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Objective: This research explores whether having accommodation needs met reduces job disruptions., Methods: A cross-sectional survey (n = 955) of Canadians working with physical and/or mental/cognitive disabilities was used to assess the association between having workplace accommodations (ie, flexibility, modifications) needs met and four types of job disruptions. Analyses used marginal effects models to adjust for demographic and work context variables., Results: Participants with work modification needs met had a 7.7% decrease in lost work time. Participants with workplace flexibility needs met had a 9.9% increase in lost work time. Having workplace flexibility or modification needs met were not associated with the other job disruption outcomes., Conclusions: Modifications may help to reduce lost work time for workers with disabilities. Flexibility may increase lost time, which is explained by it enabling workers to attend to personal needs during working hours., Competing Interests: Conflict of Interest: None declared., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Occupational and Environmental Medicine.)

Introduction: Tobacco is the leading modifiable risk factor for cancer and other chronic diseases. The workplace provides an opportunity to advance tobacco cessation efforts. Combining tobacco cessation with complementary components addressing mental health, physical activity, and healthy eating has demonstrated effectiveness in non-workplace settings. This scoping review examines the literature on multicomponent workplace tobacco cessation interventions to identify core components and implementation facilitators and barriers to support uptake in the workplace setting., Methods: A scoping review was conducted following PRISMA guidelines for Scoping Reviews and Arksey and O'Malley's five-step process. Peer-reviewed literature published in the past 20 years was searched across 9 databases. A search for relevant gray literature (i.e., conference papers/proceedings) was also completed. Articles were screened by two independent researchers for inclusion. Included studies evaluated workplace interventions recruiting individuals to participate in a tobacco cessation program alongside a complementary component (i.e., physical activity, mental health, healthy eating)., Results: Most of the 12 included studies paired tobacco cessation with mental health or stress reduction interventions. Most complementary components targeted the individual versus organizational or policy levels. The synthesized facilitators indicated that multicomponent interventions should be incentivized and tailored to adequately meet the needs of different workplaces and employees., Discussion: This scoping review synthesizes studies integrating multiple complementary program components into workplace tobacco cessation efforts. Future interventions should implement tobacco cessation interventions at multiple levels, combining complementary components to maximize effectiveness and overcome barriers (e.g., weight gain and stress) to successful outcomes., Competing Interests: Conflict of InterestThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Musculoskeletal (MSK) conditions, particularly shoulders, knees, and the low back issues, place a significant burden on individuals, society, and healthcare systems. There is a lack of attention to negative health effects impacting patients because of their interactions to access appropriate diagnostics, assessments, and treatments. This scoping review intends to search and synthesize peer-reviewed evidence on the negative health impacts associated with navigating the healthcare system for MSK care. A scoping review will be conducted following the PRISMA guidelines for Scoping Reviews and Arksey and O'Malley's 5-step process. Six databases will be searched with no time or geographic limits. Included articles must meet all the following criteria: 1) the patients must be adults, 2) patients must be seeking care for their knee, low-back, or shoulder condition, 3) interacted with the healthcare system, and 4) experienced health impacts due to navigating the healthcare system. Information from each article will be charted in a pre-determined extraction. This protocol aims to share our methods ahead of analysis to increase rigour and transparency. The scoping review results will better elucidate the health impacts of the inaccessibility of high-quality care for MSK conditions. The findings also aim to inform the development of patient-centered outcomes to evaluate alterations to the current MSK pathways., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Jessiman-Perreault 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.)

