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Promoting uptake of research findings is an objective common to those who fund, produce, and publish health services and policy research. Open access (OA) is one method being employed to maximize impact. OA articles are online, free to access and use. This paper contributes to the growing body of research exploring the 'OA advantage' by employing an article-level analysis comparing citation rates for articles drawn from the same, purposively selected journals. We used a two-stage analytic approach designed to test whether OA is associated with (1) the likelihood that an article is cited at all and (2) the total number of citations an article receives, conditional on being cited at least once. Adjusting for potential confounders (number of authors, time since publication, journal, and article subject), we found that OA archived articles were 60% more likely to be cited at least once and, once cited, were cited 29% more than non-OA articles. [ABSTRACT FROM AUTHOR]

Abstract Background Sex and gender sensitive inquiry is critical in pharmaceutical policy due to the sector's historical connection with women's health issues and due to the confluence of biological, social, political, and economic factors that shape the development, promotion, use, and effects of medicinal treatments. A growing number of research bodies internationally have issued laws, guidance or encouragement to support conducting sex and gender based analysis (SGBA) in all health related research. Methods In order to investigate the degree to which attempts to mainstream SGBA have translated into actual research practices in the field of pharmaceutical policy, we employed methods of literature scoping and mapping. A random sample of English-language pharmaceutical policy research articles published in 2008 and indexed in MEDLINE was analysed according to: 1) use of sex and gender related language, 2) application of sex and gender related concepts, and 3) level of SGBA employed. Results Two thirds of the articles (67%) in our sample made no mention of sex or gender. Similarly, 69% did not contain any sex or gender related content whatsoever. Of those that did contain some sex or gender content, the majority focused on sex. Only 2 of the 85 pharmaceutical policy articles reviewed for this study were primarily focused on sex or gender issues; both of these were review articles. Eighty-one percent of the articles in our study contained no SGBA, functioning instead at a sex-blind or gender-neutral level, even though the majority of these (86%) were focused on topics with sex or gender aspects. Conclusions Despite pharmaceutical policy's long entwinement with issues of sex and gender, and the emergence of international guidelines for the inclusion of SGBA in health research, the community of pharmaceutical policy researchers has not internalized, or "mainstreamed," the practice. Increased application of SGBA is, in most cases, not only appropriate for the topics under investigation, but well within the reach of today's pharmaceutical policy researchers.

This scoping review examines the role of digital solutions in active, participant-centered surveillance of adverse events following initial release of COVID-19 vaccines. The goals of this paper were to examine the existing literature surrounding digital solutions and technology used for active, participant centered, AEFI surveillance of novel COVID-19 vaccines approved by WHO. This paper also aimed to identify gaps in literature surrounding digital, active, participant centered AEFI surveillance systems and to identify and describe the core components of active, participant centered, digital surveillance systems being used for post-market AEFI surveillance of WHO approved COVID-19 vaccines, with a focus on the digital solutions and technology being used, the type of AEFI detected, and the populations under surveillance. The findings highlight the need for customized surveillance systems based on local contexts and the lessons learned to improve future vaccine monitoring and pandemic preparedness.

Identifying effective interventions to promote children's vaccination acceptance is crucial for the health and wellbeing of communities. Many interventions can be implemented to increase parental awareness of the benefits of vaccination and positively influence their confidence in vaccines and vaccination services. One potential approach is using narratives as an intervention. This study aims to evaluate the effects of a narrative-based intervention on parents' attitudes and vaccination intentions. In a pre-post experiment, 2,000 parents of young children recruited from an online pan-Canadian panel were randomly exposed to one of the three videos presenting narratives to promote childhood vaccination or a control condition video about the importance and benefits of physical activity in children. Pre-post measures reveal a relatively modest but positive impact of the narratives on parents' attitudes and intention to vaccinate their child(ren). The results also suggest that narratives with more emotional content may be more effective in positively influencing vaccine attitudes than the more factual narrative. Using narratives to promote vaccination can positively influence parents' views and intentions toward childhood vaccines, but research is still required to identify the best components of such interventions.

Introduction: Legalization in many jurisdictions has increased the prevalence of cannabis use, including during pregnancy and lactation. Accordingly, clinicians providing perinatal and infant care are increasingly required to counsel about this topic, even if they do not feel comfortable or prepared for this conversation. The aim of this research was to explore how prenatal clinicians and pregnant and lactating women interact with cannabis consumption., Methods: Using qualitative description, we conducted semi-structured interviews with 75 individuals in Canada: 23 clinicians who provide pregnancy and lactation care, and 52 individuals who made cannabis consumption decisions during pregnancy and/or lactation. Data were analyzed using inductive content analysis., Results: Three phases of the clinical encounter influenced decision-making about cannabis consumption: initiation of a discussion about cannabis, sense-making, and the outcome of the encounter. Patients and clinicians described similar ideals for a counseling encounter about cannabis consumption during pregnancy or lactation: open, patient-centered conversation grounded in an informed decision-making model to explore the benefits, risks, and alternatives to cannabis. While clinicians described these values as reflecting real clinical interactions, patients reported that in their experience, actual interactions did not live up to these ideals., Conclusion: Clinicians and pregnant and lactating people report desiring the same things from a counseling interaction about cannabis: sharing of information, identification of values, and facilitation of a decision. Both groups endorse an open, nonjudgemental counseling approach that explores the reasons why a patient is considering cannabis consumption and reflects these reasons against available evidence and alternatives known to be safe., (© 2024 The Author(s). Birth published by Wiley Periodicals LLC.)

