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Loverock A, Benny C, Smith BT, Siddiqi A, Pabayo R. Income inequality and deaths of despair risk in Canada, identifying possible mechanisms. Soc Sci Med 2024; 344:116623. [PMID: 38308958 DOI: 10.1016/j.socscimed.2024.116623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/02/2023] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Declines in life expectancy in developed countries have been attributed to increases in drug-related overdose, suicide, and liver cirrhosis, collectively referred to as deaths of despair. Income inequality is proposed to be partly responsible for increases in deaths of despair rates. This study investigated the associations between income inequality, deaths of despair risk in Canada, and potential mechanisms (stress, social cohesion, and access to health services). METHODS We obtained data from the Canadian Community Health Survey and the Canadian Vital Statistics Database from 2007 to 2017. A total of 504,825 Canadians were included in the analyses. We used multilevel survival analyses, as measured by the Gini coefficient, to examine the relationships between income inequality and mortality attributed to drug overdose, suicide, death of despair, and all-cause. We then used multilevel path analyses to investigate whether each mediator (stress, social cohesion, and access to mental health professionals), which were investigated using separate mediation models, influenced the relationship between income inequality and drug overdose, suicide, deaths of despair, and all-cause death. RESULTS Adjusted multilevel survival analyses demonstrated significant relationships between a one-SD increase in Gini coefficient was associated with an increased hazard for drug overdose (HRadj. = 1.28; 95 CI = 1.05, 1.55), suicide (HRadj. = 1.24; 95 CI = 1.06, 1.46), deaths of despair (HRadj. = 1.26; 95 CI = 1.12, 1.40), and all-cause death (HRadj. = 1.04; 95 CI = 1.02, 1.07). Adjusted path analyses indicated that stress, social cohesion, and access to mental health professionals significantly mediated the association between income inequality and mortality outcomes. CONCLUSION Income inequality is associated with deaths of despair and this relationship is mediated by stress, social cohesion, and access to mental health professionals. Findings should be applied to develop programs to address income inequality in Canada.
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Affiliation(s)
- Alexandra Loverock
- 3-300 Edmonton Clinic Health Academy, University of Alberta School of Public Health, 11405-87 Ave, Edmonton, Alberta, T6G 1C9, Canada; Faculty of Medicine & Dentistry, University of Alberta, Walter C. MacKenzie Health Sciences Centre Edmonton, Alberta, Canada T6G 2R7.
| | - Claire Benny
- 3-300 Edmonton Clinic Health Academy, University of Alberta School of Public Health, 11405-87 Ave, Edmonton, Alberta, T6G 1C9, Canada; 480 University Avenue, Suite 300, Public Health Ontario, Toronto, Ontario, M5G 1V2, Canada
| | - Brendan T Smith
- 480 University Avenue, Suite 300, Public Health Ontario, Toronto, Ontario, M5G 1V2, Canada; 155 College St, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada
| | - Arjumand Siddiqi
- 155 College St, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada; Department of Social and Behavioural Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Roman Pabayo
- 3-300 Edmonton Clinic Health Academy, University of Alberta School of Public Health, 11405-87 Ave, Edmonton, Alberta, T6G 1C9, Canada
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Worku F, Bennett F, Wheeler S, Siddiqi A, Papadakos J. Exploring the COVID-19 Knowledge, Attitudes, and Practices (KAPs) in the Black Community: a Scoping Review. J Racial Ethn Health Disparities 2024; 11:273-299. [PMID: 36757610 PMCID: PMC9910259 DOI: 10.1007/s40615-023-01518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION AND BACKGROUND Racial minorities have been the focal point of media coverage, attributing the disproportionate impact of COVID-19 to their individual actions; however, the ability to engage in preventative practices can also depend on one's social determinants of health. Individual actions can include knowledge, attitudes, and practices (KAPs). Since Black communities are among those disproportionately affected by COVID-19, this scoping review explores what is known about COVID-19 KAPs among Black populations. METHODS A comprehensive literature search was conducted in 2020 for articles written in English from the Medline, Embase, and PsycInfo databases. Reviews, experimental research, and observational studies were included if they investigated at least one of COVID-19 KAP in relation to the pandemic and Black communities in OECD peer countries including Canada, the United States, and the United Kingdom. RESULTS AND ANALYSIS Thirty-one articles were included for analysis, and all employed observational designs were from the United States. The following KAPs were examined: 6 (18.8%) knowledge, 21 (65.6%) attitudes, and 22 (68.8%) practices. Black communities demonstrated high levels of adherence to preventative measures (e.g., lockdowns) and practices (e.g., mask wearing), despite a strong proportion of participants believing they were less likely to become infected with the virus, and having lower levels of COVID-19 knowledge, than other racial groups. CONCLUSIONS AND IMPLICATIONS The findings from this review support that Black communities highly engage in COVID-19 preventative practices within their realm of control such as mask-wearing and hand washing and suggest that low knowledge does not predict low practice scores among this population.
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Affiliation(s)
- Fiqir Worku
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada.
| | - Falan Bennett
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah Wheeler
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Janet Papadakos
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Toronto, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, Canada
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Allen UD, Barton M, Upton J, Bailey A, Campigotto A, Abdulnoor M, Julien JP, Gubbay J, Kissoon N, Litosh A, La Neve MR, Wong P, Allen A, Bailey R, Byrne W, Jagoowani R, Phillips C, Merreles-Pulcini M, Polack A, Prescod C, Siddiqi A, Summers A, Thompson K, Thompson S, James C. Disproportionate Rates of COVID-19 Among Black Canadian Communities: Lessons from a Cross-Sectional Study in the First Year of the Pandemic. J Racial Ethn Health Disparities 2024:10.1007/s40615-023-01903-z. [PMID: 38253978 DOI: 10.1007/s40615-023-01903-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Racialized communities, including Black Canadians, have disproportionately higher COVID-19 cases. We examined the extent to which SARS-CoV-2 infection has affected the Black Canadian community and the factors associated with the infection. METHODS We conducted a cross-sectional survey in an area of Ontario (northwest Toronto/Peel Region) with a high proportion of Black residents along with 2 areas that have lower proportions of Black residents (Oakville and London, Ontario). SARS-CoV-2 IgG antibodies were determined using the EUROIMMUN assay. The study was conducted between August 15, 2020, and December 15, 2020. RESULTS Among 387 evaluable subjects, the majority, 273 (70.5%), were enrolled from northwest Toronto and adjoining suburban areas of Peel, Ontario. The seropositivity values for Oakville and London were comparable (3.3% (2/60; 95% CI 0.4-11.5) and 3.9% (2/51; 95% CI 0.5-13.5), respectively). Relative to these areas, the seropositivity was higher for the northwest Toronto/Peel area at 12.1% (33/273), relative risk (RR) 3.35 (1.22-9.25). Persons 19 years of age or less had the highest seropositivity (10/50; 20.0%, 95% CI 10.3-33.7%), RR 2.27 (1.23-3.59). There was a trend for an interaction effect between race and location of residence as this relates to the relative risk of seropositivity. INTERPRETATION During the early phases of the pandemic, the seropositivity within a COVID-19 high-prevalence zone was threefold greater than lower prevalence areas of Ontario. Black individuals were among those with the highest seroprevalence of SARS-CoV-2.
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Affiliation(s)
- Upton D Allen
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Michelle Barton
- Division of Infectious Diseases, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
| | - Julia Upton
- Division of Allergy and Immunology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Annette Bailey
- Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Aaron Campigotto
- Division of Microbiology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mariana Abdulnoor
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | | | | | - Niranjan Kissoon
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - Alice Litosh
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Maria-Rosa La Neve
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Peter Wong
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrew Allen
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Renee Bailey
- Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Walter Byrne
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Ranjeeta Jagoowani
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Chantal Phillips
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Manuela Merreles-Pulcini
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Alicia Polack
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Cheryl Prescod
- Black Creek Community Health Centre, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Kimberly Thompson
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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Benny C, Siddiqi A, Pabayo R. Income inequality and 'hospitalisations of despair' in Canada: a study on longitudinal, population-based data. J Epidemiol Community Health 2023; 78:33-39. [PMID: 37739771 DOI: 10.1136/jech-2023-220900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/08/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Rates of drug overdoses, alcohol-related liver disease and suicide attempts represent a major public health burden in Canada. While the existing literature does highlight some evidence of association between income inequality and mental health and deaths of despair, no existing research has investigated more intermediate events. As such, the objective of the current study is to investigate the association between income inequality and hospitalisations of despair over time. METHODS Data from the 2006 Canadian Census, the 2007/2008 Canadian Community Health Survey and the 2007-2018 Discharge Abstract Database were linked. Data were analysed using Cox proportional hazards modelling accounting for robust standard errors at the area level to investigate associations between income inequality at baseline and hazards for hospitalisations of despair, hospitalisations attributable to drug overdose, alcohol-related liver disease and suicide attempts, and all-cause hospitalisations, while controlling for sociodemographics characteristics (including income) and relevant area-level variables. RESULTS The results highlighted statistically significant associations between income inequality and hazard of hospitalisations of despair (HR 1.38, 95% CI 1.06 to 1.80), hospitalisations related to drug overdose (HR 1.51, 95% CI 1.07 to 2.13) and all-cause hospitalisations (HR 1.17, 95% CI 1.05 to 1.30). The association between income inequality and hospitalisations related to alcohol-related liver disease and suicide attempts/self-harm were not statistically significant. CONCLUSION Overall, the results showed evidence of associations between income inequality and hospitalisations of despair, drug overdose-related hospitalisations and all-cause hospitalisations. These findings are applicable to upstream policy discussion regarding reducing income inequality and identify potential points of intervention for prevention of drug overdose, alcohol-related liver disease and suicide attempts/self-harm.
