Canadian Territories Research Articles

What Is Known About Curriculum Modifications? A Scoping Literature Review

Modifying the curriculum is a common practice used to support students with individual education plans (IEPs). All 13 provinces and territories in Canada (and their associated federally run schools) permit the use of curriculum modifications yet, despite their frequent use, the efficacy of this long-standing practice has rarely been studied. This scoping literature review maps what is currently known about curriculum modifications. Findings reveal two significant issues with the terminology used in the existing literature—inconsistent use of terms and conflation of terms. Additionally, the limited research available reports that while some students identified as having intellectual disability may benefit from modified curricula in certain contexts, other groups of students may experience harm. These findings lay a foundation for future research on curriculum modifications, an area that warrants urgent attention from the anti-oppression movement within special education.

Nurse practitioner medication abortion providers in Canada: results from a national survey

BackgroundIn 2017, nurse practitioners (NPs) became the first non-physician healthcare providers authorised to independently provide medication abortion (MA) in Canada. We aimed to report on demographic and clinical characteristics of...

What in Earth? Analyses of Canadian soil populations of Aspergillus fumigatus

Aspergillus fumigatus is a globally distributed mold and a major cause of opportunistic infections in humans. Because most infections are from environmental exposure, it’s critical to understand environmental populations of A. fumigatus. Soil is a major ecological niche for A. fumigatus. Here we analyzed 748 soil isolates from 21 locations in six provinces and one territory in Canada. All isolates were genotyped using nine microsatellite markers. Due to small sample size and/or close proximities for some local samples, these isolates were grouped into 16 local geographic and ecological populations. Our results indicated high allelic and genotypic diversities within most local and provincial populations. Interestingly, low but statistically significant genetic differentiations were found among geographic populations within Canada, with relatively similar proportions of strains and genotypes belonging to two large genetic clusters. In Hamilton, Ontario and Vancouver, BC, where two and three ecological populations were analyzed respectively, we found limited genetic difference among them. Most local and provincial populations showed evidence of both clonality and recombination, with no population showing random recombination. Of the 748 soil isolates analyzed here, two were resistant to triazole antifungals. We discuss the implications of our results to the evolution and epidemiology of A. fumigatus.

Pan-Canadian estimates of the prevalence and risks associated with critical wandering among home care clients.

We used clinical assessment records to provide pan-Canadian estimates of the prevalence and risks associated with recent (within the last 3 days) critical wandering among home care clients, with and without dementia. The data source is interRAI Home Care (interRAI HC) assessments. The population was all long-stay home care clients assessed between 2004 and 2021 in seven Canadian provinces and territories (N=1,598,191). We tested associations between wandering and cognition and dementia diagnoses using chi-square tests and logistic regression. Approximately 84% of the sample was over the age of 65. The overall rate of recent wandering was 3.0%. Dementia diagnosis was strongly associated with two to four times higher rates in the prevalence of recent critical wandering. InterRAI HC offers insights into the wandering risk of home care clients. This information should be used to manage risks in the community and could be shared with first responders. In all the study regions combined, the rate of recent wandering is 3.0%. Dementia was associated with 18 times greater prevalence of recent critical wandering. Home care clients at risk of wandering have complex clinical profiles that pose important risks for their health and well-being. Collaboration and information sharing between search and rescue and health professions is essential for managing risks related to critical wandering.

Assessing the impact of the COVID-19 pandemic on the mental health–related hospitalization rate of youth in Canada: an interrupted time series analysis

