Alcohol sales in Canadian liquor outlets as a predictor of subsequent COVID-19 infection rates: a time-series analysis.

AIMS: Government alcohol sales data were used to examine whether age 15+ per-capita alcohol consumption (PCAC) (i) changed during COVID-19 and (ii) predicted COVID-19 infections 2-5 weeks later. DESIGN: Interrupted time-series analyses were applied to panels of data before and after COVID-19 restrictions were introduced in Canada. SETTING AND PARTICIPANTS: The populations, aged 15+, of the provinces of Ontario (ON), British Columbia (BC) and Nova Scotia (NS), Canada. INTERVENTION: Expansion of home delivery options and hours of trading for liquor stores while restrictions on travel, social and economic activities were imposed by governments during COVID-19 from 17 March 2020 until 29 March 2021. MEASUREMENTS: Weekly estimates of (i) age 15+ PCAC using sales data supplied by provincial government alcohol distributors for liquor stores, bars and restaurants, (ii) stringency of public health measures assessed by the Public Health Agency of Canada (PHAC) and (iii) new COVID-19 infections reported by PHAC. FINDINGS: PCAC increased by 7.10% (P = 0.013) during the pandemic versus previous years, with increased private liquor store sales partly offset by reduced bar/restaurant sales. Consumption was positively associated with stringency of public health measures. Weekly PCAC was positively associated with new COVID-19 infections 2 weeks later (+6.34% for a one drink/week increase, P < 0.001). Lagged associations with COVID-19 infections 2 or 3 weeks later were observed for PCAC from all sales channels, with larger effect sizes per standard drink/person/week increase for on-premise outlets (+77.27% week 2, P = 0.009) than government liquor stores (+6.49%, week 2, P < 0.001) or private liquor stores (+7.13%, week 4, P < 0.001). CONCLUSIONS: Alcohol consumption increased in three Canadian provinces during COVID-19 to degrees corresponding to the extent of the strictness of measures imposed to prevent viral spread. Increased consumption of alcohol was associated with increased COVID-19 infection rates 2 weeks later.

A life satisfaction approach to valuing the impact of health behaviours on subjective well-being.

BACKGROUND: Increasingly, decision-makers are interested in understanding the returns on investments in programs and policies that promote health and prevent chronic diseases. While the costs of these programs are more easily quantified, many of the outcomes they aspire to achieve are intangible and lack obvious market values. The subjective well-being (SWB) method was developed to value a wide range of non-market goods, including health outcomes directly in monetary terms. This paper presents an application of the SWB approach to estimate the monetary value of health-promoting behaviours as the intermediate outcomes of health promotion and chronic disease prevention programs and policies. METHODS: Life satisfaction (LS) was used as a proxy of individuals' SWB. Based on the combined Canadian Community Health Survey 2009-10 data, we modeled LS as a function of income and healthy behaviours, controlling for the socio-demographic factors associated with LS at the individual level using ordinary least squares regression. Equivalent effects of income and healthy behaviours on LS derived from the models allowed us to estimate the trade-off between income and healthy behaviours. RESULTS: We found that income and healthy behaviours were positively associated with LS. The values of increased physical activity, an additional daily serving of fruits/vegetables, and not smoking are respectively $631, $115 and $563 per week. These represent the amounts of additional weekly income required to maintain an individual at their level of LS in the absence of each of these behaviours. CONCLUSIONS: The SWB method holds promise as a method to monetize the value of a range of non-market goods, including healthy behaviours for which market values do not exist. The SWB method can be applied efficiently and cost-effectively using readily available survey data.

Socio-demographic and lifestyle factors associated with folate status among non-supplement-consuming Canadian women of childbearing age.