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Affiliation(s)
- Claire Benny
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Gilbert KL, Shaw M, Siddiqi A, Goodman MS. Achieving the Health Equity Agenda Through Transformative Community-Engaged Strategies. Prev Chronic Dis 2023; 20:E99. [PMID: 37943729 PMCID: PMC10684278 DOI: 10.5888/pcd20.230077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Affiliation(s)
- Keon L Gilbert
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO 63104
- Brookings Institution, Washington, DC
| | - Mary Shaw
- Jackson State University, Department of Behavioral & Environmental Health, College of Health Sciences, Jackson, Mississippi
| | - Arjumand Siddiqi
- University of Toronto, Dalla Lana School of Public Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melody S Goodman
- New York University, School of Global Public Health, New York, New York
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Frank J, Mustard C, Smith P, Siddiqi A, Cheng Y, Burdorf A, Rugulies R. Work as a social determinant of health in high-income countries: past, present, and future. Lancet 2023; 402:1357-1367. [PMID: 37838441 DOI: 10.1016/s0140-6736(23)00871-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 01/17/2023] [Accepted: 04/27/2023] [Indexed: 10/16/2023]
Abstract
This paper, the first in a three-part Series on work and health, provides a narrative review of research into work as a social determinant of health over the past 25 years, the key emerging challenges in this field, and the implications of these challenges for future research. By use of a conceptual framework for work as a social determinant of health, we identified six emerging challenges: (1) the influence of technology on the nature of work in high-income countries, culminating in the sudden shift to telework during the COVID-19 pandemic; (2) the intersectionality of work with gender, sexual orientation, age, race, ethnicity, migrant status, and socioeconomic status as codeterminants of health disparities; (3) the arrival in many Organisation for Economic Co-operation and Development countries of large migrant labour workforces, who are often subject to adverse working conditions and social exclusion; (4) the development of precarious employment as a feature of many national labour markets; (5) the phenomenon of working long and irregular hours with potential health consequences; and (6) the looming threat of climate change's effects on work. We conclude that profound changes in the nature and availability of work over the past few decades have led to widespread new psychosocial and physical exposures that are associated with adverse health outcomes and contribute to increasing disparities in health. These new exposures at work will require novel and creative methods of data collection for monitoring of their potential health impacts to protect the workforce, and for new research into better means of occupational health promotion and protection. There is also an urgent need for a better integration of occupational health within public health, medicine, the life sciences, and the social sciences, with the work environment explicitly conceptualised as a major social determinant of health.
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Affiliation(s)
- John Frank
- Usher Institute, University of Edinburgh, Edinburgh, UK; Institute for Work & Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Cameron Mustard
- Institute for Work & Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Peter Smith
- Institute for Work & Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Yawen Cheng
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Alex Burdorf
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
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Louie P, Wu C, Shahidi FV, Siddiqi A. Inflation hardship, gender, and mental health. SSM Popul Health 2023; 23:101452. [PMID: 37691974 PMCID: PMC10492163 DOI: 10.1016/j.ssmph.2023.101452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 09/12/2023] Open
Abstract
Inflation hit a 40 year high in the United States in 2022, yet the impact of inflation related hardships on distress is poorly understood, particularly the impact on women, whose income is already more limited. Using data from the US Household Pulse Survey (September-November 2022), we test whether exposure to inflation hardships is associated with greater distress and whether this association is moderated by gender (n = 119,531). We draw on a list of eighteen inflation related hardships (e.g., purchasing less food, working additional jobs, delaying medical treatment) to construct an ordinal measure of exposure to inflation hardship ranging from "no inflation hardship" to "five or more inflation hardships." We observe that an increasing number of inflation hardships is associated with higher levels of distress. We find no evidence of gender differences in the magnitude of that association at lower levels of inflation hardship (four inflation hardships or less). However, our findings suggest that exposure to five or more inflation hardships is more strongly associated with distress among men compared to women. The current study provides new insights into the cumulative burden of inflation hardships on mental health and the role that gender plays in this association.
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Affiliation(s)
- Patricia Louie
- Department of Sociology, University of Washington, Seattle, WA, United States
| | - Cary Wu
- Department of Sociology, York University, Toronto, ON, Canada
| | | | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, Toronto, ON, Canada
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Arpin E, de Oliveira C, Siddiqi A, Laporte A. Beyond the mean: Distributional differences in earnings and mental health in young adulthood by childhood health histories. SSM Popul Health 2023; 23:101451. [PMID: 37434657 PMCID: PMC10331842 DOI: 10.1016/j.ssmph.2023.101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 07/13/2023] Open
Abstract
Research on the long-term effects of health in early life has predominantly relied on parametric methods to assess differences between groups of children. However, this approach leaves a wealth of distributional information untapped. The objective of this study was to assess distributional differences in earnings and mental health in young adulthood between individuals who suffered a chronic illness in childhood compared to those who did not using the non-parametric relative distributions framework. Using data from the Panel Study of Income Dynamics, we find that young adults who suffered a chronic illness in childhood fare worse in terms of earnings and mental health scores in adulthood, particularly for individuals reporting a childhood mental health/developmental disorder. Covariate decompositions suggest that chronic conditions in childhood may indirectly affect later outcomes through educational attainment: had the two groups had similar levels of educational attainment, the proportion of individuals with a report of a chronic condition in childhood in the lower decile of the relative earnings distribution would have been reduced by about 20 percentage points. Findings may inform policy aimed at mitigating longer run effects of health conditions in childhood and may generate hypotheses to be explored in parametric analyses.
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Affiliation(s)
- Emmanuelle Arpin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
- Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
- Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 1000 Queen Street West, Toronto, ON, M6J 1H4, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College St 6th Floor, Toronto, ON, M5T 3M6, Canada
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, Chapel Hill, NC, USA
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
- Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
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Jetha A, Navaratnerajah L, Shahidi FV, Carnide N, Biswas A, Yanar B, Siddiqi A. Racial and Ethnic Inequities in the Return-to-Work of Workers Experiencing Injury or Illness: A Systematic Review. J Occup Rehabil 2023; 33:432-449. [PMID: 37294368 PMCID: PMC10495511 DOI: 10.1007/s10926-023-10119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Non-White workers face more frequent, severe, and disabling occupational and non-occupational injuries and illnesses when compared to White workers. It is unclear whether the return-to-work (RTW) process following injury or illness differs according to race or ethnicity. OBJECTIVE To determine racial and ethnic differences in the RTW process of workers with an occupational or non-occupational injury or illness. METHODS A systematic review was conducted. Eight academic databases - Medline, Embase, PsycINFO, CINAHL, Sociological Abstracts, ASSIA, ABI Inform, and Econ lit - were searched. Titles/abstracts and full texts of articles were reviewed for eligibility; relevant articles were appraised for methodological quality. A best evidence synthesis was applied to determine key findings and generate recommendations based on an assessment of the quality, quantity, and consistency of evidence. RESULTS 15,289 articles were identified from which 19 studies met eligibility criteria and were appraised as medium-to-high methodological quality. Fifteen studies focused on workers with a non-occupational injury or illness and only four focused on workers with an occupational injury or illness. There was strong evidence indicating that non-White and racial/ethnic minority workers were less likely to RTW following a non-occupational injury or illness when compared to White or racial/ethnic majority workers. CONCLUSIONS Policy and programmatic attention should be directed towards addressing racism and discrimination faced by non-White and racial/ethnic minority workers in the RTW process. Our research also underscores the importance of enhancing the measurement and examination of race and ethnicity in the field of work disability management.
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Affiliation(s)
- Arif Jetha
- Institute for Work & Health, Suite 1800, 400 University Avenue, M5G 1S5, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Lahmea Navaratnerajah
- Institute for Work & Health, Suite 1800, 400 University Avenue, M5G 1S5, Toronto, ON, Canada
| | - Faraz Vahid Shahidi
- Institute for Work & Health, Suite 1800, 400 University Avenue, M5G 1S5, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nancy Carnide
- Institute for Work & Health, Suite 1800, 400 University Avenue, M5G 1S5, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Aviroop Biswas
- Institute for Work & Health, Suite 1800, 400 University Avenue, M5G 1S5, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Basak Yanar
- Institute for Work & Health, Suite 1800, 400 University Avenue, M5G 1S5, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Siddiqi A, Laporte A. Anti-Black Racism in the Canadian Healthcare System: A Reckoning. Healthc Pap 2023; 21:4-7. [PMID: 37887164 DOI: 10.12927/hcpap.2023.27197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Canada is often held out by scholars as the exception to a disheartening global pattern that suggests that high levels of racial diversity in a society are incompatible with support for generous social policies (Banting et al. 2006). The explanation for this pattern is that it is a real phenomenon (rather than an artefactual one) and it can be chalked up to racist motivations that cause powerful racial groups (whites and those non-white people who ally with whites) from endorsing policies that will benefit Black and other non-white groups (Alesina et al. 2001). One of the social policies that we are most often lauded for maintaining is the Canada Health Act (1985), which mandates that the vast majority of physician and hospital services are accessible free of charge. The prevailing discourse in Canada has been that the Canada Health Act (1985) ensures equal access to healthcare among all Canadians. In addition, polling data suggest that the vast majority of Canadians believe racism is a terrible thing (Bricker and Chhim 2020). However, cases such as that of Joyce Echaquan (Nerestant 2021) who died at a hospital in Saint-Charles-Borromée, QC, as nurses looked on and mocked and demeaned her with their words, or Leonard Rodriques (Allen 2020) who was turned away from an emergency room in Toronto during the COVID-19 pandemic and died shortly after, call into serious question the narratives of an egalitarian and benevolent system, in the context of a society that publicly endorses anti-racism.
