Sexual Identity and Heavy Drinking Among Adults in Canada by Racially Minoritized Status and Income, 2015-2020.

Purpose: Our objective was to estimate inequities in heavy drinking between heterosexual, gay or lesbian, and bisexual or pansexual individuals, by sex/gender, and to determine whether this association is heterogeneous across racially minoritized status and income groups in Canadians aged 15 and older. Methods: We pooled three Canadian Community Health Survey cycles (2015-2020) and used separate modified Poisson regressions to explore the sex/gender-specific association between sexual identity and heavy drinking prevalence by racially minoritized status, and income, adjusted for survey cycle, age, marital status, and region. Results: With racially minoritized status, and income categories collapsed, heavy drinking was 1.3 times higher (95% confidence interval [CI] = 1.0-1.7) among bisexual or pansexual women compared with heterosexual women, with no differences among men. Among racially minoritized women, heavy drinking was 2.9 (95% CI = 1.3-6.4) times higher among bisexual or pansexual women and 1.9 (95% CI = 0.7-5.2) times higher among gay or lesbian women compared with heterosexual women. Among racially minoritized men, heavy drinking was 1.9 (95% CI = 0.9-4.0) times higher among gay men compared with heterosexual men. No differences were observed across sexual identity in White men or women. Bisexual or pansexual women reported increased heavy drinking relative to heterosexual women across income quintiles. Conclusion: Heavy drinking is distributed heterogeneously across sexual identity, sex/gender, racially minoritized status, and income. These results encourage equity-focused interventions to reduce heavy drinking among intersecting sociodemographic groups experiencing a greater burden of heavy drinking.

An Australian Football Themed Health Behaviour Change Intervention for Men With Cardiovascular Disease is Feasible and Acceptable: Results From a Feasibility Randomised Trial.

BACKGROUND: Physical activity (PA) and weight management are critical for cardiovascular disease (CVD) secondary prevention. However, PA adherence during or after cardiac rehabilitation is low. Here, we assess the feasibility and acceptability of the Australian football-themed Aussie Fans in Training (Aussie-FIT) program and associated trial procedures when adapted for men with CVD. METHOD: A pragmatic randomised control trial, with waitlist control arm, and follow-up measures at 3 and 6 months. Men with a CVD diagnosis and body mass index ≥25 kg/m2 were recruited from community and clinical settings, and randomised, following baseline measures of health and health behaviours. The intervention arm attended 12 face-to-face football-themed education and PA sessions. Feasibility (recruitment, retention, attendance, and adherence to trial procedures) was assessed via mixed methods. RESULTS: A total of 74% (64/86) of participants expressing interest met the eligibility criteria. Of those, 49 men (mean age=61.4, standard deviation=9.5, mean body mass index=31.3, standard deviation=4.2) were randomised. Program attendance rates (87% attended ≥80% of sessions) and retention (92%) were high. Trial retention at the primary end point (3 months) was high (86%) and at the 6-month follow-ups reduced to 67%. Program and trial procedures were acceptable, except for the request to visit a pathologist for the blood draw. CONCLUSIONS: Using a football theme and setting may be a feasible way to engage men with CVD in health behaviour change. Given the existing pilot evidence for men at risk of CVD, and that recruitment rates were under the target, trialling a program for men with or at risk of CVD is recommended.

Variability in public health programming and priorities to address health inequities across public health units in Ontario, Canada.

OBJECTIVE: In 2018, Ontario Public Health Standards were updated to include the foundational Health Equity Standard to guide planning, implementation, and evaluation of public health programs and services. Public health units (PHUs), the regional public health bodies, are now required to address health equity through four requirements: (a) Assessing and Reporting; (b) Modifying and Orienting Public Health Interventions; (c) Engaging in Multi-sectoral Collaboration; and (d) Health Equity Analysis, Policy Development, and Advancing Healthy Public Policies. METHODS: This qualitative descriptive study explored how the 27 participating PHUs (out of 34) serving urban (N = 10), mixed urban-rural (N = 15), and rural (N = 9) populations addressed the Health Equity Standard. Using document analysis, we inductively and deductively coded the content of 68 PHU Annual Service Plan and Budget Submissions from a 3-year period (2018-2020) received from the 27 PHUs. RESULTS: Emergent categories were organized into the four requirements and one additional emergent theme: Organizational Implementation of Health Equity. The approaches of embedding health equity into PHUs' activities varied across groups. Urban PHUs presented more diverse strategies, including working with a larger number of organizations, and participating in academic research projects. We found more process standardization and greater discussion of capacity building in urban and mixed urban-rural PHUs. Rural PHUs strategically addressed the needs of their diverse populations through relationship building with Indigenous communities. CONCLUSION: Findings suggest broad implementation of health equity approaches in public health independent of PHUs' geographic size and population dispersion, though strategies and key challenges differ across units.

