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Myran D, Hsu A, Kunkel E, Rhodes E, Imsirovic H, Tanuseputro P. Socioeconomic and Geographic Disparities in Emergency Department Visits due to Alcohol in Ontario: A Retrospective Population-level Study from 2003 to 2017. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:534-543. [PMID: 34254563 PMCID: PMC9234901 DOI: 10.1177/07067437211027321] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE While the overall health system burden of alcohol is large and increasing in Canada, little is known about how this burden differs by sociodemographic factors. The objectives of this study were to assess sociodemographic patterns and temporal trends in emergency department (ED) visits due to alcohol to identify emerging and at-risk subgroups. METHODS We conducted a retrospective population-level cohort study of all individuals aged 10 to 105 living in Ontario, Canada. We identified ED visits due to alcohol between 2003 and 2017 using defined International Classification of Diseases, 10th edition, codes from a pre-existing indicator. We calculated annual age- and sex-standardized, and age- and sex-specific rates of ED visits and compared overall patterns and changes over time between urban and rural settings and income quintiles. RESULTS There were 829,662 ED visits due to alcohol over 15 years. Rates of ED visits due to alcohol were greater for individual living in the lowest- compared to the highest-income quintile neighbourhoods, and disparities (rate ratio lowest to highest quintile) increased with age from 1.22 (95% CI, 1.19 to 1.25) in 15- to 18-year-olds to 4.17 (95% CI, 4.07 to 4.28) in 55- to 59-year-olds. Rates of ED visits due to alcohol were significantly greater in rural settings (56.0 per 10,000 individuals, 95% CI, 55.7 to 56.4) compared to urban settings (44.8 per 10,000 individuals, 95% CI, 44.7 to 44.9), particularly for young adults. Increases in rates of visits between 2003 and 2017 were greater in rural versus urban settings (82 vs. 68% increase in age- and sex-standardized rates) and varied across sociodemographic subgroups with the largest annual increases in rates of visits in young (15 to 29) low-income women (6.9%, 95%CI, 6.7 to 7.3) and the smallest increase in older (45 to 59) high-income men (2.7, 95%CI, 2.4 to 3.0). CONCLUSION Alcohol harms display unique patterns with the highest burden in rural and lower-income populations. Rural-urban and income-based disparities differ by age and sex and have increased over time, which offers an imperative and opportunity for further interventions by clinicians and policy makers.
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Affiliation(s)
- Daniel Myran
- 10055The Ottawa Hospital Research Institute, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Amy Hsu
- 10055The Ottawa Hospital Research Institute, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | - Emily Rhodes
- 10055The Ottawa Hospital Research Institute, Ontario, Canada
| | | | - Peter Tanuseputro
- Department of Family Medicine, University of Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ontario, Canada
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Somé NH, Wells S, Felsky D, Hamilton HA, Ali S, Elton-Marshall T, Rehm J. Self-reported mental health during the COVID-19 pandemic and its association with alcohol and cannabis use: a latent class analysis. BMC Psychiatry 2022; 22:306. [PMID: 35490222 PMCID: PMC9055215 DOI: 10.1186/s12888-022-03917-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mental health problems and substance use co-morbidities during and after the COVID-19 pandemic are a public health priority. Identifying individuals at high-risk of developing mental health problems and potential sequela can inform mitigating strategies. We aimed to identify distinct groups of individuals (i.e., latent classes) based on patterns of self-reported mental health symptoms and investigate their associations with alcohol and cannabis use. METHODS We used data from six successive waves of a web-based cross-sectional survey of adults aged 18 years and older living in Canada (6,021 participants). We applied latent class analysis to three domains of self-reported mental health most likely linked to effects of the pandemic: anxiety, depression, and loneliness. Logistic regression was used to characterize latent class membership, estimate the association of class membership with alcohol and cannabis use, and perform sex-based analyses. RESULTS We identified two distinct classes: (1) individuals with low scores on all three mental health indicators (no/low-symptoms) and (2) those reporting high scores across the three measures (high-symptoms). Between 73.9 and 77.1% of participants were in the no/low-symptoms class and 22.9-26.1% of participants were in the high-symptom class. We consistently found across all six waves that individuals at greater risk of being in the high-symptom class were more likely to report worrying about getting COVID-19 with adjusted odds ratios (aORs) between 1.72 (95%CI:1.17-2.51) and 3.51 (95%CI:2.20-5.60). Those aged 60 + were less likely to be in this group with aORs (95%CI) between 0.26 (0.15-0.44) and 0.48 (0.29-0.77) across waves. We also found some factors associated with class membership varied at different time points. Individuals in the high-symptom class were more likely to use cannabis at least once a week (aOR = 2.28, 95%CI:1.92-2.70), drink alcohol heavily (aOR = 1.71, 95%CI:1.49-1.96); and increase the use of cannabis (aOR = 3.50, 95%CI:2.80-4.37) and alcohol (aOR = 2.37, 95%CI:2.06-2.74) during the pandemic. Women in the high-symptom class had lower odds of drinking more alcohol during the pandemic than men. CONCLUSIONS We identified the determinants of experiencing high anxiety, depression, and loneliness symptoms and found a significant association with alcohol and cannabis consumption. This suggests that initiatives and supports are needed to address mental health and substance use multi-morbidities.
