Regular Medical Doctor Research Articles

Reporting a regular medical doctor index: A new measure of patient-physician affiliation for health administrative data.

Having a regular medical doctor is associated with better process of care and health outcomes. The goal of this study was to harness the richness in health administrative data to create a measure which accurately predicted whether patients self-identified as having a regular medical doctor. The Canadian Community Health Survey (2007-2012) was linked with health administrative data (HAD) (2002-2012) from Quebec, Canada's second largest province. The Canadian Community Health Survey includes respondents' answer to whether they have a regular medical doctor, but health administrative data does not. We therefore used LASSO and Random Forests to build prediction models that predict whether a patient reports having a regular medical doctor using their data only available in the HAD. Our results show that predicting patient responses to 'do you have a regular medical doctor?' using an average of single-year Usual Provider Continuity over 3 years results in an area under the receiver operator characteristic curve of 0.782 (0.778-0.787). This was almost a 14% improvement in predictive accuracy compared to the frequently used single-year Usual Provider Continuity (0.688 (0.683-0.694)). We have called this new measure the Reporting a Regular Medical Doctor (RRMD) index. The RRMD index is easy to implement in HAD, is an elegant solution to the difficulties associated with low-users having unstable UPC scores, and brings a patient-oriented perspective to previous efforts to capture patient-physician affiliations in HAD. We recommend that researchers seeking to measure whether patients have a regular medical doctor using HAD consider using the RRMD index.

Prevalence and Associated Factors of Maternal Depression and Anxiety Among African Immigrant Women in Alberta, Canada: Quantitative Cross-sectional Survey Study.

Although there is a significant body of evidence on maternal mental health, an inadequate focus has been placed on African immigrant women. This is a significant limitation given the rapidly changing demographics in Canada. The prevalence of maternal depression and anxiety among African immigrant women in Alberta and Canada, as well as the associated risk factors, are not well understood and remain largely unknown. The purpose of this study was to investigate the prevalence and associated factors of maternal depression and anxiety among African immigrant women living in Alberta, Canada up to 2 years postpartum. This cross-sectional study surveyed 120 African immigrant women within 2 years of delivery in Alberta, Canada from January 2020 to December 2020. The English version of the Edinburgh Postnatal Depression Scale-10 (EPDS-10), the Generalized Anxiety Disorder-7 (GAD-7) scale, and a structured questionnaire regarding associated factors were administered to all participants. A cutoff score of 13 on the EPDS-10 was indicative of depression, while a cutoff score of 10 on the GAD-7 scale was indicative of anxiety. Multivariable logistic regression was used to determine the factors significantly associated with maternal depression and anxiety. Among the 120 African immigrant women, 27.5% (33/120) met the EPDS-10 cutoff score for depression and 12.1% (14/116) met the GAD-7 cutoff score for anxiety. The majority of respondents with maternal depression were younger (18/33, 56%), had a total household income of CAD $60,000 or more (US $45,000 or more; 21/32, 66%), rented their homes (24/33, 73%), had an advanced degree (19/33, 58%), were married (26/31, 84%), were recent immigrants (19/30, 63%), had friends in the city (21/31, 68%), had a weak sense of belonging in the local community (26/31, 84%), were satisfied with their settlement process (17/28, 61%), and had access to a regular medical doctor (20/29, 69%). In addition, the majority of respondents with maternal anxiety were nonrecent immigrants (9/14, 64%), had friends in the city (8/13, 62%), had a weak sense of belonging in the local community (12/13, 92%), and had access to a regular medical doctor (7/12, 58%). The multivariable logistic regression model identified demographic and social factors significantly associated with maternal depression (maternal age, working status, presence of friends in the city, and access to a regular medical doctor) and maternal anxiety (access to a regular medical doctor and sense of belonging in the local community). Social support and community belonging initiatives may improve the maternal mental health outcomes of African immigrant women. Given the complexities immigrant women face, more research is needed on a comprehensive approach for public health and preventive strategies regarding maternal mental health after migration, including increasing access to family doctors.

Household food insecurity, sense of community belonging, and access to a regular medical doctor as mediators in the relationship between mood and/or anxiety disorders and self-rated general health in Canada between 2011 and 2016: a serial cross-sectional analysis.