RéSUMé: OBJECTIF: En 2018, les Normes de santé publique de l'Ontario ont été révisées pour inclure, à la base, la norme sur l'Équité en santé, qui guide la planification, la mise en œuvre et l'évaluation des programmes et des services de santé publique. Les bureaux de santé publique (BSP), qui sont les organismes de santé publique régionaux, sont maintenant tenus d'aborder l'équité en santé selon quatre exigences : a) Évaluer et produire des rapports; b) Modifier et orienter les interventions en santé publique; c) Favoriser une collaboration multisectorielle; et d) L'analyse de l'équité en santé, l'élaboration de politiques et la promotion de politiques publiques qui réduisent les iniquités en santé. MéTHODE: Notre étude qualitative descriptive a exploré comment les 27 BSP participants (sur 34) servant des populations urbaines (N = 10), mi-urbaines mi-rurales (N = 15) et rurales (N = 9) ont abordé la norme sur l'Équité en santé. Au moyen d'une analyse documentaire, nous avons inductivement et déductivement codé le contenu de 68 plans de services annuels et projets de budget des 27 BSP participants sur une période de trois ans (2018‒2020). RéSULTATS: Les catégories émergentes ont été triées selon les quatre exigences et un thème supplémentaire : la mise en œuvre de l'équité en santé à l'échelle organisationnelle. Les façons d'intégrer l'équité en santé dans les activités des BSP variaient d'un groupe à l'autre. Les BSP urbains ont présenté des stratégies plus diverses, dont la collaboration avec un plus grand nombre d'organismes et la participation à des projets de recherche universitaires. Nous avons observé une plus grande standardisation des processus et davantage de mentions du renforcement des capacités chez les BSP urbains et mi-urbains mi-ruraux. Les BSP ruraux abordaient stratégiquement les besoins de leurs populations diverses en tissant des liens avec les communautés autochtones. CONCLUSION: Selon ces constats, il y a une mise en œuvre généralisée des approches d'équité en santé dans le système de santé publique, sans égard à l'étendue géographique ou à la dispersion de la population des BSP, mais il existe des différences dans les stratégies employées et dans les difficultés rencontrées par chaque bureau.

The association between off- and on-premise alcohol outlet density and 100% alcohol-attributable emergency department visits by neighbourhood-level socioeconomic status in Ontario, Canada.

Alcohol availability is positively associated with alcohol use and harms, but the influence of socioeconomic status (SES) on these associations is not well established. This population-based cross-sectional study examined neighbourhood-level associations between physical alcohol availability (measured as off- and on-premise alcohol outlet density) and 100% alcohol-attributable emergency department (ED) visits by neighbourhood SES in Ontario, Canada from 2017 to 2019 (n = 19,740). A Bayesian spatial modelling approach was used to assess associations and account for spatial autocorrelation, which produced risk ratios (RRs) and 95% credible intervals (95% CrI). Each additional off-premise alcohol outlet in a neighbourhood was associated with a 3% increased risk of alcohol-attributable ED visits in both men (RR = 1.03, 95%CrI: 1.02-1.04) and women (RR = 1.03, 95% CrI: 1.02-1.04). Positive associations were also observed between on-premise alcohol outlet density and alcohol-attributable ED visits, although effect sizes were small. A disproportionately greater association with ED visits was observed with increasing alcohol outlet density in the lowest compared to higher SES neighbourhoods. Reducing physical alcohol availability may be an important policy lever for reducing alcohol harm and alcohol-attributable health inequities.

The association between alcohol retail access and health care visits attributable to alcohol for individuals with and without a history of alcohol-related health-care use.

