Imagining and implementing healthy city interventions: Combined results from parallel concept mapping exercises in Montreal with community members and stakeholders.

OBJECTIVE: Built environment interventions provide structural solutions to complex urban challenges. Though community voices are part of municipal decision-making, planners and public health professionals need tools to better integrate their perspectives for desired changes (what) when implementing built environment interventions (how). We present two simultaneous concept mapping exercises conducted in Montréal, Canada, to facilitate the consideration of these dimensions. METHODS: Community members were prompted about neighbourhood changes that could improve their quality of life; stakeholders were prompted about factors that contribute to successful implementation of interventions. Through each exercise, items were generated, grouped, and rated on importance and feasibility. Concept maps were produced using multidimensional scaling and hierarchical cluster analysis. The clusters identified by community members and stakeholders were combined into a Community × Stakeholder Matrix, which supported discussions on interventions with the research's Advisory Committee. RESULTS: Thirty-two community members generated 41 responses, which resulted in 6 clusters: (1) strengthen public transportation, (2) reduce space dedicated to cars, (3) foster local social connections, (4) develop quality cycling infrastructure, (5) improve pedestrian accessibility, and (6) green the city. Thirty-seven stakeholders generated 40 items, which resulted in 5 clusters: (1) collaboration with stakeholders and citizens, (2) planning and evaluation, (3) common vision for the future, (4) regulatory framework and funding, and (5) context-informed approach. CONCLUSION: Capturing the collective vision of our urban environments and the processes underlying change through concept mapping can lead to more successful changes. We propose combining understandings of the what and how into a matrix to support evaluation and strategic planning of interventions and better integrate community voices into operational planning.

RéSUMé: OBJECTIF: Les interventions sur le cadre bâti peuvent offrir des solutions structurelles aux défis urbains complexes. Bien que les communautés fassent partie du processus décisionnel municipal, les urbanistes et les professionnels de la santé publique ont besoin d'outils pour mieux intégrer leurs perspectives sur les changements souhaités (le quoi) dans la mise en œuvre réussie des programmes et des interventions sur l'environnement bâti (le comment). Nous présentons deux exercices simultanés de cartographie conceptuelle menés à Montréal, Canada, visant à capter ces dimensions de mise en œuvre. MéTHODES: Les membres de la communauté ont été sondés sur les changements dans leur quartier qui seraient susceptibles d'améliorer leur qualité de vie, tandis que des acteurs municipaux ont été sondés sur les facteurs qui contribuent à la réussite de la mise en œuvre des interventions urbaines. Pour chaque exercice, des items ont été générés, regroupés et notés en fonction de leur importance et de leur faisabilité. Des cartes conceptuelles ont été produites à l'aide d'analyse multivariée d'étalonnage multidimensionnel et d'une analyse hiérarchique ascendante. Les regroupements identifiés par les membres de la communauté et les acteurs municipaux ont été combinés dans une matrice communauté × acteurs municipaux, qui a encadré une discussion sur les interventions sur le cadre bâti avec le comité consultatif du programme de recherche. RéSULTATS: Trente-deux membres de la communauté ont généré 41 réponses uniques, qui ont formé 6 regroupements : (1) renforcer les transports en commun, (2) réduire l'espace dédié aux voitures, (3) favoriser le lien social local, (4) développer des infrastructures cyclables de qualité, (5) améliorer l'accessibilité piétonne, et (6) verdir la ville. Trente-sept acteurs municipaux ont généré 40 éléments uniques, qui ont mené à 5 regroupements : (1) collaboration avec les parties prenantes et les citoyens, (2) planification et évaluation, (3) vision commune pour l'avenir, (4) cadre réglementaire et financement, et (5) approche contextuelle. CONCLUSION: En captant la vision collective sur nos environnements urbains et la compréhension des processus sous-jacents au changement avec la cartographie conceptuelle, les transformations urbaines peuvent être plus réussies et plus inclusives. Nous proposons de combiner les perspectives sur le quoi et le comment dans une matrice pour soutenir l'évaluation et la planification stratégique d'interventions, tout en promouvant l'intégration des voix de la communauté dans la planification opérationnelle de l'aménagement urbain.