Background: The Good Life with osteoArthritis: Denmark (GLA:D™), an evidence-based education and exercise program designed for conservative management of knee and hip osteoarthritis (OA), has been shown to benefit participants by reducing pain, improving function, and quality of life. Standardized reporting in the GLA:D databases enabled the measurement of self-reported and performance-based outcomes. There is a paucity of qualitative research on the participants' perceptions of this program, and it is important to understand whether participants' perceptions of the benefits of the program align with reported quantitative findings., Methods: We conducted semi-structured telephone interviews with individuals who participated in the GLA:D program from January 2017 to December 2018 in Alberta, Canada. Data were analyzed using an interpretive description approach and thematic analysis to identify emergent themes and sub-themes associated with participants perceived benefits of the GLA:D program. We analyzed the data using NVivo Pro software. Member checking and bracketing were used to ensure the rigour of the analysis., Results: 30 participants were interviewed (70% female, 57% rural, 73% knee OA). Most participants felt the program positively benefited them. Two themes emerged from the analysis: wellness and self-efficacy. Participants felt the program benefited their wellness, particularly with regard to pain relief, and improvements in mobility, strength, and overall well-being. Participants felt the program benefited them by promoting a sense of self-efficacy through improving the confidence to perform exercise and routine activities, as well as awareness, and motivation to manage their OA symptoms. Twenty percent of participants felt no benefits from the program due to experiencing increased pain and feeling their OA was too severe to participate., Discussion: The GLA:D program was viewed as beneficial to most participants, this study also identified factors (e.g., severe OA, extreme pain) as to why some participants did not experience meaningful improvements. Early intervention with the GLA:D program prior to individuals experiencing severe OA could help increase the number of participants who experience benefits from their participation., Conclusion: As the GLA:D program expands across jurisdictions, providers of the program may consider recruitment earlier in disease progression and targeting those with mild and moderate OA., (© 2024. The Author(s).)

Background: Attitudes toward the human papillomavirus (HPV) vaccine and accuracy of information shared about this topic in web-based settings vary widely. As real-time, global exposure to web-based discourse about HPV immunization shapes the attitudes of people toward vaccination, the spread of misinformation and misrepresentation of scientific knowledge contribute to vaccine hesitancy., Objective: In this study, we aimed to better understand the type and quality of scientific research shared on Twitter (recently rebranded as X) by vaccine-hesitant and vaccine-confident communities., Methods: To analyze the use of scientific research on social media, we collected tweets and retweets using a list of keywords associated with HPV and HPV vaccines using the Academic Research Product Track application programming interface from January 2019 to May 2021. From this data set, we identified tweets referring to or sharing scientific literature through a Boolean search for any tweets with embedded links, hashtags, or keywords associated with scientific papers. First, we used social network analysis to build a retweet or reply network to identify the clusters of users belonging to either the vaccine-confident or vaccine-hesitant communities. Second, we thematically assessed all shared papers based on typology of evidence. Finally, we compared the quality of research evidence and bibliometrics between the shared papers in the vaccine-confident and vaccine-hesitant communities., Results: We extracted 250 unique scientific papers (including peer-reviewed papers, preprints, and gray literature) from approximately 1 million English-language tweets. Social network maps were generated for the vaccine-confident and vaccine-hesitant communities sharing scientific research on Twitter. Vaccine-hesitant communities share fewer scientific papers; yet, these are more broadly disseminated despite being published in less prestigious journals compared to those shared by the vaccine-confident community., Conclusions: Vaccine-hesitant communities have adopted communication tools traditionally wielded by health promotion communities. Vaccine-confident communities would benefit from a more cohesive communication strategy to communicate their messages more widely and effectively., (©Geneviève Jessiman-Perreault, Jean-Christophe Boucher, So Youn Kim, Nicole Frenette, Abbas Badami, Henry M Smith, Lisa K Allen Scott. Originally published in JMIR Infodemiology (https://infodemiology.jmir.org), 09.05.2024.)

Background: Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions., Objective: The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada., Methods: Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results., Results: The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95% CI 1.006-1.185) and 1.831 (95% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95% CI 1.200-1.381) and 1.099 (95% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots., Conclusions: Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions., (©Jennifer Malkin, Geneviève Jessiman-Perreault, Amanda Alberga Machado, Gary Teare, Joanne Snider, Syed Farhan Tirmizi, Erik Youngson, Ting Wang, Jessica Law, Thilina Bandara, Mika Rathwell, Cordell Neudorf, Lisa Allen Scott. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 27.03.2024.)