To assess whether (household) food insecurity, access to a regular medical doctor, and sense of community belonging mediate the relationship between mood and/or anxiety disorders and self-rated general health. We used six annual cycles of the Canadian Community Health Survey, including Canadian adults aged 18-59 years, between 2011 and 2016. Mediation models, adjusted for key determinants of health, were based on a series of weighted logistic regression models. The Sobel products of coefficients approach was used to estimate the indirect effect, and bootstrapping to estimate uncertainty. The annual (weighted) prevalence of mood and/or anxiety disorders increased from 11.3% (2011) to 13.2% (2016). Across the 6 years, 23.9-27.7% of individuals with mood and/or anxiety disorders reported fair/poor self-rated health as compared with 4.9-6.5% of those without mood and/or anxiety disorders (p<0.001). Similarly, the 7.2-8.9% of the population reporting fair/poor self-rated health were disproportionately represented among individuals reporting food insecurity (21.1-26.2%, p<0.001) and a weak sense of community belonging (10.0-12.2%, p<0.001). A significantly lower prevalence of poor self-rated health was observed among respondents reporting having access to a regular medical doctor in 2012, 2015, and 2016. In 2016, sense of community belonging and food insecurity significantly mediated the effect of mood and/or anxiety disorders on self-rated general health. Access to a regular medical doctor did not mediate this relationship. Efficient policies that address food insecurity and sense of community belonging are needed to decrease the mental health burden and improve health satisfaction of Canadians.

Provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians.

Despite spending 11.0% of the total gross domestic product, the quality of healthcare services in Canada has received mixed reviews. We first separately examined provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. Second, we evaluated provincial variations in the impact of not having a regular medical doctor on having unmet healthcare needs among Canadians. We applied logistic regressions using data from the 2014 and 2017-2018 Canadian Community Health Surveys (CCHS). The total sample size for this study was 120,345 individuals aged 12years and older: 61,240 from the 2014 CCHS and 59,105 from the 2017-2018 CCHS. We found significant provincial variations in not having a regular medical doctor and having unmet healthcare needs among Canadians. People in Quebec and the Territories were more likely not to have a regular medical doctor than their peers in Alberta. People in Quebec and the Territories were also more likely to have unmet healthcare needs than their counterparts in Alberta. Not having a regular medical doctor impacted whether Canadians reported having unmet healthcare needs to varying degrees across provinces. Findings from this study may contribute to designing province-specific policy interventions and inform efforts that seek to address barriers to having a regular medical doctor and reducing unmet healthcare needs among Canadians.

Factors associated with higher healthcare costs in a cohort of homeless adults with a mental illness and a general cohort of adults with a history of homelessness

BackgroundHealthcare costs are disproportionately incurred by a relatively small group of people often described as high-cost users. Understanding the factors associated with high-cost use of health services among people experiencing homelessness could help guide service planning.MethodsSurvey data from a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness were linked with administrative healthcare records in Ontario, Canada. Total costs were calculated using a validated costing algorithm and categorized based on population cut points for the top 5%, top 6–10%, top 11–50% and bottom 50% of users in Ontario. Multinomial logistic regression was used to identify the predisposing, enabling, and need factors associated with higher healthcare costs (with bottom 50% as the reference).ResultsSixteen percent of the general homeless cohort and 30% percent of the cohort with a mental illness were in the top 5% of healthcare users in Ontario. Most healthcare costs for the top 5% of users were attributed to emergency department and inpatient service costs, while the costs from other strata were mostly for physician services, hospital outpatient clinics, and medications. The odds of being within the top 5% of users were higher for people who reported female gender, a regular medical doctor, past year acute service use, poor perceived general health and two or more diagnosed chronic conditions, and were lower for Black participants and other racialized groups. Older age was not consistently associated with higher cost use; the odds of being in the top 5% were highest for 35-to-49-year year age group in the cohort with a mental illness and similar for the 35–49 and ≥ 50-year age groups in the general homeless cohort.ConclusionsThis study combines survey and administrative data from two cohorts of homeless adults to describe the distribution of healthcare costs and identify factors associated with higher cost use. These findings can inform the development of targeted interventions to improve healthcare delivery and support for people experiencing homelessness.