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Affiliation(s)
- Arjumand Siddiqi
- Professor and Division Head of Epidemiology, Dalla Lana School of Public Health, Canada Research Chair in Population Health Equity, University of Toronto, Toronto, ON
| | - Audrey Laporte
- Director, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Arpin E, de Oliveira C, Siddiqi A, Laporte A. The "Long-arm" of chronic conditions in childhood: Evidence from Canada using linked survey-administrative data. Econ Hum Biol 2023; 50:101257. [PMID: 37348288 DOI: 10.1016/j.ehb.2023.101257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 06/24/2023]
Abstract
The objective of this study was to investigate the relationship between health conditions in childhood (ages 4-11), and health and socioeconomic outcomes in adulthood (ages 21-33). This study takes advantage of a new linkage between the National Longitudinal Survey of Children and Youth (NLSCY) and administrative tax data from the T1 Family File (T1FF) from Statistics Canada. The NLSCY includes rich longitudinal information on child development, while the T1FF includes administrative tax information on each child in adulthood (e.g., income, social assistance). The primary measures of child health relate to the diagnosis of a chronic condition, affecting the child's physical or mental/developmental health. The results suggest that mental/developmental health conditions in childhood more negatively influence adult health and socioeconomic conditions, compared to physical health conditions. Interaction models reveal modest heterogenous effects; for example, there is some evidence of a cushioning effect from higher household income in childhood, as well as an exacerbating negative effect from lower birth weight for mental/developmental health conditions. Using a covariate decomposition approach to explore underlying pathways, the results reveal that associations between health in early life and outcomes in adulthood are partially explained by differences in cognitive skills (i.e., mathematics test scores) in adolescence (ages 16-17). Results may encourage policy investments to mitigate the occurrence of health conditions in childhood and to ensure timely access to educational supports and health services for children with chronic conditions.
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Affiliation(s)
- Emmanuelle Arpin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada.
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Centre for Health Economics and Hull York Medical School, University of York, Heslington, York YO10 5DD, UK; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 1000 Queen Street West, Toronto, ON M6J 1H4, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College St 6th Floor, Toronto, ON M5T 3M6, Canada; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Canadian Center for Health Economics, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada
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Jairam JA, Vigod SN, Siddiqi A, Guan J, Boblitz A, Wang X, O'Campo P, Ray JG. Neighborhood Income Mobility and Risk of Neonatal and Maternal Morbidity. JAMA Netw Open 2023; 6:e2315301. [PMID: 37219900 DOI: 10.1001/jamanetworkopen.2023.15301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Importance Residing in a low-income neighborhood is generally associated with worse pregnancy outcomes. It is not known if moving from a low- to higher-income area between 2 pregnancies alters the risk of adverse birth outcomes in the subsequent birth compared with women who remain in low-income areas for both births. Objective To compare the risk of adverse maternal and newborn outcomes among women who achieved upward area-level income mobility vs those who did not. Design, Setting, and Participants This population-based cohort study was completed in Ontario, Canada, from 2002 to 2019, where there is universal health care. Included were all nulliparous women with a first-time singleton birth at 20 to 42 weeks' gestation, each residing in a low-income urban neighborhood at the time of the first birth. All women were then assessed at their second birth. Statistical analysis was conducted from August 2022 to April 2023. Exposure Movement from a lowest-income quintile (Q1) neighborhood to any higher-income quintile neighborhood (Q2-Q5) between the first and second birth. Main Outcomes and Measures The maternal outcome was severe maternal morbidity or mortality (SMM-M) at the second birth hospitalization or up to 42 days post partum. The primary perinatal outcome was severe neonatal morbidity or mortality (SNM-M) within 27 days of the second birth. Relative risks (aRR) and absolute risk differences (aARD) were estimated by adjusting for maternal and infant characteristics. Results A total of 42 208 (44.1%) women (mean [SD] age at second birth, 30.0 [5.2] years) experienced upward area-level income mobility, and 53 409 (55.9%) women (age at second birth, 29.0 [5.4] years) remained in income Q1 between births. Relative to women who remained in income Q1 between births, those with upward mobility had a lower associated risk of SMM-M (12.0 vs 13.3 per 1000 births), with an aRR of 0.86 (95% CI, 0.78 to 0.93) and aARD of -2.09 per 1000 (95% CI, -3.1 to -0.9 per 1000 ). Likewise, their newborns experienced lower respective rates of SNM-M (48.0 vs 50.9 per 1000 live births), with an aRR of 0.91 (95% CI, 0.87 to 0.95) and aARD of -4.7 per 1000 (95% CI, -6.8 to -2.6 per 1000). Conclusions and Relevance In this cohort study of nulliparous women living in low-income areas, those who moved to a higher-income area between births experienced less morbidity and death in their second pregnancy, as did their newborns, compared with those who remained in low-income areas between births. Research is needed to determine whether financial incentives or enhancement of neighborhood factors can reduce adverse maternal and perinatal outcomes.
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Affiliation(s)
- Jennifer A Jairam
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | - Patricia O'Campo
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Joel G Ray
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Keenan Research Centre, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada
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Jairam JA, Vigod SN, Siddiqi A, Guan J, Boblitz A, Wang X, O'Campo P, Ray JG. Morbidity and mortality of newborns born to immigrant and nonimmigrant females residing in low-income neighbourhoods. CMAJ 2023; 195:E537-E547. [PMID: 37068807 PMCID: PMC10110337 DOI: 10.1503/cmaj.221711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Living in low-income neighbourhoods and being an immigrant are each independently associated with adverse neonatal outcomes, but it is unknown if disparities exist in the neonatal period for children of immigrant and nonimmigrant females living in low-income areas. We sought to compare the risk of severe neonatal morbidity and mortality (SNMM) between newborns of immigrant and nonimmigrant mothers who resided in low-income neighbourhoods. METHODS This population-based cohort study used administrative data for females residing in low-income urban neighbourhoods in Ontario, who had an in-hospital, singleton live birth at 20-42 weeks' gestation, from 2002 to 2019. We defined immigrant status as nonrefugee immigrant or nonimmigrant, further detailed by country of birth and duration of residence in Ontario. The primary outcome was a SNMM composite (with 16 diagnoses, including neonatal death and 7 neonatal procedures as indicators), arising within 0-27 days after birth. We estimated relative risks (RRs) and 95% confidence intervals (CIs) using modified Poisson regression with generalized estimating equations. RESULTS Our cohort included 148 050 and 266 191 live births among immigrant and nonimmigrant mothers, respectively. Compared with newborns of non-immigrant females, SNMM was less frequent among newborns of immigrant females (49.7 v. 65.6 per 1000 live births), with an adjusted RR of 0.76 (95% CI 0.74 to 0.79). The most frequent SNMM indicator was receipt of ventilatory support. Relative to neonates of nonimmigrant females, the risk of SNMM was highest among those of immigrants from Jamaica (adjusted RR 1.14, 95% CI 1.05 to 1.23) and Ghana (adjusted RR 1.20, 95% CI 1.05 to 1.38), and lowest among those of immigrants from China (adjusted RR 0.44, 95% CI 0.40 to 0.48). Among immigrants, the risk of SNMM declined with shorter duration of residence before the index birth. INTERPRETATION Within low-income urban areas, newborns of immigrant females had an overall lower risk of SNMM than those of nonimmigrant females, with considerable variation by maternal birthplace and duration of residence. Initiatives should focus on improving preconception health and perinatal care within subgroups of females residing in low-income neighbourhoods.
