Canadian Women Research Articles

The association between age at natural menopause and risk of asthma among postmenopausal women from the Canadian Longitudinal Study on Aging.

This study aimed to investigate the association between age at natural menopause and incidence of asthma among postmenopausal Canadian women. Women between the ages of 45-85 yr were followed for a 10-yr period. Analysis was restricted to naturally postmenopausal women who are nonsmokers and did not have asthma prior to menopause. Age at natural menopause was examined using the following categories: 40-44, 45-49, 50-54 (reference), and ≥55. Survival analysis was utilized to determine time to onset of asthma. Multivariable Cox regression analysis was performed to assess the relationship between age at natural menopause and asthma after adjusting for covariates. The multivariable Cox regression analysis showed a 30% decreased risk of asthma in women with age at natural menopause of 40-44 yr compared with age at natural menopause of 50-54 yr with a hazard ratio of 0.7 (95% confidence interval: 0.49-0.95). Women with later ages at natural menopause may be at increased risk for asthma.

Environmental Health Attitudes, Practices, and Educational Preferences: A National Survey of Reproductive-Aged Women in Canada

Prenatal exposures to environmental toxicants can adversely affect fetal and child development and lead to increased risk of chronic disease. While regulatory action is essential to reduce sources of environmental toxicants, prenatal care presents an opportunity to educate, mobilize, and support prospective parents to reduce exposures to such hazards. As the first phase of an interdisciplinary research collaboration to inform the development of prenatal environmental health education strategy in Canada, we surveyed reproductive-aged female individuals. The online survey (July–September 2021) yielded a nationally representative sample of 1914 reproductive-aged females living in Canada. The questionnaire topics addressed the respondents’ knowledge and perceptions of environmental health risks, preventive actions and related facilitators and barriers, information sources and preferences, reproductive history, and demographics. The analysis included bivariate and multivariate techniques. Our results suggest broad awareness among reproductive-aged females that exposure to toxicants can be harmful, and that reducing prenatal exposures can benefit child health. However, fewer than half of respondents felt that they had enough knowledge to take protective measures. Despite high levels of preference for prenatal care as an ideal context for learning about environmental health risks and protective measures, fewer than one in four respondents had ever discussed environmental health concerns with a healthcare provider. Our findings reveal a knowledge–action gap and a corresponding opportunity to improve environmental health education and advocacy in prenatal care in the Canadian context.

The continuum of gender-based violence experienced by migrant and refugee women in Canada: perspectives from key informants.

Little research has been done on conceptualizing gender-based violence (GBV) against immigrant and refugee women as a continuum of violence. The objective of the larger study was to understand gender-based violence in migration and analyze the ways in which discriminations and inequalities interact to increase vulnerability and decrease access to supports and services for some women. Using (a) the concept of continuum of [sexual] violence and (b) intersectionality, we demonstrate the need to both document the range of violence in women's lives and the tactics of victimization among immigrant and refugee women and show how they are different than the cumulated literature showing victimization tactics against the Canadian-born population. Using semi-structured interviews via phone or video, we asked professionals (N = 43) who worked with migrant women across Canada about forms of GBV experienced in the immigrant and refugee populations they worked with. Participants reported that non-physical forms of violence are more normalized, but also more commonly experienced than physical forms of violence in Canada. Additionally, intersecting social identities impact both the distinct and amplified forms of GBV immigrant and refugee women experienced. Results contribute theoretically and empirically to the conceptualization of the GBV experiences by immigrant and refugee women in Canada.