Paid sick leave benefits among essential frontline workers serving people experiencing homelessness in Canada during the COVID-19 pandemic

ObjectivesThis study examined the prevalence and factors associated with paid sick leave benefits among direct service providers who work with people experiencing homelessness. Study designCross-sectional study using an online survey disseminated during the second wave of the COVID-19 pandemic in Canada. MethodsSurvey data from 572 direct service providers working in the homeless, supportive housing, and harm reduction service sectors were analyzed for this study. Univariate and multivariate logistic regression models were used to examine predictors of paid sick leave benefits. ResultsOne hundred one (17.7%) participants did not have any paid sick leave benefits. In the univariate models, paid sick leave was associated with older age, greater family income, full-time work, specific employment settings (supportive housing and not emergency shelters or harm reduction programs), having a regular medical doctor, and fewer occupational impacts of the COVID-19 pandemic. Older age, full-time work, and non-receipt of emergency financial benefits remained statistically significant predictors in the multivariate model. ConclusionsAlthough the majority of service providers working with people experiencing homelessness have some amount of paid sick leave benefits, there is a precariously employed subset of individuals who are younger and working part-time in the sector. Temporary expansion of paid sick leave and removal of waiting periods for new employees to qualify for benefits are recommended.

Health care access and use among male and female Canadian Armed Forces veterans.

Veterans are more likely than other Canadians to have chronic health conditions, making access to health care an important issue. However, little research has addressed health care access and use among veterans. This paper examines access and use among veterans compared with other Canadians. Health care access and use indicators were examined for Regular Force veterans using the 2016 Life After Service Survey. Information for male and female veterans was compared with information on the Canadian general population from the 2015 and 2016 Canadian Community Health Survey, using age-adjusted rates and 95% confidence intervals. More than 80% of male and female veterans reported having a regular medical doctor in the 12 months before the survey. The majority of veterans (71% of males and 81% of females) had consulted a family doctor, while a minority had been hospitalized (8% of males and females). These rates were similar to those in the Canadian general population. However, veteran consultation rates for mental health care and with audiologists, speech therapists or occupational therapists among both sexes were double to triple those of the Canadian general population. Among veterans, males reported lower rates of unmet needs compared with females. Veterans had similar rates of access to a regular medical doctor and higher rates of use compared with other Canadians. However, these may be comparatively low, given previous findings on higher rates of disability and some chronic conditions among veterans. Noted differences between males and females highlight the importance of research and services that account for sex and gender. The extent to which health care needs explain health care use and barriers to care requires further research.

Respiratory Health and Suspected Asthma among Hired Latinx Child Farmworkers in Rural North Carolina.

The aim of this study was to evaluate respiratory health problems, including suspected asthma, and healthcare provider utilization among a sample of Latinx hired child farmworkers in rural North Carolina (n = 140). In 2018, a respiratory health questionnaire and breathing tests were collected from Latinx child (11–19 years) farmworkers (35.0% girls and 65.0% boys). Overall, 21.4% of children reported having been told by a medical provider that they had asthma, yet based on a combination of responses to respiratory survey questions, 36.4% or 15% more were identified as having suspected asthma. While 56.4% reported having a regular medical doctor, 38% had not had a medical exam in the past year. Respiratory dysfunction, including suspected, or uncontrolled asthma was prevalent among this group. Latinx children working in agriculture are vulnerable to occupational hazards and exposures and require assurances that they will receive access to high quality healthcare services that include routine respiratory health screenings.

The Unique Needs of Homeless Youths With Mental Illness: Baseline Findings From a Housing First Trial

Although youth homelessness presents a significant public health problem, the needs of homeless youths with mental illness, as distinct from adults, are not well understood. This study examined the unique demographic, clinical, and service use characteristics of homeless youths. At Home/Chez Soi was a large randomized controlled trial of the Housing First model in five cities in Canada. Of 2,255 participants, 7% (N=164) were youths ages 18 to 24. Youths were compared with older participants on baseline demographic, clinical, and service use characteristics. More youths than adults had not finished high school (76% versus 54%), had a drug use disorder (66% versus 52%), and had been assaulted in the past six months (44% versus 36%) (all p<.05). Fewer than half the youths (49%) had a regular medical doctor, 50% reported unmet need for health care, and 61% visited an emergency department in the past six months. This sample of homeless youths with mental illness had low education, high rates of substance use disorders and victimization, and problems accessing services. These findings suggest that youths have trajectories to homelessness and service needs that are distinct from adults and may guide future planning for this vulnerable population.