Purpose: We aimed to determine the incidence of mental health diagnoses and associated health and social risk factors among perinatal people in three different COVID-19 phases., Methods: We conducted a population-based, retrospective cohort study using linked administrative datasets. We included persons with live, in-hospital births in Ontario, Canada from January 1 to March 31 in 2019, 2021, or 2022 (three phases relative to COVID-19 with different public health policy measures). We excluded people with prior mental health diagnoses. We used diagnostic codes to identify new onset of depression, anxiety, or adjustment disorder in the antenatal and postpartum period. We developed multivariable, modified Poisson models to examine associations between sociodemographic and clinical factors and new mental health diagnoses in each phase., Results: There were 72,242 people in our cohort. Antenatal mental health diagnoses were significantly higher in 2021 (aRR = 1.32; CI = 1.20-1.46) and 2022 (aRR = 1.22; CI = 1.11-1.35) versus 2019. Postpartum diagnoses were significantly greater in 2021 (aRR = 1.16; CI = 1.08-1.25) versus 2019. Antenatal diagnoses were associated with birth year, previous stillbirth, pre-existing hypertension, multiparity, residential instability, and ethnocultural diversity. Postpartum diagnoses were associated with birth year, maternal age, multiparity, care provider profession, assisted reproductive technology, birthing mode, pre-existing hypertension, intensive care admission, hospital readmission, residential instability, and ethnocultural diversity. Family physicians increasingly made mental health diagnoses in 2021 and 2022., Conclusion: Increased incidence of perinatal mental health diagnoses during COVID-19 suggests complex dynamics involving pandemic and health and social risk factors., Registration: This study was registered with Clinicaltrials.gov (NCT05663762) on December 21, 2022., Competing Interests: Declaration Ethics The use of ICES data is authorized under Sect. 45 of Ontario’s Personal Health Information Protection Act (PHIPA), which allows ICES to collect and analyze health care and demographic data, without consent, for health system evaluation and improvement. Therefore, ethics approval was waived by the Hamilton Integrated Research Ethics Board (HiREB) on September 22, 2022. Competing interests The authors have no competing interests to declare., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Objectives: We examined the length of postpartum hospitalization for live births during the COVID-19 pandemic and explored how pandemic circumstances influenced postpartum hospital experiences., Methods: We conducted a cross-provincial, convergent parallel mixed-methods study in Ontario (ON) and British Columbia (BC), Canada. We included birthing persons (BPs) with an in-hospital birth in ON from 1 January to 31 March 2019, 2021, and 2022 (quantitative), and BPs (≥18 years) in ON or BC from 1 May 2020 to 1 December 2021 (qualitative). We linked multiple health administrative datasets at ICES and developed multivariable linear regression models to examine the length of hospital stay (quantitative). We conducted semi-structured interviews using qualitative descriptive to understand experiences of postpartum hospitalization (qualitative). Data integration occurred during design and interpretation., Results: Relative to 2019, postpartum hospital stays decreased significantly by 3.29 hours (95% CI -3.58 to -2.99; 9.2% reduction) in 2021 and 3.89 hours (95% CI -4.17 to -3.60; 9.0% reduction) in 2022. After adjustment, factors associated with shortened stays included: giving birth during COVID-19, social deprivation (more ethnocultural diversity), midwifery care, multiparity, and lower newborn birth weight. Postpartum hospital experiences were impacted by risk perception of COVID-19 infection, clinical care and hospital services/amenities, visitor policies, and duration of stay., Conclusions: Length of postpartum hospital stays decreased during COVID-19, and qualitative findings described unmet needs for postpartum services. The integration of large administrative and interview data expanded our understanding of observed differences. Future research should investigate the impacts of shortened stays on health service outcomes and personal experiences., (Copyright © 2024 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Background: Hesitancy about vaccination during pregnancy posed challenges to SARS-CoV-2 vaccination efforts. We aimed to examine rates of SARS-CoV-2 vaccination among Ontario residents who gave birth in early 2022, and to compare rates of SARS-CoV-2 vaccine uptake with rates of tetanus, diphtheria, and pertussis (Tdap) and influenza vaccination during pregnancy in 2019, 2021, and 2022., Methods: We conducted a population-based retrospective cohort study to describe vaccination rates among pregnant and comparable nonpregnant populations in Ontario using linked administrative data. Provincially insured females who had a live, in-hospital birth from Jan. 1 to Mar. 31 in 2019, 2021, or 2022 were our primary cohort. Using log-binomial regression, we tested associations between SARS-CoV-2 (2022) and Tdap and influenza (2019, 2021, 2022) vaccination status, with birth group and covariates. We compared SARS-CoV-2 vaccination status with the status of a matched cohort of nonpregnant females and conducted subgroup analyses by age and prenatal clinician type., Results: Among birthing people, 78.7% received their first SARS-CoV-2 vaccine dose and 74.2% received a second dose. The rate was significantly higher among nonpregnant comparators (dose 1: relative risk [RR] 0.94, 95% confidence interval [CI] 0.93-0.94; dose 2: RR 0.91, 95% CI 0.90-0.91). However, the rate of SARS-CoV-2 vaccination uptake among birthing people was higher than uptake of Tdap or influenza vaccination. Tetanus, diphtheria, and pertussis vaccination increased over time from 22.2% in 2019 to 32.6% in 2022, and influenza vaccination rose to 35.3% in 2021 but returned to prepandemic levels in 2022 (27.7%). Vaccination rates were lower among pregnant people who were young, multiparous, or residents of rural or economically deprived areas for all 3 vaccines., Interpretation: Rates of SARS-CoV-2 vaccination were lower among pregnant people than among nonpregnant comparators but were higher than rates of routinely recommended Tdap and influenza vaccinations. Pandemic urgency may have overcome a great deal of hesitancy about vaccinating against SARS-CoV-2 during pregnancy in 2022, but uptake of routinely recommended vaccines in pregnancy remains a challenge., Trial Registration: Clinicaltrials.gov, no. NCT05663762., Competing Interests: Competing interests:: Devon Greyson reports support for other research from the Canadian Institutes of Health Research (CIHR), British Columbia Immunization Committee, Canadian Immunization Research Network, BC Children’s Hospital Research Canucks for Kids Fund, University of British Columbia (UBC) Hampton Fund, UBC Faculty of Medicine, and Social Sciences and Humanities Research Council. Dr. Greyson also reports honoraria from the University of Sydney and University of Oulu, and unpaid membership with the Association for Information Science and Technology Special Interest Group on Health Information Executive Committee. Meredith Vanstone reports CIHR salary support from Canada Research Chairs program, Banting Postdoctoral Fellowships, Michael Smith Health Research BC Scholar Award, and CIHR/Public Health Agency of Canada (PHAC) Applied Public Health Chair., (© 2024 CMA Impact Inc. or its licensors.)

Objective: Successful clinical conversations about vaccination in pregnancy (pertussis, COVID-19, and influenza) are key to improving low uptake rates of both vaccination in pregnancy and infancy. The purpose of this study was to understand Canadian perinatal care providers' knowledge, attitudes, and practices around vaccination in pregnancy., Methods: Qualitative interviews with 49 perinatal care providers (nurse practitioner, general practitioner, registered nurse, registered midwife, obstetrician-gynecologist, and family physicians) in 6 of 13 provinces and territories were deductively coded using directed content analysis [1] and analyzed according to key themes., Results: Participants detailed their professional training and experiences, patient community demographics, knowledge of vaccines, views and beliefs about vaccination in pregnancy, and attitudes about vaccine counselling. Providers generally described having a good range of information sources to keep vaccine knowledge up to date. Some providers lacked the necessary logistical setups to administer vaccines within their practice. Responses suggest diverging approaches to vaccine counselling. With merely hesitant patients, some opted to dig in and have more in-depth discussions, while others felt the likelihood of persuading an outright vaccine-refusing patient to vaccinate was too low to be worthwhile., Conclusion: Provider knowledge, attitudes, and practices around vaccination varied by professional background. To support perinatal providers' knowledge and practices, clinical guidelines should detail the importance of vaccination relative to other care priorities, emphasize the positive impact of engaging hesitant patients in vaccine counselling., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Background: Rates of perinatal depression and anxiety increased during the COVID-19 pandemic. It remains unclear how the COVID-19 pandemic influenced risk perception and help-seeking behaviours among pregnant and postpartum individuals., Objectives: To explore pregnant and postpartum individuals' decision-making process about when and how to seek support for feelings of depression and/or anxiety during the COVID-19 pandemic., Design: A qualitative descriptive design was used., Methods: The current study is a secondary analysis of qualitative data collected for a larger mixed-methods project that recruited participants who gave birth from 1 May 2020, to 1 December 2021, in Ontario and British Columbia, Canada, using maximum variation and purposive sampling. Seventy-three semi-structured interviews were conducted over Zoom or telephone. This analysis focuses on 56 individuals who discussed their self-identified feelings of prenatal or postpartum depression and/or anxiety. Conventional (inductive) content analysis was employed with iterative stages of open coding, focused coding and cross-checking themes., Results: Most participants recognized their need to seek help for their feelings of depression and/or anxiety through discussions with a mental health professional or someone within their social circle. Nearly all participants accessed informal social support for these feelings, which sometimes entailed social contact in contravention of local COVID-19 public health policies. Many also attempted to access formal mental healthcare, encountering barriers both related and unrelated to the pandemic. Participants described the pandemic as having the dual effect of causing or exacerbating their feelings of depression and/or anxiety while also constraining their ability to access timely professional care., Conclusion: Participants struggled to address their feelings of perinatal depression and anxiety during the COVID-19 pandemic, with many describing a lack of readily available resources and limited access to professional mental healthcare. This study highlights the need for improved provision of instrumental mental health support for pregnant and postpartum populations.