Purpose: Workplace support needs for women and men living with mental health conditions are not well understood. This study examined workplace accommodation and support needs among women and men with and without mental health or cognitive conditions and individual and workplace factors associated with having unmet needs., Methods: A cross-sectional survey of 3068 Canadian workers collected information on disability, gender, gendered occupations, job conditions, work contexts, and workplace accommodations. Multivariable logistic regression analyses examined gender- and disability-based differences in unmet needs for workplace flexibility, work modifications, and health benefits, and the association of work context (i.e., work schedule, job sector) and job conditions (i.e., precarious work) on the likelihood of unmet accommodation needs. The additive (i.e., super- or sub-additive) and multiplicative effects of disability, gender, and occupational gender distribution on the probability of unmet accommodation needs were also assessed., Results: The most common unmet workplace accommodation was work modifications reported by 35.9% of respondents with mental/cognitive disability and workplace flexibility reported by 19.6% of individuals without a mental/cognitive disability. Women, employees in female dominant occupations, and participants with mental/cognitive disabilities were more likely to report unmet needs compared with men, employees in non-female dominant occupations, and participants without disabilities but these findings were largely explained by differences in job conditions and work contexts. No interacting effects on the likelihood of reporting unmet needs for workplace accommodations were observed., Conclusions: To support employee mental health, attention is needed to address work contexts and job conditions, especially for people working with mental/cognitive disabilities, women, and workers in female-dominated occupations where unmet accommodation needs are greatest., (© 2023. The Author(s).)

Background: Despite growing attention paid to health equity and efforts to promote gender mainstreaming-a global strategy to promote gender equality-how policymakers have 'institutionalized' this in their work is less clear. Therefore, this planned scoping review seeks to search the peer-reviewed and grey literature to compile evidence on the ways in which policymakers have routinely or systematically considered equity and/or gender in their work., Methods: A scoping review will be undertaken by drawing on the PRISMA guidelines for Scoping Reviews (PRISMA-ScR). With the expert guidance of a research librarian, Ovid MEDLINE, Ovid EMBASE, PAIS Index, and Scopus databases will be searched, in addition to custom Google searches of government documents. The search will be conducted from 1995 and onwards, as there were no hits prior to this date that included the term "gender mainstream*" in these databases. The inclusion criterion is that: (i) texts must provide information on how equity and/or gender has been considered by government officials in the development of public policy in a routine or systematic manner (e.g., descriptive, empirical); (ii) both texts produced by government or not (e.g., commentary about government action) will be included; (iii) there are no restrictions on study design or article type (i.e., commentaries, reports, and other documents, would all be included); and (iv) texts must be published in English due to resource constraints. However, texts that discuss the work of nongovernmental or intergovernmental organizations will be excluded. Data will be charted by: bibliographic information, including the authors, year, and article title; country the text discussed; and a brief summary on the approach taken., Discussion: This protocol was developed to improve rigour in the study design and to promote transparency by sharing our methods with the broader research community. This protocol will support a scoping review of the ways in which policymakers have routinely or systematically considered equity and/or gender in their work. We will generate findings to inform government efforts to initiate, sustain, and improve gender and equity mainstreaming approaches in policymaking., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Amri 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.)

Introduction: The Good Life with osteoArthritis: Denmark (GLA:DTM) is an evidence-based program designed for individuals with symptomatic hip and knee osteoarthritis (OA). This program has reported improvement in pain, quality of life and self-efficacy, as well as delays in joint replacement surgery for adults with moderate to severe hip or knee OA. Evaluations of GLA:DTM implementation in several countries have focused on effectiveness, training, and feasibility of the program primarily from the provider perspective. Our objective was to examine how the GLA:DTM program was perceived and experienced by individuals with hip and knee OA to inform on-going program refinement and implementation., Methods: Thirty semi-structured telephone interviews were conducted with participants who completed the GLA:DTM program in Alberta. An interpretive description approach was used to frame the study and thematic analysis was used to code the data and identify emergent themes and sub-themes associated with participants' experience and perception of the GLA:DTM program., Results: Most participants had a positive experience of the GLA:DTM program and particularly enjoyed the group format, although some participants felt the group format prevented one-on-one support from providers. Three emergent themes related to acceptability were identified: accessible, adaptable, and supportive. Participants found the program to be accessible in terms of location, cost, and scheduling. They also felt the program was adaptable and allowed for individual attention and translatability into other settings. Finally, most participants found the group format to be motivating and fostered connections between participants., Conclusion: The GLA:DTM program was perceived as acceptable by most participants, yet the group format may not be useful for all individuals living with OA. Recommended improvements included adapting screening to identify those suited for the group format, providing program access earlier in the disease progression trajectory, modifying educational content based on participants' knowledge of OA and finally, providing refresher sessions after program completion., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kania-Richmond 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.)