Immigrant status and having a regular medical doctor among Canadian adults.

New immigrants generally arrive in Canada with a health advantage over their Canadian counterparts, but lose that advantage over time. Difficulties in acquiring a physician may contribute. Past studies relied on older data, and lacked control for many confounders and assessment of gender differences. We assessed the relationship between immigrant status and having a regular doctor among Canadian adults. Cross-sectional data from the 2011-2012 Canadian Community Health Survey were self-reported by 73,958 respondents aged 18-64, representing >20 million Canadian adults. The relationship between immigrant status and having a doctor was analyzed usingχ2 and logistic regression analyses stratified by gender. Age, body mass index, race, education, province of residence, physical activity, chronic conditions, self-perceived health, and number of children in household were controlled. Approximately 77% of males and 87% of females reported having a doctor. About 7% of respondents reported being new immigrants in Canada (0-9 years), while 16% were established immigrants (≥10 years). For males (M) and females (F) respectively, 78% and 88% of non-immigrants, 55% and 68% of new immigrants, and 84% and 91% of established immigrants reported having a doctor (p < 0.001). Compared to non-immigrants, new immigrants were significantly less likely to have a doctor (OR (95% CI) M: 0.43 (0.38-0.47); F: 0.36 (0.32-0.41)), while established immigrants were significantly more likely to have a doctor (M: 1.13 (1.03-1.24); F: 1.16 (1.03-1.30)). New Canadian immigrants are less likely to have a regular doctor compared to non-immigrants, and should be targeted by policies and programs facilitating finding a doctor.

Access to primary care and other health care use among western Canadians with chronic conditions: a population-based survey.

For adults with chronic conditions, access to primary care, including multidisciplinary care, is associated with better outcomes. Few studies have assessed barriers to such care. We sought to describe barriers to primary care, including care from allied health professionals, for adults with chronic conditions. We surveyed western Canadians aged 40years or older who had hypertension, diabetes, heart disease or stroke about access to primary care and other use of health care. Using log binomial regression, we determined the association between sociodemographic variables and several indicators of access to primary care and care from allied health professionals. Of the 2316 people who were approached, 1849 (79.8%) completed the survey. Most of the respondents (95.1%) had a regular medical doctor, but two-thirds (68.1%) did not have after-hours access. Only 6.1% indicated that allied health professionals were involved in their care, although most respondents (87.3%) indicated they would be willing to see a nurse practitioner if their primary care physician was not available. Respondents who were obese or less than 65years of age were less likely to have a regular medical doctor. Individuals who had diabetes, lived in a rural area, were residents of Alberta or had poorer health were more likely to have allied health professionals involved in their care. The survey results identified barriers to accessing primary care for people with chronic conditions. Opportunities for improving access to primary care may include greater involvement by allied health professionals, such as nurse practitioners.

Smoking during Pregnancy: Findings from the 2009–2010 Canadian Community Health Survey

ObjectivesSmoking during pregnancy may cause many health problems for pregnant women and their newborns. However, there is a paucity of research that has examined the predictors of smoking during pregnancy in Canada. This study used data from the 2009–2010 Canadian Community Health Survey (CCHS) to estimate the prevalence of smoking during pregnancy and examine the demographic, socioeconomic, health-related and behavioral determinants of this behavior.Methods and FindingsThe data were obtained from the 2009–2010 CCHS master data file. Weighted estimates of the prevalence were calculated. Multivariable logistic regression was used to determine demographic, socioeconomic, health related and behavioral characteristics associated with smoking behavior during pregnancy. Women living in the Northern Territories had a high rate of smoking during pregnancy (59.3%). The prevalence of smoking during pregnancy was also high among women under 25 years old, of low socioeconomic status, who reported not having a regular medical doctor, being fair to poor in self-perceived health, having at least one chronic disease, having at least one mental illness, being heavy smokers, and being regular alcohol drinkers. Results from multivariable logistic regression revealed that the odds of smoking during pregnancy were decreased with increasing age (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.91–0.99), having a regular family doctor [OR, 0.24; 95% CI, 0.11–0.52], having highest level of family income [OR, 0.09; 95% CI, 0.03–0.29]. Mothers who reported poor or fair self-perceived health [OR, 2.13; 95% CI, 0.96–4.71] and those who had at least one mental illness [OR, 1.81; 95% CI, 1.00–3.28] had greater odds of smoking during pregnancy.ConclusionsThere are a number of demographic, socio-economic, health-related and behavioral characteristics that should be considered in developing and implementing effective population health promotional strategies to prevent smoking during pregnancy, promoting health and well-being of pregnant women and their newborns.