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Affiliation(s)
- Jennifer A Jairam
- Division of Epidemiology (Jairam, Siddiqi, O'Campo), Dalla Lana School of Public Health, University of Toronto; MAP Centre for Urban Health Solutions (Jairam, O'Campo), St. Michael's Hospital; Women's College Hospital (Vigod); ICES Central (Vigod, Guan, Boblitz, Wang, Ray), Toronto, Ont.; Gillings School of Global Public Health (Siddiqi), University of North Carolina-Chapel Hill, Chapel Hill, NC; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital, Toronto, Ont
| | - Simone N Vigod
- Division of Epidemiology (Jairam, Siddiqi, O'Campo), Dalla Lana School of Public Health, University of Toronto; MAP Centre for Urban Health Solutions (Jairam, O'Campo), St. Michael's Hospital; Women's College Hospital (Vigod); ICES Central (Vigod, Guan, Boblitz, Wang, Ray), Toronto, Ont.; Gillings School of Global Public Health (Siddiqi), University of North Carolina-Chapel Hill, Chapel Hill, NC; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital, Toronto, Ont
| | - Arjumand Siddiqi
- Division of Epidemiology (Jairam, Siddiqi, O'Campo), Dalla Lana School of Public Health, University of Toronto; MAP Centre for Urban Health Solutions (Jairam, O'Campo), St. Michael's Hospital; Women's College Hospital (Vigod); ICES Central (Vigod, Guan, Boblitz, Wang, Ray), Toronto, Ont.; Gillings School of Global Public Health (Siddiqi), University of North Carolina-Chapel Hill, Chapel Hill, NC; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital, Toronto, Ont
| | - Jun Guan
- Division of Epidemiology (Jairam, Siddiqi, O'Campo), Dalla Lana School of Public Health, University of Toronto; MAP Centre for Urban Health Solutions (Jairam, O'Campo), St. Michael's Hospital; Women's College Hospital (Vigod); ICES Central (Vigod, Guan, Boblitz, Wang, Ray), Toronto, Ont.; Gillings School of Global Public Health (Siddiqi), University of North Carolina-Chapel Hill, Chapel Hill, NC; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital, Toronto, Ont
| | - Alexa Boblitz
- Division of Epidemiology (Jairam, Siddiqi, O'Campo), Dalla Lana School of Public Health, University of Toronto; MAP Centre for Urban Health Solutions (Jairam, O'Campo), St. Michael's Hospital; Women's College Hospital (Vigod); ICES Central (Vigod, Guan, Boblitz, Wang, Ray), Toronto, Ont.; Gillings School of Global Public Health (Siddiqi), University of North Carolina-Chapel Hill, Chapel Hill, NC; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital, Toronto, Ont
| | - Xuesong Wang
- Division of Epidemiology (Jairam, Siddiqi, O'Campo), Dalla Lana School of Public Health, University of Toronto; MAP Centre for Urban Health Solutions (Jairam, O'Campo), St. Michael's Hospital; Women's College Hospital (Vigod); ICES Central (Vigod, Guan, Boblitz, Wang, Ray), Toronto, Ont.; Gillings School of Global Public Health (Siddiqi), University of North Carolina-Chapel Hill, Chapel Hill, NC; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital, Toronto, Ont
| | - Patricia O'Campo
- Division of Epidemiology (Jairam, Siddiqi, O'Campo), Dalla Lana School of Public Health, University of Toronto; MAP Centre for Urban Health Solutions (Jairam, O'Campo), St. Michael's Hospital; Women's College Hospital (Vigod); ICES Central (Vigod, Guan, Boblitz, Wang, Ray), Toronto, Ont.; Gillings School of Global Public Health (Siddiqi), University of North Carolina-Chapel Hill, Chapel Hill, NC; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital, Toronto, Ont
| | - Joel G Ray
- Division of Epidemiology (Jairam, Siddiqi, O'Campo), Dalla Lana School of Public Health, University of Toronto; MAP Centre for Urban Health Solutions (Jairam, O'Campo), St. Michael's Hospital; Women's College Hospital (Vigod); ICES Central (Vigod, Guan, Boblitz, Wang, Ray), Toronto, Ont.; Gillings School of Global Public Health (Siddiqi), University of North Carolina-Chapel Hill, Chapel Hill, NC; Department of Obstetrics and Gynaecology (Ray), St. Michael's Hospital, Toronto, Ont.
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Jairam JA, Vigod SN, Siddiqi A, Guan J, Boblitz A, Wang X, O’Campo P, Ray JG. Severe Maternal Morbidity and Mortality Among Immigrant and Canadian-Born Women Residing Within Low-Income Neighborhoods in Ontario, Canada. JAMA Netw Open 2023; 6:e2256203. [PMID: 36795412 PMCID: PMC9936351 DOI: 10.1001/jamanetworkopen.2022.56203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
IMPORTANCE Evidence indicates that immigrant women and women residing within low-income neighborhoods experience higher adversity during pregnancy. Little is known about the comparative risk of severe maternal morbidity or mortality (SMM-M) among immigrant vs nonimmigrant women living in low-income areas. OBJECTIVE To compare the risk of SMM-M between immigrant and nonimmigrant women residing exclusively within low-income neighborhoods in Ontario, Canada. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used administrative data for Ontario, Canada, from April 1, 2002, to December 31, 2019. Included were all 414 337 hospital-based singleton live births and stillbirths occurring between 20 and 42 weeks' gestation, solely among women residing in an urban neighborhood of the lowest income quintile; all women were receiving universal health care insurance. Statistical analysis was performed from December 2021 to March 2022. EXPOSURES Nonrefugee immigrant status vs nonimmigrant status. MAIN OUTCOMES AND MEASURES The primary outcome, SMM-M, was a composite outcome of potentially life-threatening complications or mortality occurring within 42 days of the index birth hospitalization. A secondary outcome was SMM severity, approximated by the number of SMM indicators (0, 1, 2 or ≥3 indicators). Relative risks (RRs), absolute risk differences (ARDs), and odds ratios (ORs) were adjusted for maternal age and parity. RESULTS The cohort included 148 085 births to immigrant women (mean [SD] age at index birth, 30.6 [5.2] years) and 266 252 births to nonimmigrant women (mean [SD] age at index birth, 27.9 [5.9] years). Most immigrant women originated from South Asia (52 447 [35.4%]) and the East Asia and Pacific (35 280 [23.8%]) regions. The most frequent SMM indicators were postpartum hemorrhage with red blood cell transfusion, intensive care unit admission, and puerperal sepsis. The rate of SMM-M was lower among immigrant women (2459 of 148 085 [16.6 per 1000 births]) than nonimmigrant women (4563 of 266 252 [17.1 per 1000 births]), equivalent to an adjusted RR of 0.92 (95% CI, 0.88-0.97) and an adjusted ARD of -1.5 per 1000 births (95% CI, -2.3 to -0.7). Comparing immigrant vs nonimmigrant women, the adjusted OR of having 1 SMM indicator was 0.92 (95% CI, 0.87-0.98), the adjusted OR of having 2 indicators was 0.86 (95% CI, 0.76-0.98), and the adjusted OR of having 3 or more indicators was 1.02 (95% CI, 0.87-1.19). CONCLUSIONS AND RELEVANCE This study suggests that, among universally insured women residing in low-income urban areas, immigrant women have a slightly lower associated risk of SMM-M than their nonimmigrant counterparts. Efforts aimed at improving pregnancy care should focus on all women residing in low-income neighborhoods.
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Affiliation(s)
- Jennifer A. Jairam
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Simone N. Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Women’s College Hospital, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill
| | | | | | | | - Patricia O’Campo
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Joel G. Ray
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Keenan Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St Michael’s Hospital, Toronto, Ontario, Canada
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Efird CR, Bennett F, Metzl JM, Siddiqi A. Perceived status threat and health among White Americans: A scoping review. SSM Popul Health 2022; 21:101326. [PMID: 36605332 PMCID: PMC9803373 DOI: 10.1016/j.ssmph.2022.101326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 01/01/2023] Open
Abstract
Previous research on pre-COVID-19 pandemic rising White mortality in the United States suggests that White Americans' perceived decline in relative group status may have influenced worsening mortality. In conjunction with other social and economic indicators, social status threat is one determinant of this population-level health shift, yet it is unclear how perceptions of status threat shape individual health outcomes. Because of this, we sought to identify and synthesize research studies across disciplines that broadly explored how perceived threats to White Americans' social status affect their health. Our research objectives were to (1) examine how status threat (and related constructs) have been measured across the health and social sciences, (2) determine which health outcomes and behaviors are related to status threat, and (3) identify gaps in the existing knowledge base. We systematically searched six multidisciplinary databases. Only 12 studies met inclusion criteria, suggesting that status threat and Whites' health is an understudied topic that warrants continued investigation. Furthermore, there was inconsistency in how threats to status were measured and conceptualized across disciplines. Threat-related indicators evaluated changes in Democratic or Republican vote share, perceived racial treatment, financial status, personal identification with political party affiliation, perceptions of hypothetical "majority-minority" population shifts, racial awareness, and subjective social status. Studies primarily relied on self-rated measures of overall health, mental health status, and social determinants of health. Consequently, there is a gap in the literature concerning which specific health outcomes (besides mortality) are directly affected by status threat. Overall, included studies demonstrated that Whites' can experience negative health effects when they perceive threats in societal conditions, within their interpersonal social experiences, or related to their individual social standing. Moving forward, researchers should consider how Whites' beliefs about their position within social hierarchies potentially affect individual and group-level health outcomes.
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Affiliation(s)
- Caroline R. Efird
- Racial Justice Institute, Georgetown University, Washington, DC, USA,Corresponding author. Racial Justice Institute, Georgetown University, 225 Intercultural Center, 3700 O Street N.W., Washington, DC, 20057 USA.
| | - Falan Bennett
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jonathan M. Metzl
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, USA
| | - Arjumand Siddiqi
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Blair A, Siddiqi A. The social determinants of substance use associated with deaths of despair: Individual risks and population impacts. Prev Med 2022; 164:107327. [PMID: 36334684 DOI: 10.1016/j.ypmed.2022.107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 10/03/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022]
Abstract
As the incidence of deaths from external causes including poisonings, suicide, and alcohol-related liver disease, increases in countries such as the United States and Canada, a better understanding of the fundamental social determinants of the substance use underlying these so-called "deaths of despair", at the population level, is needed. Using data from the nationally representative data from the Canadian Community Health Survey (2003, 2015-2016, 2018 cycles) (N = 30,729), the independent associations between age, sex, marital status, immigrant status, race/ethnicity, education, income, rurality, affective health and the use of illicit substances, opioids (without distinction for prescription status), problematic levels of alcohol, and combined past-year use (≥2) of substances, were explored using multivariate logistic regression, marginal risk, and population attributable fraction estimation, with propensity score-adjusted sensitivity analyses. Males, those who were under 29 years, without a partner, born in Canada, White, or had an affective disorder reported both higher use of individual substances and multiple substances in the past year. Social determinants appear to explain a substantial proportion of substance use patterns overall. Between 10% and 45% of illicit substance, problematic alcohol, and polysubstance use prevalence was attributable to non-partnered marital status, non-immigrant status, and White race/ethnicity. Of opioid use prevalence, 25% was attributable to White race/ethnicity, 13% to affective disorder status and 4% to lower-income. Though not all substance use will result in substance-related morbidity or mortality, these findings highlight the role of social determinants in shaping the intermediary behavioural outcomes that shape population-level risk of "deaths of despair".