Background: School vaccine mandates (SVMs) are population health interventions that require monitoring and communicating about vaccination of school-aged children, with an aim of controlling infectious disease outbreaks. While 43 % of World Health Organization member states report having some sort of SVM, their details vary. A newer element of some SVMs is an "education component" requiring compulsory information, education, or counseling of parents/guardians who decline to vaccinate their children for non-medical reasons., Methods: This environmental scan sought, mapped, and synthesized evidence on the existence, format, and impacts of education components of SVMs in 18 affluent Organization for Economic Co-operation and Development comparator countries., Findings: We found current SVMs in nine of the 18 comparator countries, but education components to those SVMs only in Canada (n = 2) and the U.S. (n = 9), where such policies were made at the provincial/state level. The earliest was implemented in 2011 and most recent has not yet been implemented. Education components were used as requirements for obtaining non-medical exemptions from SVMs, and involved either an informational paper to be read and signed, a counseling or information session from a health professional (public health worker or licensed provider such as family doctor), or an online module to be completed. Peer-reviewed research on in-person sessions suggests association with at least short-term increased vaccine uptake and reduction of non-medical exemptions. Available data on online module education components suggests similar impacts, but research to date is limited., Conclusion: SVMs with educational components are uncommon but have been increasing since 2011. The details of these education components vary, although topics covered in online modules are relatively consistent. Evidence to date suggests at least short-term reduction in non-medical exemptions associated with implementation of SVM education components, but additional research is required to follow-up and confirm, especially as regards online education modules., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Devon Greyson reports financial support was provided by British Columbia Immunization Committee. Devon Greyson reports financial support was provided by Michael Smith Health Research BC., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Studies of parents' online safety concerns typically centre on information privacy and on worries over unknown third parties preying on children, whereas investigations into youth perspectives on online safety have found young people to focus on threats to safety or reputation by known individuals. The case of youth who are themselves parents raises questions regarding how these differing perspectives are negotiated by individuals who are in dual roles as youth and parents. Using interview and ethnographic observation data from the longitudinal Young Parent Study in British Columbia, Canada, this analysis investigates social media and online safety practices of 113 young parents. Online safety concerns of young parents in this study focused on personal safety, their children's online privacy and image management. These concerns reflect their dual roles, integrating youth image and information management concerns with parental concerns over the safety and information privacy of their own children., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2021.)

Objective: As part of COVID-19 pandemic control efforts, digital proof-of-vaccination credentials were launched in Canada in 2021-2022 following widespread vaccine availability. Given the controversy over proof-of-vaccination credentials-often colloquially called vaccine or immunization "passports"-it is imperative to document successes, shortcomings, and recommendations for any future uses., Methods: This expert consultation applied inductive qualitative content analysis to online video interviews with key informants whose expertise ranged from ethics to public health to computer science to identify what we can learn from this experience with proof-of-vaccination credentials, and what decision-makers must keep in mind for possible future use of such technologies., Results: There remains a lack of consensus regarding appropriate language and scope for digital proof-of-vaccination technologies, the respective roles of the technology sector versus government in design and implementation, and parameters for future use. However, experts agree on many recommendations, including the importance of clear communication, evidence-based rationale for the use of proof-of-vaccination credentials, multidisciplinary consultation including academic experts and the public, and the importance of pan-Canadian standards for accessibility and interoperability. Identified risks of use that emerged, and should be minimized in the future, include risks of coercion and backlash; threats to access, equity and privacy; and impacts such as costs of the technology and workload burden of enforcement and fraud detection., Conclusions: There is much to learn from this first major use of digital proof-of-vaccination credentials. A full scientific review of the impacts on health and equity should be combined with expert recommendations to create pan-Canadian guidelines for the future use of digital proof-of-vaccination solutions., (© The Author(s) 2023.)

Background: Cannabis use during pregnancy and lactation continues to increase as some perceive cannabis to be helpful for symptom management and coping. As such, pregnant and lactating people are faced with challenging decisions, weighing benefits against the potential risks of cannabis use. To help clinicians facilitate informed choices, we explored the self-identified information needs of pregnant and lactating people who are deciding whether or not to use cannabis. We aimed to describe the modes and sources of their information-seeking and their satisfaction with the information they found., Methods: We interviewed 52 people in Canada who made the decision to start, stop, or continue using cannabis during pregnancy and lactation. Participants were recruited from advertisements in prenatal clinics and on social media. We utilized an inductive approach to analysis focused on information used in decision-making about cannabis use, including the process of seeking and evaluating that information., Results: Participants were deliberate in their search for information, most commonly seeking information on risks of use. Information sources were mainly online material or people in their social networks. Clinicians were not commonly described as a knowledgeable or supportive source of information. Overwhelmingly, participants described the information they found as insufficient and emphasized the need for more comprehensive and trustworthy sources of information., Conclusions: Participants identified distinct and unmet information needs associated with their decision to use cannabis. They described a desire for clear evidence about the impact of cannabis use, including information about how to balance the benefits they perceived from cannabis use with the risks of harm., (© 2022 Wiley Periodicals LLC.)

Introduction: Pregnant people have a higher risk of severe COVID-19 disease. They have been disproportionately impacted by COVID-19 infection control policies, which exacerbated conditions resulting in intimate partner violence, healthcare access, and mental health distress. This project examines the impact of accumulated individual health decisions and describes how perinatal care and health outcomes changed during the COVID-19 pandemic., Objectives: Quantitative strand: Describe differences between 2019, 2021, and 2022 birth groups related to maternal vaccination, perinatal care, and mental health care. Examine the differential impacts on racialized and low-income pregnant people.Qualitative strand: Understand how pregnant people's perceptions of COVID-19 risk influenced their decision-making about vaccination, perinatal care, social support, and mental health., Methods and Analysis: This is a Canadian convergent parallel mixed-methods study. The quantitative strand uses a retrospective cohort design to assess birth group differences in rates of Tdap and COVID-19 vaccination, gestational diabetes screening, length of post-partum hospital stay, and onset of depression, anxiety, and adjustment disorder, using administrative data from ICES, formerly the Institute for Clinical Evaluative Sciences (Ontario) and PopulationData BC (PopData) (British Columbia). Differences by socioeconomic and ethnocultural status will also be examined. The qualitative strand employs qualitative description to interview people who gave birth between May 2020- December 2021 about their COVID-19 risk perception and health decision-making process. Data integration will occur during design and interpretation., Ethics and Dissemination: This study received ethical approval from McMaster University and the University of British Columbia. Findings will be disseminated via manuscripts, presentations, and patient-facing infographics., Trial Registration: Registration: Clinicaltrials.gov registration number: NCT05663762., Competing Interests: The authors have no conflicts of interest to declare., (Copyright: © 2023 Vanstone et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Vaccine certificates have been implemented worldwide, aiming to promote vaccination rates and to reduce the spread of COVID-19. However, their use during the COVID-19 pandemic was controversial and has been criticized for infringing upon medical autonomy and individual rights. We administered a national online survey exploring social and demographic factors predicting the degree of public approval of vaccine certificates in Canada. We conducted a multivariate linear regression which revealed which factors were predictive of vaccine certificate acceptance in Canada. Self-reported minority status ( p  < .001), rurality ( p  < .001), political ideology ( p  < .001), age ( p  < .001), having children under 18 in the household ( p  < .001), education ( p  = .014), and income status ( p  = .034) were significant predictors of attitudes toward COVID-19 vaccine certificates. We observed the lowest vaccine-certificate approval among participants who: self-identify as a visible minority; live in rural areas; are politically conservative; are 18-34 years of age; have children under age 18 living in the household; have completed an apprenticeship or trades education; and those with an annual income between $100,000-$159,999. The present findings are valuable for their ability to inform the implementation of vaccine certificates during future pandemic scenarios which may require targeted communication between public health agencies and under-vaccinated populations.