Successes and failures of built environment interventions: Using concept mapping to assess stakeholder perspectives in four Canadian cities.

BACKGROUND: Healthy communities can be supported through built environment interventions that redesign cities for improved health outcomes. Understanding the context of these interventions is critical for assessing how an intervention impacts population health; such context is often poorly documented. This study uses concept mapping to capture stakeholders' perspectives on the factors that influence the success and failure of built environment interventions across cities. METHODS: The INTErventions, Research, and Action in Cities Team (INTERACT) research program undertook concept mapping exercises related to interventions in four Canadian cities: public bike share program (Vancouver); a cycling network (Victoria); a bus rapid transit program (Saskatoon); and interventions related to the Montreal Sustainability Plan (Montreal). Concept mapping synthesised stakeholder perceptions and Go zones were used to prioritise factors based on importance and feasibility. Resulting themes were integrated into implementation science frameworks. RESULTS: Across four cities, 95 stakeholders participated. An average of 38 factors were identified in each city, resulting in 5 emerging clusters in Victoria and Montreal and 6 clusters in Vancouver and Saskatoon. Clusters covered domains of economic and political context, intervention planning, equity considerations, user experience, and stakeholder engagement. Common across all cities was the importance of stakeholder engagement. Concerns for citizen safety were prominent in Victoria, Vancouver, and Saskatoon. Interventions in Saskatoon and Vancouver were related to programs, and reliability of service and ease of use emerged. Go zones highlighted 2-5 items in each city, which can inform priority actions. CONCLUSION: Our study provides stakeholders' collective thinking on the contextual factors that influence the success and failure of built environment interventions. Organising context within an implementation science framework can provide a common language to synthesise stakeholder perspectives across settings. Go zone items can inform city-specific priority actions to support a common vision around implementing built environment interventions in pursuit of designing equitable and healthy cities.

European Hospitals' Transition Toward Fully Electronic-Based Systems: Do Information Technology Security and Privacy Practices Follow?

BACKGROUND: Traditionally, health information has been mainly kept in paper-based records. This has deeply changed throughout approximately the last three decades with the widespread use of multiple health information technologies. The digitization of health care systems contributes to improving health care delivery. However, it also exposes health records to security and privacy breaches inherently related to information technology (IT). Thus, health care organizations willing to leverage IT for improved health care delivery need to put in place IT security and privacy measures consistent with their use of IT resources. OBJECTIVE: In this study, 2 main objectives are pursued: (1) to assess the state of the implementation of IT security and privacy practices in European hospitals and (2) to assess to what extent these hospitals enhance their IT security and privacy practices as they move from paper-based systems toward fully electronic-based systems. METHODS: Drawing on data from the European Commission electronic health survey, we performed a cluster analysis based on IT security and privacy practices implemented in 1723 European hospitals. We also developed an IT security index, a compounded measure of implemented IT security and privacy practices, and compared it with the hospitals' level in their transition from a paper-based system toward a fully electronic-based system. RESULTS: A total of 3 clearly distinct patterns of health IT-related security and privacy practices were unveiled. These patterns, as well as the IT security index, indicate that most of the sampled hospitals (70.2%) failed to implement basic security and privacy measures consistent with their digitization level. CONCLUSIONS: Even though, on average, the most electronically advanced hospitals display a higher IT security index than hospitals where the paper system still dominates, surprisingly, it appears that the enhancement of IT security and privacy practices as the health information digitization advances in European hospitals is neither systematic nor strong enough regarding the IT-security requirements. This study will contribute to raising awareness among hospitals' managers as to the importance of enhancing their IT security and privacy measures so that they can keep up with the security threats inherently related to the digitization of health care organizations.

Intergenerational continuity/discontinuity of child maltreatment among low-income mother-child dyads: The roles of childhood maltreatment characteristics, maternal psychological functioning, and family ecology.