Sleep laboratory test referrals in Canada: sleep apnea rapid response survey.

An estimated 5.4 million Canadian adults have been diagnosed with sleep apnea or are at high risk of experiencing obstructive sleep apnea (OSA). There are no recent Canadian data regarding access to and predictors of referral for diagnostic testing in these populations. The Sleep Apnea Rapid Response survey sampled 8647 Canadian adults and captured information about risk, testing, diagnosis and treatment of sleep apnea. Predictors of sleep laboratory test referrals were assessed using log-linked binomial regression modelling. Information regarding sleep testing facilities was updated at the provincial and regional levels. Approximately 76.8% (95% CI 70.1% to 83.6%) of adult Canadians with sleep apnea and 5.1% (95% CI 3.4% to 6.7%) of those at high risk for OSA reported being referred to a sleep laboratory. Significant predictors of sleep laboratory referral in the general population were male sex, middle age, overweight or obese, a chronic condition, having a regular medical doctor and reporting symptoms of sleep apnea. Region of residence was also a predictor of reported sleep laboratory referral, with individuals from Ontario being more likely to report being referred to a sleep laboratory versus individuals from other regions. Individuals reporting risk factors and symptoms associated with OSA were more likely to report a sleep laboratory testing referral compared with those without risk factors or symptoms. However, Canada's diagnostic sleep laboratory testing capacity varies across regions and is believed to be inadequate given the number of individuals at high risk for OSA who did not report testing referral.

The proportion of influenza vaccination in Ontario, Canada in 2007/2008 compared with other provinces

In 2000, Ontario, Canada introduced a universal influenza immunization program (UIIP) to provide free vaccines to its residents, whose ages are six months or older. The current study sought to measure the effect of the UIIP on influenza vaccination uptake in Ontario compared with other provinces combined. Data from the 2007/2008 Canadian Community Health Survey (cycle 4.1) were used in the analyses. Logistic regression analyses were conducted to estimate the odds ratios for influenza vaccination 2007/2008 associated with province of residence (Ontario versus other provinces combined) and other factors including chronic disease status, age, gender, household income, smoking status, having a medical doctor, and self-perceived health status. Living in Ontario was positively associated with having an influenza vaccine during the 2007/2008 season [odds ratio (OR) 1.50, 95% confidence interval (CI) 1.45-1.55]. Increased age (OR 6.13, 95% CI 5.77-6.51), a positive chronic disease status (OR 1.70, 95% CI 1.63-1.77) and having a regular medical doctor (OR 1.95, 95% CI 1.85-2.07) also demonstrated a positive relationship with influenza vaccination in 2007/2008. A stratified analysis by province of residence suggested that having a chronic disease, old age and high income had less impact on the likelihood of receiving a vaccine in Ontario than other provinces. The results of this study may help to inform the development of strategies to increase vaccination coverage in Canada.