Background: Negative information about vaccines that spreads online may contribute to parents' vaccine hesitancy or refusal. Studies have shown that false claims about vaccines that use emotive personal narratives are more likely to be shared and engaged with on social media than factual evidence-based public health messages. The aim of this study was to explore parents' views regarding the use of positive narratives to promote childhood vaccination., Methods: We identified three ∼4-minute video narratives from social media that counter frequent parental concerns about childhood vaccination: parents and informed decision-making (online misinformation about vaccines); a paediatrician's clinical experience with vaccine-preventable diseases (prevention of still existing diseases); and a mother's experience with vaccine-preventable disease (risks of the disease). Focus group discussions were held with parents of children aged 0 to 5 years to assess their views on these three narratives and their general opinion on the use of narratives as a vaccine promotion intervention., Results: Four focus groups discussions were virtually held with 15 parents in December 2021. In general, parents trusted both health care provider's and parent's narratives, but participants identified more with stories having a parent as the main character. Both narratives featuring personal stories with vaccine-preventable diseases were preferred by parents, while the story about informed decision-making was perceived as less influential. Parents expressed the need for reliable and nuanced information about vaccines and diseases and felt that a short video format featuring a story was an efficient vaccine promotion intervention. However, many mentioned that they generally are not watching such videos while navigating the Web., Conclusion: While vaccine-critical stories are widely shared online, evidence on how best public health could counter these messages remains scarce. The use of narratives to promote vaccination was well-perceived by parents. Future studies are needed to assess reach and impact of such an intervention., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Dubé et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In Canada, the first COVID-19 vaccine was approved for use in December 2020, marking the beginning of a large vaccination campaign. The campaign was not only unprecedented in terms of reach, but also with regards to the amount of information about vaccines that circulated in traditional and social media. This study's aim was to describe COVID-19 vaccine related discourses in Canada through an analysis of editorial cartoons. We collected 2172 cartoons about COVID-19 published between January 2020 and August 2022 in Canadian newspapers. These cartoons were downloaded and a first thematic analysis was conducted using the WHO-EPIWIN taxonomy (cause, illness, treatment, interventions, and information). From this, 389 cartoons related to COVID-19 vaccines were identified under the treatment category. These were subjected to a second thematic analysis to assess main themes (e.g., vaccine development, campaign progress, etc.), characters featured (e.g., politicians, public figures, public) and position with respect to vaccine (favorable, unfavorable, neutral). Six main themes emerged: Research and development of vaccines; Management of the vaccination campaign; Perceptions of and experiences with vaccination services; Measures and incentives to increase COVID-19 vaccine uptake; Criticism of the unvaccinated; and Effectiveness of vaccination. Our analysis revealed a shift in attitudes toward COVID-19 vaccination from high hopes to disenchantment, which may reflect some vaccine fatigue. In the future, public health authorities could face some challenges in maintaining confidence and high COVID-19 vaccine uptake., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Health care providers' recommendations can play an important role in individuals' vaccination decisions. Despite being one of the most popular complementary and alternative medicine (CAM), naturopathy is understudied in relation to vaccination decisions. We sought to address this gap through this study of vaccination perspectives of naturopathy practitioners in the province of Quebec, Canada. We conducted in-depth interviews with 30 naturopaths. Thematic analysis was conducted. Main themes were developed deductively (i.e., based on prior literature) and expanded through inductive coding of the data. Participants noted that they discuss vaccination in their practice, but only when clients asked questions or wanted advice. Naturopaths described refraining from explicitly recommending for or against vaccination. Instead, they focus on empowering their clients to make their own informed decision regarding vaccination. Most participants noted that they direct clients towards sources of information so that clients could decide for themselves, but some mentioned they discussed with clients what they considered to be risks associated with vaccination, as well as its benefits. These discussions were framed through a personalized and individual approach with clients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: In Canada, vaccination that protects against pertussis and influenza is recommended in every pregnancy, but uptake remains low. Communicating the risks and benefits of vaccination is key to clinical conversations about vaccination, which may influence the uptake of pregnancy and subsequent infant vaccines. Canadian midwives use an informed choice model of care, which is distinct from informed consent and prioritizes client autonomy in decision-making., Methods: Using institutional ethnography, which treats lived experience as expertise, we aimed to understand how Canadian midwives, governed by intersecting professional standards and regulations, navigate vaccine discussions with their clients. We conducted interviews with individuals involved in midwifery training, regulation, and continuing education, as well as key public health professionals with expertise in immunization training. Following the phases of thematic analysis outlined by Braun and Clarke, data were analyzed holistically, emergent themes identified, and coding categories developed., Results: Two types of confidence emerged as important to midwives' ability to conduct a thoroughly informed choice discussion about vaccines: confidence in vaccination itself (vaccine confidence), and confidence in vaccine knowledge and counseling skills (vaccine counseling confidence). A deferred or shortened vaccine discussion could be the result of either vaccine hesitancy or counseling hesitancy., Discussion: Currently, available clinical communication tools and recommended techniques for addressing vaccine hesitancy do not always adapt well to the needs of midwives working to support clients' informed choice decisions. Our findings suggest that Canadian midwives require more and clearer resources on both the risks and benefits of vaccination in pregnancy., (© 2022 The Authors. Birth published by Wiley Periodicals LLC.)

Background: Patients increasingly use web-based evaluation tools to assess their physicians, health care teams, and overall medical experience., Objective: This study aimed to evaluate the extent to which the standardized physician competencies of the CanMEDS Framework are present in web-based patient reviews (WPRs) and to identify patients' perception of important physician qualities in the context of quality cancer care., Methods: The WPRs of all university-affiliated medical oncologists in midsized cities with medical schools in the province of Ontario (Canada) were collected. Two reviewers (1 communication studies researcher and 1 health care professional) independently assessed the WPRs according to the CanMEDS Framework and identified common themes. Comment scores were then evaluated to identify κ agreement rates between the reviewers, and a descriptive quantitative analysis of the cohort was completed. Following the quantitative analysis, an inductive thematic analysis was performed., Results: This study identified 49 actively practicing university-affiliated medical oncologists in midsized urban areas in Ontario. A total of 473 WPRs reviewing these 49 physicians were identified. Among the CanMEDS competencies, those defining the roles of medical experts, communicators, and professionals were the most prevalent (303/473, 64%; 182/473, 38%; and 129/473, 27%, respectively). Common themes in WPRs include medical skill and knowledge, interpersonal skills, and answering questions (from the patient to the physician). Detailed WPRs tend to include the following elements: experience and connection; discussion and evaluation of the physician's knowledge, professionalism, interpersonal skills, and punctuality; in positive reviews, the expression of feelings of gratitude and a recommendation; and in negative reviews, discouragement from seeking the physician's care. Patients' perception of medical skills is less specific than their perception of interpersonal qualities, although medical skills are the most commented-on element of care in WPRs. Patients' perception of interpersonal skills (listening, compassion, and overall caring demeanor) and other experiential phenomena, such as feeling rushed during appointments, is often specific and detailed. Details about a physician's interpersonal skills or "bedside manner" are highly perceived, valued, and shareable in an WPR context. A small number of WPRs reflected a distinction between the value of medical skills and that of interpersonal skills. The authors of these WPRs claimed that for them, a physician's medical skills and competence are more important than their interpersonal skills., Conclusions: CanMEDS roles and competencies that are explicitly patient facing (ie, those directly experienced by patients in their interactions with physicians and through the care that physicians provide) are the most likely to be present and reported on in WPRs. The findings demonstrate the opportunity to learn from WPRs, not simply to discern physicians' popularity but to grasp what patients may expect from their physicians. In this context, WPRs can represent a method for the measurement and assessment of patient-facing physician competency., (©Nina Morena, Nicholas Zelt, Diana Nguyen, Emilie Dionne, Carrie A Rentschler, Devon Greyson, Ari N Meguerditchian. Originally published in JMIR Formative Research (https://formative.jmir.org), 04.05.2023.)