8352 Association Between Sleep and Physical Activity Among Women with Obesity and Infertility

Abstract Disclosure: K. Brûlé: None. F. Jean-Denis: None. M. Belan: None. M. Langlois: None. S. Ruchat: None. J. Baillargeon: Grant Recipient; Self; Ferring Pharmaceuticals. BACKGROUND: Infertility affects up to 15% of couples and a major modifiable risk factor is obesity. Thus, it has been recommended that women with obesity should be assisted to adopt healthy lifestyle behaviors prior to conception. Also, individuals with obesity often present reduced sleep quantity and quality, which could affect their physical activity (PA) practice. On the other hand, PA seems to improve sleep quality. Regular practice of PA could also improve an individual’s functional capacity, and thus could be an objective measure of a person's level of PA. Hence, our study aimed to: 1) compare the sleep quantity of women with obesity and infertility to the Canadian population; and 2) determine the relationship between their PA practice, functional capacity and sleep quantity and quality. Methods: This cross-sectional study is nested within a multicenter randomized controlled trial recruiting women of 18-40 years old with obesity and infertility in Canadian fertility clinics. At their initial research visit, they were assessed for body mass index (BMI), functional capacity (distance at 6-min walk test); total energy expenditure (EE, kcal/day), total PA (steps/day) and time spent in light (min/day) or moderate-to-vigorous physical activity (MVPA, min/day) or sedentarity (min/day) (Fitbit monitor); as well as sleep quality and duration (Pittsburgh Sleep Quality Index questionnaire and Fitbit monitor), and total time asleep per night (Fitbit monitor). For the Canadian population, we used the mean sleep duration of women aged 18-60 years reported in the Canadian Community Health Survey of 2020. Associations were tested using Pearson’s correlations (some measures were made normally distributed by square root transformation). Results: A total of 98 women (mean age = 31.5 years and mean BMI = 39.2 kg/m2) from 5 centers were included, 48% of whom were recruited in Sherbrooke (Qc). Their sleep duration was significantly lower than that of Canadian women (7.2±1.1 vs 8.1 h; p<0.001). Poor perceived sleep quality was negatively associated with EE (r=-0.271; p=0.020) and steps (r=-0.280; p=0.026), but directly with sedentary time (r=0.277; p=0.033). Light PA was negatively associated with measured sleep duration (r=-0.241; p=0.016), but positively associated with measured sleep efficiency (r=0.237; p=0.036). Functional capacity is positively associated with measures of EE, steps and MVPA (r=0.239 to 0.347; p=0.005 to 0.031), and there is a tendency with total time asleep (r=0.238, p=0.061). Conclusion: Canadian women with obesity and infertility have, on average, less sleep time than women in the general Canadian population. Their PA practice is associated with better perceived sleep quality but does not improve their sleep quantity per se. Furthermore, the association between their functional capacity and PA practice suggests that it is a valid objective indirect measure of PA practice. Presentation: 6/1/2024

Institutional and systemic barriers and facilitators affecting healthcare access for Black women in Alberta

Canada's Black population has experienced significant growth in recent years, with substantial increases noted in the prairie provinces. As Black people continue to make up a growing proportion of the population, it is important to understand their experiences in accessing healthcare services, especially for those who are multiply marginalized. We undertook a qualitative study to examine the healthcare access experiences of Black women in Canada. We completed semi-structured interviews with a sample of 30 Black women from Alberta. Our study was guided by intersectionality to examine how Black women's experience of healthcare access is shaped by social processes related to their socio-demographic characteristics such as being Black, a woman, an immigrant or non-immigrant, and having high or low income. From our thematic analysis we identified three key factors that hinders healthcare access for Black women: socioeconomic barriers, health systems issues, and racism. We identified two types of facilitators: community and institutional facilitators and structural facilitators. Our findings elucidate how Black women's experiences of accessing and utilizing health services in Alberta are influenced by overlapping institutional, structural, and systemic factors.

The Landscape of Breast Cancer Molecular and Histologic Subtypes in Canada.

Purpose: To characterize the histologic and molecular subtype distribution of, and survival from, breast cancer (BC) among Canadian women overall, and by stage and age at diagnosis. Methods: Invasive BC cases from the Canadian Cancer Registry for women aged 15-99 years between 2012 and 2017 in Canada, excluding Quebec, were examined using pre-existing mortality linkages. Stage at diagnosis, molecular, and histologic subtypes, and 5-year net survival (NS) by age, subtype, and stage were determined. Results: 107,271 women with BC were included. Luminal A was the most common subtype, present in increasing proportions as women aged, up to a maximum of 55% of cases in 70-74. Ductal and luminal A were most likely to be diagnosed at stage I, while HER2+ had the highest proportion of diagnosis at stage III; triple negative (TN) and unknown had the highest proportion of stage IV. For all stages combined, luminal A had a five-year NS of 98%, while TN was 74%. NS for stage I BC was 99-100% for all subtypes, excepting TN, which was 96%. Survival decreased with advancing stage, most markedly for TN, for which stage III was 47% and stage IV 7%. Survival by equivalent stage and subtype was comparable across age groups but declined in older age categories. Conclusions: The varying natural histories of BC subtypes and histologies can inform prognoses, health system economics, and screening practices. The NS of 96% or greater for stage I, regardless of subtype, highlights the importance of early detection for all subtypes of BC, especially in aggressive subtypes.