BACKGROUND AND AIMS: Alcohol retail access is associated with alcohol use and related harms. This study measured whether this association differs for people with and without heavy and disordered patterns of alcohol use. DESIGN: The study used a repeated cross-sectional analysis of health administrative databases. SETTING, PARTICIPANTS/CASES: All residents of Ontario, Canada aged 10-105 years with universal health coverage (n = 10 677 604 in 2013) were included in the analysis. MEASUREMENTS: Quarterly rates of emergency department (ED) and outpatient visits attributable to alcohol in 464 geographic regions between 2013 and 2019 were measured. Quarterly off-premises alcohol retail access scores were calculated (average drive to the closest seven stores) for each geographic region. Mixed-effect linear regression models adjusted for area-level socio-demographic covariates were used to examine associations between deciles of alcohol retail access and health-care visits attributable to alcohol. Stratified analyses were run for individuals with and without prior alcohol-attributable health-care use in the past 2 years. FINDINGS: We included 437 707 ED visits and 505 271 outpatient visits attributable to alcohol. After adjustment, rates of ED visits were 39% higher [rate ratio (RR) = 1.39, 95% confidence interval (CI) = 1.20-1.61] and rates of outpatient visits were 49% higher (RR = 1.49, 95% CI = 1.26-1.75) in the highest versus lowest decile of alcohol access. There was a positive association between alcohol access and outpatient visits attributable to alcohol for individuals without prior health-care attributable to alcohol (RR = 1.65, 95% CI = 1.39-1.95 for the highest to lowest decile of alcohol access) but not for individuals with prior health-care attributable to alcohol (RR = 1.08, 95% CI = 0.90-1.30). There was a positive association between alcohol access and ED visits attributable to alcohol for individuals with and without prior health-care for alcohol for ED visits. CONCLUSION: In Ontario, Canada, greater alcohol retail access appears to be associated with higher rates of emergency department (ED) and outpatient health-care visits attributable to alcohol. Individuals without prior health-care for alcohol may be more susceptible to greater alcohol retail access for outpatient but not ED visits attributable to alcohol.

The equitable impact of sugary drink taxation structures on sugary drink consumption among Canadians: a modelling study using the 2015 Canadian Community Health Survey-Nutrition.

OBJECTIVE: Estimate the impact of 20 % flat-rate and tiered sugary drink tax structures on the consumption of sugary drinks, sugar-sweetened beverages and 100 % juice by age, sex and socio-economic position. DESIGN: We modelled the impact of price changes - for each tax structure - on the demand for sugary drinks by applying own- and cross-price elasticities to self-report sugary drink consumption measured using single-day 24-h dietary recalls from the cross-sectional, nationally representative 2015 Canadian Community Health Survey-Nutrition. For both 20 % flat-rate and tiered sugary drink tax scenarios, we used linear regression to estimate differences in mean energy intake and proportion of energy intake from sugary drinks by age, sex, education, food security and income. SETTING: Canada. PARTICIPANTS: 19 742 respondents aged 2 and over. RESULTS: In the 20 % flat-rate scenario, we estimated mean energy intake and proportion of daily energy intake from sugary drinks on a given day would be reduced by 29 kcal/d (95 % UI: 18, 41) and 1·3 % (95 % UI: 0·8, 1·8), respectively. Similarly, in the tiered tax scenario, additional small, but meaningful reductions were estimated in mean energy intake (40 kcal/d, 95 % UI: 24, 55) and proportion of daily energy intake (1·8 %, 95 % UI: 1·1, 2·5). Both tax structures reduced, but did not eliminate, inequities in mean energy intake from sugary drinks despite larger consumption reductions in children/adolescents, males and individuals with lower education, food security and income. CONCLUSIONS: Sugary drink taxation, including the additional benefit of taxing 100 % juice, could reduce overall and inequities in mean energy intake from sugary drinks in Canada.

An ELISA Using Synthetic Mycolic Acid-Based Antigens with DIVA Potential for Diagnosing Johne's Disease in Cattle.

THE PROBLEM: Ante-mortem diagnosis of Johne's disease, caused by Mycobacterium avium subsp. paratuberculosis (MAP), is normally achieved through faecal culture, PCR, or serological tests, but agreement as to which samples are positive for Johne's disease is often poor and sensitivities are low, particularly in early-stage infections. The potential solution: Mycobacterial cells contain very complex characteristic mixtures of mycolic acid derivatives that elicit antibodies during infection; this has been used to detect infections in humans. Here, we explore its application in providing an assay differentiating infected from vaccinated animals (DIVA assay) for Johne's disease in cattle. METHOD: Antibody responses to different classes of mycolic acid derivatives were measured using ELISA for serum from cattle positive for MAP by both faecal PCR and commercial serum ELISA, or just by PCR, and from animals from herds with no history of Johne's disease, bovine tuberculosis reactors, BCG-vaccinated, BCG-vaccinated and M. bovis-infected, and Gudair-vaccinated animals. RESULTS: The best-performing antigens, ZAM295 and ST123-the latter a molecule present in the cells of MAP but not of Mycobacterium bovis-achieved a sensitivity of 75% and 62.5%, respectively, for serum from animals positive by both faecal PCR and a commercial MAP serum ELISA, at a specificity of 94% compared to 80 no-history negatives. Combining the results of separate assays with two antigens (ST123 and JRRR121) increased the sensitivity/specificity to 75/97.5%. At the same cut-offs, animals vaccinated with Gudair or BCG vaccines and bTB reactors showed a similar specificity. The specificity in BCG-vaccinated but M. bovis-infected animals dropped to 85%. Combining the results of two antigens gave a sensitivity/specificity of 37.5/97.5% for the full set of 80 PCR-positive samples, detecting 30 positives compared 16 for IDEXX. CONCLUSION: Serum ELISA using synthetic lipids distinguishes effectively between MAP-negative cattle samples and those positive by both PCR and a commercial MAP serodiagnostic, without interference by Gudair or BCG vaccination. It identified almost twice as many PCR positives as the commercial serodiagnostic, offering the possibility of earlier detection of infection.