Introduction This study evaluated the effect of the COVID-19 pandemic on temporal trends in mental health and addiction–related inpatient hospitalization rates among youth (aged 10–17 years) in Canadian provinces and territories (excluding Quebec) from 1 April 2018 to 5 March 2022. Methods We conducted an interrupted time series analysis across three periods: T0 (pre-pandemic: 1 April 2018 to 15 March 2020); T1 (early pandemic: 15 March 2020 to 5 July 2020); and T2 (later pandemic: 6 July 2020 to 5 March 2022). Results Pre-pandemic mental health and addiction–related hospitalization rates had significant regional variability, with weekly rates from 6.27 to 85.59 events per 100 000 persons in Manitoba and the territories combined, respectively. During T1, the national (excluding Quebec) weekly hospitalization rate decreased from a pre-pandemic level of 12.82 (95% CI: 12.14 to 13.50) to 5.11 (95% CI: 3.80 to 6.41) events per 100 000 persons. There was no statistically significant change in the mental health and addiction– related hospitalization rate across provinces and territories in T2 compared to T0. However, there was a significant increase in the rate of self-harm–related hospitalizations among females Canada-wide and in most provinces during this period. Conclusion Although several Canadian studies have reported increases in mental health and addiction–related outpatient and emergency department visits among youth during the COVID-19 pandemic, this did not correspond to an increase in the inpatient hospital burden, with the notable exception of self-harm among young females.

Progress and Challenges in Canada's Path Toward the Elimination of Cervical Cancer.

Cervical cancer is almost entirely preventable and treatable when detected early, making its elimination within reach for Canada and the world. However, cervical cancer is now the fastest-increasing cancer (+3.7% per year since 2015) in Canada as of 2023, marking the first significant increase in cervical cancer incidence since 1984. The human papillomavirus (HPV) vaccine and cervical screening are key preventive measures, with targets set by the WHO and the Canadian Partnership Against Cancer (CPAC) to eliminate cervical cancer in Canada by 2030 and 2040, respectively. These targets include increasing HPV vaccination rates, implementing primary HPV screening, and improving follow-up for abnormal HPV+ results. However, Canada's progress has been impeded by significant challenges. As of the most recent data, HPV vaccine coverage rates in Canada range from 47% to 81%, with an estimated national HPV vaccination completion rate of 64% in Canada, far below the target of 90% by 2025 set by the CPAC. With the exception of British Columbia and Prince Edward Island, the adoption of HPV DNA testing as the primary screening method has been slow across the Canadian provinces and territories despite its superior sensitivity compared with traditional cytology. This article reviews the current state of HPV vaccination and screening in Canada, emphasizing the need for coordinated efforts, transparency, and resource sharing to overcome barriers. Key recommendations include the dissemination of accessible educational materials, partnerships, and collaboration, including nationwide task forces and roundtables, and the implementation of standardized guidelines for HPV screening. Achieving cervical cancer elimination requires a united approach involving federal, provincial, and territorial health authorities, researchers, clinicians, NGOs, community groups, and patients' voices working together to ensure consistent, effective, timely, and meaningful cervical cancer prevention strategies are used across the country.

Use of cannabis for mental health in the Canadian territories: a cross-sectional study

Background Population prevalence and patterns of cannabis use for mental health (CUMH) are underexplored. This is important to understand in the Canadian territories which has the highest prevalence of cannabis use in Canada. This study aimed to examine socio-demographic factors associated with CUMH in the territories and associations between CUMH and cannabis use outcomes. Methods This study is a cross-sectional analysis of survey data from the 2022 Cannabis Policy Study in the Territories, including 2431 respondents aged 16+. Multivariable logistic regression models were used to examine socio-demographic characteristics associated with CUMH. Among past 12-month cannabis consumers, multivariable logistic regression models were used to examine whether CUMH was associated with daily/near-daily use, cannabis product type, healthcare interactions, and self-reported impacts on mental health, controlling for socio-demographic characteristics. Results Overall, 29.6% of all participants, and 55.5% of past 12-month cannabis consumers reported ever using cannabis for mental health. Use for mental health was higher among those with lower education, lower perceived income adequacy, and younger ages. Those reporting CUMH were more likely to report daily/near-daily use (ORadj = 3.00, 95%CI: 2.01–4.49), potent product types like solid concentrates (ORadj = 2.76, 1.62–4.70), and perceived positive impacts on mental health (ORadj = 3.71, 2.49–5.52). Conclusion Due to the high prevalence of CUMH, more research is needed to examine its long-term impacts and effectiveness. Future research is also needed to understand the social context underlying socioeconomic inequalities in CUMH, including access to mental healthcare and harm reduction measures for mitigating adverse mental health impacts.