Despite evidence of some intergenerational continuity of maltreatment, a notable proportion of parents maltreated in childhood do not perpetuate the cycle of maltreatment. The aim of this study was to identify factors that would distinguish mother-child dyads where intergenerational continuity was present from dyads characterized by intergenerational discontinuity. The sample included 193 children and their mothers, drawn from two populations: 74 maltreated children recruited through Child Protection Services and 119 nonmaltreated children recruited among low-income families. Factors investigated included maternal childhood maltreatment, psychological functioning, and family ecology. Compared to maltreated mothers who broke the cycle of maltreatment, those who perpetuated the cycle were more likely to have experienced childhood physical neglect and multitype maltreatment, and to experience sociodemographic risk, intimate partner violence, and lack of family support. Compared to nonmaltreated mothers who maintained a nonmaltreating child-rearing environment: (a) maltreated mothers who broke the cycle were more likely to experience residential instability and lack of family support, and (b) nonmaltreated mothers whose child was maltreated were more likely to experience sociodemographic risk and lack of family support. Maternal psychological functioning did not discriminate maltreatment groups. Lending empirical support to a diathesis-stress model of poor parenting, these findings suggest that family-ecology related stress, but not maternal psychological difficulties, may create additional burden that will precipitate the risk of maltreatment intergenerational continuity.

INTERACT: A comprehensive approach to assess urban form interventions through natural experiments.

BACKGROUND: Urban form interventions can result in positive and negative impacts on physical activity, social participation, and well-being, and inequities in these outcomes. Natural experiment studies can advance our understanding of causal effects and processes related to urban form interventions. The INTErventions, Research, and Action in Cities Team (INTERACT) is a pan-Canadian collaboration of interdisciplinary scientists, urban planners, and public health decision makers advancing research on the design of healthy and sustainable cities for all. Our objectives are to use natural experiment studies to deliver timely evidence about how urban form interventions influence health, and to develop methods and tools to facilitate such studies going forward. METHODS: INTERACT will evaluate natural experiments in four Canadian cities: the Arbutus Greenway in Vancouver, British Columbia; the All Ages and Abilities Cycling Network in Victoria, BC; a new Bus Rapid Transit system in Saskatoon, Saskatchewan; and components of the Sustainable Development Plan 2016-2020 in Montreal, Quebec, a plan that includes urban form changes initiated by the city and approximately 230 partnering organizations. We will recruit a cohort of between 300 and 3000 adult participants, age 18 or older, in each city and collect data at three time points. Participants will complete health and activity space surveys and provide sensor-based location and physical activity data. We will conduct qualitative interviews with a subsample of participants in each city. Our analysis methods will combine machine learning methods for detecting transportation mode use and physical activity, use temporal Geographic Information Systems to quantify changes to urban intervention exposure, and apply analytic methods for natural experiment studies including interrupted time series analysis. DISCUSSION: INTERACT aims to advance the evidence base on population health intervention research and address challenges related to big data, knowledge mobilization and engagement, ethics, and causality. We will collect ~ 100 TB of sensor data from participants over 5 years. We will address these challenges using interdisciplinary partnerships, training of highly qualified personnel, and modern methodologies for using sensor-based data.

Cohort Profile: The Interdisciplinary Study of Inequalities in Smoking (ISIS).

The Interdisciplinary Study of Inequalities in Smoking (ISIS) is a cohort study investigating the joint effects of residents' socio-demographic characteristics and neighbourhood attributes on the social distribution of smoking in a young adult population. Smoking is a behaviour with an increasingly steep social class gradient; smoking prevalence among young adults is no longer declining at the same rate as among the rest of the population, and there is evidence of growing place-based disparities in smoking. ISIS was established to examine these pressing concerns. The ISIS sample comprises non-institutionalized individuals aged 18-25 years, who are proficient in English and/or French and who had been living at their current address in Montréal, Canada, for at least 1 year at time of first contact. Two waves of data have been collected: baseline data were collected November 2011-September 2012 (n = 2093), and a second wave of data was collected January-June 2014 (n = 1457). Data were collected from respondents using a self-administered questionnaire, developed by the research team based on sociological theory, which includes questions concerning social, economic, cultural and biological capital, and activity space as well as smoking behaviour. Data are available upon request from [katherine.frohlich@umontreal.ca].