OBJECTIVE: Mandatory folic acid fortification was implemented in Canada in 1998 to reduce the risk of neural tube defects (NTD). Our objective was to assess the relationship between socio-demographic factors and folate status in non-supplement-consuming Canadian women of childbearing age. METHODS: Data on demographic factors, lifestyle factors, physical measures and red blood cell (RBC) folate concentration were collected from 1,008 non-supplement-consuming women aged 15-49 years in the Canadian Health Measures Survey (2007-2009). RBC folate ³906 nmol/L was used as a cut-off for optimal folate status for protection from NTD. RESULTS: Approximately 75% of non-supplement consuming women had an RBC folate concentration ³906 nmol/L. Young age (15-19 years), White ethnicity, less than secondary education, lowest income adequacy, smoking and high body mass index were associated with a higher prevalence of lower folate status. After adjustment, only young age (adjusted odds ratio [OR] 1.99-95% confidence interval [CI]: 1.25-3.18) was associated with lower folate status. Less than secondary education (adjusted OR 5.66, 95% CI: 1.10-29.04) and lowest income adequacy (adjusted OR 4.77, 95% CI: 1.06-21.49) were associated with lower folate status in women aged 15-24 and 25-49 years, respectively. CONCLUSIONS: Many risk factors for lower folate status identified before food fortification was implemented were not associated with folate status in our representative sample of non-supplement-consuming Canadian women. However, younger women, women aged 15-24 with less than secondary education and women aged 25-49 with low income adequacy remain at risk of lower folate status, supporting the continued promotion of folic acid supplement use to women of childbearing age.

High-dose compared with low-dose vitamin B-12 supplement use is not associated with higher vitamin B-12 status in children, adolescents, and older adults.

Over-the-counter vitamin supplements on the Canadian market are permitted to contain a daily vitamin B-12 dose of up to 1000 µg. Our objective was to determine the association between total daily vitamin B-12 supplement dose and markers of vitamin B-12 status in Canadians. Blood collected from a nationally representative sample aged 6-79 y (n = ∼5600) in the Canadian Health Measures Survey (2007-2009) was analyzed for serum vitamin B-12 and plasma total homocysteine (tHcy). Total daily intake of vitamin B-12 from single and multivitamin supplements was calculated. Individuals that indicated proton pump inhibitor or vitamin B-12 injection treatment were excluded from the supplement dose and tHcy analyses; folate-deficient individuals were also excluded from the tHcy analysis. Twenty-three percent of children, 12.3% of adolescents, and 25.5% of adults consumed a vitamin B-12-containing supplement. Supplement users had 33% higher serum vitamin B-12 and 4.2% higher prevalence of adequacy than did non-supplement users. Children and adolescents consuming >10 µg/d supplemental vitamin B-12 did not demonstrate higher serum vitamin B-12, higher prevalence of serum vitamin B-12 adequacy, or lower tHcy than did those consuming >0-10 µg/d. The association between serum vitamin B-12 reached a plateau at doses of >25 and >10-25 µg/d in adults aged 46-59 and 60-79 y, respectively. The prevalences of serum vitamin B-12 adequacy and normal tHcy, and tHcy did not differ by vitamin B-12 supplement dose in adults >45 y. In this cross-sectional study, vitamin B-12 supplement doses >10-25 µg/d were not associated with higher vitamin B-12 status in children, adolescents, or older adults compared with lower doses.

Perinatal and early childhood factors for overweight and obesity in young Canadian children.

BACKGROUND: This study assessed potential early-life factors and their interrelationships with obesity among young Canadian children. METHODS: Data from a nationally representative sample of children aged 6 to 11 years in the Canadian Health Measures Survey were analyzed. The associations of perinatal and early childhood behaviours and socio-economic factors with overweight or obesity were evaluated using multivariate logistic regression models. Adjusted population attributable risk fractions (PARFs) were calculated using multivariate logistic regression models. RESULTS: Of 968 term-born children, 21% were overweight and another 13% were obese. Maternal smoking during pregnancy (adjusted odds ratio, 2.26; 95% confidence interval, 1.23-4.15) was positively associated with obesity. This association was mediated by birth weight (suppression effect); once controlled, the strength of the association between smoking and child obesity increased by 12%. Birth weight per 100 g (1.05; 1.005-1.09) was significantly associated with obesity. Exclusive breastfeeding for 6 months (0.44; 0.31-0.61), adequate sleep hours (0.39; 0.16-0.94) and being physically active (0.50; 0.26-0.93) were found to be protective. Breastfeeding, whether exclusive or not, significantly reduced obesity risk among children whose mothers never smoked in pregnancy. PARFs indicated that 24.4%, 11.5%, 11.3% and 6.0% prevalent cases of child obesity might be prevented by exclusive breastfeeding, smoking cessation during pregnancy, adequate sleep during childhood, and avoiding high birth weight, respectively. CONCLUSIONS: This study identified multiple perinatal and childhood factors associated with obesity in young Canadian children. Effective prevention strategies targeting four modifiable maternal and child risk factors may reduce childhood obesity by up to 54% in Canada.