Background: Multiple studies have demonstrated that pregnant and lactating people who use cannabis perceive a variety of benefits from that use, offering some explanation of why rates of use continue to increase., Objectives: The aim of this study was to explore pregnant and lactating people's perceptions of the risks of cannabis use and understand what steps, if any, they take to mitigate these risks., Design: Qualitative description., Methods: We analyzed semi-structured interviews with 52 Canadians who made the decision to start, stop, or continue using cannabis during pregnancy or lactation between 2019 and 2021. Data collection iterated with analysis. We used a conventional (inductive) approach to content analysis., Results: Perception of risk was found to be an essential component of decision-making about cannabis use. We identified a cycle of "risk identification," "management," and "observation" of effects. First, the pregnant or lactating person assesses the risks and weighs them against the perceived benefits of cannabis use. Second, they take action to minimize risks, with some choosing abstinence. Others, often those who were using cannabis to manage symptoms, continued cannabis use but devised a variety of other risk mitigation strategies such as, decreasing the amount or frequency of their use, changing the form of cannabis, and strategically timing their use with caregiving responsibilities. The final stage of the cycle involves seeking information about whether or not the initial perceived risk has manifested after implementing mitigation strategies, through observations and clinical information about the pregnancy or child., Conclusion: Participants consistently engaged in deliberation about the risks and benefits associated with their perinatal cannabis use. Nearly all implemented strategies intended to minimize risk. Our results highlight the need for more research to inform clear public health messaging about risk mitigation to minimize the potential harms of perinatal cannabis use. This work informs clinicians about patient-perceived risks and mitigation strategies which could in turn help inform shared decision-making conversations.

Background: The COVID-19 pandemic has spotlighted the politicization of public health issues. A public health monitoring tool must be equipped to reveal a public health measure's political context and guide better interventions. In its current form, infoveillance tends to neglect identity and interest-based users, hence being limited in exposing how public health discourse varies by different political groups. Adopting an algorithmic tool to classify users and their short social media texts might remedy that limitation., Objective: We aimed to implement a new computational framework to investigate discourses and temporal changes in topics unique to different user clusters. The framework was developed to contextualize how web-based public health discourse varies by identity and interest-based user clusters. We used masks and mask wearing during the early stage of the COVID-19 pandemic in the English-speaking world as a case study to illustrate the application of the framework., Methods: We first clustered Twitter users based on their identities and interests as expressed through Twitter bio pages. Exploratory text network analysis reveals salient political, social, and professional identities of various user clusters. It then uses BERT Topic modeling to identify topics by the user clusters. It reveals how web-based discourse has shifted over time and varied by 4 user clusters: conservative, progressive, general public, and public health professionals., Results: This study demonstrated the importance of a priori user classification and longitudinal topical trends in understanding the political context of web-based public health discourse. The framework reveals that the political groups and the general public focused on the science of mask wearing and the partisan politics of mask policies. A populist discourse that pits citizens against elites and institutions was identified in some tweets. Politicians (such as Donald Trump) and geopolitical tensions with China were found to drive the discourse. It also shows limited participation of public health professionals compared with other users., Conclusions: We conclude by discussing the importance of a priori user classification in analyzing web-based discourse and illustrating the fit of BERT Topic modeling in identifying contextualized topics in short social media texts., Competing Interests: Conflicts of Interest: None declared., (©Weiai Wayne Xu, Jean Marie Tshimula, Ève Dubé, Janice E Graham, Devon Greyson, Noni E MacDonald, Samantha B Meyer. Originally published in JMIR Infodemiology (https://infodemiology.jmir.org), 09.12.2022.)

Background: In recent years, Canadian provinces have been discussing, implementing, and tightening vaccination "mandate" policies for school enrolment. British Columbia (BC), Canada's westernmost province, implemented a Vaccination Status Reporting Regulation (VSRR) in September 2019, which requires the vaccination status of children in public, private, and home schooling be reported to a provincial vaccination registry and education for parents who refuse to vaccinate. Legal vaccination mandates can carry the risk of backlash, thereby making it important to monitor public attitudes across policy implementation windows. The present study aimed to evaluate public support for this new provincial mandate following implementation., Methods: An online panel of BC adults (n = 1301) was surveyed about 15 vaccine-promotion policy options in April 2020 following mandate implementation. Respondents were representative of the provincial population by gender, age, geographic residence, and percentage of households with children younger than 19 years of age. Poisson regression was used to estimate predictors of policy endorsement, and support for the VSRR., Results: Strong support existed for the VSRR with 88.2% of respondents agreeing or strongly agreeing that parents should be required to provide their children's immunization records at school entry, and 74.6% supporting required education sessions for parents who refuse to vaccinate their children. Overall, the sample was supportive of vaccination, and pro-vaccine attitudes were associated with strong agreement for nearly all vaccine policy options. Policies to impose rewards (e.g., tax credits) and penalties (e.g., fines) were the least likely to receive strong agreement from respondents., Conclusions: Near the end of the first school year in British Columbia subject to the Vaccination Status Reporting Regulation, support for both the mandated documentation and mandated education elements of the policy are high, and associated with pro-vaccine attitudes. There are not marked differences in strong support based on gender, age, parenting, education level, or income., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Health care providers' knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines, and their patients' vaccine uptake. This qualitative study' objective was to better understand health care providers' vaccination decisions, their views on barriers to COVID-19 vaccine acceptance and proposed solutions, their opinions on vaccine policies, and their perceived role in discussing COVID-19 vaccination with patients., Methods: Semi-structured interviews on perceptions of COVID-19 vaccines were conducted with Canadian health care providers (N = 14) in spring 2021. A qualitative thematic analysis using NVivo was conducted., Results: Participants had positive attitudes toward vaccination and were vaccinated against COVID-19 or intended to do so once eligible (two delayed their first dose). Only two were actively promoting COVID-19 vaccination to their patients; others either avoided discussing the topic or only provided answers when asked questions. Participants' proposed solutions to enhance COVID-19 vaccine uptake in the public were in relation to access to vaccination services, information in multiple languages, and community outreach. Most participants were in favor of mandatory vaccination policies and had mixed views on the potential impact of the Canadian vaccine-injury support program., Conclusions: While health care providers are recognized as a key source of information regarding vaccines, participants in our study did not consider it their role to provide advice on COVID-19 vaccination. This is a missed opportunity that could be avoided by ensuring health care providers have the tools and training to feel confident in engaging in vaccine discussions with their patients.