Background: Colorectal cancer (CRC) is a leading cause of death in Canada and early detection can prevent deaths through screening. However, CRC screening in Alberta, Canada remains suboptimal and varies by sociodemographic and health system characteristics, as well as geographic location. This study aimed to further the understanding of these participant and health system characteristics associated with CRC screening in Alberta and identify clusters of regions with higher rates of overdue or unscreened individuals., Methods: We included Albertans aged 52 to 74 as of December 31, 2019 (index date) and we used data from administrative health data sources and linked to the Alberta Colorectal Cancer Screening Program database to determine colorectal cancer screening rates. We used multivariable multinomial logistic regression analysis to investigate the relationship between sociodemographic, health system characteristics and participation in CRC screening. We used optimized Getis-Ord Gi* hot-spot analysis to identify hot and cold-spots in overdue for and no record of CRC screening., Results: We included 919,939 Albertans, of which 65% were currently up to date on their CRC screening, 21% were overdue, and 14% had no record of CRC screening. Compared to Albertans who were currently up to date, those who were in older age groups, those without a usual provider of care, those who were health system non-users, and those living in more deprived areas were more likely to have no record of screening. Areas with high number of Albertans with no record of screening were concentrated in the North and Central zones., Conclusions: Our study showed important variation in colorectal cancer screening participation across sociodemographic, health system and geographical characteristics and identified areas with higher proportions of individuals who have no record of screening or are under-screened in Alberta, Canada., (© 2023. The Author(s).)

Background: The Good Life with osteoArthritis: Denmark (GLA:D TM ) program is an evidence-based education and exercise program designed for individuals with symptomatic hip and knee osteoarthritis. Launched in Denmark, it has been implemented across Europe, Australia, and North America. The authors assessed the feasibility of GLAD TM implementation in Canada (Alberta) by applying the RE-AIM framework. An evaluation objective was to identify factors impacting the implementation of the program in both publicly funded and private rehabilitation settings, based on the experience of the initial cohort of providers and clinic leaders who set up and delivered the program., Methods: Semi-structured telephone interviews were conducted with GLA:D TM -trained providers, managers, or directors of clinics across Alberta. Braun and Clarke's thematic approach was used to code the data and identify emergent categories and themes. Those relevant to the implementation were identified and by consensus, categorized as facilitators of and challenges to the implementation process., Results: Eighteen GLA:D TM -trained providers and three clinic leaders from a range of clinical settings completed an interview. Seven common themes emerged in relation to implementation across the study settings. Three themes reflect facilitators of implementation (program acceptability by providers, multi-level support mechanisms, and program flexibility) and four implementation challenges (direct and indirect costs, lack of external referrals, program access issues, and lack of suitable space). The initial implementation of the program was exploratory with limited focus on long-term sustainability., Conclusions: The GLA:D TM program is a translatable program that can be implemented with relative ease in both public and private rehabilitation settings; however, costs, space constraints, and having an adequate referral base were noted challenges. Further work is warranted to explore equitable access across public and private settings and program sustainability., (© 2023 The Authors. Musculoskeletal Care published by John Wiley & Sons Ltd.)