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Affiliation(s)
- Alexandra Blair
- University of Toronto Dalla Lana School of Public Health, 155 College Street, Toronto, Ontario M5T 3M7, Canada.
| | - Arjumand Siddiqi
- University of Toronto Dalla Lana School of Public Health, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, USA
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Amri M, O’Campo P, Enright T, Siddiqi A, Di Ruggiero E, Bump JB. Probing key informants’ views of health equity within the World Health Organization’s Urban HEART initiative. BMC Public Health 2022; 22:1989. [PMID: 36316679 PMCID: PMC9620663 DOI: 10.1186/s12889-022-14395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
To date, no studies have assessed how those involved in the World Health Organization’s (WHO) work understand the concept of health equity. To fill the gap, this research poses the question, “how do Urban Health Equity Assessment and Response Tool (Urban HEART) key informants understand the concept of health equity?”, with Urban HEART being selected given the focus on health equity. To answer this question, this study undertakes synchronous electronic interviews with key informants to assess how they understand health equity within the context of Urban HEART. Key findings demonstrate that: (i) equity is seen as a core value and inequities were understood to be avoidable, systematic, unnecessary, and unfair; (ii) there was a questionable acceptance of need to act, given that political sensitivity arose around acknowledging inequities as “unnecessary”; (iii) despite this broader understanding of the key aspects of health inequity, the concept of health equity was seen as vague; (iv) the recognized vagueness inherent in the concept of health equity may be due to various factors including country differences; (v) how the terms “health inequity” and “health inequality” were used varied drastically; and (vi) when speaking about equity, a wide range of aspects emerged. Moving forward, it would be important to establish a shared understanding across key terms and seek clarification, prior to any global health initiatives, whether explicitly focused on health equity or not.
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Affiliation(s)
- Michelle Amri
- grid.38142.3c000000041936754XTakemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Bldg. 1, 02115-6021 Boston, MA United States of America ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada
| | - Patricia O’Campo
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada ,grid.415502.7Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, M5B 1T8 Toronto, ON Canada
| | - Theresa Enright
- grid.17063.330000 0001 2157 2938Department of Political Science, University of Toronto, 100 St George Street, M5S 3G3 Toronto, ON Canada
| | - Arjumand Siddiqi
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada ,grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, USA
| | - Erica Di Ruggiero
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada
| | - Jesse Boardman Bump
- grid.38142.3c000000041936754XTakemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Bldg. 1, 02115-6021 Boston, MA United States of America ,grid.7914.b0000 0004 1936 7443Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway
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Blair A, Siddiqi A. Social determinants of ethno-racial inequalities in substance use: a decomposition of national survey data. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2013-2022. [PMID: 35482051 DOI: 10.1007/s00127-022-02281-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/31/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Similar to the US, mortality due to suicide and the use of opioids, alcohol, and other substances (so-called "Deaths of Despair"), is rising in Canada and has been disproportionately observed among Whites compared to other racial and ethnic groups. This study aimed to assess the determinants of the ethno-racial differences in the use of substances that underlie these deaths. METHODS Using nationally representative data from the Canadian Community Health Survey (2003, 2015-2016, 2018 cycles), a decomposition analysis was performed to estimate the contribution of psychosocial determinants, including age, sex, marital status, immigration, education, income, rurality, and affective health on inequalities between White and non-White populations in illicit substance, opioid, and problematic alcohol use and combined use (≥ 2) of substances. RESULTS Overall, White respondents reported higher levels (by 5% to 10%) of substance use than non-White peers. Over 30% of the ethno-racial inequalities in illicit substance, problematic alcohol, and polysubstance use are explained by the protective role of immigration among those who are not White, whose low levels of substance use lower the prevalence in the non-White population overall. Among those born in Canada, no ethno-racial differences in substance use were observed. CONCLUSION Social determinants, particularly immigrant status, explain a substantial proportion of ethno-racial inequalities in substance use in Canada. The jump in substance use between racialized populations who immigrated to Canada and those Canadian-born highlights the importance of exploring within-group variability in deaths of despair risk and considering how intersecting forces including systemic racism shape substance use patterns across generations.
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Affiliation(s)
- Alexandra Blair
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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19
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Zajacova A, Siddiqi A. A comparison of health and socioeconomic gradients in health between the United States and Canada. Soc Sci Med 2022; 306:115099. [PMID: 35779499 PMCID: PMC9383268 DOI: 10.1016/j.socscimed.2022.115099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
Abstract
Data from the early 2000s indicated worse overall health and larger socioeconomic (SES) health inequalities in the U.S. than in Canada. Yet, sociopolitical contexts, health levels, and SES-health inequalities have changed in both countries during the intervening two decades. Drawing on new data, we update the comparison of health levels and SES-health gradients between the two countries. Analyses, focused on self-rated health, are based on two complementary sets of data sources: Resilience and Recovery (RR) data, a harmonized U.S.-Canada survey of social conditions collected in 2020 (N = 3743); and a pair of leading nationally representative health data sources from each country: the National Health Interview Surveys (NHIS, N = 104,027) and the Canadian Community Health Survey (CCHS, N = 97,605), both collected in 2017-2018. Health levels and disparities, net of demographic and socioeconomic covariates, were estimated using modified Poisson models for relative comparisons; descriptives and predicted levels of fair/poor health show the comparisons from absolute perspective. Both data sources show that U.S. adults continue to have significantly worse health than Canadians; the disadvantage may be due to SES differences between the two populations. However, the two data sources yield conflicting findings on SES-health inequalities: the RR data indicate no difference between the two countries in socioeconomic health gradients, while the NHIS/CCHS data show a significantly steeper gradient in the U.S. than in Canada for both education and income. Canadian adults continue to report better health than their U.S. peers, but it is unclear whether health inequalities remain smaller as well. We discuss potential reasons for the conflicting findings and call for a large new cross-national data collection, which will enable scholars and policymakers to better understand health and wellbeing in the U.S. and Canadian contexts.
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Affiliation(s)
- Anna Zajacova
- 5330 Social Science Centre, University of Western Ontario, London, ON, N6A 5C2, Canada.
| | - Arjumand Siddiqi
- University of Toronto, Dalla Lana School of Public Health, Toronto, ON, Canada
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20
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Dunn JR, Park GR, Brydon R, Wolfson M, Veall M, Rolheiser L, Siddiqi A, Ross NA. Income inequality and population health: a political-economic research agenda. J Epidemiol Community Health 2022; 76:jech-2022-219252. [PMID: 35676074 DOI: 10.1136/jech-2022-219252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/28/2022] [Indexed: 11/03/2022]
Abstract
There is more than 30 years of research on relationships between income inequality and population health. In this article, we propose a research agenda with five recommendations for future research to refine existing knowledge and examine new questions. First, we recommend that future research prioritise analyses with broader time horizons, exploring multiple temporal aspects of the relationship. Second, we recommend expanding research on the effect of public expenditures on the inequality-health relationship. Third, we introduce a new area of inquiry focused on interactions between social mobility, income inequality and population health. Fourth, we argue the need to examine new perspectives on 21st century capitalism, specifically the population health impacts of inequality in income from capital (especially housing), in contrast to inequality in income from labour. Finally, we propose that this research broaden beyond all-cause mortality, to cause-specific mortality, avoidable mortality and subcategories thereof. We believe that such a research agenda is important for policy to respond to the changes following the COVID-19 pandemic.
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Affiliation(s)
- James R Dunn
- Department of Health, Aging and Society, McMaster University Faculty of Social Sciences, Hamilton, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Gum-Ryeong Park
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada
- Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, Republic of Korea
| | - Robbie Brydon
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada
| | - Michael Wolfson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Veall
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Lyndsey Rolheiser
- Center for Real Estate and Urban Economic Studies, University of Connecticut School of Business, Storrs, Connecticut, USA
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nancy A Ross
- Department of Geography, McGill University, Montreal, Quebec, Canada
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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21
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Fuller AE, Zaffar N, Cohen E, Pentland M, Siddiqi A, Vandermorris A, Van Den Heuvel M, Birken CS, Guttmann A, de Oliveira C. Cash transfer programs and child health and family economic outcomes: a systematic review. Can J Public Health 2022; 113:433-445. [PMID: 35088347 PMCID: PMC8794041 DOI: 10.17269/s41997-022-00610-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
Objectives Family income is an important determinant of child and parental health. In Canada, cash transfer programs to families with children have existed since 1945. This systematic review aimed to examine the association between cash transfer programs to families with children and health outcomes in Canadian children (ages 0 to 18) as well as family economic outcomes. Methods We reviewed academic and grey literature published up to November 2021. Additional studies were identified through reference review. We included any study that examined children 0–18 years old and/or their parents, took place in Canada and reported Canada-specific data, and reported child, youth and/or parental health outcomes, as well as family economic outcomes. Risk of bias was assessed by two reviewers using a modified Newcastle-Ottawa Scale. Synthesis Our search yielded 23 studies meeting the inclusion criteria out of 7052 identified. Eight studies in total measured child health outcomes, including birth outcomes, child overall health, and developmental and behavioural outcomes, and four directly addressed parental health, including mental health, injuries, and obesity. Most studies reported generally positive associations, though some findings were specific to certain subgroups. Some studies also examined fertility and labour force participation outcomes, which described varying effects. Conclusion Cash transfer programs to families with children in Canada are associated with better child and parental health outcomes. Additional research is needed to evaluate the mechanisms of effects, and to identify which types and levels of government transfers are most effective, and target populations, to optimize the positive effects of these benefits. Supplementary Information The online version contains supplementary material available at 10.17269/s41997-022-00610-2.
