Montreal Metropolitan Area Research Articles

‘It’s not a me thing’: the role of transcendence and critical politics in Black LGBTQ wellness in Montreal

This study explores well-being strategies and challenges for Black LGBTQ individuals in Montreal, Canada. Semi-structured interviews were conducted between March and May 2023 with key informants, or advocates and service providers for LGBTQ communities in the Montreal metropolitan area. Thematic analysis was used and involved transcription, memo-writing and a multi-step, inductive coding process using MAXQDA. The findings highlight three areas of well-noted challenges for Black LGBTQ individuals: systemic barriers; lack of targeted support; and challenges to accessing services. Two strategic domains emerged as innovative approaches to support well-being: transcendental practices and intersectional sociopolitical awareness raising. Transcendental practices, ranging from fine arts and dance to reiki energy healing, offered avenues for healing and community-building. Intersectional sociopolitical awareness was described as crucial in informing and contributing to existing efforts to improve well-being such as therapeutic engagement with clients and facilitating mutual aid. The identified transcendental practices and political awareness offer promising avenues for holistic well-being and comprehensive approaches to challenges such as inequitable HIV burden. Recognising the convergence of identities and social power axes can inform future interventions to foster more inclusive and empowering health strategies for Black LGBTQ communities.

Portrait of COVID-19 Outbreaks in the Workplaces of the Monteregie Region.

The aims of the studies are to describe COVID-19 outbreaks in the workplaces of the Monteregie Region, Quebec, Canada, and to evaluate potential risk factors for identifying at least one COVID-19 outbreak in these workplaces. An ecological retrospective cohort study was conducted using deidentified databases of COVID-19 outbreaks that occurred in workplaces from February 27, 2020, to June 30, 2021. Among 30,489 workplaces studied, 897 workplaces with at least one COVID-19 outbreak were identified. These outbreaks were associated with a sizeable number of workers in the workplace (adjusted odds ratio [aOR] = 6.78; 95% CI: 5.43-8.47), the presence of temporary foreign workers (aOR = 2.26; 95% CI: 1.53-3.33), contacts with clients (aOR = 1.93; 95% CI: 1.68-2.21), and being localized in the Montreal Metropolitan Area (aOR = 1.26; 95% CI: 1.09-1.45). These results enable the identification of potential risk factors for COVID-19 outbreaks in workplaces, with the aim of targeting workplaces where infection control and prevention measures might be enhanced or adapted to improve workers' health.

Supporting Reassigned Hospital Staff During the COVID-19 Pandemic in the Montreal Region: What Does it say About Leadership Styles?

Globally, the COVID-19 pandemic took a high toll on health human resources, especially in contexts where these resources were already fragile. In Quebec, to make up for the shortage of health human resources, and to contain the COVID-19 outbreaks in long-term care facilities, many hospital staff (including a majority of nurses) were sent to those facilities, with varying degrees of support. Building on the body of evidence linking leadership style and resilience, we conducted a qualitative comparative analysis of two hospitals in the Montreal Metropolitan Area, Quebec. We explored respondents' experience of psychosocial support tools provided to hospital staff reassigned to COVID-affected facilities. Data from 27 in-depth interviews with high- and mid-level managers, and front-line workers, was analyzed through the lens of leadership styles. Our findings highlighted how the design and implementation of support tools revealed major differences across the two hospitals' leadership styles (i.e., one hospital expressing leader-centered styles vs. the other expressing follower-centered leadership styles). The expression of these leadership styles was largely shaped by recent policies, notably a major political reform of 2015, which enforced more centralized decision-making. Our study offered additional empirical evidence that leadership styles fostering the recovery of health human resources may be a key indicator of successful response to crises.

Who is Buying SUVs and Light Trucks in Montreal? A Factor and Cluster Analysis

The steady growth in light truck use and ownership in Canada is a cause for concern because it poses significant negative externalities in the form of higher fatalities, increased congestion, impacts on the environment, and infrastructure wear and tear. Understanding why drivers choose to use these vehicles is important for policymakers interested in decreasing their use. Using data from 2,203 vehicle owners in the Montreal metropolitan area, this study uses a factor-cluster analysis approach to generate five distinct groups of drivers: a uto-dependent families, pragmatic drivers, established drivers, physically active workers, and urban drivers. Identifying these unique groups can be a useful step for policymakers interested in reducing light truck ownership by influencing vehicle choice changes, mode shifts, and land use changes. Findings from this study can help transport policymakers better understand the nuanced factors that influence the choice of a light truck on Montreal’s roads.