A Longitudinal Treatment Effect Analysis of Antipsychotics on Behavior of Residents in Long-Term Care

ObjectiveThe proportion of long-term care (LTC) residents being treated with antipsychotic medication is high, and these medications may exacerbate behavioral symptoms. We used propensity scores to investigate the effect of antipsychotic use on the worsening of behavioral symptoms among residents in LTC facilities. DesignA retrospective study. Setting and participantsResidents in LTC in 8 provinces and 1 territory in Canada, without severe aggressive behavior at baseline and reassessed at follow-up, between March 2000 and March 2022. MethodsWe used propensity score matching and weighting to balance baseline covariates and logistic regression to estimate the effect of antipsychotics on the worsening of behavioral symptoms in the original, matched, and weighted cohorts. The treatment variable was use of antipsychotic medication at baseline and the outcome was worsening of behavior at follow-up. ResultsA total of 494,215 participants were included [318,234 women and 175,981 men; mean age 82.8 years (SD 10.1; range 18–112)].130 558 (26.4%) used antipsychotics at baseline and 88,632 (17.9%) had worsening behavior in follow-up. In the matched cohort, there were 249,698 participants, and 124,849 were matched (1:1) in each treatment group. There was a significant association between antipsychotic use at baseline and worsening in behavior at follow-up in the adjusted regression models [OR 1.27 (95% CI 1.25–1.29), <0.0001] as well as in matched [OR 1.20 (95% CI 1.17–1.21), <0.0001] and weighted [OR 1.26 (95% CI 1.24–1.28), <0.0001] cohorts. Conclusions and implicationsThis study further evidence to support the cautious use of antipsychotics in LTC facilities. Future research in LTC facilities could include a more granular analyses of behavior change, including bidirectional analyses between different symptom severity classifications.

From challenge to innovation: A grassroots study of teachers’ classroom assessment innovations

AbstractWe are at a critical moment for assessment in schools. Teachers are called to navigate advances in classroom assessment research, top‐down assessment policies, and lingering effects of the COVID‐19 pandemic on teaching and learning. Embedded in this context are also systemic challenges to teachers’ assessment practice. This paper analyses these challenges to characterise the current context for teachers’ assessment work and considers teachers’ innovative responses to these challenges. Data are drawn from 168 qualitative responses to a baseline assessment innovation survey across 10 Canadian provinces and territories as well as 10 other international jurisdictions. Eight themes were identified related to teachers’ assessment challenges and innovations, including: negating innovation, the emotions of assessment, grade obsession and the gradeless spectrum, conflicting orientations towards assessment, the use of ‘assessment talk’, data overload, equitable assessment and actions that make learning and assessment visible. These findings directly support the widespread goal of implementing assessments that effectively and consistently serve student learning. The paper concludes with a discussion on how teachers move from facing assessment challenges to engaging in assessment innovations.

Geographic distribution of conversion therapy prevalence in Canada. Findings from a national cross-sectional survey, 2020

Background: Conversion therapy practices (CTPs) are discredited efforts that target lesbian, gay, bisexual, trans, queer, Two-Spirit, or other (LGBTQ2S+) people and seek to change, deny, or discourage their sexual orientation, gender identity, and/or gender expression. This study aims to investigate the prevalence of CTPs across Canadian provinces and territories and identify whether CTP bans reduce the prevalence of CTPs. Methods: We collected 119 CTPs from 31 adults (18+) in Canada who have direct experience with CTPs, know people who have gone to CTPs, or know of conversion therapy practitioners using a 2020 anonymous online survey. Mapping analysis was conducted using ArcGIS Online. CTP prevalence was compared between provinces/territories with and without bans using chi-square tests. Results: Three provinces and eleven municipalities had CTP bans. The prevalence of CTPs in provinces/territories with bans was 2.34 per 1,000,000 population (95% CI 1.65, 3.31). The prevalence of CTPs in provinces/territories without bans was 4.13 per 1,000,000 population (95% CI 3.32, 5.14). Accounting for the underlying population, provinces/territories with the highest prevalence of CTPs per 1,000,000 population were New Brunswick (6.69), Nova Scotia (6.50), and Saskatchewan (6.37). Conclusions: Findings suggest only 55% of Canadians were protected under CTP bans. The prevalence of CTPs in provinces/territories without bans was 1.76 times greater than provinces/territories with bans. CTPs are occurring in most provinces/territories, with higher prevalence in the west and the Atlantic. These findings and continued efforts to monitor CTP prevalence can help inform policymakers and legislators as society is increasingly acknowledging CTPs as a threat to the health and well-being of LGBTQ2S+ people.