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Affiliation(s)
- Anne E Fuller
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
- Department of Health Research Methods, Evidence and Impact, McMaster University, Toronto, Ontario, Canada.
| | - Nusrat Zaffar
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ashley Vandermorris
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meta Van Den Heuvel
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- ICES, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Health Economics and Hull York Medical School, University of York, York, UK
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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22
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Abstract
We will likely look back on 2020 as a turning point. The pandemic put a spotlight on existing societal issues, accelerated the pace of change in others, and created some new ones too. For example, concerns about inequalities in health by income and race are not new, but they became more apparent to a larger number of people during 2020. The speed and starkness of broadening societal conversation, including beyond the direct effects of COVID-19, create an opportunity and motivation to reassess our understanding of health. Perhaps more importantly, it is an opportunity to reduce inequities in who has access to, who uses, and who benefits from the resources that promote health and well-being. To this end, we offer three questions to guide thinking about health and health inequities after 2020: (1) what do we mean by "health" and "health inequality and inequity"? (2) what are the structures and policies we put in place to support or promote health, and how effective are they? And (3) who has the power to shape structures and policies, and whose interests do those structures and policies serve?
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Affiliation(s)
- Kimberlyn McGrail
- Centre for Health Services and Policy Research, UBC Health, The University of British Columbia, Vancouver, Canada
| | - Jeffrey Morgan
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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23
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Gilman SE, Aiello A, Galea S, Howe CJ, Kawachi I, Lovasi GS, Dean LT, Oakes JM, Siddiqi A, Glymour MM. Advancing the Social Epidemiology Mission of the American Journal of Epidemiology. Am J Epidemiol 2022; 191:557-560. [PMID: 34791025 DOI: 10.1093/aje/kwab277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/15/2021] [Accepted: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
Social epidemiology is concerned with how social forces influence population health. Rather than focusing on a single disease (as in cancer or cardiovascular epidemiology) or a single type of exposure (e.g., nutritional epidemiology), social epidemiology encompasses all the social and economic determinants of health, both historical and contemporary. These include features of social and physical environments, the network of relationships in a society, and the institutions, politics, policies, norms and cultures that shape all of these forces. This commentary presents the perspective of several editors at the Journal with expertise in social epidemiology. We articulate our thinking to encourage submissions to the Journal that: 1) expand knowledge of emerging and underresearched social determinants of population health; 2) advance new empirical evidence on the determinants of health inequities and solutions to advance health equity; 3) generate evidence to inform the translation of research on social determinants of health into public health impact; 4) contribute to innovation in methods to improve the rigor and relevance of social epidemiology; and 5) encourage critical self-reflection on the direction, challenges, successes, and failures of the field.
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24
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Sergeant A, Saha S, Lalwani A, Sergeant A, McNair A, Larrazabal E, Yang K, Bogler O, Dhoot A, Werb D, Maghsoudi N, Richardson L, Hawker G, Siddiqi A, Verma A, Razak F. Diversity among health care leaders in Canada: a cross-sectional study of perceived gender and race. CMAJ 2022; 194:E371-E377. [PMID: 35288408 PMCID: PMC8920524 DOI: 10.1503/cmaj.211340] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diverse health care leadership teams may improve health care experiences and outcomes for patients. We sought to explore the race and gender of hospital and health ministry executives in Canada and compare their diversity with that of the populations they serve. METHODS This cross-sectional study included leaders of Canada's largest hospitals and all provincial and territorial health ministries. We included individuals listed on institutional websites as part of the leadership team if a name and photo were available. Six reviewers coded and analyzed the perceived race and gender of leaders, in duplicate. We compared the proportion of racialized health care leaders with the race demographics of the general population from the 2016 Canadian Census. RESULTS We included 3056 leaders from 135 institutions, with reviewer concordance on gender for 3022 leaders and on race for 2946 leaders. Reviewers perceived 37 (47.4%) of 78 health ministry leaders as women, and fewer than 5 (< 7%) of 80 as racialized. In Alberta, Saskatchewan, Prince Edward Island and Nova Scotia, provinces with a centralized hospital executive team, reviewers coded 36 (50.0%) of 72 leaders as women and 5 (7.1%) of 70 as racialized. In British Columbia, New Brunswick and Newfoundland and Labrador, provinces with hospital leadership by region, reviewers perceived 120 (56.1%) of 214 leaders as women and 24 (11.5%) of 209 as racialized. In Manitoba, Ontario and Quebec, where leadership teams exist at each hospital, reviewers perceived 1326 (49.9%) of 2658 leaders as women and 243 (9.2%) of 2633 as racialized. We calculated the representation gap between racialized executives and the racialized population as 14.5% for British Columbia, 27.5% for Manitoba, 20.7% for Ontario, 12.4% for Quebec, 7.6% for New Brunswick, 7.3% for Prince Edward Island and 11.6% for Newfoundland and Labrador. INTERPRETATION In a study of more than 3000 health care leaders in Canada, gender parity was present, but racialized executives were substantially under-represented. This work should prompt health care institutions to increase racial diversity in leadership.
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Affiliation(s)
- Anjali Sergeant
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Sudipta Saha
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Anushka Lalwani
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Anand Sergeant
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Avery McNair
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Elias Larrazabal
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Kelsey Yang
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Orly Bogler
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Arti Dhoot
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Dan Werb
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Nazlee Maghsoudi
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Lisa Richardson
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Gillian Hawker
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Arjumand Siddiqi
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Amol Verma
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Fahad Razak
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont.
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Tian J, Lim JJJ, Moh FKC, Siddiqi A, Zachar J, Zafar S. Parental and training coaches' knowledge and attitude towards dental trauma management of children. Aust Dent J 2022; 67 Suppl 1:S31-S40. [PMID: 35510930 PMCID: PMC9790494 DOI: 10.1111/adj.12913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study was to evaluate parental and training coaches' knowledge and attitude towards traumatic dental injuries (TDIs) among children. MATERIAL AND METHODS A 31-item questionnaire was distributed to the parents and training coaches attending local sporting clubs in Brisbane region, Australia. The questionnaire consisted of five parts (i) demographic and professional information; (ii) TDIs in the primary dentition; (iii) fractures and subluxation of permanent teeth (iv) avulsion of permanent teeth, and (v) information and knowledge related to the management of traumatized teeth. The jamovi (Version 1.6.3) and GraphPad Prism were used for data analysis. RESULTS A total of 233 participants were surveyed, 211 parents and 22 coaches. Of all types of injuries, parental knowledge of managing avulsion to permanent teeth was poorest (9.5%), followed by management of injuries of primary teeth (17.5%) and management of fractures or subluxation of permanent teeth (29.4%). Parents in health care occupations had higher satisfaction on self-knowledge in managing TDIs however there was no significant difference in knowledge levels between health care personnel and other professions (P = 0.128). There was a discrepancy between the lack of knowledge and willingness to further self-educate with online platforms being the preferred medium. CONCLUSION The study showed a gap in parents' and training coaches' knowledge regarding the management of TDIs among children.
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Affiliation(s)
- J Tian
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
| | - JJJ Lim
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
| | - FKC Moh
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
| | - A Siddiqi
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia,School of Dentistry and Oral HealthGriffith UniversitySouthportQueenslandAustralia
| | - J Zachar
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
| | - S Zafar
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
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Lee-Foon NK, Logie CH, Siddiqi A, Grace D. Exploring young Black gay, bisexual and other men who have sex with men's PrEP knowledge in Toronto, Ontario, Canada. Cult Health Sex 2022; 24:301-314. [PMID: 33196378 DOI: 10.1080/13691058.2020.1837958] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
Despite significant advances in the HIV treatment and prevention landscape such as pre-exposure prophylaxis (PrEP), young Black-Canadian gay, bisexual and other sexual minority men continue to experience disproportionately high rates of HIV infection. While research has explored the factors associated with their higher HIV exposure and the efficacy of STI/HIV prevention programmes, there remains a paucity of research on their knowledge of HIV prevention strategies such as PrEP. We interviewed twenty-two young men and used a constructivist grounded theory approach to qualitatively analyse these young men's PrEP knowledge. Intersectionality and the social ecological model allowed us to explore how social locations (e.g. race, sexual orientation), interacted with individual, interpersonal and community contexts to shape their understanding. Our analysis revealed two interrelated barriers to PrEP knowledge and uptake. The first centred on the ineffectiveness of institutions in disseminating PrEP information to participants. The second focused on the impact of participants' social locations and perceptions of PrEP users based on their PrEP knowledge. Findings suggest the need for more targeted, culturally congruent PrEP dissemination strategies and PrEP prescription policies that acknowledge the various social locations and ecologies in which young Black gay, bisexual and other men who have sex with men reside.