Social disparities in children's exposure to secondhand smoke in privately owned vehicles.

INTRODUCTION: Secondhand smoke (SHS) can quickly attain high concentrations in cars, posing health risks to passengers and especially to children. This paper assesses whether there are social disparities in children's exposure to SHS in privately owned vehicles. METHODS: On weekday mornings and afternoons from September to November 2011, trained observers were stationed at 100 selected street intersections in Montreal, Canada. For each car transporting at least one passenger aged 0-15 years travelling through the intersection, observers recorded the estimated age of the youngest child in the car, whether any occupant was smoking and the licence plate number of the car. Licence plate numbers were linked to an area material deprivation index based on the postal code of the neighbourhood in which the car was registered. RESULTS: Smoking was observed in 0.7% of 20 922 cars transporting children. There was an apparent dose-response in the association between area material deprivation level and children's exposure to SHS in cars. Children travelling in cars registered in the most disadvantaged areas of Montreal were more likely to be exposed to SHS than children travelling in cars registered in the most advantaged areas (unadjusted OR=3.46, 95% CI 1.99 to 6.01). CONCLUSIONS: This study revealed social disparities in children's exposure to SHS in privately owned vehicles.

Frequency and risk factors related to smoking in cars with children present.

OBJECTIVES: Second-hand smoke (SHS) can attain high concentrations in cars. To protect children's health, nine Canadian provinces have enacted legislation prohibiting smoking in privately owned vehicles when children are present; Quebec is the only province with no such legislation. The objective of this study was to estimate the proportion of smokers in Quebec who smoke while travelling in a private vehicle in which children are present, and to compare the characteristics of smokers who do and do not smoke in cars. METHODS: In 2011-12, 754 daily smokers who recently travelled in a car with children completed a telephone survey in which they reported how frequently they smoked in a car, if there were smoking restrictions, and perceptions about the effectiveness of legislation prohibiting smoking in cars when children are present. RESULTS: Twenty-three percent of daily smokers smoked at least occasionally in their car when children were present. This proportion was higher among smokers who knew that there was no legislation in Quebec prohibiting smoking in cars, compared to smokers who believed that such legislation was already in effect (32% vs. 12%). Smokers with a university degree and those who reported that smoking was prohibited at home were less likely to expose children to SHS in cars. Most daily smokers (75%) believed that legislation would be effective. DISCUSSION: The results of this study suggest that legislation prohibiting smoking in cars is necessary to protect children from SHS, that such legislation would be effective, and that it may be relatively easy to implement.

Impact of residential schooling and of child abuse on substance use problem in Indigenous Peoples.

Residential schools were the institutions, in operation from the 19th century to the late 20th century, which Indigenous children in Canada were forced to attend. The literature shows that many young people who attended these institutions were victims of neglect and abuse. Negative psychological effects resulting from child abuse have been amply documented. However, very few studies on this subject have been carried out among Canada's Indigenous Peoples. The objective of this study is to evaluate, for an Indigenous population in Quebec (Canada), the impact of residential schooling as well as self-reported experiences of sexual and physical abuse during childhood on the development of alcohol and drug use problems in adulthood. A total of 358 Indigenous participants were interviewed (164 men [45.8%] and 194 women [54.2%]). Alcoholism was evaluated using the Michigan Alcoholism Screening Test (MAST). Drug abuse was assessed with the Drug Abuse Screening Test-20 (DAST). Child abuse and residential schooling were assessed with dichotomous questions (yes/no). Among the participants, 28.5% (n=102) had attended residential schools, 35.2% (n=121) reported having experienced sexual abuse, and 34.1% (n=117) reported having experienced physical abuse before adulthood. Results of the exact logistic regression analyses indicated that residential school attendance was linked to alcohol problems, while child abuse was related to drug use problems. The results of this study highlight the importance of considering the consequences of historical traumas related to residential schools to better understand the current situation of Indigenous Peoples in Canada.