Resources to Support Canadian Nurses to Deliver Virtual Care: Environmental Scan.

Regulatory and professional nursing associations have an important role in ensuring that nurses provide safe, competent, and ethical care and are capable of adapting to emerging phenomena that influence society and population health needs. Telehealth and more recently virtual care are 2 digital health modalities that have gained momentum during the COVID-19 pandemic. Telehealth refers to telecommunications and digital communication technologies used to deliver health care, support health care provider and patient education, and facilitate self-care. Virtual care facilitates the delivery of health care services via any remote communication between patients and health care providers and among health care providers, either synchronously or asynchronously, through information and communication technologies. Despite nurses' adaptability to delivering virtual care, many have also reported challenges. This study aims to describe resources about virtual care, digital health, and nursing informatics (ie, practice guidelines and fact sheets) available to Canadian nurses through their regulatory and professional associations. An environmental scan was conducted between March and July 2023. The websites of nursing regulatory bodies across 13 Canadian provinces and territories and relevant nursing and a few nonnursing professional associations were searched. Data were extracted from the websites of these organizations to map out educational materials, training opportunities, and guidelines made available for nurses to learn and adapt to the ongoing digitalization of the health care system. Information from each source was summarized and analyzed using an inductive content analysis approach to identify categories and themes. The Virtual Health Competency Framework was applied to support the analysis process. Seven themes were identified: (1) types of resources available about virtual care, (2) terminologies used in virtual care resources, (3) currency of virtual care resources identified, (4) requirements for providing virtual care between provinces, (5) resources through professional nursing associations and other relevant organizations, (6) regulatory guidance versus competency in virtual care, and (7) resources about digital health and nursing informatics. Results also revealed that practice guidance for delivering telehealth existed before the COVID-19 pandemic, but it was further expanded during the pandemic. Differences were noted across available resources with respect to terms used (eg, telenursing, telehealth, or virtual care), types of documents (eg, guideline vs fact sheet), and the depth of information shared. Only 2 associations provided comprehensive telenursing practice guidelines. Resources relative to digital health and nursing informatics exist, but variations between provinces were also noted. The use of telehealth and virtual care services is becoming mainstream in Canadian health care. Despite variations across jurisdictions, the existing nursing practice guidance resources for delivering telehealth and virtual care are substantial and can serve as a beginning step for developing a standardized set of practice requirements or competencies to inform nursing practice and the education of future nurses.