Cervical cancer screening outcomes among First Nations and non‐First Nations women in Alberta, Canada

BackgroundCervical cancer disproportionately affects First Nations women in Canada but there is limited information on their participation in organized cervical cancer screening programs. MethodsThis co-led retrospective cohort study linked population-based Alberta Cervical Cancer Screening Program point of care data with First Nations identifiers. This Screening Program database includes cervical cancer screening history, screen test results, colposcopy procedure findings, and pathology results for all women in Alberta. First Nations identifiers were obtained from Alberta Health who steward these data on their behalf. Data were available from 2012 to 2018 for women 25 – 69 years of age who were age eligible to participate in cervical cancer screening. Screening participation and retention rates, and screening outcomes were compared between First Nations and non- First Nations women using descriptive statistics with trends estimated using joinpoint models. ResultsAge standardized screening participation and retention rates of First Nations women were lower than those for the non-First Nations women, with an average difference of 13.9 % lower for participation rates (95 % confidence interval = 12.9–14.8 %; P <.0001) and 7.2 % for retention rates (95 % confidence interval = 2.2 % to 12.72; P = 0.013). First Nations women consistently had higher percentages of high risk (high-grade squamous intraepithelial lesion, atypical glandular cells, atypical squamous cells where HSIL cannot be excluded, Carcinoma in situ) abnormal cytology tests than non-First Nations women. ConclusionIdentifying where inequities were found in cervical cancer screening participation and retention in this study is the first step to reduce the disproportionate burden of cervical cancer for First Nations women in Canada.

“The healthcare system did fail me repeatedly”: a qualitative study on experiences of healthcare among Canadian women with Cushing’s syndrome

BackgroundAs a rare endocrine disorder, Cushing’s Syndrome (Cushing’s) is characterized by numerous symptoms and a non-specific presentation, leading to a delay to diagnosis for patients with this disease. To date, research examining the lived experiences of patients with Cushing’s in healthcare is absent in the literature. This preliminary inquiry into the healthcare experiences of women with Cushing’s aimed to examine the utility of this line of inquiry to support the patient centered care of individuals with Cushing’s.MethodsSeven women from across Canada with endogenous Cushing’s participated in the study. Semi-structured interviews were conducted examining participants’ healthcare and body-related experiences with Cushing’s. Results pertaining to healthcare experiences were analyzed for the current study using reflexive thematic analysis.ResultsFour themes emerged whereby women with Cushing’s experienced (1) a lack of patient centered care, characterized by provider miscommunication and medical gaslighting; (2) a misunderstanding of their symptoms as related to weight gain; (3) weight stigma in healthcare encounters; and (4) a shift in their quality of care following diagnosis.ConclusionsThe results highlight the importance of patient centered care as well as the negative impact of commonly reported barriers to patient centered care. Cushing’s specific barriers to patient centered care may include weight stigma as well as the rare incidence of Cushing’s. Further research is needed to better understand the healthcare experiences of people with Cushing’s in Canada.

Education level is associated with the occurrence and timing of hysterectomy: A cohort study of Canadian women.