Objective: The Good Life with osteoArthritis: Denmark (GLA:D™) program for knee and hip osteoarthritis has been shown to be effective, but evaluations have yet to explore whether effectiveness differs by program context. The present study explores whether there are differences in effectiveness of the GLA:D™ program for treatment of hip and knee osteoarthritis across program location (i.e., rural, urban, metro) and program payor (i.e., public, private) within Alberta, Canada., Design: The study population was adults with hip or knee osteoarthritis attending the 8-week GLA:D™ supervised exercise and education programme in Alberta between Sep 2017-Mar 2020. Outcomes of interest were joint-related pain and quality of life (HOOS/KOOS), health quality of life (EQ-5D-5L), and performance-based functional (30-s chair stand test; 40-m walk test) measures. Minimally clinically important changes were calculated for each outcome and ANOVA and chi-square tests were used to determine statistical significance by program location or payor., Results: Of the 1321 eligible participants, 974 (73.7%) completed the baseline questionnaire, about 50% of participants participated in a metro area and 60% paid privately for the program. There were no statistically significant differences in improvements of joint-related pain, joint-related quality of life, health-related quality of life, or performance-based functional measures by program location or program payor, except for participants who received the program in a publicly covered primary care clinic who experienced significantly larger improvements in joint-related pain., Conclusion: The implementation of the GLA:D™ program for the treatment of knee and hip osteoarthritis in Alberta is effective across a range of contexts., Competing Interests: The authors declare no competing interests., (© 2023 The Authors.)

Introduction: The COVID-19 pandemic has increased online interactions and the spread of misinformation. Some researchers anticipate benefits stemming from improved public awareness of the value of vaccines while others worry concerns around vaccine development and public health mandates may have damaged public trust. There is a need to understand whether the COVID-19 pandemic, vaccine development, and vaccine mandates have influenced HPV vaccine attitudes and sentiments to inform health communication strategies., Methods: We collected 596,987 global English-language tweets from January 2019-May 2021 using Twitter's Academic Research Product track. We determined vaccine confident and hesitant networks discussing HPV immunization using social network analysis. Then, we used a neural network approach to natural language processing to measure narratives and sentiment pertaining to HPV immunization., Results: Most of the tweets in the vaccine hesitant network were negative in tone (54.9%) and focused on safety concerns surrounding the HPV vaccine while most of the tweets in the vaccine confident network were neutral (51.6%) and emphasized the health benefits of vaccination. Growth in negative sentiment among the vaccine hesitant network corresponded with legislative efforts in the State of New York to mandate HPV vaccination for public school students in 2019 and the WHO declaration of COVID-19 as a Global Health Emergency in 2020. In the vaccine confident network, the number of tweets concerning the HPV vaccine decreased during the COVID-19 pandemic but in both vaccine hesitant and confident networks, the sentiments, and themes of tweets about HPV vaccine were unchanged., Conclusions: Although we did not observe a difference in narratives or sentiments surrounding the HPV vaccine during the COVID-19 pandemic, we observed a decreased focus on the HPV vaccine among vaccine confident groups. As routine vaccine catch-up programs restart, there is a need to invest in health communication online to raise awareness about the benefits and safety of the HPV vaccine., (© 2023. The Author(s).)

The virtual setting is an important setting for health promotion as individuals increasingly go online for health information and support. Yet, users can have difficulty finding valid, trustworthy, and user-friendly health information online. In 2022, we launched an interactive Fact or Fiction Tobacco virtual health tool. The virtual health tool uses evidence-informed tailored content to engage users and refer them to local tobacco cessation resources. The present paper describes the development, user testing, and evaluation of this tool. The Fact or Fiction virtual health tool was designed by tobacco cessation and health marketing experts and informed by health behaviour theories of change. The tool captures data on who is seeking health information, the user's stage of readiness to quit tobacco products, and whether they act by accessing referred resources. In 2021, we conducted two phases of user testing prior to marketing the tool publicly. After 7 weeks of marketing, we collected data on user interactions with the tool and evaluated the reach of the tool. Results from user testing found the tool to be engaging, easy to use, and quick to complete. Adaptations were made to simplify and condense text and include additional animations. During the first seven weeks of the tool being live, it reached 2306 users, and 38.7% of those users were current or occasional tobacco users. Users were classified based on their intention to quit. Bivariate analysis found that the tool was successful in driving tobacco users towards action as 21.2% tobacco users who were looking to quit and 8.8% of tobacco users who were not looking to quit clicked on local tobacco cessation resources. This virtual health tool is reaching the targeted population and providing tailored information needed at each stage of the continuum of health behaviour change. Among tobacco users looking to quit, this virtual health tool acts as a quick referral to local tobacco cessation resources.