Strategies to Reduce Alternate Level of Care

What Is the Issue? Alternate level of care (ALC) is when a patient is occupying a bed in a hospital and does not require the intensity of resources or services provided in that hospital. ALC is a persistent barrier to providing efficient health care in Canada, as it is in most health systems worldwide (where ALC is referred to as delayed discharge). Older adults (aged 65 years or older) who require placement in residential care are the largest subgroup of the ALC patient population. Analyzing ALC use data can inform decision-makers about data trends and which jurisdictions have reduced ALC times. By understanding the strategies, policies, or other interventions that have been used to reduce ALC in Canada, and which have been successful at minimizing ALC, decision-makers can consider which strategies to implement in their health jurisdictions. What Did We Do? We analyzed Canadian Institute for Health Information data related to ALC and average length of ALC in older adults in the provinces and territories of Canada. We conducted an environmental scan of the academic and grey literature to: identify strategies to address ALC in older adults in Canada identify strategies that have been effective in reducing ALC in older adults in Canada. What Did We Find? In 2022 to 2023, Canada (excluding Quebec) had 15 ALC hospitalizations per 1,000 population, 369 total ALC days per 1,000 population, and a mean of 25 ALC days per hospitalization in patients aged 65 and older awaiting admission to residential care or elsewhere. While there were variations across jurisdictions, the trends in ALC over time for adults aged 55 years and older were relatively consistent. Patients with more ALC days were aged 75 years and older, had lower incomes, and were admitted to the hospital as urgent. We identified 19 strategies that addressed ALC in older adults in Canada. These included input, throughput, and system-level interventions, which we categorized as live information sharing, recommended initiatives, tools and guidelines, practice changes, and infrastructure and finance. We identified 4 studies that reported a favourable effect of a throughput or system-level strategy compared to no strategy or standard care on ALC hospitalizations, length of stay, or discharge to home. Two throughput strategies may be effective: The Subacute Care for the Frail Elderly (SAFE) Unit improved ALC length of stay (LOS), hospital LOS, and discharge to home. The Transitional Care Unit improved discharge to home. Two system-level strategies may be effective: Home First improved ALC hospitalizations, ALC LOS, and discharge to home. Behavioural Supports Ontario improved ALC hospitalizations and ALC LOS. What Does This Mean? We found common themes in our environmental scan that decision-makers may incorporate into strategies for addressing ALC in older adults waiting for residential care, including the provision of integrated care, promotion of age-friendly care, early identification of patients at risk of ALC, sharing of tools and resources, transitional care, and inclusion of families and caregivers in care planning. This report may serve as the first step for future systematic reviews or other evidence syntheses with a broader scope. Future research might investigate the factors that contribute to ALC and interventions to address those factors.

Cutaneous Melanoma Mortality-to-Incidence Ratio and Its Association With Socioeconomic and Healthcare Factors in Canada: A National Ecological Study.

The mortality-to-incidence ratio (MIR) can be used to approximate healthcare inequities and is helpful to understand/compare cancer survival between geographic regions/jurisdictions. We investigated cutaneous melanoma (CM) outcomes through MIR analysis in Canadian jurisdictions and census divisions (CDs) between 1992 and 2016. Data were obtained from the national databases from 1992 to 2016 for all Canadian jurisdictions, except Quebec. Age-standardized overall and median MIRs were calculated per province per year, while crude MIRs were calculated for CDs. Generalized linear regression models were conducted to study the effect of province and year on MIR, while a mixed effect regression model was used to determine how healthcare and socioeconomic factors affect MIR, while accounting for possible clustering effects (eg, year and province). We identified 106,015 CM cases and 20,570 CM deaths between 1992 and 2016. National MIR from 1992 to 2016 demonstrated a significant linear decrease (P value < .0001). The national median MIR was 15.4 (ie, 0.154 × 100), whereby Manitoba (19.9), Ontario (19.5), Saskatchewan (18.5), British Columbia (16.1), and Newfoundland and Labrador (15.9) demonstrated higher MIRs than the Canadian average. CDs with the highest MIRs were commonly identified in the southern regions of provinces. No healthcare or socioeconomic factors were found to be significantly associated with higher MIR at the provincial level. MIRs have decreased at the national and provincial levels in recent decades, which is reassuring. Higher MIRs were noted in select rural CDs and in the Canadian territories, reinforcing the importance of proper dermatological care in all parts of the country.

The majority of Canadians likely behaved as myopic rationalists rather than success-based learners when deciding on their first dose of COVID-19 vaccine.

Successful vaccine promotion communication strategies require knowing how eligible recipients will respond to the opportunity to get vaccinated. Two main classes of recipients are myopic rationalists, those who receive a dose of vaccine only if it maximizes their own instant benefit and if so, do it as soon as possible, and success-based learners, those who learn from others that they perceive to be most successful. A recent study models these two decision-making types, and estimates the population proportion of myopic rationalists in each U.S. state. In this report, we fit a similar model to data on COVID-19 vaccine uptake across the Canadian provinces and territories. We estimated that 64% of Canadians behaved as myopic rationalists in taking the first dose of a COVID-19 vaccine, compared to an estimated 47% in the United States. Among the provinces, the lowest proportion of myopic rationalists was 0.51 in Saskatchewan, while the highest was 0.74 in Prince Edward Island. The correlation analysis suggested a positive correlation between the proportion of myopic rationalists and the average age across the Canadian provinces (Pearson-r = 0.71). Canadian health management may benefit from these results in tailoring the vaccine promotion communication strategies.