Can a health warning label diminish the persuasive effects of health-oriented nutrition advertising on ready-to-drink alcohol product packaging? A randomized experiment.

BACKGROUND AND AIMS: A health warning label (HWL) cautioning about the link between alcohol and cancer may be able to communicate alcohol risks to consumers and potentially counter health-oriented nutrition advertising on ready-to-drink alcoholic beverages. This study aimed to examine the independent and combined effects of nutrient content claims (e.g. 0 g sugar) and a HWL on perceived product characteristics and intentions to consume, and whether these effects differed by gender and age. DESIGN: A between-subjects randomized experiment. Participants were randomized to view one of six experimental label conditions: nutrient content claims plus nutrition declaration (NCC + ND), ND only, NCC + ND + HWL, ND + HWL, HWL only and no NCC, ND or HWL, all on a ready-to-drink (RTD) vodka-based soda container. SETTING AND PARTICIPANTS: Alcohol consumers (n = 5063; 52% women) in Canada aged 18-64 recruited through a national online panel. MEASUREMENTS: Participants completed ratings of perceived product characteristics, perceived product health risks, and intentions to try, buy, binge and drink the product. FINDINGS: Compared with the reference condition NCC + ND (current policy scenario in Canada), the other five experimental label conditions were associated with lower ratings for perceiving the product as healthy. All experimental conditions with a HWL were associated with lower product appeal, higher risk perceptions and reduced intentions to try, buy and binge. The experimental condition with a HWL only was associated with intentions to consume fewer cans in the next 7 days (ß = -0.72, 95% confidence interval [CI] = -1.37,-0.08) versus the reference. Few interactions were observed, suggesting that label effects on outcomes were similar by gender and age. CONCLUSIONS: Health warning labels on alcohol packaging appear to be associated with lower product appeal, higher perceived health risks and reduced consumption intentions, even in the presence of nutrient content claims.

Income inequality and deaths of despair risk in Canada, identifying possible mechanisms.

BACKGROUND: Declines in life expectancy in developed countries have been attributed to increases in drug-related overdose, suicide, and liver cirrhosis, collectively referred to as deaths of despair. Income inequality is proposed to be partly responsible for increases in deaths of despair rates. This study investigated the associations between income inequality, deaths of despair risk in Canada, and potential mechanisms (stress, social cohesion, and access to health services). METHODS: We obtained data from the Canadian Community Health Survey and the Canadian Vital Statistics Database from 2007 to 2017. A total of 504,825 Canadians were included in the analyses. We used multilevel survival analyses, as measured by the Gini coefficient, to examine the relationships between income inequality and mortality attributed to drug overdose, suicide, death of despair, and all-cause. We then used multilevel path analyses to investigate whether each mediator (stress, social cohesion, and access to mental health professionals), which were investigated using separate mediation models, influenced the relationship between income inequality and drug overdose, suicide, deaths of despair, and all-cause death. RESULTS: Adjusted multilevel survival analyses demonstrated significant relationships between a one-SD increase in Gini coefficient was associated with an increased hazard for drug overdose (HRadj. = 1.28; 95 CI = 1.05, 1.55), suicide (HRadj. = 1.24; 95 CI = 1.06, 1.46), deaths of despair (HRadj. = 1.26; 95 CI = 1.12, 1.40), and all-cause death (HRadj. = 1.04; 95 CI = 1.02, 1.07). Adjusted path analyses indicated that stress, social cohesion, and access to mental health professionals significantly mediated the association between income inequality and mortality outcomes. CONCLUSION: Income inequality is associated with deaths of despair and this relationship is mediated by stress, social cohesion, and access to mental health professionals. Findings should be applied to develop programs to address income inequality in Canada.

Socio-economic inequities in emergency department visits for wholly alcohol-attributable acute and chronic harms in Canada, 2003-2017.