People may choose to receive vaccines in response to pressures that outweigh any concerns that they have. We explored Racialized minority and Indigenous Peoples' motivations for, perceptions of choice in, and concerns about, COVID-19 vaccination. We used a sequential explanatory mixed methods approach, including a national survey administered around the time vaccines were first authorized (Dec 2020) followed by qualitative interviews when vaccines were becoming more readily available to adults (May-June 2021). We analyzed survey data using descriptive statistics and interviews using critical feminist methodologies. Survey respondents self-identified as a Racialized minority (n = 1488) or Indigenous (n = 342), of which 71.4% and 64.6%, respectively, intended to receive a COVID-19 vaccine. Quantitative results indicated perceptions of COVID-19 disease were associated with vaccination intention. For instance, intention was associated with agreement that COVID-19 disease is severe, risk of becoming sick is great, COVID-19 vaccination is necessary, and vaccines available in Canada will be safe (p < 0.001). COVID-19 vaccines were in short supply in Canada when we subsequently completed qualitative interviews with a subset of Racialized minority (n = 17) and Indigenous (n = 10) survey respondents. We coded interview transcripts around three emergent themes relating to governmentality and cultural approaches to intersectional risk theories: feelings of collective responsibility, choice as privilege, and remaining uncertainties about COVID-19 vaccines. For example, some mentioned the responsibility and privilege to receive a vaccine earlier than those living outside of Canada. Some felt constraints on their freedom to choose to receive or refuse a vaccine from intersecting oppressions or their health status. Although all participants intended to get vaccinated, many mentioned uncertainties about the safety and effectiveness of COVID-19 vaccination. Survey respondents and interview participants demonstrated nuanced associations of vaccine acceptance and hesitancy shaped by perspectives of vaccine-related risks, symbolic associations of vaccines with hope, and intersecting social privileges and inequities (including racialization)., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The COVID-19 pandemic has generated an explosion in the amount of information shared on the internet, including false and misleading information on SARS-CoV-2 and recommended protective behaviors. Prior to the pandemic, web-based misinformation and disinformation were already identified as having an impact on people's decision to refuse or delay recommended vaccination for themselves or their children., Objective: The overall aims of our study are to better understand the influence of web-based misinformation and disinformation on COVID-19 vaccine decisions and investigate potential solutions to reduce the impact of web-based misinformation and disinformation about vaccines., Methods: Based on different research approaches, the study will involve (1) the use of artificial intelligence techniques, (2) a web-based survey, (3) interviews, and (4) a scoping review and an environmental scan of the literature., Results: As of September 1, 2022, data collection has been completed for all objectives. The analysis is being conducted, and results should be disseminated in the upcoming months., Conclusions: The findings from this study will help with understanding the underlying determinants of vaccine hesitancy among Canadian individuals and identifying effective, tailored interventions to improve vaccine acceptance among them., International Registered Report Identifier (irrid): DERR1-10.2196/41012., (©Eve Dubé, Shannon E MacDonald, Terra Manca, Julie A Bettinger, S Michelle Driedger, Janice Graham, Devon Greyson, Noni E MacDonald, Samantha Meyer, Geneviève Roch, Maryline Vivion, Laura Aylsworth, Holly O Witteman, Félix Gélinas-Gascon, Lucas Marques Sathler Guimaraes, Hina Hakim, Dominique Gagnon, Benoît Béchard, Julie A Gramaccia, Richard Khoury, Sébastien Tremblay. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 17.10.2022.)

Uptake of vaccination during pregnancy in Canada is lower than comparator countries. A recommendation from a trusted perinatal healthcare provider is a key opportunity to promote vaccine uptake and improve confidence. This study aims to identify barriers and opportunities to vaccination in midwifery care. Seventeen semi-structured telephone interviews with practicing midwives, educators and public health professionals with immunization training experiences were conducted. Documents pertaining to the midwifery profession (approx. 50) were reviewed. Inductive thematic analysis identified logistical, interprofessional, and information barriers preventing Canadian midwives from administering vaccines and counseling clients about vaccination, as well as opportunities to address each barrier. Key interventions at the level of logistics, training, and client information materials would help address barriers to the integration of midwives into the provision and recommendation of vaccines in perinatal care across Canada., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Cannabis is the most commonly used drug during pregnancy, excluding alcohol and tobacco, in the United States. Cannabis consumption during pregnancy is increasing along with greater legal and social acceptance., Methods: We conducted a qualitative content analysis of 23 in-depth interviews with pregnant and lactating people in Massachusetts, a state that legalized cannabis for adult use in 2016. Our aim was to explore how policy constrains or facilitates people's ability to make informed decisions about cannabis use during pregnancy and lactation. Our analysis was conducted using an ecosocial approach, recognizing that the implementation and interpretation of cannabis policy can be understood at multiple levels, which interact with each other and shape the health and experiences of individuals. Additionally, this analysis was informed by a harm reduction approach in which we acknowledge the complexity surrounding cannabis use during pregnancy and lactation, while attempting to identify ways to reduce potentially harmful consequences., Results: Findings revealed that, despite the legal status of cannabis, there continues to be a lack of clarity for pregnant and lactating people regarding the legal implications of cannabis use. Inconsistent state and institutional policies about drug testing of mothers and newborns leave a cloud of fear hanging over the experiences of people who use cannabis and inhibit their ability to obtain expert advice from healthcare providers., Conclusion: Decision makers in public and institutional policy should work to clarify and update policies regarding substance use during pregnancy following legalization of a new substance, and ensure that pregnant and lactating people are afforded the same legal protections as the general population., Competing Interests: Declarations of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)

Background: Post-licensure adverse events following immunization (AEFI) surveillance is conducted to monitor vaccine safety, such as identifying batch/brand issues and rare reactions, which consequently improves community confidence. The integration of technology has been proposed to improve AEFI surveillance, however, there is an absence of description regarding which digital solutions are successfully being used and their unique characteristics., Objectives: The objectives of this scoping review were to 1) map the research landscape on digital systems used for active, participant-centred, AEFI surveillance and 2) describe their core components., Methods: We conducted a scoping review informed by the PRISMA Extension for Scoping Reviews (PRSIMA-ScR) guideline. OVID-Medline, Embase Classic + Embase, and Medrxiv were searched by a medical librarian from January 1, 2000 to January 28th, 2021. Two independent reviewers determined which studies met inclusion based on pre-specified eligibility criteria. Data extraction was conducted using pre-made tables with specific variables by one investigator and verified by a second., Results: Twenty-seven publications met inclusion, the majority of which came from Australia (n = 15) and Canada (n = 6). The most studied active, participant-centred, digital AEFI surveillance systems were SmartVax (n = 8) (Australia), Vaxtracker (n = 7) (Australia), and Canadian National Vaccine Safety (CANVAS) Network (Canada) (n = 6). The two most common methods of communicating with vaccinees reported were short-message-service (SMS) (n = 15) and e-mail (n = 14), with online questionnaires being the primary method of data collection (n = 20)., Conclusion: Active, participant-centred, digital AEFI surveillance is an area actively being researched as depicted by the literature landscape mapped by this scoping reviewWe hypothesize that the AEFI surveillance approach herein described could become a primary method of collecting self-reported subjective symptoms and reactogenicity from vaccinees, complementing existing systems. Future evaluation of identified digital solutions is necessary to bring about improvements to current vaccine surveillance systems to meet contemporary and future public health needs., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kumanan Wilson, Julie Bettinger reports financial support was provided by Canadian Immunization Research Network. Kumanan Wilson reports a relationship with CANImmunize Inc. that includes: board membership and equity or stocks. Karina Top reports a relationship with GlaxoSmithKline USA that includes: funding grants. KW is cofounder and CEO of CANImmunize; KW served as a member of the independent data safety advisory board for the COVID-19 Medicago vaccine trial., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Perinatal cannabis use is increasing, and clinician counselling is an important aspect of reducing the potential harm of cannabis use during pregnancy and lactation. To understand current counselling practices, we conducted a systematic review and integrative mixed-methods synthesis to determine "how do perinatal clinicians respond to pregnant and lactating patients who use cannabis?", Methods: We searched 6 databases up until 2021-05-31. Eligible studies described the attitudes, perceptions, or beliefs of perinatal clinician about cannabis use during pregnancy or lactation. Eligible clinicians were those whose practice particularly focusses on pregnant and postpartum patients. The search was not limited by study design, geography, or year. We used a convergent integrative analysis method to extract relevant findings for inductive analysis., Results: Thirteen studies were included; describing perspectives of 1,366 clinicians in 4 countries. We found no unified approach to screening and counselling. Clinicians often cited insufficient evidence around the effects of perinatal cannabis use and lacked confidence in counselling about use. At times, this meant clinicians did not address cannabis use with patients. Most counselled for cessation and there was little recognition of the varied reasons that patients might use cannabis, and an over-reliance on counselling focussed on the legal implications of use., Conclusion: Current approaches to responding to cannabis use might result in inadequate counselling. Counselling may be improved through increased education and training, which would facilitate conversations to mitigate the potential harm of perinatal cannabis use while recognizing the benefits patients perceive., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Rates of perinatal cannabis use are rising, despite clinical evidence about the potential for harm. Accordingly, pregnant and lactating people who perceive a benefit from cannabis use may have a difficult time making informed decisions about cannabis use., Methods: We conducted a systematic review of mixed-methods research to synthesize existing knowledge on the perspectives of pregnant people and their partners about cannabis use in pregnancy. Six health and social science databases were searched up until May 30, 2021. There were no methodological, time, or geographic limits applied. We employed a convergent integrative approach to the inductive analysis of findings from all studies., Results: We identified 26 studies describing views of 17,781 pregnant and postpartum people about cannabis use in pregnancy. No studies describing the views of partners were identified, and only one study specifically addressed the perspectives of lactating people. Comparative analysis revealed that whether cannabis was studied alone or grouped with other substances resulted in significant diversity in descriptions of participant decision-making priorities and perceptions of risks and benefits. Studies of cannabis alone demonstrated a complex decision-making process whereby perceived benefits are balanced against the available information about risk, which is often unclear and uncertain. Clear and helpful information was difficult to identify, and health care providers were not described as a helpful and trusted resource for decision-making., Discussion: Decision-making about cannabis use is difficult for pregnant and lactating people who perceive a benefit from this use, although this decisional difficulty is seldom reflected in studies that examine cannabis as one of multiple substances that pregnant or lactating people may use. Our review suggests several approaches clinicians may take to encourage open and supportive conversations to facilitate informed decisions about cannabis use during the perinatal period., (© 2022 The Authors. Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM).)