Understanding adolescent and young adult use of family physician services: a cross-sectional analysis of the Canadian Community Health Survey

BackgroundPrimary health care is known to have positive effects on population health and may reduce at-risk behavior and health problems in adolescence. Yet little is known about the factors that are associated with adolescent and young adult utilization of family physician services. It is critical to determine the factors associated with utilization to inform effective primary health care policy. We address this gap in the primary health care literature by examining three issues concerning adolescent and young adult family physician use: inequity; the unique developmental stage of adolescence; and the distinction between utilization (users versus non-users) and intensity (high users versus low users).MethodsWe conducted nested logistic regressions for two outcomes: utilization and intensity of family physician services for early adolescence, middle adolescence, and young adulthood using the 2005 Canadian Community Health Survey.ResultsChronic conditions were associated with utilization in early and middle adolescence and intensity in all age groups. Respondents from Quebec had lower odds of utilization. Those without a regular medical doctor had much lower odds of being users. The factors associated with use in early and middle adolescence were in keeping with parental involvement while the factors in young adulthood show the emerging independence of this group.ConclusionsWe highlight key messages not known previously for adolescent and young adult use of family physician services. There is inequity concerning regional variation and for those who do not have a regular medical doctor. There is variation in factors associated with family physician services across the three age groups of adolescence. Health care and health care policies aimed at younger adolescents must consider that parents are still the primary decision-maker while older adolescents are more autonomous. There is variation in the factors associated with the two outcomes of utilization and intensity of services. Factors associated with utilization must be understood when considering the equitability of access to primary health care while factors associated with intensity must be understood when considering appropriate use of resources. The understanding gained from this study can inform health care policy that is responsive to the critical developmental stage of adolescence and young adulthood.

Nativity Status and Access to Care in Canada and the U.S.: Factoring in the Roles of Race/Ethnicity and Socioeconomic Status

We conducted cross-country comparisons of Canada and the U.S., and assessed the extent to which access to care varies by nativity status overall, as well as in conjunction with race/ethnicity and socioeconomic status. Data came from the Joint Canada-U.S. Survey of Health (n=6,620 non-elderly adults). Access measures included having a regular medical doctor, consultation with a health professional in the past year, dentist visit in the past year, Pap test in the past three years, and any unmet health care needs in the past year. Logistic regression was employed to estimate the relative odds of access to care, adjusting for potential confounders. Disparities in access to care based on nativity status overall, as well as nativity-by-race joint effects, were found in both countries. There was also a dose-response effect of education on access to care among the native-born but not among the foreign-born; there were few nativity-by-income joint effects.

An evaluation of access to health care services along the rural-urban continuum in Canada

BackgroundStudies comparing the access to health care of rural and urban populations have been contradictory and inconclusive. These studies are complicated by the influence of other factor which have been shown to be related to access and utilization. This study assesses the equity of access to health care services across the rural-urban continuum in Canada before and after taking other determinants of access into account.MethodsThis is a cross-sectional study of the population of the 10 provinces of Canada using data from the Canadian Community Health Survey (CCHS 2.1). Five different measures of access and utilization are compared across the continuum of rural-urban. Known determinants of utilization are taken into account according to Andersen's Health Behaviour Model (HBM); location of residence at the levels of province, health region, and community is also controlled for.ResultsThis study found that residents of small cities not adjacent to major centres, had the highest reported utilisation rates of influenza vaccines and family physician services, were most likely to have a regular medical doctor, and were most likely to report unmet need. Among the rural categories there was a gradient with the most rural being least likely to have had a flu shot, use specialist physicians services, or have a regular medical doctor. Residents of the most urban centres were more likely to report using specialist physician services. Many of these differences are diminished or eliminated once other factors are accounted for. After adjusting for other factors those living in the most urban areas were more likely to have seen a specialist physician. Those in rural communities had a lower odds of receiving a flu shot and having a regular medical doctor. People residing in the most urban and most rural communities were less likely to have a regular medical doctor. Those in any of the rural categories were less likely to report unmet need.ConclusionInequities in access to care along the rural-urban continuum exist and can be masked when evaluation is done at a very large scale with gross indicators of rural-urban. Understanding the relationship between rural-urban and other determinants will help policy makers to target interventions appropriately: to specific demographic, provincial, community, or rural categories.