INTRODUCTION: Individuals with low socio-economic position (SEP) experience disproportionate alcohol-attributable harm. Limited research has investigated whether these inequities are driven by alcohol-attributable conditions that are acute or chronic. The study aimed to estimate the sex-specific associations between SEP and incident wholly alcohol-attributable emergency department (ED) visits for acute and chronic harms, respectively. METHODS: A cohort study was conducted using the Canadian Community Health Survey (2003-2008) linked to the National Ambulatory Care Reporting System (2002-2017) in Alberta and Ontario. SEP was measured using educational attainment. Acute and chronic ED visits were captured in the National Ambulatory Care Reporting System follow-up data. Hazard models were fit to estimate the association between SEP and acute and chronic wholly alcohol-attributable ED visits. RESULTS: The analytical sample included 88,865 respondents. In men and women, individuals with lower SEP had increased hazard of acute ED visits (women hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.07-2.87; men HR 3.47, 95% CI 2.29-5.25) and chronic ED visits (women HR 2.24, 95% CI 1.04-4.80; men HR 5.02, 95% CI 2.88-8.75). Acute and chronic wholly alcohol-attributable ED visit rates were higher in men than women. DISCUSSION AND CONCLUSIONS: The findings indicated lower SEP was associated with greater harms for both acute and chronic wholly alcohol-attributable ED visits when compared to their higher SEP counterparts. We conclude that gradients in SEP are associated with acute and chronic harms. These results highlight a need for equitable interventions that reduce the absolute burden of inequities in both acute and chronic wholly alcohol-attributable ED visits.

Child abuse and neglect during the COVID-19 pandemic: An umbrella review.

BACKGROUND: During the COVID-19 pandemic, multiple child health experts postulated that the stay-at-home orders would negatively impact child abuse and neglect. OBJECTIVES: We aimed to examine the impact of the COVID-19 pandemic on child abuse and neglect in children ages 18 and under; and review author recommendations for future emergency lockdown procedures. METHODS: We completed a systematic search of articles across five databases. Review-level studies were included if they examined any abuse or neglect related outcomes in children and youth (e.g., injuries, case openings), and were published in English. We completed quality appraisals of each included article using the Health Evidence™ tool. We categorized the findings by data source including administrative and survey data, or other data sources. We also narratively summarized reported recommendations. RESULTS: In total, 11 reviews were included. Two reviews were of strong quality, 7 moderate, and 2 were weak. Overall, studies within reviews that reported from administrative data sources demonstrated decreased child abuse and neglect outcomes compared to before the pandemic. Studies using cross-sectional data demonstrated increases. Reviews with mixed results often reported increases in emotional, neglect and psychological abuse cases and decreases physical and sexual abuse cases. CONCLUSIONS: This study found consistent results across reviews; depending on the data source and study design, child abuse and neglect outcomes either increased or decreased during the COVID-19 pandemic. Future work should enhance data collection methods for surveillance and intervention of child abuse and neglect during public health emergencies when traditional mechanisms are limited, with an increased focus on the rigor of reporting.

The Impacts of Selling Alcohol in Grocery Stores in Ontario, Canada: A Before-After Study.

OBJECTIVE: From 2015 to 2019, the Government of Ontario expanded privatized sales of alcohol, licensing 450 grocery stores to sell beer, cider, and wine. The impacts of a nearby grocery store gaining an alcohol license on adults' alcohol use in Ontario are examined, including whether impacts differed by gender. METHOD: Data from 2015-2019 Canadian Community Health Survey participants in Ontario (age ≥ 20 years), living within 1,000 m and 1,500 m of grocery stores that gained a license to sell alcohol and propensity-matched controls were included (1,000 m n = 14,052, 1,500 m n = 30,486). Alcohol use outcomes included past-7-day number of standard drinks consumed, near-daily drinking (≥4 days/week), and heavy drinking (5+ drinks in men/4+ in women, at least once/month). Gender-specific difference-in-differences (DiD) analyses compared changes in alcohol use before and after intervention in intervention and control populations. RESULTS: Decreases in past-7-day drinks, near-daily drinking, and heavy drinking were observed after intervention in both intervention and control populations. At the 1,000 m level, adjusted DiD analyses showed past-7-day drinking in women (risk ratio = 1.21, 95% CI [0.88, 1.60]) and heavy drinking in men (odds ratio = 1.38, 95% CI [0.92, 2.08]) had effect sizes above 1, a relative increase over controls, although confidence intervals crossed 1. Findings did not indicate significant differences in alcohol use in intervention relative to controls for other alcohol use measures and at 1,500 m. CONCLUSIONS: Findings suggest no association between a partial alcohol deregulation initiative in Ontario and alcohol use from 2015 to 2019. It is important to monitor the impacts on alcohol use over time as further alcohol deregulation plans in Ontario and other jurisdictions are considered.