Contested densification: Sustainability, place and expectations at the urban fringe

The discourse of sustainability-by-density is dominant in urban policies and climate-friendly urbanism today. Yet, with current failures and disparities in the regulation of dense development and land speculation, the effects of such policies are not exclusively positive. In this article, we address citizen opposition to densification in urban peripheries of the Global North, especially in the North American context, with particular focus on a case at the urban fringe of the Montreal metropolitan area (Canada). We contribute to existing scholarship on a relational approach to urban sustainability with the objective of better understanding the narratives and governance dynamics that unfold in urban peripheries. In the case studied, the gap between residents' subjective experience of the ongoing transformations and the State discourses at different scales is particularly important, yet little understood after several years of public participatory meetings and two lawsuits. We develop the notion of situated expectations to show how actors entertain different expectations of the performance of State and citizen practices in favor of sustainability, which are grounded in their respective relationships to place, scale and the urban boundary. The lack of circulation and mutual recognition between these expectations makes the construction of coalitions and shared participatory governance practices much more problematic.

Black students applying and admitted to medicine in the province of Quebec, Canada: what do we know so far?

To address the underrepresentation of Black students in medical schools in Canada and identify barriers in selection processes, we compare data from the latest Canadian census to that of an exit-survey conducted after a situational judgment test (Casper) among medical school applicants and from questionnaires done after selection interviews in Quebec, Canada. The proportion of Black people aged 15-34 years old in Quebec in 2016 was 5.3% province-wide and 8.2% in the Montreal metropolitan area. The proportion in the applicant pool for 2020 in Quebec was estimated to be 4.5% based on Casper exit-survey data. Comparatively, it is estimated that Black people represented 1.8% of applicants invited to admission interviews and 1.2% of admitted students in Quebec in 2019. Although data from different cohorts and data sources do not allow for direct comparisons, these numbers suggest that Black students applying to medical school are disproportionately rejected at the first step compared to non-Black students. Longitudinal data collection among medical school applicants will be necessary to monitor the situation. Further studies are required to pinpoint the factors contributing to this underrepresentation, to keep improving the equity of our selection processes.

Immigrant linguistic integration in the multilingual context of Montreal

Abstract We investigate the relative intensity of use of English and French at home for allophone immigrants in the Montreal metropolitan area. We find that the linguistic distances between immigrants’ mother tongues and English and French have an important impact on the relative intensities of use at home of the two Canadian official languages. However, immigrants whose mother tongues are closer to French than to English are relatively less likely to use an official language at home. We further investigate the role of spousal and other characteristics on the integration of immigrants. The results suggest that the home environment is an important factor contributing to the linguistic integration. Individuals exposed to an official language at home with their spouse have significantly higher rates of linguistic integration. Also, English is more attractive than French in the sense that immigrants with an Anglophone partner will have higher integration rates to English than those with a Francophone partner integrating to French.

Linguistic Distance, Languages of Work and Wages of Immigrants in Montreal

We use the Levenshtein linguistic distance measure to explore the question of whether the distance between an immigrant’s mother tongue and a Canadian official language (English or French) has an impact on his/her economic integration into the labor market. Using microdata from the master files of the 2001 and 2006 Canadian censuses and from the 2011 National Household Survey, we investigate the relationship between linguistic distance and the intensity of use of English and French at work in the Montreal metropolitan area. That region is characterized by the presence of sizeable French- and English-speaking communities, as well as by a large number of immigrants from a wide variety of linguistic backgrounds. Those elements of linguistic diversity interact in the environment of English being the lingua franca. We find that linguistic distances between immigrants’ mother tongues and English and French have an important impact on the relative intensities of use of the two Canadian official languages at work. We further investigate the role of the languages used at work on the earnings of immigrants by estimating earnings functions. We find that the use of both French and English is remunerated positively in the labor market, but that using English at work has a larger impact on earnings.

Quebec’s new language dynamic

Abstract Census data are used to monitor the efficiency of Bill 101 in reorienting language shift more favourably for French. Immigration from former French colonies or Romance-language countries is shown to be the major factor driving the increase in the share of French in the assimilation of Allophones since 1991. The schooling provisions of Bill 101 are seen to play a significant supporting role in this respect, but not those promoting French as language of work. It is further shown that the corresponding trend towards a greater share for French in overall assimilation has become seriously compromised by a growing Anglicization of Francophones themselves, notably in the Montreal metropolitan area. The resulting consolidation of the superiority of English as language of assimilation in Quebec is seen to explain in large part the emergence of a new language dynamic since 2001, combining a record decline in relative weight of Quebec’s French-speaking majority with a mild but equally historic increase in weight of its English-speaking minority.