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Affiliation(s)
- Nibene Habib Somé
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, ON, N6G 4X8, London, Canada. .,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. .,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Samantha Wells
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, ON N6G 4X8 London, Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario Canada ,grid.39381.300000 0004 1936 8884Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Ontario Canada ,grid.1021.20000 0001 0526 7079School of Psychology, Deakin University, Victoria, Australia
| | - Daniel Felsky
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, Ontario Canada ,grid.155956.b0000 0000 8793 5925Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Hayley A. Hamilton
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, ON N6G 4X8 London, Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Shehzad Ali
- grid.39381.300000 0004 1936 8884Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario Canada ,grid.39381.300000 0004 1936 8884Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Canada ,grid.5685.e0000 0004 1936 9668Department of Health Sciences, University of York, York, UK ,grid.1004.50000 0001 2158 5405Department of Psychology, Macquarie University, Sydney, Australia ,grid.418792.10000 0000 9064 3333Bruyere Research Institute, Ottawa, Canada
| | - Tara Elton-Marshall
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, ON N6G 4X8 London, Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario Canada ,grid.39381.300000 0004 1936 8884Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada ,grid.258900.60000 0001 0687 7127Department of Health Sciences, Lakehead University, Thunder Bay, Ontario Canada
| | - Jürgen Rehm
- grid.155956.b0000 0000 8793 5925Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 100 Collip Circle, Suite 200, ON N6G 4X8 London, Canada ,grid.155956.b0000 0000 8793 5925Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Institute of Medical Science, University of Toronto, Toronto, Ontario Canada ,grid.4488.00000 0001 2111 7257Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
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MacNabb K, Blades S, Thompson K, Dutton DJ, Liu T, Asbridge M. Alcohol access and purchasing behaviour during COVID-19 pandemic restrictions: An exploration of sociodemographic, health and psychosocial correlates in two Canadian provinces. Drug Alcohol Rev 2021; 41:902-911. [PMID: 34923690 DOI: 10.1111/dar.13423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Alcohol access has changed in Canada during the COVID-19 pandemic. This study compares the use of two novel purchasing modes (via delivery and in excess/stockpiling) to traditional, in-person purchasing to determine if their use is associated with sociodemographic and psychosocial characteristics, perceived COVID-19 health risk or consumption frequency. METHODS We draw on cross-sectional survey data from 2000 residents of the Canadian provinces of Nova Scotia and New Brunswick, ages 19 years and older that were administered online and by telephone. Associations between purchasing modes and sociodemographic and psychosocial characteristics, perceived COVID-19 health risk or consumption frequency were assessed using logistic regression. RESULTS About 70% of people who drink purchased in-person, 17% used delivery and 30% purchased in excess/stockpiled. Sociodemographic and psychosocial attributes varied among those at increased odds of using each purchasing mode. Those at higher COVID-19 health risk were at higher odds of getting alcohol delivered. Increased drinking frequency was associated with alcohol delivery and purchasing in excess/stockpiling. DISCUSSION AND CONCLUSIONS This study highlights the need for increased public health considerations regarding changes to alcohol regulations. Alcohol delivery and purchasing in excess/stockpiling is positively associated with heavier drinking. Drinkers at higher COVID-19 health risk were more likely to purchase online for delivery, which suggests novel purchasing modes may serve a partial public health function.
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Affiliation(s)
- Kathleen MacNabb
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Sarah Blades
- Health Promotion Team, Mental Health and Addictions, IWK Health, Halifax, Canada
| | - Kara Thompson
- Department of Psychology, Faculty of Arts, St. Francis Xavier University, Antigonish, Canada
| | - Daniel J Dutton
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Tong Liu
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada
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Vallance K, Stockwell T, Wettlaufer A, Giesbrecht N, Chow C, Card KG, Farrell-Low A. Strategies for engaging policy stakeholders to translate research knowledge into practice more effectively: Lessons learned from the Canadian Alcohol Policy Evaluation project. Drug Alcohol Rev 2021; 41:246-255. [PMID: 34046948 DOI: 10.1111/dar.13313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 04/19/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Evidence-based alcohol policies have the potential to reduce a wide range of related harms. Yet, barriers to adoption and implementation within governments often exist. Engaging relevant stakeholders may be an effective way to identify and address potential challenges thereby increasing reach and uptake of policy evaluation research and strengthening jurisdictional responses to alcohol harms. METHODS As part of the 2019 Canadian Alcohol Policy Evaluation project, we conducted interviews with government stakeholders across alcohol-related sectors prior to a second round of researcher-led policy assessments in Canada's 13 provinces and territories. Stakeholders were asked for feedback on the design and impact of an earlier policy assessment in 2013 and for recommendations to improve the design and dissemination strategy for the next iteration. Content analysis was used to identify ways of improving stakeholder engagement. RESULTS We interviewed 25 stakeholders across 12 of Canada's 13 jurisdictions, including representatives from government health ministries and from alcohol regulation, distribution and finance departments. In providing feedback on our stakeholder engagement strategy, participants highlighted the importance of maintaining ongoing contact; presenting results in accessible online formats; providing advance notice of results; and offering jurisdiction-specific webinars. DISCUSSION AND CONCLUSIONS This study offers important insight into the engagement preferences of government stakeholders involved in the health, regulation, distribution and financial aspects of alcohol control policy. Findings suggest that seeking input from stakeholders as part of conducting evaluation research is warranted; increasing the relevance, reach and uptake of results. Specific stakeholder engagement strategies are outlined.