Background: High rates of COVID-19 vaccination uptake are required to attain community immunity. This study aims to identify factors associated with COVID-19 vaccine uncertainty and refusal among young adults, an underexplored population with regards to vaccine intention generally, in two high-income settings: Canada and France., Methods: A cross-sectional online survey was conducted from October to December 2020 among young adults ages 18-29 years (n = 6663) living in Canada (51.9%) and France (48.1%). Multinomial logistic regression analyses were performed to identify the sociodemographic and COVID-19-related measures (e.g., prevention behavior and perspectives, health-related concerns) associated with vaccine uncertainty and refusal. We conducted weighted analyses by age, gender and province/region of residence., Results: Intention to accept vaccination was reported by 84.3% and 59.7% of the sample in Canada and France, respectively. Higher levels of vaccine uncertainty and refusal were observed in France compared to Canada (30.1% versus 11%, 10.2% versus 4.7%). In both countries, we found higher levels of vaccine acceptance among young adults who reported COVID-19 prevention actions. Vaccine uncertainty and refusal were associated with living in a rural area, having lower levels of educational attainment, not looking for information about COVID-19, not wearing a face mask, and reporting a lower level of concern for COVID-19's impact on family. Participants who had been tested for COVID-19 were less likely to intend to refuse a vaccine., Conclusions: COVID-19 vaccine acceptance was high among young adults in Canada and France during a time in which vaccines were approved for use. Targeted interventions to build confidence in demographic groups with greater hesitance (e.g., rural and with less personal experience with COVID-19) may further boost acceptance and improve equity as vaccine efforts continue to unfold., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The COVID-19 pandemic represents not only the spread of a highly contagious and potentially fatal virus, but also an outbreak of theories, rumors, discourses and representations trying to make sense of a crisis. In this article, we explore the issue of blame and stigma in the context of the COVID-19 pandemic in Canada. We do so by studying editorial cartoons published about COVID-19 in ten mainstream Canadian newspapers between January 2020 and March 2021. We identified 203 editorial cartoons that highlight common discourses which blame or stigmatize specific groups of people for the origin or transmission of COVID-19, or for their behavior during the pandemic. The cartoons focused on four groups: 1) people of Chinese origin or descent and of other national/geographic provenance (Americans, Canadians from specific provinces, urban residents); 2) international travelers; 3) people who do not respect the preventive measures to contain the pandemic; and 4) people who question or criticize the scientific discourses about COVID-19. Our analysis revealed an "othering process" common in times of pandemic. Our analysis of editorial cartoons in Canada also uncovered a moralization around the respect of the counter measures against COVID-19. These editorial cartoons largely divide the population into two groups: 1) "virtuous" people who are "selfless" and "smart" and who respect the public health preventive measures; 2) those who are "immoral", "self-centered", "silly" and even "stupid", who do not respect the recommended measures to prevent the transmission of COVID-19. While negatively portraying these individuals may help promote adherence to the recommended measures, it also can exacerbate polarization. Analyzing editorial cartoons can be a useful approach to rapidly gather information on attitudes and feelings in the public at a specific time and place., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Growing evidence shows that many parents begin the decision-making process about infant vaccination during pregnancy and these decisions - once established - may be resistant to change. Despite this, many interventions targeting vaccination are focused on communicating with parents after their baby is born. This suggests that the prenatal period may constitute a missed opportunity for communicating with expectant parents about infant vaccination., Methods: Using a longitudinal qualitative design, we conducted two interviews (prepartum and postpartum) with women (n = 19) to explore the optimal timing of vaccination information. The data were analyzed thematically, and examined across all sets of pre- and post-partum interviews as well as within each individual participant to draw out salient themes., Results: Most participants formed their intentions to vaccinate before the baby was born and indicated that they would welcome information about vaccination from their maternity care providers. However, few individuals recalled their maternity care providers initiating vaccination-related conversations with them., Conclusion: The prenatal period is an important time to begin conversations with expectant parents about vaccinating their infants, particularly if these conversations are initiated by trusted maternity care providers. More information is needed on how maternity care providers can be better supported to have these conversations with their patients., (© 2022. The Author(s).)

Background: Cannabis use among pregnant and lactating people is increasing, despite clinical evidence showing that cannabis use may be associated with low birth weight and childhood developmental deficits. Our objective was to understand why pregnant and lactating people use cannabis and how these motivations change across perinatal stages., Methods: Using qualitative, constructivist grounded theory methodology, we conducted telephone and virtual interviews with 52 individuals from across Canada. We selected participants using maximum variation and theoretical sampling. They were eligible if they had been pregnant or lactating within the past year and had decided to continue, cease or decrease their cannabis use during the perinatal period., Results: We identified 3 categories of reasons that people use cannabis during pregnancy and lactation: sensation-seeking for fun and enjoyment; symptom management of chronic conditions and conditions related to pregnancy; and coping with the unpleasant, but nonpathologized, experiences of life. Before pregnancy, participants endorsed reasons for using cannabis in these 3 categories in similar proportions, with many offering multiple reasons for use. During pregnancy, reasons for use shifted primarily to symptom management. During lactation, reasons returned to resemble those expressed before pregnancy., Interpretation: In this study, we showed that pregnant and lactating people use cannabis for many reasons, particularly for symptom management. Reasons for cannabis use changed across reproductive stages. The dynamic nature of the reasons for use across stages speaks to participant perception of benefits and risks, and perhaps a desire to cast cannabis use during pregnancy as therapeutic because of perceived stigma., Competing Interests: Competing interests: From April to December 2019, Janelle Panday was employed as a research analyst at PureSinse Inc. (a licensed cannabis producer), outside the submitted work. She does not hold any remaining financial or personal connection to PureSinse, which is no longer in operation., (© 2021 CMA Joule Inc. or its licensors.)