Cephalomedullary Nailing has a Higher Reoperation Rate Compared to Sliding Hip Screw Fixation in the Treatment of Intertrochanteric Femur Fractures: A Systematic Literature Review and Meta-analysis.

Objectives: Intertrochanteric hip fractures are a common orthopaedic injury in the United States. Complications of surgical treatment include nonunion, lag screw cutout, implant failure, post-operative pain, risk of refracture or reoperation, and infection. The purpose of this study was to compare the rate of complications of sliding hip screw fixation (SHS) compared to cephalomedullary nailing (CMN) for the treatment of closed intertrochanteric femur fractures in adult patients. Methods: PubMed, CINAHL, and Cochrane Library databases were searched for studies comparing SHS to CMN in the treatment of closed intertrochanteric femur fractures in adults. Data were compiled to observe the rate of nonunion, cutout failure, infection, refracture, perioperative blood loss, reoperation, postoperative pain, pulmonary embolism/deep venous thrombosis (DVT), length of hospital stay, and mortality. Results: Seventeen studies were included comprising 1,500 patients treated with SHS and 1,890 patients treated with CMN. Treatment of intertrochanteric femur fractures with SHS demonstrated significantly fewer refractures and reoperations. There was no significant difference in other variables between SHS and CMN treated groups. Conclusion: This meta-analysis shows that the only notable difference in outcomes is patients treated with CMN have a higher rate of refracture and reoperation. With new advances in the development of both CMNs and SHS, further studies will be required to see if these differences persist in the coming years.

Income inequality and mental health in adolescents during COVID-19, results from COMPASS 2018-2021.

INTRODUCTION: Understanding the inequitable impacts of the ongoing COVID-19 pandemic on youth mental health are leading priorities. Existing research has linked income inequality in schools to adolescent depression, however, it is unclear if the onset of the pandemic exacerbated the effects of income inequality on adolescent mental health. The current study aimed to quantify the association between income inequality and adolescent mental health during COVID-19. MATERIAL AND METHODS: Longitudinal data were taken from three waves (2018/19 to 2020/21) of the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) school-based study. Latent Growth Curve modelling was used to assess the association between Census District (CD)-level income inequality and depressive symptoms before and after the onset of COVID-19. RESULTS: The study sample included 29,722 students across 43 Census divisions in British Columbia, Alberta, Ontario, and Quebec. The average age of the sample at baseline was 14.9 years [standard deviation (SD) = 1.5] and ranged between 12 and 19 years of age. Most of the sample self-reported as white (76.3%) and female (54.4%). Students who completed the COMPASS survey after the onset of COVID reported 0.20-unit higher depressive scores (95% CI = 0.16, 0.24) compared to pre-COVID. The adjusted analyses indicated that the association between income inequality on anxiety scores was strengthened following the onset of COVID-19 (ß = 0.02, 95% CI = 0.0004, 0.03), indicating that income inequality was associated with a greater increase in anxiety scores during COVID-19. DISCUSSION: The adjusted results indicate that the association between income inequality and adolescent anxiety persisted and was heightened at the onset of COVID-19. Future studies should use quasi-experimental methods to strengthen this finding. The current study can inform policy and program discussions regarding the effects of the COVID-19 pandemic and pandemic recovery for young Canadians and relevant social policies for improving adolescent mental health.

Scale-up of the Australian Fans in Training (Aussie-FIT) men's health behaviour change program: a protocol for a randomised controlled hybrid effectiveness-implementation trial.