Objectives: This study contributes to empirical evidence by examining the impact of the first and second waves of the COVID-19 pandemic on modifiable risk factors (MRF) and whether these patterns differ according to level of material deprivation among people living in Alberta., Methods: Using data from a repeated cross-sectional provincial health survey (Alberta Community Health Survey (ACHS): 2018-2021), we conducted logistic regression analyses examining the impacts of the COVID-19 pandemic on meeting national guidelines on four MRFs (tobacco use, physical activity, fruit and vegetable consumption, alcohol use) (n=11,249). We compared population-level changes in MRFs from one year before the COVID-19 pandemic (March 2019-February 2020) to one year during the pandemic (March 2020-February 2021) in Alberta. We also assessed whether these trends differed by a measure of material deprivation., Results: Compared to the pre-COVID-19 period, the fully adjusted odds of meeting recommended guidelines for fruit and vegetable consumption (OR=0.42) decreased during the pandemic. Individuals experiencing high material deprivation had lower odds of meeting recommended guidelines for physical activity (OR=0.65) and higher odds of not being current tobacco users (OR=1.36) during the pandemic versus during the pre-pandemic period., Conclusion: At a population level, analyses from the ACHS showed minimal impacts of the first year of the COVID-19 pandemic on MRFs, besides fruit and vegetable consumption. Yet, stratifying results showed statistically significant differences in pandemic impacts on MRFs by level of material deprivation. Therefore, understanding the influence of material deprivation on MRFs during the pandemic is key to tailoring future public health interventions promoting health and preventing cancer and chronic disease., (© 2022. The Author(s).)

Background: The Healthy Cities project supports municipal policymakers in the struggle to safeguard the health of urban citizens around the world (and in other limited geographies such as islands). Although Healthy Cities has been implemented in thousands of settings, no synthesis of implementation experiences have been conducted. In this article, we develop a scoping review protocol that can be applied to collect evidence on process evaluations of Healthy Cities., Methods: To develop a scoping review protocol that could identify experiences evaluating the Healthy Cities project, we followed the PRISMA guidelines for Scoping Reviews (PRISMA-ScR). We applied these guidelines in consultation with a research librarian to design a search of the peer-reviewed literature, specifically Ovid Medline, Ovid Embase, Web of Science Core Collection, and Scopus databases, and a grey literature search., Discussion: In addition to the aim of collecting evidence on Healthy Cities process evaluation experiences, the broader goal is to spark discussions and inform future evaluations of Healthy Cities. This work can also inform other evaluations of initiatives seeking to raise socio-political change, such as those focused on enhancing intersectoral and multisectoral action., Competing Interests: The authors have declared that no competing interests exist.

Background: The workplace provides a unique opportunity to intervene on tobacco use, by implementing multilevel interventions engaging diverse employees. Using the social ecological model (SEM), this scoping review aimed to synthesize descriptions of multilevel workplace tobacco control programs to create a health equity informed framework for intervention planning., Methods: Multiple databases were searched for articles published from January 2010 to December 2020 meeting inclusion criteria (i.e., discussed multilevel tobacco cessation interventions that intervene, target, or incorporate two or more levels of influence, and one of the levels must be the workplace). Articles were screened by two independent researchers and included if they discussed multilevel tobacco cessation interventions that intervened, targeted, or incorporated two or more levels of influence. To integrate the extracted information into the SEM, we utilized the McLeroy et al. model and definitions to describe potential multilevel interventions and their determinants., Results: Nine articles were included in this review. No studies intervened across all five levels (individual, interpersonal, institutional, community, and policy), and the most common levels of intervention were individual (e.g., individual counseling), interpersonal (e.g., group therapy), and institutional (e.g., interventions during work hours). Participation rates varied by key social determinants of health (SDOHs) such as age, gender, education and income. Barriers including cost and sustainability influenced successful implementation, while leadership endorsement and accessibility facilitated successful implementation., Discussion/application to Practice: Multilevel interventions targeting at least two SEM levels may reduce persistent health inequities if they address how SDOHs influence individual health behaviors. Employee characteristics impacted the success of tobacco cessation interventions, but more research is needed to understand the barriers and facilitators related to workplace characteristics.