Impact of summer season on pre-hospital time delays in women and men undergoing primary percutaneous coronary intervention

BackgroundPre-hospital delays have been associated with poor outcomes in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). It is currently unknown how environmental variables affect treatment delays in these patients. Methods and resultsThe association between environmental variables, time to treatment including transportation times and adverse in-hospital events was assessed in 1828 consecutive patients with STEMI undergoing primary PCI between 2010 and 2014 in the Montreal metropolitan area. Median[Q1;Q3] total ischemia time was significantly longer during summer season (April–September) as compared to winter season (October–March, 201[140;305] min vs 187[126;266] min, p = 0.022). This difference between seasons was due to a significant increase in median decision time to seek treatment for symptoms during summer (90[46;185] min vs 78[40;156], p = 0.004). The former peaked during July and August and was most pronounced in men. Hence, outside temperature and summer season were identified as strong predictors of prolonged decision time in patients with STEMI (p < 0.001 and p = 0.002, respectively). Transportation times slightly increased during winter season and snow fall, this difference, however, was not significant (p = 0.46). A significant increase in in-hospital adverse outcomes following primary PCI was observed during summer season as compared to winter season (7.2% vs 4.8%, p = 0.032). Accordingly, multivariate logistic regression models adjusted for baseline variables identified summer season as a strong predictor of periprocedural adverse events (OR 1.83, 95% CI 1.2–3.11, p = 0.037). ConclusionContrary to our initial hypothesis, pre-hospital delays in patients with STEMI are considerably longer and associated with adverse in-hospital outcomes during summer season. Considering the consequences of global warming, it is imperative that educational efforts targeting patients' perception are implemented to counter treatment delays.

Shared social mechanisms underlying the risk of nine cancers: A life course study.

Identifying life periods during which social conditions have the highest impact on risk of common cancers in a population may help to reveal their underlying shared social mechanisms. We used the life course framework to estimate the extent to which life course SEP is associated with risk of nine cancers. In addition, we tested whether these associations conform to a critical period or cumulative life course model. Data were from a population-based case-control study of occupational exposures and cancer conducted in Montreal, Canada. Participants were males aged 35-70 years (n = 2,547) residing in the Montreal metropolitan area with primary, histologically confirmed cancers diagnosed between 1979 and 1985. Population controls (n = 512) were sampled from electoral lists. SEP was measured at three different periods of life based on respondent's report: during childhood, young adulthood and mid-life. We used a structured modeling approach using a series of unconditional logistic regressions to test which models best fit the data. Life course SEP increased the risk of all cancers. SEP in childhood was identified as a critical period for prostate and all gastrointestinal tract cancers except for esophagus cancer. In addition, the accumulation model best explained the data for melanoma and lung squamous cell carcinoma. Our findings suggest that childhood social circumstances are a common risk factor for several cancers among men; our results provide insights into the mechanisms involved in the etiology of nine cancers.

Spatial Variation of Injury Risk in a Metropolitan Area, According to Home Location, Transportation Mode, Distance Travelled and Route

At the route level, traffic volume and road geometry greatly influence the risk of injury. At the state or country level, population rates of road injuries vary according to household density and transportation mode. This study aims to integrate these two perspectives to describe the spatial variation of injury risk according to home location within a metropolitan area. Police reports (2006-2010) provided injury data (e.g. crash location). Population trips, travel mode and routes were estimated using a representative Origin-Destination Survey (2008) for the entire Montreal Metropolitan area. Home location for each individual was classified into population density quintiles, using property assessment rolls. Regression models were developed to estimate the number of car occupant, bus occupant and pedestrian injuries, accounting for exposure to traffic as well as road geometry. These models were applied to predict the risk associated with each road, intersection and highway and then accumulated throughout each trip. Results show that in the densest sector, injuries per kilometre of road are six times greater compared to the least dense one. At intersections, road segments and on highways, the number of injuries is strongly associated with traffic volume and proxies of vehicle speed. Unsurprisingly, trips by public transit are safer than by car. At the individual level, the likelihood of injury increases with distance traveled. People living in the least dense sector make more trips by car and travel greater distances and are almost three times more likely to be injured than those in the densest sector. Within a metropolitan area, more injuries occur in the densest sector, however it is the population living in the least dense sector that have the greatest risk of injury. In urban settings, road injury prevention strategies should not only target road geometry but also urban development.