Sexual abuse, residential schooling and probable pathological gambling among Indigenous Peoples.

Sexual abuse leads to short-term and long-lasting pervasive outcomes, including addictions. Among Indigenous Peoples, sexual abuse experienced in the context of residential schooling may have led to unresolved grief that is contributing to social problems, such as pathological (disordered) gambling. The aim of this study is to investigate the link between child sexual abuse, residential schooling and probable pathological gambling. The participants were 358 Indigenous persons (54.2% women) aged between 18 and 87 years, from two communities and two semi-urban centers in Quebec (Canada). Probable pathological gambling was evaluated using the South Oaks Gambling Screen (SOGS), and sexual abuse and residential schooling were assessed with dichotomous questions (yes/no). The results indicate an 8.7% past-year prevalence rate of pathological gambling problems among participants, which is high compared with the general Canadian population. Moreover, 35.4% were sexually abused, while 28.1% reported having been schooled in a residential setting. The results of a logistic regression also indicate that experiences of child sexual abuse and residential schooling are associated with probable pathological gambling among Indigenous Peoples. These findings underscore the importance of using an ecological approach when treating gambling, to address childhood traumas alongside current addiction problems.

Implementing an indoor smoking ban in prison: enforcement issues and effects on tobacco use, exposure to second-hand smoke and health of inmates.

OBJECTIVES: To describe the issues encountered during the implementation of an indoor smoking ban in prison and its effects on self-reported tobacco use, perceived exposure to second-hand smoke (SHS) and perceived health status of inmates in Quebec's provincial correctional facilities. METHODS: Quantitative data were obtained from 113 inmates in three provincial correctional facilities in the province of Quebec, Canada. Qualitative data were obtained from 52 inmates and 27 staff members. Participants were recruited through a self-selection process. Particular efforts were made to enrol proportions of men, women, smokers and non-smokers similar to those generally found among correctional populations. RESULTS: Despite the indoor smoking ban, 93% of inmates who declared themselves smokers reported using tobacco products inside the correctional facilities and 48% did not report any reduction in their tobacco use. Only 46% of smokers declared having been caught smoking inside the facility, and more than half of them (58%) reported no disciplinary consequences to their smoking. A majority of inmates incarcerated before the implementation of the ban (66%) did not perceive a reduction of their exposure to SHS following the indoor ban. Enforcement issues were encountered during the implementation of the indoor ban, notably because of the amendment made to the original regulation (total smoking ban) and tolerance from smokers in the staff towards indoor smoking. They were also related to perceptions that banning indoor smoking is complex and poses management problems. CONCLUSION: This study's findings emphasize the importance of considering organizational and environmental factors when planning the implementation of an indoor smoking ban in correctional facilities.

Concept mapping of diet and physical activity: uncovering local stakeholders perception in the Quebec City region.

Overweight and obesity are major public health concerns that are neither evenly distributed among the population nor between regions. Many studies suggest that beyond individual characteristics, the place where one lives influences lifestyle choices that underpin overweight and obesity. We observed such a situation in the province of Quebec (Canada), and because data availability from surveys was limited to a local level, the observed overweight disparities between local communities could not be entirely explained. Aiming to uncover local factors not captured by national survey data sets and in order to aid local level intervention, we investigated how the overweight problem was perceived by stakeholders through a concept mapping methodology. Concept mapping is a mixed method that relies upon stakeholders' perception as well as statistical techniques to draw a synthesis of the problem in the form of a conceptual map. A total of 45 stakeholders working in four areas with contrasting overweight prevalence in the Quebec City region were involved in the process. The map enables a global understanding of stakeholders' perception. This perception is not necessarily in line with public health knowledge however. For example, key concepts on the map suggest that physical activity is perceived to be much more important than diet with regards to population overweight and that urban design elements seem to be of low concern. Concept mapping is an innovative tool for planning and evaluation and can help stakeholders to develop adapted interventions to promote healthy lifestyle. It also provides relevant information to enhance the comprehension of local health disparities with a geographical perspective where data availability is limited.