Hysterectomy is a common surgery with discernible practice variations that could be influenced by socioeconomic factors. We examined the association between level of educational attainment and the occurrence and timing of hysterectomy in Canadian women. We conducted a prospective cohort study of 30 496 females in the Alberta's Tomorrow Project (2000-2015) followed approximately every 4 years using self-report questionnaires. Educational attainment was defined as high school diploma or less, college degree, university degree (reference group), and postgraduate degree. We used logistic regression analyzing hysterectomy occurrence at any time and before menopause, separately, and flexible parametric survival models analyzing hysterectomy timing with age as the time scale. Multivariable models controlled for race/ethnicity, rural/urban residence, parity, oral contraceptive use, and smoking. Overall, 39.1% of females reported a high school diploma or less, 28.9% reported a college degree, 23.5% reported a university degree, and 8.5% reported a postgraduate degree. A graded association was observed between lower education and higher odds of hysterectomy (high school or less: adjusted odds ratio [AOR] 1.68, 95% CI 1.55-1.82; college degree: AOR 1.58, 95% CI 1.45-1.72); results were similar for premenopausal hysterectomy. A graded association between lower education and earlier timing of hysterectomy was also observed up to approximately age 60 (e.g., at age 40: high school or less adjusted hazard ratio [AHR] 1.61, 95% CI 1.49-1.75; college degree AHR 1.53, 95% CI 1.40-1.67). Women with lower levels of education were more likely to experience hysterectomy, including hysterectomy before menopause and at younger ages.

Prevalence and Associated Risk Factors with Unawareness of Folic Acid Benefits Prior to Pregnancy: Results From Canadian Community Health Survey

Recent national studies on awareness of folic acid (FA) prior to pregnancy among Canadian women are lacking. Using the 2017–2018 Canadian Community Health Survey, we aimed to estimate prevalence and risk factors associated with Canadian women who reported they were unaware of the benefits of FA supplementation before pregnancy. Prevalence of unawareness of FA was 22.1%. Lower education, lack of a health care provider, low household income, and an immigrant background were associated with greater odds of unawareness of the benefits of FA supplementation. Persistent associations with measures of social disadvantage and social determinants of health emphasize the need for new targeted public health campaigns.

Residential Proximity to Oil and Gas Development and Mental Health in a North American Preconception Cohort Study: 2013-2023.

Objectives. To evaluate associations between oil and gas development (OGD) and mental health using cross-sectional data from a preconception cohort study, Pregnancy Study Online. Methods. We analyzed baseline data from a prospective cohort of US and Canadian women aged 21 to 45 years who were attempting conception without fertility treatment (2013-2023). We developed residential proximity measures for active OGD during preconception, including distance from nearest site. At baseline, participants completed validated scales for perceived stress (10-item Perceived Stress Scale, PSS) and depressive symptoms (Major Depression Inventory, MDI) and reported psychotropic medication use. We used log-binomial regression and restricted cubic splines to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results. Among 5725 participants across 37 states and provinces, residence at 2 km versus 20 to 50 km of active OGD was associated with moderate to high perceived stress (PSS ≥ 20 vs < 20: PR = 1.08; 95% CI = 0.98, 1.18), moderate to severe depressive symptoms (MDI ≥ 20 vs < 20: PR = 1.27; 95% CI = 1.11, 1.45), and psychotropic medication use (PR = 1.11; 95% CI = 0.97, 1.28). Conclusions. Among North American pregnancy planners, closer proximity to OGD was associated with adverse preconception mental health symptomatology. (Am J Public Health. 2024;114(9):923-934. https://doi.org/10.2105/AJPH.2024.307730).

Maud L. Menten: Pioneering Physician and Biochemist.

Dr. Maud Leanora Menten, an esteemed Canadian physician, biochemist, and organic chemist, conducted a wide range of valuable biochemistry research for over 40 years, making groundbreaking discoveries about cancer treatments, enzyme kinematics, anesthesia medicine, bacterial toxins, vitamin deficiencies, hematology, and histochemistry. Menten demonstrated intense perseverance and tenacity in her education, defying societal norms to not only become one of the first Canadian women to earn a research-intensive Doctor of Medicine (MD) degree, but to also be one of the first to earn a PhD. Although she was restricted in her work in Canada, she moved to the U.S. and published an estimated 100 research studies over her career. She is most well known for her work with Dr. Leonor Michaelis, with whom she created the Michaelis-Menten equation for the relationship between reaction rate and enzyme-substrate concentration. However, she conducted many other noteworthy research projects, such as using radium bromide for cancer treatment in rats and using electrophoretic mobility to study human hemoglobin, which allowed for a more advanced protein analysis. Her research in hemoglobinpreceded the findings of Linus Pauling by several years, however, he is often the only one credited for this work. After her death, the extent and depth of her work was better understood and appreciated by many, and she was recognized byher alma mater, the University of Toronto, and her former workplace, the University of Pittsburgh. She was also posthumously inducted into the Canadian Medical Hall of Fame.