Setting: People in Alberta are more likely to seek information about cancer prevention online than they are to have this conversation with their primary care provider. As people turn to the internet to support health decision-making, it is critical that we improve the supportiveness of the virtual health setting for cancer prevention., Intervention: In 2014, the Alberta Cancer Prevention Legacy Fund launched an online HPV Decision Aid Tool to support evidence-informed decision-making in response to suboptimal uptake of the HPV (human papillomavirus) vaccine. Google Analytics data from approximately 2000 recent interactions with this tool have yielded insights into the concerns that impact people's decision-making about the vaccine., Outcomes: Most users of this tool are adults interested in the vaccine for themselves (69%), rather than parents considering immunizing their children (31%). No differences were found in the information-seeking behaviour of parents of girls compared with parents of boys, suggesting that mental models among those who are considering the HPV vaccine may have shifted in recent years. Concerns differed by respondent; cost was the most important concern among adults (62.0%), while parents were most concerned about vaccine safety (61.5%). Only 23% of users asked "what is HPV", suggesting that many people in Alberta now have basic knowledge about the virus., Implications: Results provide a real-time "pulse" on knowledge and attitudes towards HPV immunization, which informs our approach to tailoring messaging with the aim of increasing vaccine uptake in Alberta. Outcomes will provide evidence needed to inform new interventions aimed at increasing HPV immunization rates.

In Canada, public safety personnel, including correctional officers, experience high rates of mental health problems. Correctional officers' occupational stress has been characterized as insidious and chronic due to multiple and unpredictable occupational risk factors such as violence, unsupportive colleagues and management, poor prison conditions, and shift work. Given the increased risk of adverse mental health outcomes associated with operational stressors, organizational programs have been developed to provide correctional officers with support to promote mental well-being and to provide mental health interventions that incorporate recovery and reduction in relapse risk. This paper uses two theories, the Job Demand Control Support (JDCS) Model and Social Ecological Model (SEM), to explore why workplace social support programs may not been successful in terms of uptake or effectiveness among correctional officers in Canada. We suggest that structural policy changes implemented in the past 15 years have had unintentional impacts on working conditions that increase correctional officer workload and decrease tangible resources to deal with an increasingly complex prison population. Notably, we believe interpersonal support programs may only have limited success if implemented without addressing the multilevel factors creating conditions of job strain.

Background and Objective: Given the heightened rhetorical prominence the World Health Organization has afforded to equity in the past half-century, it is important to better understand how equity has been referred to and its conceptual underpinning, which may have broader global implications., Eligibility Criteria: Articles were included if they met inclusion criteria - chiefly the explicit discussion of the WHO's concept of health equity, for example in terms of conceptualization and/or definitions. Articles which mentioned health equity in the context of WHO's programs, policies, and so on, but did not discuss its conceptualization or definition were excluded., Sources of Evidence: We focused on peer-reviewed literature by scanning Ovid MEDLINE and SCOPUS databases, and supplementing by hand-search., Results: Results demonstrate the WHO has held - and continues to hold - ambiguous, inadequate, and contradictory views of equity that are rooted in different theories of social justice., Conclusions: Moving forward, the WHO should revaluate its conceptualization of equity and normative position, and align its work with Amartya Sen's Capabilities Approach, as it best encapsulates the broader views of the organization. Further empirical research is needed to assess the WHO interpretations and approaches to equity.