INTRODUCTION: Improving physical activity (PA) and healthy eating is critical for primary and secondary prevention of cardiovascular disease (CVD). Behaviour change programmes delivered in sporting clubs can engage men in health behaviour change, but are rarely sustained or scaled-up post trial. Following the success of pilot studies of the Australian Fans in Training (Aussie-FIT) programme, a hybrid effectiveness-implementation trial protocol was developed. This protocol outlines methods to: (1) establish if Aussie-FIT is effective at supporting men with or at risk of CVD to sustain improvements in moderate-to-vigorous PA (primary outcome), diet and physical and psychological health and (2) examine the feasibility and utility of implementation strategies to support programme adoption, implementation and sustainment. METHODS AND ANALYSIS: A pragmatic multistate/territory hybrid type 2 effectiveness-implementation parallel group randomised controlled trial with a 6-month wait list control arm in Australia. 320 men aged 35-75 years with or at risk of CVD will be recruited. Aussie-FIT involves 12 weekly face-to-face sessions including coach-led interactive education workshops and PA delivered in Australian Football League (Western Australia, Northern Territory) and rugby (Queensland) sports club settings. Follow-up measures will be at 3 and 6 months (both groups) and at 12 months to assess maintenance (intervention group only). Implementation outcomes will be reported using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework. ETHICS AND DISSEMINATION: This multisite study has been approved by the lead ethics committees in the lead site's jurisdiction, the South Metropolitan Health Service Human Research Ethics Committee (Reference RGS4254) and the West Australian Aboriginal Health Ethics Committee (HREC1221). Findings will be disseminated at academic conferences, peer-reviewed journals and via presentations and reports to stakeholders, including consumers. Findings will inform a blueprint to support the sustainment and scale-up of Aussie-FIT across diverse Australian settings and populations to benefit men's health. TRIAL REGISTRATION NUMBER: This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12623000437662).

Bridging ethics and epidemiology: Modelling ethical standards of health equity.

Health inequities are differences in health that are 'unjust'. Yet, despite competing ethical views about what counts as an 'unjust difference in health', theoretical insights from ethics have not been systematically integrated into epidemiological research. Using diabetes as an example, we explore the impact of adopting different ethical standards of health equity on population health outcomes. Specifically, we explore how the implementation of population-level weight-loss interventions using different ethical standards of equity impacts the intervention's implementation and resultant population health outcomes. We conducted a risk prediction modelling study using the nationally representative 2015-16 Canadian Community Health Survey (n = 75,044, 54% women). We used the Diabetes Population Risk Tool (DPoRT) to calculate individual-level 10-year diabetes risk. Hypothetical weight-loss interventions were modelled in individuals with overweight or obesity based on each ethical standard: 1) health sufficiency (reduce DPoRT risk below a high-risk threshold (16.5%); 2) health equality (equalize DPoRT risk to the low risk group (5%)); 3) social-health sufficiency (reduce DPoRT risk <16.5 in individuals with lower education); 4) social-health equality (equalize DPoRT risk to the level of individuals with high education). For each scenario, we calculated intervention impacts, diabetes cases prevented or delayed, and relative and absolute educational inequities in diabetes. Overall, we estimated that achieving health sufficiency (i.e., all individuals below the diabetes risk threshold) was more feasible than achieving health equality (i.e., diabetes risk equalized for all individuals), requiring smaller initial investments and fewer interventions; however, fewer diabetes cases were prevented or delayed. Further, targeting only diabetes inequalities related to education reduced the target population size and number of interventions required, but consequently resulted in even fewer diabetes cases prevented or delayed. Using diabetes as an example, we found that an explicit, ethically-informed definition of health equity is essential to guide population-level interventions that aim to reduce health inequities.

A Dual Transcriptomic Approach Reveals Contrasting Patterns of Differential Gene Expression During Drought in Arbuscular Mycorrhizal Fungus and Carrot.

While arbuscular mycorrhizal (AM) fungi are known for providing host plants with improved drought tolerance, we know very little about the fungal response to drought in the context of the fungal-plant relationship. In this study, we evaluated the drought responses of the host and symbiont, using the fungus Rhizophagus irregularis with carrot (Daucus carota) as a plant model. Carrots inoculated with spores of R. irregularis DAOM 197198 were grown in a greenhouse. During taproot development, carrots were exposed to a 10-day water restriction. Compared with well-watered conditions, drought caused diminished photosynthetic activity and reduced plant growth in carrot with and without AM fungi. Droughted carrots had lower root colonization. For R. irregularis, 93% of 826 differentially expressed genes (DEGs) were upregulated during drought, including phosphate transporters, several predicted transport proteins of potassium, and the aquaporin RiAQPF2. In contrast, 78% of 2,486 DEGs in AM carrot were downregulated during drought, including the symbiosis-specific genes FatM, RAM2, and STR, which are implicated in lipid transfer from the host to the fungus and were upregulated exclusively in AM carrot during well-watered conditions. Overall, this study provides insight into the drought response of an AM fungus in relation to its host; the expression of genes related to symbiosis and nutrient exchange were downregulated in carrot but upregulated in the fungus. This study reveals that carrot and R. irregularis exhibit contrast in their regulation of gene expression during drought, with carrot reducing its apparent investment in symbiosis and the fungus increasing its apparent symbiotic efforts. [Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

The distribution of alcohol-attributable healthcare encounters across the population of alcohol users in Ontario, Canada.