To improve uptake of influenza vaccine in pregnancy, it is important to understand the factors that predict prenatal vaccination. The aim of this study was to test the capability of the theory of planned behavior, augmented with information constructs, to predict and explain influenza vaccination uptake in a sample of 600 pregnant individuals in Canada. A baseline survey at the start of influenza season assessed beliefs, norms, perceived control, and information-seeking behavior related to influenza vaccination in pregnancy, as well as respondent demographics. A follow-up survey at the conclusion of influenza season assessed self-reported influenza vaccine uptake as well as infant vaccination intentions. Multivariable analysis indicated that attitudes toward influenza vaccination in pregnancy, subjective norms, information seeking, and past vaccination behavior predicted intentions to be vaccinated, and intentions predicted vaccine uptake. Neither perceived control nor demographics were significant predictors of intentions or vaccine uptake. These findings suggest that presumptive offering of vaccination in pregnancy by health care providers, as well as patient and public health educational interventions, may be effective in communicating norms and strengthening positive attitudes and intentions concerning influenza vaccination in pregnancy, resulting in higher vaccine coverage.

Background: Registered midwives in British Columbia (BC) are primary health care practitioners for healthy people throughout pregnancy and for approximately 6 weeks postpartum. BC registered midwives are authorized to prescribe and administer certain vaccines to adults under their care during the perinatal period and hepatitis B vaccine to high-risk newborns. However, little has been documented about their recommendations for, and administration of, prenatal and infant vaccinations. This study surveyed midwives currently practicing in British Columbia to understand their vaccination practices., Methods: An online survey was administered to the members of the Midwives Association of BC in spring 2018. Outcome measures were the proportion of midwives who discussed, recommended, and administered the following vaccines: influenza, varicella, rubella, and infant hepatitis B. The proportion of midwives who discussed and recommended infant vaccines was measured. Barriers to discussion, recommendation, and administration of vaccines were captured., Results: Sixty-three percent of 108 respondents administered vaccines to their clients. Hepatitis B and rubella were the most frequent vaccines administered. Logistical concerns were the greatest barrier to vaccine administration. This was followed by the perception that vaccine administration is not within the scope of practice of midwives, especially for influenza vaccine. Midwives who administered vaccines were significantly more likely to discuss and recommend vaccines to their clients and their infants., Conclusions: The majority of BC midwives discuss, recommend, and administer vaccines to their clients. Our survey highlighted key areas to address to strengthen midwifery capacity to discuss, recommend, and provide prenatal and infant vaccines., (© 2021 The Authors. Birth published by Wiley Periodicals LLC.)

Cannabis is the most commonly used drug during pregnancy in the United States and Canada, and the American College of Obstetricians and Gynecologists recommends that all pregnant individuals be screened for cannabis use and counseled regarding potential adverse health impacts of use. However, those considering or using cannabis during pregnancy report experiencing stigma and lack of information from health care providers and, thus, frequently rely on friends, family, and the internet for information. This article describes 3 types of decisions individuals may be making about cannabis use during pregnancy and suggests approaches health care providers may take to minimize judgment and provide optimal support for informed cannabis use decisions among pregnant individuals. Desistance decisions involve consideration of whether and how to reduce or stop using during pregnancy. Self-treatment decisions are made by those exploring cannabis to help alleviate troublesome symptoms such as nausea or anxiety. Substitution decisions entail weighing whether to use cannabis instead of another substance with greater perceived harms. Health care providers should be able to recognize the various types of cannabis use decisions that are being made in pregnancy and be ready to have a supportive conversation to provide current and evidence-based information to individuals making desistance, self-treatment, and substitution decisions. Individuals making desistance decisions may require support with potential adverse consequences such as withdrawal or return of symptoms for which cannabis was being used, as well as potentially navigating social situations during which cannabis use is expected. Those making self-treatment decisions should be helped to fully explore treatment options for their symptoms, including evidence on risks and benefits. Regarding substitution decisions, health care providers should endeavor to help pregnant individuals understand the available evidence regarding risks and benefits of available options and be open to revisiting the topic over time., (© 2021 The Authors. Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM).)

A number of countries have implemented vaccination in pregnancy as a strategy to reduce the burden of influenza and pertussis. The aim of this study was to assess the involvement of Canadian maternity care providers in administration of vaccines to their pregnant patients. A cross-sectional web-based survey was sent to family physicians, obstetricians-gynecologists, midwives, pharmacists, and nurses. A multivariable logistic regression model was used to determine variables independently associated with offering vaccination services in pregnancy in providers' practice. A total of 1,135 participants participated. Overall, 64% (n = 724) of the participants reported offering vaccines in their practice and 56% (n = 632) reported offering vaccines to pregnant patients. The main reasons reported for not offering vaccination services in pregnancy were the belief that vaccination was outside of the scope of practice; logistical issues around access to vaccines; or lack of staff to administer vaccines. In multivariable analysis, the main factors associated with vaccination of pregnant patients in practices where vaccination services were offered were: providers' confidence in counseling pregnant patients about vaccines, seeing fewer than 11 pregnant patients on average each week, and being a nurse or a family physician. Although the majority of participants expressed strong support for vaccination during pregnancy, half were not offering vaccination services in their practice. Many were not equipped to offer vaccines in their practice or felt that it was not their role to do so. To enhance vaccine acceptance and uptake in pregnancy, it will be important to address the logistical barriers identified in this study.

Vaccine hesitancy-the reluctance to receive recommended vaccination because of concerns and doubts about vaccines-is recognized as a significant threat to the success of vaccination programs and has been associated with recent major outbreaks of vaccine-preventable diseases. Moreover, the association between complementary and alternative medicine (CAM) use and vaccine hesitancy and/or refusal has been frequently reported in the literature. To date, significant gaps persist in our understanding of contemporary Canadian CAM providers' beliefs regarding vaccination and how socio-professional influences may shape their vaccine-related attitudes and behaviours. To address the latter gap, the current study aims to explore the content of professional guidelines, recommendations and other discourses among CAM providers as they concern vaccination by analyzing both academic, peer-reviewed literature and Canadian organizational webpages prepared by and/or for practicing chiropractors, naturopaths and homeopaths. In the academic literature, we identified a number of complex and diverging views on vaccination that spanned topics of effectiveness; safety; theoretical, empirical, and ethical soundness; political justifiability; and compatibility with CAM philosophy and professional boundaries. However, in its current state the CAM literature cannot be described in broad strokes as being either pro- or anti-vaccination without considering finer areas of disagreement. Compared to the academic literature, which focuses more on the conceptual and evidentiary basis of vaccination, a greater proportion of vaccine-related content on Canadian CAM organizations' webpages seems to be dedicated to offering specific directives and prescriptions to providers. Guidelines and standards of practice address a number of issues, including vaccine administration, counsel, education and marketing. As CAM organizations further evolve in Canada and elsewhere as part of a broader "professionalization" initiative, greater attention will need to be directed at their role in shaping providers' beliefs and practices that both support and undermine vaccine promotion efforts., Competing Interests: The authors have declared that no competing interests exist.