“It Sounds Like You Don’t Want to Help Me”: How Everyday Bordering in Settlement Services Impacts Immigrant Women in Canada

“It Sounds Like You Don’t Want to Help Me”: How Everyday Bordering in Settlement Services Impacts Immigrant Women in Canada

Air pollutants and plasma total folate among pregnant women in Canada, 2008-2011

Air pollutants and plasma total folate among pregnant women in Canada, 2008-2011

Vitamin D, Folate, Vitamin B12, and Iron Status in Pregnant/Postpartum Old Order Anabaptist Women in Southwestern Ontario.

Purpose: To assess vitamin D, folate, vitamin B12, and iron status in Old Order Anabaptist (OOA) pregnant/postpartum women.Methods: Blood was analyzed for plasma 25 hydroxy vitamin D (25(OH)D), red blood cell (RBC) folate, serum vitamin B12, and iron status indicators. Dietary intakes (food and supplements) from 3-day estimated records were compared to Dietary Reference Intakes and Canada's Food Guide (2007).Results: Fifty women participated in this descriptive cross-sectional study. Concentrations of 25(OH)D were low (<50 nmol/L for 20% and < 75 nmol/L for 63%); 42% had total vitamin D intakes < estimated average requirement (EAR). All women had RBC folate above the 1360 mmol/L cut-off. Nineteen percent had folate intakes <EAR; 80% had folic acid supplement intakes >upper limit. One woman had low serum vitamin B12 (<148 pmol/L); serum vitamin B12 was high (>652 pmol/L) for 24%. None had vitamin B12 intakes <EAR; intakes were high compared to the recommended dietary intake. One woman had low hemoglobin; 13% had ferritin <15 μg/L. Thirteen percent had total iron intake <EAR.Conclusions: Overall, dietary intake and serum micronutrient status of OOA pregnant and postpartum women in our study were similar to those reported in previous studies of Canadian women. While some women had low intakes of vitamin D and iron, most had high intakes of folate and vitamin B12. These findings provide guidance to ensure appropriate dietary and supplement intakes in this potentially vulnerable and rarely studied population.

Intimate Partner Violence and Breastfeeding Outcomes Among Canadian Women: An Exploratory Correlational Study.

Human breastmilk is the optimal nutrition for infants; however, preliminary research suggests that women who experience intimate partner violence (IPV) are less likely to initiate and continue breastfeeding. Self-efficacy is a known facilitator to achieve positive breastfeeding outcomes. This study aimed to explore the relationship between experiencing IPV and breastfeeding duration, exclusivity, and self-efficacy for Canadian mothers, and to identify potential variables that influence breastfeeding decision-making among women with experiences of IPV. This was a cross-sectional secondary analysis of surveys completed by 129 mothers with children under the age of 2 years from Ontario, Canada. Data were stratified according to those who had experienced IPV and those who had not. Breastfeeding outcomes assessed included breastfeeding self-efficacy and breastfeeding duration and exclusivity. Non-parametric tests and correlations were used to determine if relationships existed between IPV and breastfeeding outcomes. 72.3% (n = 94) of women in this sample breastfed their child(ren). Experiencing IPV was associated with lower breastfeeding self-efficacy scores (W = 768, p = 0.055) with a moderate effect size (r = 0.32 [95% 0.06,0.55]). This relationship was significant in the context of psychological abuse (W = 816.5, p = 0.015) with a small effect size (r = 0.22 [95% 0.03,0.41]). This study provides novel preliminary evidence suggesting that experiencing IPV of any type can negatively impact breastfeeding self-efficacy, with psychological abuse potentially being the most detrimental. Future research is required to build upon these findings.