Recent evidence suggests there may be no safe level of alcohol use as even low levels are associated with increased risk for harm. However, the magnitude of the population-level health burden from lower levels of alcohol use is poorly understood. The objective was to estimate the distribution of alcohol-attributable healthcare encounters (emergency department (ED) visits and hospitalizations) across the population of alcohol users aged 15+ in Ontario, Canada. Using the International Model of Alcohol Harms and Policies (InterMAHP) tool, wholly and partially alcohol-attributable healthcare encounters were estimated across alcohol users: (1) former (no past-year use); (2) low volume (≤67.3 g ethanol/week); (3) medium volume (>67.3-134.5 g ethanol/week for women and >67.3-201.8 g ethanol/week for men); and (4) high volume (>134.5 g ethanol/week for women and >201.8 g ethanol/week for men). The alcohol-attributable healthcare burden was distributed across the population of alcohol users. A small population of high volume users (23% of men, 13% of women) were estimated to have contributed to the greatest proportion of alcohol-attributable healthcare encounters, particularly among men (men: 65% of ED visits and 71% of hospitalizations, women: 49% of ED visits and 50% of hospitalizations). The 71% of women low and medium volumes users were estimated to have contributed to a substantial proportion of alcohol-attributable healthcare encounters (47% of ED visits and 34% of hospitalizations). Findings provide support for universal alcohol policies (i.e., delivered to the entire population) for reducing population-level alcohol-attributable harm in addition to targeted policies for high-risk users.

The association between social fragmentation and deaths attributable to alcohol, drug use, and suicide: Longitudinal evidence from a population-based sample of Canadian adults.

BACKGROUND: Social fragmentation has been theorized and empirically associated with suicide in prior research. However, less is known about whether social fragmentation is associated with deaths attributed to alcohol use or drug use. This research examined the association between social fragmentation and risk for deaths attributable to alcohol use, drug use, and suicide (collectively known as deaths of despair) among Canadian adults. METHODS: A weighted sample representing 15,324,645 Canadians within 288 census divisions between 2006 and 2019 was used. Mortality data from the Canadian Vital Statistics Database (alcoholic liver disease, drug use, and suicide) was linked with census division socioeconomic data from the 2006 Canadian census using the Canadian Census Health and Environment Cohorts. Social fragmentation at the census division was created based on the Congdon Index. Cox-proportional hazard regression with survey weights and the sandwich estimator were used to account for clustering of individuals (level-1) nested within census divisions (level-2). RESULTS: After adjusting for individual and census division confounders, social fragmentation was positively associated with all-cause mortality (HR = 1.04; 95% CI: 1.02, 1.07), suicide (HR = 1.09; 95%CI: 1.01, 1.18), drug overdose related mortality (HR = 1.13; 95%CI: 1.03, 1.24), and deaths of despair (HR = 1.10; 95% CI: 1.04, 1.16), and not significantly associated with alcohol related liver disease (HR = 1.06; 95% CI: 0.91, 1.23). CONCLUSION: Social fragmentation is associated with an increased hazard of deaths of despair among Canadian adults. Efforts to improve social cohesion in areas that are highly socially fragmented need to be evaluated.

Pathways from Men's Shed engagement to wellbeing, health-related quality of life, and lower loneliness.

Extensive qualitative evidence, but limited quantitative evidence, indicates that mutual aid organizations such as Men's Sheds have positive impacts on wellbeing, health-related quality of life, and loneliness. A recently developed theoretical model proposes that Men's Sheds may have these impacts via mediating factors such as broadening social networks, increasing behavioural activation and physical activity, reducing alcohol use, and providing meaning in life. The aim of this study was to quantitatively test a model whereby psychological safety (feeling safe, accepted, and valued) is associated with Men's Shed engagement (frequency of attendance, duration of membership, diversity of activities), which is associated with the hypothesized mediators, which, in turn, are associated with wellbeing, health-related quality of life, and loneliness. Men's Shed members (N = 333, Mage = 70.90 years, SD = 10.34, 98% male) completed a survey assessing the factors in the model. The hypothesized path model provided an excellent fit to the data. Findings indicated that higher psychological safety was associated with higher engagement, which, in turn, was associated with larger social networks and more meaning in life, which were associated with higher wellbeing and lower loneliness. Higher behavioural activation and less alcohol use were also associated with higher wellbeing. Higher Men's Shed engagement was not associated with higher behavioural activation and physical activity, or less alcohol use, but behavioural activation and alcohol use were directly associated with health-related quality of life. Implications for optimizing health outcomes within Men's Sheds are discussed.