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Affiliation(s)
- Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada.,Department of Psychology, University of Victoria, Victoria, Canada
| | - Ashley Wettlaufer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Norman Giesbrecht
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Clifton Chow
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Kiffer G Card
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Amanda Farrell-Low
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
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Grittner U, Wilsnack S, Kuntsche S, Greenfield TK, Wilsnack R, Kristjanson A, Bloomfield K. A Multilevel Analysis of Regional and Gender Differences in the Drinking Behavior of 23 Countries. Subst Use Misuse 2019; 55:772-786. [PMID: 31876222 PMCID: PMC7125004 DOI: 10.1080/10826084.2019.1702700] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Drinking behavior differs not only among countries, but also among regions within a country. However, the extent of such variation and the interplay between gender and regional differences in drinking have not been explored and are addressed in this study. Methods: Data stem from 105,061 individuals from 23 countries of the GENACIS data set. The outcomes were heavy drinking (10/20 g or more of pure ethanol per day for women/men), and risky single occasion drinking (RSOD) (5+ drinks per occasion) at least monthly. Analyses used binary logistic mixed models. Variance at specific levels was measured by the intra-class correlation coefficient (ICC). Gender differences in outcomes were measured using gender ratios. Results: Country-level ICC was 0.13 (95% CI: 0.09-0.18) for heavy drinking and 0.16 (95% CI: 0.10-0.26) for RSOD. Within-country regional-level ICC for heavy drinking and RSOD was 0.02 (95% CI: 0.009-0.05; 0.01-0.04, respectively), implying that 2% of variation in heavy drinking and RSOD was explained by regional variation. Variance in drinking indicators was larger for women compared to men across countries. Gender ratios were higher in low- and middle-income countries. Conclusions: Regional variations in risky drinking were more often present in low- to middle-income countries as well as in a few higher-income countries, and could be due to cultural and demographic differences. Variations in gender differences were larger on the country level than on the regional level, with lower-income countries showing larger differences. These results can help to better identify specific high-risk groups for prevention strategies.
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Affiliation(s)
- Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Sharon Wilsnack
- School of Medicine and Health Sciences, University of North Dakota, USA
| | - Sandra Kuntsche
- Centre for Alcohol Policy Research, College of Science, Health and Engineering, School of Psychology and Public Health, La Trobe University Melbourne, Australia
| | | | - Richard Wilsnack
- School of Medicine and Health Sciences, University of North Dakota, USA
| | | | - Kim Bloomfield
- Institute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Germany
- Centre for Alcohol & Drug Research, University of Aarhus, Denmark
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Buch-Andersen T, Helms Andreasen A, Jørgensen T, Holger Ehlers L, Toft U. Price and sales volume of sugar-sweetened beverages, diet drinks, sweets and chocolates: analysis of Danish retail scanner data. Eur J Clin Nutr 2019; 74:581-587. [PMID: 31316172 DOI: 10.1038/s41430-019-0470-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The objective of the present study was to investigate the relationship between price and sales volume of non-alcoholic sugar-sweetened beverages (SSBs), diet drinks, sweets and chocolates, including own and cross price elasticity to further quantify the potential impact of price. METHODS The study was based on retail scanner data for grocery sales from retail outlet chains in Denmark during the year 2008-2015. A fixed-effects model was used to estimate the association between price and sales volume, using own price and cross price elasticity. RESULTS Sales volume of all sugary products except for chocolates were significantly negatively associated with price. Own price elasticity varied from -0.3 to -0.4 for drinks and sweets indicating that a 10% increase in price would cause a reduction in sales by 3 or 4%. A 10% increase in price of carbonated SSBs would increase sales of diet drinks by 7%. Cross price elasticities for other products were not significant. CONCLUSIONS The results of the present study demonstrated significant negative associations between changes in price and changes in the sale of SSBs, diet drinks and sweets.
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Affiliation(s)
- Tine Buch-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
| | - Anne Helms Andreasen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.,Faculty of Medicine, Aalborg University, Niels Jernes Vej 10, 9220, Aalborg Ø, Denmark
| | - Lars Holger Ehlers
- Danish Center for Healthcare Improvements, Department of Business and Management, Aalborg University, Fibigerstræde 11, 9220, Aalborg Ø, Denmark
| | - Ulla Toft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
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Minimum alcohol pricing policies in practice: A critical examination of implementation in Canada. J Public Health Policy 2016; 38:39-57. [DOI: 10.1057/s41271-016-0051-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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