Mental Health Hospitalizations in Canadian Children, Adolescents, and Young Adults Over the COVID-19 Pandemic

The COVID-19 pandemic resulted in multiple socially restrictive public health measures and reported negative mental health impacts in youths. Few studies have evaluated incidence rates by sex, region, and social determinants across an entire population. To estimate the incidence of hospitalizations for mental health conditions, stratified by sex, region, and social determinants, in children and adolescents (hereinafter referred to as youths) and young adults comparing the prepandemic and pandemic-prevalent periods. This Canadian population-based repeated ecological cross-sectional study used health administrative data, extending from April 1, 2016, to March 31, 2023. All youths and young adults from 6 to 20 years of age in each of the Canadian provinces and territories were included. Data were provided by the Canadian Institute for Health Information for all provinces except Quebec; the Institut National d'Excellence en Santé et en Services Sociaux provided aggregate data for Quebec. The COVID-19-prevalent period, defined as April 1, 2020, to March 31, 2023. The main outcome measures were the prepandemic and COVID-19-prevalent incidence rates of hospitalizations for anxiety, mood disorders, eating disorders, schizophrenia or psychosis, personality disorders, substance-related disorders, and self-harm. Secondary measures included hospitalization differences by sex, age group, and deprivation as well as emergency department visits for the same mental health conditions. Among Canadian youths and young adults during the study period, there were 218 101 hospitalizations for mental health conditions (ages 6 to 11 years: 5.8%, 12 to 17 years: 66.9%, and 18 to 20 years: 27.3%; 66.0% female). The rate of mental health hospitalizations decreased from 51.6 to 47.9 per 10 000 person-years between the prepandemic and COVID-19-prevalent years. However, the pandemic was associated with a rise in hospitalizations for anxiety (incidence rate ratio [IRR], 1.11; 95% CI, 1.08-1.14), personality disorders (IRR, 1.21; 95% CI, 1.16-1.25), suicide and self-harm (IRR, 1.10; 95% CI, 1.07-1.13), and eating disorders (IRR, 1.66; 95% CI, 1.60-1.73) in females and for eating disorders (IRR, 1.47; 95% CI, 1.31-1.67) in males. In both sexes, there was a decrease in hospitalizations for mood disorders (IRR, 0.84; 95% CI, 0.83-0.86), substance-related disorders (IRR, 0.83; 95% CI, 0.81-0.86), and other mental health disorders (IRR, 0.78; 95% CI, 0.76-0.79). This cross-sectional study of Canadian youths and young adults found a rise in anxiety, personality disorders, and suicidality in females and a rise in eating disorders in both sexes in the COVID-19-prevalent period. These results suggest that in future pandemics, policymakers should support youths and young adults who are particularly vulnerable to deterioration in mental health conditions during public health restrictions, including eating disorders, anxiety, and suicidality.