"These Conversations Shouldn't be Easy … You're Going to Have to Shift. It Means Reflection … It Means Change": Moving Anti-Oppression Beyond Incremental Changes in the GBV Sector.

Little is known about racialized women's work experiences in EDI/AO policy-led Canadian women's organizations in the gender-based violence (GBV) sector. Twenty-three racialized and white GBV workers participated in a critical qualitative study. Five themes emerged illustrating that racialized women workers are experiencing systemic violence through acts of racism and discrimination. The two themes examined in this paper: a culture of silence and shifting the needle forward reveal that the GBV sector is primarily an affirmative space. Creating greater safety for racialized women workers means moving toward transformative approaches that challenge the system's responsibility in creating and supporting anti-oppressive efforts in the elimination of violence.

Experiences of accessing mental health services for women living on a low income in Canada: a qualitative systematic review protocol.

The objective of this review is to comprehensively analyze qualitative evidence on the experiences of Canadian women aged 18 years or above living on a low income. The review will examine the intersectionality of their identities and privileges when accessing mental health services, with the aim of informing targeted interventions and policy improvements. Despite the growing body of research on mental health disparities and a call for improved mental health care, both globally and in Canada, there is a need to identify recommendations for system enhancement and to improve gender equality by understanding the nuanced experiences of accessing mental health care for Canadian women living on a low income. This review will include qualitative studies conducted within the past decade about women of diverse backgrounds aged 18 years or above who identify as living on a low income and who have resided in Canada for 6 months or longer. Studies using any qualitative methodology will be included. The following databases will be searched for published studies: MEDLINE and PsycINFO (Ovid); CINAHL and Pre-CINAHL (EBSCOhost); LiSSa; and Google Scholar. Searches for unpublished studies will include the Primo Central Index, ProQuest Dissertations and Theses Global, and the Canadian Women's Foundation Studies. The review will include studies published in English and French in Canada, from 2013 to the present. The JBI methodology for systematic reviews of qualitative evidence will be followed, informing study selection, appraisal, extraction, synthesis, and assessment of confidence, which will be conducted by 2 independent reviewers. PROSPERO CRD42023430100.

Sexual victimization among Royal Canadian Mounted Police.

The present study was designed to provide the first in-depth, academically peer-reviewed assessment of sexual victimization among Royal Canadian Mounted Police (RCMP). A representative sample of RCMP (n = 1,324; 76.5% men) completed the self-report survey. Participants reported a higher overall lifetime history of sexual assault than would be expected for the general population (p < .05). Women participants reported a higher prevalence of lifetime history of sexual assault (p < .05). Participants reported being sexually assaulted during the RCMP Cadet Training Program (CTP; n = 27), with comparable proportions of men and women. Participants reported being sexually assaulted while on duty (n = 168), with a greater proportion of women reporting being sexually assaulted than men (p < .05). Women more often reported being sexually assaulted while on duty by a superior, coworker or peer, or subordinate, whereas men more often reported being sexually assaulted by a civilian. Participants (n = 94) reported being sexually harassed during the CTP and while on duty (n = 282), with a greater proportion of women reporting being sexually harassed during the CTP and while on duty. RCMP cadets appear to be sexually assaulted and sexually harassed less frequently than Canadian university and military college students, whereas RCMP appear to be sexually assaulted more often while on duty than Canadian men and women in the general population while at work; however, direct comparisons are problematic because of differing frames for questions and time spans. The current results help quantify sexual victimization among RCMP, which can support ongoing and novel prevention and intervention strategies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The experience of ageing, spirituality, and health as a Muslim woman in Canada

ABSTRACT How does spirituality relate to ageing for Muslim women? The purpose of this study was to better understand the experience and intersections of ageing, spirituality, and health for Muslim women in Canada. This better understanding would be beneficial for care providers who may be unaware of the needs of ageing Muslim women. Four Muslim women, each in their fifties, participated in a qualitative, semi-structured interview. Seven themes were identified to be most relevant: Faith, identity, spiritual wisdom, accommodation, self-care, perceived judgement, and reconnecting the Muslim community. Recommendations are made not only for care providers, but for Muslim women and for the Muslim community in general.