Workplace health programs (WHPs) have been shown to improve employee health behaviours and outcomes, increase productivity, and decrease work-related costs over time. Nonetheless, organizational characteristics, including size, prevent certain workplaces from implementing these programs. Past research has examined the differences between small and large organizations. However, these studies have typically used a cut-off better suited to large countries such as the USA. Generalizing such studies to countries that differ based on population size, scale of economies, and health systems is problematic. We investigated differences in WHP knowledge, attitudes, and practices between organizations with under 20 employees, 20-99 employees, and more than 100 employees. In 2017-2018, a random sample of employers from 528 workplaces in Alberta, Canada, were contacted for participation in a cross-sectional survey. Latent Class Analysis (LCA) was used to identify underlying response pattern and to group clusters of similar responses to categorical variables focused on WHP knowledge, attitudes, practices and likelihood of action. Compared to large organizations, organizations with fewer than 20 employees were more likely to be members of the Medium-Low Knowledge of WHP latent class ( p = 0.01), the Low Practices for WHP latent class ( p < 0.001), and more likely to be members of Low Likelihood of Action in place latent class ( p = 0.033). While the majority of workplaces, regardless of size, recognized the importance and benefits of workplace health, capacity challenges limited small employers' ability to plan and implement WHP programs. The differences in capacity to implement WHP in small organizations are masked in the absence of a meaningful cut-off that reflects the legal and demographic reality of the region of study.

The sex gap (i.e., the significant difference in an outcome between men and women) in the occurrence of a variety of mental health conditions has been well documented. Household food insecurity has also repeatedly been found to be associated with a variety of poor mental health outcomes. Although both sex and household food insecurity have received attention individually, rarely have they been examined together to explore whether or how these indicators of two social locations interact to impact common mental health outcomes. Using a pooled sample (N = 302,683) of the Canadian Community Health Survey (2005⁻2012), we test whether sex modifies the relationship between household food insecurity assessed by the Household Food Security Survey Module and five adverse mental health outcomes, controlling for confounding covariates. Although the sex gap was observed among food secure men versus women, males and females reporting any level of food insecurity were equally likely to report adverse mental health outcomes, compared with those reporting food security. Therefore, household food insecurity seems to narrow the sex gap on five adverse mental health outcomes.

Purpose: This paper aims to: (i) visualize the networks of food insecurity policy actors in Canada, (ii) identify potential food insecurity policy entrepreneurs (i.e., individuals with voice, connections, and persistence) within these networks, and (iii) examine the political landscape for action on food insecurity as revealed by social network analysis., Methods: A survey was administered to 93 Canadian food insecurity policy actors. They were each asked to nominate 3 individuals whom they believed to be policy entrepreneurs. Ego-centred social network maps (sociograms) were generated based on data on nominees and nominators., Results: Seventy-two percent of the actors completed the survey; 117 unique nominations ensued. Eleven actors obtained 3 or more nominations and thus were considered policy entrepreneurs. The majority of actors nominated actors from the same province (71.5%) and with a similar approach to theirs to addressing food insecurity (54.8%). Most nominees worked in research, charitable, and other nongovernmental organizations., Conclusions: Networks of Canadian food insecurity policy actors exist but are limited in scope and reach, with a paucity of policy entrepreneurs from political, private, or governmental jurisdictions. The networks are divided between food-based solution actors and income-based solution actors, which might impede collaboration among those with differing approaches to addressing food insecurity.

Purpose: Household food insecurity is related to poor mental health. This study examines whether the level of household food insecurity is associated with a gradient in the risk of reporting six adverse mental health outcomes. This study further quantifies the mental health impact if severe food insecurity, the extreme of the risk continuum, were eliminated in Canada., Methods: Using a pooled sample of the Canadian Community Health Survey (N = 302,683), we examined the relationship between level of food insecurity, in adults 18-64 years, and reporting six adverse mental health outcomes. We conducted a probit analysis adjusted for multi-variable models, to calculate the reduction in the odds of reporting mental health outcomes that might accrue from the elimination of severe food insecurity., Results: Controlling for various demographic and socioeconomic covariates, a food insecurity gradient was found in six mental health outcomes. We calculated that a decrease between 8.1% and 16.0% in the reporting of these mental health outcomes would accrue if those who are currently severely food insecure became food secure, after controlling for covariates., Conclusion: Household food insecurity has a pervasive graded negative effect on a variety of mental health outcomes, in which significantly higher levels of food insecurity are associated with a higher risk of adverse mental health outcomes. Reduction of food insecurity, particularly at the severe level, is a public health concern and a modifiable structural determinant of health worthy of macro-level policy intervention.