A mixed logit model analysis of residential choices of the young-elderly in the Montreal metropolitan area

The residential choices of seniors are an important issue to be considered in both social sciences and in urban planning. In this study, we aimed to analyze how the young-elderly in the Montreal metropolitan area deal with the duality opposing a dwelling's characteristics with those of the neighborhood in their residential choices. Therefore, those who move need to make choices within the constraints of both dwelling and neighborhood characteristics. We employed a statistical approach combining both dwelling and neighborhood characteristics from the 2011 National Household Survey (2011 NHS) and geospatial data, first in separate models and then in a joint model. Our results revealed that the general characteristics of an ideal home of retirees are 3 to 4 rooms, a high-rise building, and a low-density neighborhood. We noted that the geographical location of the previous dwelling is an important determinant of the geographical location of the new one, suggesting a strong territorial attachment among the young-elderly. By stratifying the model with the income quintile, we noted that choices varied widely according to the socioeconomic profile. Thus, for the lower-class of young-elderly, housing costs are a predominant factor, while condos are the preferred housing tenure of the upper class, who also sought to live in a wealthy neighborhood. This segregation dynamic may lead to territorial segmentation, where the upper class seeks to live apart from the rest of the population.

Urban Sustainability Indicators from a Regional Perspective: Lessons from the Montreal Metropolitan Area

In this paper, we assess the performance variation of the municipalities in the greater Montreal area between 2005 and 2010 for a set of 12 common urban sustainability indicators. We then measure the global and local spatial autocorrelation of each indicator’s variation in order to describe the regional distribution of the indicators. Three different patterns emerge from this analysis: (1) converging pattern; (2) diverging pattern, and (3) random pattern of the performance variation of the municipalities across the region. The results suggest the relevance of further research on the potential spillover effects of an individual city’s performance, which could be overlooked because a local administration’s monitoring of progress is generally performed within its own jurisdiction. Examples of urban sustainability issues for which assessment and monitoring could be more effective at a regional scale include urban densification and public security.

Medical management of benign prostatic hyperplasia: Results from a population-based study.

In men with bothersome lower urinary tract symptoms (LUTS), medical treatment usually represents the first line. We examined the patterns of medical management of benign prostatic hyperplasia (BPH) in the Montreal metropolitan area, within the context of a case control study focusing on incident prostate cancer. Cases were 1933 men with incident prostate cancer. Population controls included 1994 age-matched men. In-person interviews collected sociodemographic characteristics and medical history, including BPH diagnosis, its duration, and type of medical treatment received. Baseline characteristics were compared by the chi-square likelihood test for categorical variables and by the students t-test for continuously coded variables. Overall, 1120 participants had history of BPH; of those 53.7% received medical treatment for BPH. Individuals with medically treated BPH, compared to individuals with medically untreated BPH, were older at index date [mean: 66.9 vs. 64.9 years, p<0.001)] and at diagnosis of BPH [mean: 62.3 vs. 60.3 years, p<0.001]. They also had a longer duration of BPH-history [mean: 4.7 vs. 4.0 years, p=0.02]. Regarding medical treatment, mono-therapy was more often used than combination therapy [87.6% vs. 12.4%, p<0.001]. Alpha-blockers (69.9%) were most commonly used as monotherapy, followed by 5alpha-reductase inhibitors (5ARIs) (26.6%). Alpha-blockers plus 5ARIs were the most common combination therapy (97.3%). Despite evidence from randomized, controlled trials for better efficacy with use of combination therapy, monotherapy consisting of alpha-blockers or 5ARI, in that order, is most frequently used. Additionally, 5ARI use was more common than previously reported (27% vs. 15%).

Food capacities and satisfaction in participants in food security community interventions in Montreal, Canada.

Food insecurity is steadily increasing in Canada. The objective of this paper is to determine if food capacities and satisfaction of recently enrolled participants in food security interventions are associated with the intervention having either a traditional or an alternative type of approach. Participants having recently accessed traditional (n = 711) or alternative community interventions (n = 113) in the Montreal metropolitan area, Canada, were interviewed with a questionnaire. The categorizing variable was participation in a community organization providing either traditional interventions, aimed to help people cope with the urgent need of food, or alternative interventions, aimed at first assistance, in addition to the creation of long-term solutions such as social integration and skills development. Participants' food and nutrition-related capacities and food satisfaction are studied. Multilevel regression models were used to assess whether participants took part in a traditional or alternative interventions. These interventions do not reach the same population. Relative to participants in alternative food security interventions, participants in traditional interventions demonstrated less capacity for accessing information about food safety and healthiness, and perceived their diet as less healthy. Traditional food security participants also paid less attention to the nutritional properties of food and reported less satisfaction with quantity, variety and taste of the food they accessed. The reasons why individuals who may benefit the most from alternative interventions were unlikely to participate should be investigated. The potential that food security interventions may inadvertently reinforce social inequalities in health should be considered in future intervention research.