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Affiliation(s)
- Nakia K Lee-Foon
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, Factor Inwentash School of Social Work University of Toronto, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Fuller A, Siddiqi A, Shahidi FV, Anderson LN, Hildebrand V, Keown-Stoneman CDG, Maguire JL, Birken C. Understanding income-related differences in distribution of child growth, behaviour and development using a cross-sectional sample of a clinical cohort study. BMJ Open 2022; 12:e056991. [PMID: 35168982 PMCID: PMC8852748 DOI: 10.1136/bmjopen-2021-056991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Children from low-income households are at an increased risk of social, behavioural and physical health problems. Prior studies have generally relied on dichotomous outcome measures. However, inequities may exist along the range of outcome distribution. Our objective was to examine differences in distribution of three child health outcomes by income categories (high vs low): body mass index (BMI), behaviour difficulties and development. DESIGN AND SETTING This was a cross-sectional study using data from a primary care-based research network with sites in three Canadian cities, and 15 practices enrolling participants. PARTICIPANTS, INDEPENDENT VARIABLE AND OUTCOMES The independent variable was annual household income, dichotomised at the median income for Toronto (<$C80 000 or ≥$C80 000). Outcomes were: (1) growth (BMI z-score (zBMI) at 5 years, 1628 participants); (2) behaviour (Strengths and Difficulties Questionnaire (SDQ) at 3-5 years, 649 participants); (3) development (Infant Toddler Checklist (ITC) at 18 months, 1405 participants). We used distributional decomposition to compare distributions of these outcomes for each income group, and then to construct a counterfactual distribution that describes the hypothetical distribution of the low-income group with the predictor profile of the higher-income group. RESULTS We included data from 1628 (zBMI), 649 (SDQ) and 1405 (ITC) children. Children with lower family income had a higher risk distribution for all outcomes. For all outcomes, thecounterfactual distribution, which represented the distribution of children with lower-income who were assigned the predictor profile of the higher-income group, was more favourable than their observed distributions. CONCLUSION Comparing the distributions of child health outcomes and understanding different risk profiles for children from higher-income and lower-income groups can offer a deeper understanding of inequities in child health outcomes. These methods may offer an approach that can be implemented in larger datasets to inform future interventions.
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Affiliation(s)
- Anne Fuller
- Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Faraz V Shahidi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Work and Health, Toronto, Ontario, Canada
| | - Laura N Anderson
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Vincent Hildebrand
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Economics, York University - Glendon Campus, Toronto, Ontario, Canada
| | - Charles D G Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Paediatrics, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Birken
- Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
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Laporte A, Siddiqi A. Rethinking Long-Term Care. Healthc Pap 2021; 20:4-7. [PMID: 34792454 DOI: 10.12927/hcpap.2021.26647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Across Canada, the long-term care sector has received increased attention since the devastating impact of the COVID-19 pandemic. The now often-cited statistic - 80% of deaths in the first wave occurred among individuals residing in institutional long-term care - is tragic enough and is only compounded by the fact that the number of deaths in long-term care were still higher in the second wave in all but two provinces. Many have argued that the impact of the pandemic was amplified in the institutional long-term care sector because of a number of long-standing shortfalls in funding, space, staffing and infrastructure. For example, Canadian provinces had lower average direct hours of care (three hours per day) provided to residents in long-term care facilities than even the average of four hours per day provided in the United States (Hsu et al. 2016).
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Affiliation(s)
- Audrey Laporte
- Director, Institute for Health Policy, Measurement and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Arjumand Siddiqi
- Professor, Division Head of Epidemiology, Dalla Lana School of Public Health, Canada Research Chair in, Population Health Equity, University of Toronto, Toronto, ON
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Blair A, Parnia A, Shahidi FV, Siddiqi A. Social inequalities in protective behaviour uptake at the start of the COVID-19 pandemic: results from a national survey. Can J Public Health 2021; 112:818-830. [PMID: 34410654 PMCID: PMC8375287 DOI: 10.17269/s41997-021-00553-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/09/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We aimed to assess social patterns of handwashing, social distancing, and working from home at the start of the COVID-19 pandemic in Canada, and determine what proportions of the overall prevalence and social inequalities in handwashing and social distancing are related to inequalities in the opportunity to work from home, to guide pandemic preparedness and response. METHODS Using cross-sectional data from the Canadian Perspectives Survey Series, collected between March 29 and April 3, 2020, among Canadian adults (N=4455), we assessed prevalence of not working from home, social distancing in public, or practicing frequent handwashing, according to age, sex, marital status, immigration, education, chronic disease presence, and source of COVID-19 information. Multivariate regression, population attributable fraction estimation, and generalized product mediation analysis were applied. RESULTS Absence of frequent handwashing and distancing was more common among those working outside than within the home (prevalence differences of 7% (95% CI: 4, 10) and 7% (95% CI: 3, 10), respectively). Inequalities in handwashing and distancing were observed across education and immigration status. Over 40% of the prevalence of non-uptake of handwashing and distancing was attributable to populations not being able to work from home. If all worked from home, over 40% (95% CI: 8, 70) of education-based inequalities in handwashing and distancing could be eliminated, but differences by immigration status would likely remain. CONCLUSION For pandemic response, both workplace safety initiatives and mechanisms to address the inequitable distribution of health risks across socio-economic groups are needed to reduce broader inequalities in transmission risk.
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Affiliation(s)
- Alexandra Blair
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
| | - Abtin Parnia
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | | | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Louie P, Upenieks L, Siddiqi A, Williams DR, Takeuchi DT. Race, Flourishing, and All-Cause Mortality in the United States, 1995-2016. Am J Epidemiol 2021; 190:1735-1743. [PMID: 33728457 DOI: 10.1093/aje/kwab067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/12/2022] Open
Abstract
We assessed whether race moderates the association between flourishing and all-cause mortality. We used panel data from the Midlife in the United States Study (MIDUS) (1995-2016; n = 2,851). Approximately 19% of White respondents and 23% of Black respondents in the baseline sample died over the course of the 21-year study period (n = 564). Cox proportional hazard models showed that Blacks had a higher mortality rate relative to Whites and higher levels of flourishing were associated with a lower mortality rate. Furthermore, a significant interaction between flourishing and race in predicting death was observed. Blacks with higher levels of flourishing had a mortality rate that was not significantly different from that of Whites. However, Blacks, but not Whites, with low flourishing scores had a higher mortality rate. As such, health-promotion efforts focused on enhancing flourishing among Black populations may reduce the Black-White gap in mortalityrate.
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Affiliation(s)
- Geetanjali Datta
- Department of Social and Preventive Medicine (Datta), Université de Montréal; Health Innovation and Evaluation Hub (Datta), CRCHUM, Montréal, Que.; Department of Medicine (Datta), Cedars-Sinai Medical Center, Los Angeles, United States; Dalla Lana School of Public Health (Siddiqi), University of Toronto; Hospital for Sick Children Research Institute (Siddiqi); Women's College Hospital (Lofters); Department of Family and Community Medicine (Lofters), Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Arjumand Siddiqi
- Department of Social and Preventive Medicine (Datta), Université de Montréal; Health Innovation and Evaluation Hub (Datta), CRCHUM, Montréal, Que.; Department of Medicine (Datta), Cedars-Sinai Medical Center, Los Angeles, United States; Dalla Lana School of Public Health (Siddiqi), University of Toronto; Hospital for Sick Children Research Institute (Siddiqi); Women's College Hospital (Lofters); Department of Family and Community Medicine (Lofters), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Aisha Lofters
- Department of Social and Preventive Medicine (Datta), Université de Montréal; Health Innovation and Evaluation Hub (Datta), CRCHUM, Montréal, Que.; Department of Medicine (Datta), Cedars-Sinai Medical Center, Los Angeles, United States; Dalla Lana School of Public Health (Siddiqi), University of Toronto; Hospital for Sick Children Research Institute (Siddiqi); Women's College Hospital (Lofters); Department of Family and Community Medicine (Lofters), Faculty of Medicine, University of Toronto, Toronto, Ont
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Siddiqi A, Sod-Erdene O. Invited Commentary: Do Small Cause-of-Death Correlations Throw Into Question the Notion of a Collective "Deaths of Despair" Phenomenon? Am J Epidemiol 2021; 190:1172-1174. [PMID: 33534894 DOI: 10.1093/aje/kwab016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 11/24/2020] [Accepted: 12/07/2020] [Indexed: 11/12/2022] Open
Abstract
Since the turn of the 21st century, during which White mortality has been rising, there has been a sharp increase in only 3 causes of death: drug use, alcohol use, and suicide. Because all 3 of these causes conjure notions of anguish and hopelessness, they have been conceptualized as a collective "deaths of despair" phenomenon. Simon and Masters (Am J Epidemiol. 2021;190(6)1169-1171) challenge this conceptualization by asking whether these 3 causes are empirically associated with each other. Their analyses produce small correlations, which lead them to call into question that the 3 causes are part of a unified phenomenon. We contest their work on several grounds. Their analyses suffer from several technical problems, including the fact that, for any given year and cause of death, 65.8%-97.6% of counties examined have death counts under 10. More fundamentally, it is unclear that we should expect these causes of death to rise and fall together, even if they are connected to a singular phenomenon. Instead, "despair" might manifest differently in different places (i.e., these causes might be substitutes for each other). We argue that the best answer to the authors' important question comes from assessing whether there is a common, despair-based causal mechanism underlying all 3 of them.