Impulsivity and socio-economic status interact to increase the risk of gambling onset among youth.

AIMS: To determine if impulsivity and socio-economic status (SES) interact to influence gambling onset in youth. DESIGN: Longitudinal study of grade 7 students followed for 8 years. SETTING: Montréal, Canada. PARTICIPANTS: A total of 628 adult students aged 12.6 years on average at cohort inception. MEASUREMENTS: Impulsivity and SES (parent education, area deprivation) were collected during secondary school. Age of gambling onset was collected retrospectively when participants were aged 20.3 years. Cox proportional hazards regression was used to model the association between time to first report of gambling and interaction terms for each of impulsivity and parent education, and impulsivity and area deprivation accounting for sex and ethnicity. FINDINGS: Median (interquartile range) age of gambling onset was 17.0 (4.0) years. Impulsivity independently increased the risk of gambling onset among participants with no university-educated parent [hazard ratio (HR) 1.3; 95% confidence interval 1.1-1.5] and those living in highly deprived areas (HR 1.7; 1.5-2.0). Impulsivity was not associated with gambling onset among high SES youth. Among participants with high impulsivity, risks were elevated for those with no university-educated parent relative to one or more university-educated parent (HR 1.7; 1.1-2.7), and for participants living in deprived relative to advantaged areas (HR 5.0; 2.6-9.6). SES was not associated with gambling onset among participants with low impulsivity. CONCLUSIONS: Impulsivity is a risk factor for gambling onset among low but not high SES youth, and low SES influences gambling onset primarily among impulsive youth. Gambling prevention programmes may need to consider potential interaction between impulsivity and SES.

Links between casino proximity and gambling participation, expenditure, and pathology.

Two studies investigated the relationship between casino proximity and gambling participation, expenditure, and pathology. In Study 1, 8,842 participants were categorized into 1 of 4 driving distances from their home to the nearest casino in the province of Quebec: 0-100 km, 100.01-200 km, 200.01-300 km, or 300.01-981 km. In Study 2, 5,158 participants, who lived within a 100-km driving distance from the Montreal casino, were classified into 1 of 5 equidistant, 20-km driving distances. A survey company interviewed participants regarding their gambling habits. Results indicated a positive link between casino proximity and gambling participation (at the provincial and Montreal levels) and expenditure (at the provincial level only) but no link with the current prevalence rate of probable pathological gambling or of problem gambling. In a setting in which many types of gambling activities are available, casino proximity in itself does not appear to explain the rate of gambling-related problems. It is necessary to continue prospective research on exposure and adaptation theories as potential explanations for the development of pathological gambling.

Harm Reduction and electronic gambling machines: does this pair make a happy couple or is divorce foreseen?

Recent empirical studies have evaluated if modifying electronic gambling machine (EGM) structural features could encourage safer gambling behaviors and decrease gambling-related problems. Several of these studies refer to Harm Reduction (HR), suggesting that the HR paradigm is useful to design, implement and test the efficacy of various prevention and treatment programs applied to EGM users. After reviewing the origins of HR and specifying its operational definition, this paper discusses the relevance of the HR framework for the study of measures related to EGM use and gambling in general. Examples are given to illustrate the arguments. The results show that HR has been over-inclusive in the field of gambling. A specific and operational definition and application of the HR framework is required for HR to be useful for the advancement of research in the gambling field.

Sports betting: can gamblers beat randomness?

Although skills are not considered relevant in chance-governed activities, only a few studies have assessed the extent to which sport expert skills in wagering are a manifestation of the illusion of control. This study examined (a) whether expert hockey bettors could make better predictions than chance, (b) whether expert hockey bettors could achieve greater monetary gains than chance, and (c) what kind of strategies hockey gamblers rely on when betting. Accordingly, 30 participants were asked to report their state lottery hockey bets on 6 occasions. We suggest that the information used by bettors, along with near-misses, reinforces their perception of expertise. The results of this experiment suggest that the so-called "skills" of the sports bettors are cognitive distortions.