General Practitioner Preferences in Managing Care of Multiple Sclerosis Patients.

Multiple sclerosis (MS) is a lifelong neurological disorder requiring care in a variety of settings. The purpose of this study is to describe preferences of general practitioners (GPs) with regards to providing care for MS patients. A stratified sample of 900 GPs in the province of Quebec were sent a questionnaire, with 266 returning completed questionnaires. Respondents were surveyed about their preferences using four clinical scenarios describing hypothetical patients experiencing different stages of MS. Respondents were asked whether they would continue managing the patient themselves, formally refer the patient to a specialist, or seek specialist advice. In two scenarios representing stable courses, 40.9% and 61.6% of GPs, respectively, intended to manage the patient themselves. GPs who reported having experience with MS patients were more likely to report an intention to continue management. In one scenario, GPs operating in rural areas were less likely to consider management than those in the Montreal metropolitan area (odds ratio=0.422, 95% confidence interval 0.20-0.90). For MS patients with a stable disease course, an important proportion of GPs appear to be willing to manage long-term care for MS patients.

A comparison of two methods for classifying trajectories: a case study on neighborhood poverty at the intra-metropolitan level in Montreal

In recent years several studies have examined changes in the distribution of poverty in the North American cities, with most empirical work assessing neighbourhood change between two time points. This paper aims to make a methodological contribution to the study of neighbourhood change, by comparing two classification methods, one classical (k-means clustering) the other more novel (Latent Class Growth Modelling; LCGM) to identify groups of census tracts having followed similar trajectories of poverty in the Montreal metropolitan area, Canada. Here trajectories of poverty are measured over a twenty year period, using five time points. The relative performance of the LCGM vs. the k-means clustering was assessed using a series of multinomial logistic regressions examining how different socioeconomic variables were associated with the trajectories of poverty. Results showed that k-means and LCGM identified similar groups of census tracts characterised by ascending, descending, or stable poverty levels throughout the period, with LGCM only marginally outperforming k-means clustering.

Analyzing the impact of urban planning on population distribution in the Montreal metropolitan area using a small-area microsimulation projection model

The objective of this paper was to project the population of the Montreal Metropolitan Community’s municipalities over the 2006–2031 period and assess the effects of changes to urban planning on the expected spatial distribution of the population. For this purpose, we develop a microsimulation model that performs small-area population projections at a municipal level. This model, called local demographic simulations, takes into account local contextual variables such as the expected number of new housing units to be built. We then compare the results from three scenarios with different constraints on the planned residential development of municipalities. We show that although urban sprawl cannot be avoided, increasing the development potential of the central area can slow it. Results also suggest that the age structure of the central area is not significantly affected by different mobility patterns.

Cohort Profile: The Montreal Neighbourhood Networks and Healthy Aging (MoNNET-HA) study.

The Montreal Neighbourhood Networks and Healthy Aging study was established: (i) to assess the added value in using formal network methods and instruments to measure social capital and its relationship to health; (ii) to determine whether older adults are more vulnerable to the effects of network and neighbourhood environments; and (iii) to examine longitudinally the relationship between social capital and health among adults in Montreal, Canada. The MoNNET-HA cohort consists of men and women aged 25 years and older, residing in the Montreal Metropolitan Area (MMA). Participants were recruited using a random stratified cluster sampling design with oversampling of adults older than 65 years. Initial MoNNET-HA study participants (n = 2707) were recruited for telephone interviews in the summer of 2008. Since 2008, participants were interviewed in the autumn of 2010 and the winter of 2013/2014. Data currently fall into five categories: (i) social network and social capital; (ii) psychosocial and psychological; (ii) socio-demographic and socioeconomic; (iv) health behaviours and conditions; and (v) neighbourhood environmental characteristics. Healthcare utilization data will be available for a subsample of participants. Upon funding, future work will measure anthropometric and metabolic health directly. Based on agreements with participants, external researchers should request access to data via collaborations with the study group.