Pandemic Stringency Measures and Hospital Admissions for Eating Disorders

Hospitalizations for eating disorders rose dramatically during the COVID-19 pandemic. Public health restrictions, or stringency, are believed to have played a role in exacerbating eating disorders. Few studies of eating disorders during the pandemic have extended to the period when public health stringency restrictions were lifted. To assess the association between hospitalization rates for eating disorders and public health stringency during the COVID-19 pandemic and after the easing of public health restrictions. This Canadian population-based cross-sectional study was performed from April 1, 2016, to March 31, 2023, and was divided into pre-COVID-19 and COVID-19-prevalent periods. Data were provided by the Canadian Institute for Health Information and the Institut National d'Excellence en Santé et Services Sociaux for all Canadian provinces and territories. Participants included all children and adolescents aged 6 to 20 years. The exposure was public health stringency, as measured by the Bank of Canada stringency index. The primary outcome was hospitalizations for a primary diagnosis of eating disorders (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code F50), stratified by region, age group, and sex. Interrupted time series analyses based on Poisson regression were used to estimate the association between the stringency index and the rate of hospitalizations for eating disorders. During the study period, there were 11 289 hospitalizations for eating disorders across Canada, of which 8726 hospitalizations (77%) were for females aged 12 to 17 years. Due to low case counts in other age-sex strata, the time series analysis was limited to females within the 12- to 17-year age range. Among females aged 12 to 17 years, a 10% increase in stringency was associated with a significant increase in hospitalization rates in Quebec (adjusted rate ratio [ARR], 1.05; 95% CI, 1.01-1.07), Ontario (ARR, 1.05; 95% CI, 1.03-1.07), the Prairies (ARR, 1.08; 95% CI, 1.03-1.13), and British Columbia (ARR, 1.11; 95% CI, 1.05-1.16). The excess COVID-19-prevalent period hospitalizations were highest at the 1-year mark, with increases in all regions: Quebec (RR, 2.17), Ontario (RR, 2.44), the Prairies (RR, 2.39), and British Columbia (RR, 2.02). In this cross-sectional study of hospitalizations for eating disorders across Canada, hospitalization rates for eating disorders in females aged 12 to 17 years were associated with public health measure stringency. The findings suggest that future pandemic preparedness should consider implications for youths at risk for eating disorders and their resource and support needs.

Associations between noticing public health education campaigns about cannabis and risk perceptions in the northern Canadian territories: a cross-sectional study.

This study investigated whether noticing cannabis education campaigns was associated with increased cannabis risk perceptions in Canada's three territories following non-medical cannabis legalization. Data were from the Cannabis Policy Study in the Territories, including 2452 participants, age ≥16years residing in Yukon, Northwest Territories and Nunavut. Poisson regression with robust standard errors were used to estimate associations between noticing cannabis education campaigns and moderate to very high risk perceptions of daily cannabis smoking, vaping, edible use and exposure to second-hand cannabis smoke, adjusting for sociodemographic characteristics and cannabis-use frequency. Results were compared with associations with risk perceptions of daily alcohol consumption and cigarette smoking, not included in cannabis education campaigns. Interactions were examined between noticing education campaigns and age group and cannabis-use frequency. Cannabis education campaigns were noticed by 40.4% of respondents, with lower awareness among those with lower education and income. Noticing campaigns was associated with higher risk perceptions of daily cannabis smoking [adjusted risk ratio (RRadj) = 1.09, 95% confidence interval (CI): 1.02-1.16] and vaping (RRadj = 1.09, 95%CI: 1.02-1.16). Significant interactions were not found with age group or cannabis-use frequency. Findings are consistent with modest effects of cannabis education campaigns. Approaches are needed to increase reach of cannabis education campaigns, including among groups with lower education and income.

COVID-19 Stressors and Cannabis and Alcohol Use in the Canadian Territories

Background: The COVID-19 pandemic and related public health restrictions have been associated with high cannabis and alcohol use among Canadians. Little is known about cannabis and alcohol use in the Canadian territories during the pandemic, despite generally higher substance use rates. This study’s objective was to examine the association between self-reported changes in mental health status and financial stressors resulting from the pandemic on daily/almost daily cannabis use and heavy drinking in the Canadian territories. Methods: This study analyzed data from 993 individuals aged 16 and over residing in the territories collected from September to December 2021 as part of the 2021 Cannabis Policy Study in the Territories. Weighted logistic regression models estimated the association of self-reported mental health status (“worse”/“not worse”) and financial impact (“negative impact”/“no negative impact”) related to the pandemic with daily/almost daily cannabis use (≥5 days per week) and heavy drinking (≥ 4 drinks for women and ≥ 5 drinks for men per occasion at least once a month) in the past 12 months. Models were adjusted for sex, age group, education, perceived income adequacy, territory, ethnicity, living in a capital city, living alone, and having children ≤17 years old. Results: In adjusted models, self-reported worse mental health related to the pandemic had no significant associations with daily/almost daily cannabis use (OR = 1.17, 95% CI:0.72,1.91) and no association with heavy drinking (OR = 1.01, 95% CI:0.63,1.62). Self-reported negative financial impact showed associations above one for daily/almost daily cannabis use (OR = 1.10, 95% CI:0.58,2.08) and with heavy drinking (OR = 1.27, 95% CI:0.75,2.17), though confidence intervals crossed one, indicating no statistical significance. Conclusion: No significant associations were observed between COVID-19 stressors and higher substance use in late 2021. Continued monitoring of the long-term impacts of the pandemic on substance use in the Canadian territories is warranted.