Increasing blood pressure and its associated factors in Canadian children and adolescents from the Canadian Health Measures Survey.

BACKGROUND: Canada is facing a childhood obesity epidemic. Elevated blood pressure (BP) is a major complication of obesity. Reports on the impact of excess adiposity on BP in children and adolescents have varied significantly across studies. We evaluated the independent effects of obesity, physical activity, family history of hypertension, and socioeconomic status on BP in a nationally representative sample of children and adolescents. METHODS: We analysed cross-sectional data for 1850 children aged 6 to 17 years who participated in the Canadian Health Measures Survey, Cycle 1, 2007-2009. Systolic BP (SBP) and diastolic BP (DBP) were age-, sex-, and height-adjusted to z-scores (SBPZ and DBPZ). Body mass index (BMI) z-scores were calculated based on World Health Organization growth standards. Multivariate linear regression was used to evaluate the independent effects of relevant variables on SBPZ and DBPZ. RESULTS: For most age/sex groups, obesity was positively associated with SBP. Being obese was associated with higher DBP in adolescent boys only. The BP effect of obesity showed earlier in young girls than boys. Obese adolescents were estimated to have an average 7.6 mmHg higher SBP than normal weight adolescents. BMI had the strongest effect on BP among obese children and adolescents. Moderately active adolescent boys had higher SBP (3.9 mmHg) and DBP (4.9 mmHg) than physically active boys. Family history of hypertension showed effects on SBP and DBP in younger girls and adolescent boys. Both family income and parent education demonstrated independent associations with BP in young children. CONCLUSIONS: Our findings demonstrate the early impact of excess adiposity, insufficient physical activity, family history of hypertension, and socioeconomic inequalities on BP. Early interventions to reduce childhood obesity can, among other things, reduce exposure to prolonged BP elevation and the future risk of cardiovascular disease.

Vitamin B-12 and homocysteine status in a folate-replete population: results from the Canadian Health Measures Survey.

BACKGROUND: Vitamin B-12 is an important cofactor required for nucleotide and amino acid metabolism. Vitamin B-12 deficiency causes anemia and neurologic abnormalities-a cause for concern for the elderly, who are at increased risk of vitamin B-12 malabsorption. Vitamin B-12 deficiency is also associated with an increased risk of neural tube defects and hyperhomocysteinemia. The metabolism of vitamin B-12 and folate is interdependent, which makes it of public health interest to monitor biomarkers of vitamin B-12, folate, and homocysteine in a folic acid-fortified population. OBJECTIVE: The objective was to determine the vitamin B-12, folate, and homocysteine status of the Canadian population in the period after folic acid fortification was initiated. DESIGN: Blood was collected from a nationally representative sample of ∼5600 participants aged 6-79 y in the Canadian Health Measures Survey during 2007-2009 and was analyzed for serum vitamin B-12, red blood cell folate, and plasma total homocysteine (tHcy). RESULTS: A total of 4.6% of Canadians were vitamin B-12 deficient (<148 pmol/L). Folate deficiency (<320 nmol/L) was essentially nonexistent. Obese individuals were less likely to be vitamin B-12 adequate than were individuals with a normal BMI. A total of 94.9% of Canadians had a normal tHcy status (≤13 µmol/L), and individuals with normal tHcy were more likely to be vitamin B-12 adequate and to have high folate status (>1090 nmol/L). CONCLUSIONS: Approximately 5% of Canadians are vitamin B-12 deficient. One percent of adult Canadians have metabolic vitamin B-12 deficiency, as evidenced by combined vitamin B-12 deficiency and high tHcy status. In a folate-replete population, vitamin B-12 is a major determinant of tHcy.