approach is increasingly recognized for its role in reducing healthcare demand and contributing to health system sustainability. This study demonstrated the growing need to clarify terminology among multiform partners to establish a foundation for future healthcare integration and inter-sectoral action.

Background National health surveys are sometimes used to provide estimates on risk factors for policy and program development at the regional/local level. However, as regional/local needs may differ from national ones, an important question is how to also enhance capacity for risk factor surveillance regionally/locally. Methods A Think Tank Forum was convened in Canada to discuss the needs, characteristics, coordination, tools and next steps to build capacity for regional/local risk factor surveillance. A series of follow up activities to review the relevant issues pertaining to needs, characteristics and capacity of risk factor surveillance were conducted. Results Results confirmed the need for a regional/local risk factor surveillance system that is flexible, timely, of good quality, having a communication plan, and responsive to local needs. It is important to conduct an environmental scan and a gap analysis, to develop a common vision, to build central and local coordination and leadership, to build on existing tools and resources, and to use innovation. Conclusions Findings of the Think Tank Forum are important for building surveillance capacity at the local/county level, both in Canada and globally. This paper provides a follow-up review of the findings based on progress over the last 4 years.

Objective: The purpose of this paper was to use a linked dataset to compare health care utilization rates and costs between income groups in Saskatoon, Canada. Methods: The Canadian Community Health Survey was linked to hospital, physician and medication data in Saskatoon. Results: Of 3,688 eligible participants, 3,433 agreed to the health survey and data linkage with health records (83.7% overall response). Low-income residents were 27-33% more likely to be hospitalized and 36-45% more likely to receive a medication than middle- and higher-income residents, but were 5-7% less likely to visit a physician over a one-year period. In comparison to middle-income residents, low-income residents had 56% more high users of hospitals, 166% more high users of physicians and 90% more high users of medications. Low-income residents had 34-35% higher health care costs overall than middle- and high-income residents. After multivariate adjustment for increased disease prevalence, low income had a reduced association with high health care utilization. Conclusions: The results demonstrate that residents with lower income are responsible for disproportionate usage of hospitals, physicians and medications; due mainly (but not entirely) to higher disease prevalence.

Objective: To determine if Aboriginal (in this paper, First Nations and Métis people) cultural status is independently associated with lifetime suicidal ideation in the Saskatoon Health Region after controlling for other covariates, particularly income status. Methods: Data collected by Statistics Canada in all 3 cycles of the Canadian Community Health Survey (CCHS) were merged with identical questions asked in February 2007 by the Saskatoon Health Region. The health outcome was lifetime suicidal ideation. The risk indicators included demographics, socioeconomic status, cultural status, behaviours, life stress, health care use, and other health problems. Results: Participants ( n = 5948) completed the survey with a response rate of 81.1%. The prevalence of lifetime suicidal ideation was 11.9%. After stratification, it was found that high-income Aboriginal people have similar low levels of suicidal ideation, compared with high-income Caucasian people. The risk–hazard model demonstrated a larger independent effect of income status in explaining the association between Aboriginal cultural status and lifetime suicidal ideation, compared with the independent effect of age. After full multivariate adjustment, Aboriginal cultural status had a substantially reduced association with lifetime suicidal ideation. The odds of lifetime suicidal ideation for Aboriginal people reduced from 3.28 to 1.99 after multivariate adjustment for household income alone. Conclusion: The results of this study suggest reductions in lifetime suicidal ideation can be observed in Aboriginal people in Canada by adjusting levels of household income.

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

BACKGROUND: A number of reports suggest that we need to determine public understanding about the broad determinants of health and also determine public support for actions to reduce health disparities in Canada. METHODS: A cross-sectional random survey of 5,000 Saskatoon residents was used to determine knowledge about health determinants and health disparity and then determine public support for various interventions to address health disparity. FINDINGS: Saskatoon residents understand most of the determinants of health except they understate the importance of social class and gender. Saskatoon residents do not have a good understanding of the magnitude of health disparity between income groups. A majority believe risk behaviours are mostly individual choices and are not associated with income status. Most residents believe even small differences in health status between income groups is unacceptable and a majority believe that something can be done to address health disparity by income status. Interventions proposed by residents to alleviate health disparity were evidence-based, including work-earning supplements and strengthening early intervention programs. Logistic regression revealed that greatest support for transferring money from health care treatment to health creation services (like affordable housing and education) came from young Aboriginal males with low income. INTERPRETATION: Saskatoon residents have knowledge of health determinants and have a strong desire to support health disparity intervention. More knowledge transfer is required on the magnitude of health disparity based on income status. Broad-based health disparity intervention in Saskatoon appears possible.

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

There have been too few studies on urban Aboriginal youth to permit inferences about depressed mood in this subgroup. The purpose of the present study was to determine whether Aboriginal cultural status is independently associated with moderate or severe depressed mood in youth after controlling for other covariates, including socioeconomic status.Every student between grades 5 and 8 in the city of Saskatoon, Saskatchewan, was asked to complete a questionnaire in February of 2007. Depressed mood was measured with a 12-question depression scale derivative of the 20-question Center for Epidemiologic Studies Depression Scale.Four thousand ninety-three youth participated in the school health survey. For Aboriginal youth, the prevalence rate of moderate or severe depressed mood was 21.6% in comparison with 8.9% for Caucasian youth (rate ratio 2.43; 95% CI 1.92 to 3.08). Aboriginal cultural status was not associated with depressed mood after adjustment for other covariates in the final multivariate model (OR 1.132; 95% CI 0.682 to 1.881). Parental educational status and sex were confounders to the association between Aboriginal cultural status and depressed mood.The recognition that Aboriginal cultural status is not independently associated with moderate or severe depressed mood in youth after full multivariate adjustment allows policy makers to acknowledge that mental health disparity prevention is possible because the determinants of health (ie, education) are modifiable (in comparison with Aboriginal cultural status).

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.