Is SARS-CoV-2 elimination or mitigation best? Regional and disease characteristics determine the recommended strategy.

Public health responses to the COVID-19 pandemic varied across the world. Some countries (e.g. mainland China, New Zealand and Taiwan) implemented elimination strategies involving strict travel measures and periods of rigorous non-pharmaceutical interventions (NPIs) in the community, aiming to achieve periods with no disease spread; while others (e.g. many European countries and the USA) implemented mitigation strategies involving less strict NPIs for prolonged periods, aiming to limit community spread. Travel measures and community NPIs have high economic and social costs, and there is a need for guidelines that evaluate the appropriateness of an elimination or mitigation strategy in regional contexts. To guide decisions, we identify key criteria and provide indicators and visualizations to help answer each question. Considerations include determining whether disease elimination is: (1) necessary to ensure healthcare provision; (2) feasible from an epidemiological point of view and (3) cost-effective when considering, in particular, the economic costs of travel measures and treating infections. We discuss our recommendations by considering the regional and economic variability of Canadian provinces and territories, and the epidemiological characteristics of different SARS-CoV-2 variants. While elimination may be a preferable strategy for regions with limited healthcare capacity, low travel volumes, and few ports of entry, mitigation may be more feasible in large urban areas with dense infrastructure, strong economies, and with high connectivity to other regions.

Midwives' Belief in Normal Birth: The Canadian Survey of Maternity Care Providers’ Attitudes Toward Labour and Birth

Background: Midwifery has been integrated into the health care systems of over half of Canadian provinces and territories. While there are differences in legislation and payment mechanisms, the model of midwifery is fairly similar across the country. This study examined the similarities and differences among midwives' attitudestowardlabourandbirth. Inaddition,wecompareditemswhichrelatedtobeliefsaboutnormal birth between midwives and other care providers.Methods: A national cross-sectional survey was conducted comparing maternity care providers’ beliefs aboutchildbirthandintra-professionalvariationsinmidwives'attitudestowardsbirth. Therewere400 (54%) midwife respondents: 218 from Ontario, 75 from B.C, 53 from Quebec, 48 from the remaining regulated or pre-regulated provinces (six missed information for this field).Results: All midwives were critical of the routine use of interventions such as episiotomy, epidural analgesia andelectronicfetalmonitoring(EFM). Therewasstrongagreementaboutthesafetyofhomebirth,outof hospital birth centres and the importance of women's autonomy and decision-making in pregnancy and birth. However, some regional variations were identified. Quebec midwives were more opposed to epidural analgesia than BC and Ontario (p&lt;.001), and were more likely to believe that cesarean birth is more costly than vaginal birth (p=.005). Ontario midwives were most likely to believe that cesarean birth protects against urinary incontinence (p=.001), and sexual dysfunction (p=.002). Qualitative comments of midwives indicated a strong desire to reduce unnecessary medical intervention and to lower cesarean section rates.Conclusion: Canadian midwives share similar beliefs regarding place of birth, the routine use of episiotomy, EFM, and epidurals, but reported significant attitudinal differences for other issues. Regional differences may be related to midwives' primary practice settings, the historical development of midwifery in their region and the number of new midwives with less than 5 years of clinical experience. A set of core midwifery values was identified that demonstrate a strong belief in normal birth.