Socioeconomic Status and Utilization of Health Care Services in Canada and the United States

Building on Andersen's behavioral model for the utilization of health care services, we examined factors associated with utilization of physician and hospital services among adults in Canada and the United States, with a focus on socioeconomic status (enabling resources in Andersen's framework). Using the 2002-2003 Joint Canada/United States Survey of Health, we conducted country-specific multivariate logistic regressions predicting doctor contacts/visits and overnight hospitalizations in the past year, controlling for predisposing characteristics, enabling resources, and several factors representing perceived need for health care. All analyses were appropriately weighted to yield nationally representative results. Several measures of socioeconomic status-having a regular medical doctor, education, and, in the US income and insurance coverage-were associated with doctor contacts or visits in both countries, along with various predisposing and need factors. However, these same measures were not associated with hospitalizations in either country. Instead, only the individual's predisposing characteristics (eg, age and sex) and his/her need for health care predicted utilization of hospital services in Canada and the United States. Insurance coverage status in the United States became a significant predictor of hospitalizations when count data were analyzed via Poisson regression. Given our particular outcome measures, adults in Canada and the United States exhibited similar patterns of hospital utilization, and socioeconomic status played no explanatory role. However, relative to Canadian adults, we found disparities in doctor contacts among US adults-between those with more income and those with less, between those with health insurance and those without-after adjusting for health care needs and predisposing characteristics.

Determinants of Condom Use: Results of the Canadian Community Health Survey 3.1

Objectives: To examine the independent effects of mood disorder, age, race/ethnicity, personal income, being a current student, having a regular medical doctor and substance use in relationship to condom use at last intercourse in a Canadian population stratified by sex. Methods: We used Cycle 3.1 of the 2006 Canadian Community Health Survey (CCHS 3.1), a population-based, voluntary, cross-sectional survey of subjects ages 12–85 years. Data collection took place between January and December 2005. From the survey, a study sample of 20,975 people was drawn, consisting of individuals providing valid responses (yes/no) to mood disorder and last-time condom use. The question of sexual behaviours was asked only of those ages 15–49 years. Logistic regression was used to examine individual variables as potential determinants of last-time condom use stratified by sex. Results: The relationship between mood disorder and condom use was non-significant in both males (AOR= 0.85, 95% CI=0.70−1.04) and females (AOR=0.90, 95% CI=0.78−1.03). Increasing age was found to be inversely associated with last-time condom use in both males and females. Male factors significantly associated with last-time condom use were being of white ethnicity (AOR=0.71, 95% CI=0.64−0.79) and being a current student (AOR=1.28, 95% CI=1.16−1.42). Female factors associated with last-time condom use were being of white ethnicity (AOR=0.71, 95% CI = 0.63−0.79) and being a former drinker (AOR=2.25, 95% CI=1.63−3.11). Conclusion: Our results identify important determinants of last-time condom use in both males and females in the CCHS 3.1. These findings may have important implications for the devising and implementation of safe sex programs in a Canadian population ages 15–49 years.

Determinants of condom use: Results of the Canadian Community Health Survey 3.1

To examine the independent effects of mood disorder, age, race/ethnicity, personal income, being a current student, having a regular medical doctor and substance use in relationship to condom use at last intercourse in a Canadian population stratified by sex. We used Cycle 3.1 of the 2006 Canadian Community Health Survey (CCHS 3.1), a population-based, voluntary, cross-sectional survey of subjects ages 12-85 years. Data collection took place between January and December 2005. From the survey, a study sample of 20,975 people was drawn, consisting of individuals providing valid responses (yes/no) to mood disorder and last-time condom use. The question of sexual behaviours was asked only of those ages 15-49 years. Logistic regression was used to examine individual variables as potential determinants of last-time condom use stratified by sex. The relationship between mood disorder and condom use was non-significant in both males (AOR = 0.85, 95% CI = 0.70-1.04) and females (AOR = 0.90, 95% CI = 0.78-1.03). Increasing age was found to be inversely associated with last-time condom use in both males and females. Male factors significantly associated with last-time condom use were being of white ethnicity (AOR = 0.71, 95% CI = 0.64-0.79) and being a current student (AOR = 1.28, 95% CI =1.16-1.42). Female factors associated with last-time condom use were being of white ethnicity (AOR = 0.71, 95% CI = 0.63-0.79) and being a former drinker (AOR = 2.25, 95% CI = 1.63-3.11). Our results identify important determinants of last-time condom use in both males and females in the CCHS 3.1. These findings may have important implications for the devising and implementation of safe sex programs in a Canadian population ages 15-49 years.