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Shahidi FV, Parnia A, Siddiqi A. Trends in socioeconomic inequalities in premature and avoidable mortality in Canada, 1991-2016. CMAJ 2021; 192:E1114-E1128. [PMID: 32989024 DOI: 10.1503/cmaj.191723] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Recent epidemiologic findings suggest that socioeconomic inequalities in health may be widening over time. We examined trends in socioeconomic inequalities in premature and avoidable mortality in Canada. METHODS We conducted a population-based repeated cohort study using the 1991, 1996, 2001, 2006 and 2011 Canadian Census Health and Environment Cohorts. We linked individual-level Census records for adults aged 25-74 years to register-based mortality data. We defined premature mortality as death before age 75 years. For each census cohort, we estimated age-standardized rates, risk differences and risk ratios for premature and avoidable mortality by level of household income and education. RESULTS We identified 16 284 045 Census records. Between 1991 and 2016, premature mortality rates declined in all socioeconomic groups except for women without a high school diploma. Absolute income-related inequalities narrowed among men (from 2478 to 1915 deaths per 100 000) and widened among women (from 1008 to 1085 deaths per 100 000). Absolute education-related inequalities widened among men and women. Relative socioeconomic inequalities in premature mortality widened progressively over the study period. For example, the relative risk of premature mortality associated with the lowest income quintile increased from 2.10 (95% confidence interval [CI] 2.02-2.17) to 2.79 (95% CI 2.66-2.91) among men and from 1.72 (95% CI 1.63- 1.81) to 2.50 (95% CI 2.36-2.64) among women. Similar overall trends were observed for avoidable mortality. INTERPRETATION Socioeconomically disadvantaged groups have not benefited equally from recent declines in premature and avoidable mortality in Canada. Efforts to reduce socioeconomic inequalities and associated patterns of disadvantage are necessary to prevent this pattern of widening health inequalities from persisting or worsening over time.
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Affiliation(s)
- Faraz Vahid Shahidi
- Institute for Work & Health (Shahidi); Dalla Lana School of Public Health (Parnia, Siddiqi), University of Toronto, Toronto, Ont.; Gillings School of Public Health (Siddiqi), University of North Carolina, Chapel Hill, NC
| | - Abtin Parnia
- Institute for Work & Health (Shahidi); Dalla Lana School of Public Health (Parnia, Siddiqi), University of Toronto, Toronto, Ont.; Gillings School of Public Health (Siddiqi), University of North Carolina, Chapel Hill, NC
| | - Arjumand Siddiqi
- Institute for Work & Health (Shahidi); Dalla Lana School of Public Health (Parnia, Siddiqi), University of Toronto, Toronto, Ont.; Gillings School of Public Health (Siddiqi), University of North Carolina, Chapel Hill, NC
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Datta G, Siddiqi A, Lofters A. Transformer la recherche en santé au Canada en tenant compte de la race. CMAJ 2021; 193:E433-E435. [PMID: 33753372 PMCID: PMC8096385 DOI: 10.1503/cmaj.201742-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Geetanjali Datta
- Département de médecine sociale et préventive (Datta), Université de Montréal; Carrefour de l'innovation et de l'évaluation en santé (Datta), CRCHUM, Montréal, Qc; Service de médecine (Datta), Centre médical Cedars-Sinai, Los Angeles, É.-U.; École de santé publique Dalla Lana (Siddiqi), Université de Toronto; Institut de recherche de l'Hôpital pour enfants malades (SickKids) (Siddiqi); Hôpital Women's College (Lofters); Département de médecine familiale et communautaire (Lofters), Faculté de médecine, Université de Toronto, Toronto, Ont.
| | - Arjumand Siddiqi
- Département de médecine sociale et préventive (Datta), Université de Montréal; Carrefour de l'innovation et de l'évaluation en santé (Datta), CRCHUM, Montréal, Qc; Service de médecine (Datta), Centre médical Cedars-Sinai, Los Angeles, É.-U.; École de santé publique Dalla Lana (Siddiqi), Université de Toronto; Institut de recherche de l'Hôpital pour enfants malades (SickKids) (Siddiqi); Hôpital Women's College (Lofters); Département de médecine familiale et communautaire (Lofters), Faculté de médecine, Université de Toronto, Toronto, Ont
| | - Aisha Lofters
- Département de médecine sociale et préventive (Datta), Université de Montréal; Carrefour de l'innovation et de l'évaluation en santé (Datta), CRCHUM, Montréal, Qc; Service de médecine (Datta), Centre médical Cedars-Sinai, Los Angeles, É.-U.; École de santé publique Dalla Lana (Siddiqi), Université de Toronto; Institut de recherche de l'Hôpital pour enfants malades (SickKids) (Siddiqi); Hôpital Women's College (Lofters); Département de médecine familiale et communautaire (Lofters), Faculté de médecine, Université de Toronto, Toronto, Ont
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Blair A, Warsame K, Naik H, Byrne W, Parnia A, Siddiqi A. Identifying gaps in COVID-19 health equity data reporting in Canada using a scorecard approach. Can J Public Health 2021; 112:352-362. [PMID: 33742310 PMCID: PMC7978170 DOI: 10.17269/s41997-021-00496-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess health equity-oriented COVID-19 reporting across Canadian provinces and territories, using a scorecard approach. METHODS A scan was performed of provincial and territorial reporting of five data elements (cumulative totals of tests, cases, hospitalizations, deaths, and population size) across three units of aggregation (province or territory level, health regions, and local areas) (15 "overall" indicators), and for four vulnerable settings (long-term care and detention facilities, schools, and homeless shelters) and eight social markers (age, sex, immigration status, race/ethnicity, healthcare worker status, occupational sector, income, and education) (180 "equity-related" indicators) as of December 31, 2020. Per indicator, one point was awarded if case-delimited data were released, 0.7 points if only summary statistics were reported, and 0 if neither was provided. Results were presented using a scorecard approach. RESULTS Overall, information was more complete for cases and deaths than for tests, hospitalizations, and population size denominators needed for rate estimation. Information provided on jurisdictions and their regions, overall, tended to be more available (average score of 58%, "D") than that for equity-related indicators (average score of 17%, "F"). Only British Columbia, Alberta, and Ontario provided case-delimited data, with Ontario and Alberta providing case information for local areas. No jurisdiction reported on outcomes according to patients' immigration status, race/ethnicity, income, or education. Though several provinces reported on cases in long-term care facilities, only Ontario and Quebec provided detailed information for detention facilities and schools, and only Ontario reported on cases within homeless shelters and across occupational sectors. CONCLUSION One year into the pandemic, socially stratified reporting for COVID-19 outcomes remains sparse in Canada. However, several "best practices" in health equity-oriented reporting were observed and set a relevant precedent for all jurisdictions to follow for this pandemic and future ones.
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Affiliation(s)
- Alexandra Blair
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Kahiye Warsame
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Harsh Naik
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Walter Byrne
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Abtin Parnia
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Amri MM, Jessiman-Perreault G, Siddiqi A, O’Campo P, Enright T, Di Ruggiero E. Scoping review of the World Health Organization's underlying equity discourses: apparent ambiguities, inadequacy, and contradictions. Int J Equity Health 2021; 20:70. [PMID: 33658033 PMCID: PMC7931570 DOI: 10.1186/s12939-021-01400-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Given the heightened rhetorical prominence the World Health Organization has afforded to equity in the past half-century, it is important to better understand how equity has been referred to and its conceptual underpinning, which may have broader global implications. ELIGIBILITY CRITERIA Articles were included if they met inclusion criteria - chiefly the explicit discussion of the WHO's concept of health equity, for example in terms of conceptualization and/or definitions. Articles which mentioned health equity in the context of WHO's programs, policies, and so on, but did not discuss its conceptualization or definition were excluded. SOURCES OF EVIDENCE We focused on peer-reviewed literature by scanning Ovid MEDLINE and SCOPUS databases, and supplementing by hand-search. RESULTS Results demonstrate the WHO has held - and continues to hold - ambiguous, inadequate, and contradictory views of equity that are rooted in different theories of social justice. CONCLUSIONS Moving forward, the WHO should revaluate its conceptualization of equity and normative position, and align its work with Amartya Sen's Capabilities Approach, as it best encapsulates the broader views of the organization. Further empirical research is needed to assess the WHO interpretations and approaches to equity.
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Affiliation(s)
- Michelle M. Amri
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Bldg. 1, Boston, MA 02115-6021 USA
- School of Public Health and Social Policy, Human and Social Development Building, University of Victoria, 3800 Finnerty Road, Victoria, British Columbia V8P 5C2 Canada
| | | | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, USA
| | - Patricia O’Campo
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, Ontario M5B 1T8 Canada
| | - Theresa Enright
- Department of Political Science, University of Toronto, 100 St George Street, Toronto, Ontario M5S 3G3 Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
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Zafar S, Siddiqi A, Yasir M, Zachar JJ. Pedagogical development in local anaesthetic training in paediatric dentistry using virtual reality simulator. Eur Arch Paediatr Dent 2021; 22:667-674. [PMID: 33566287 PMCID: PMC7874567 DOI: 10.1007/s40368-021-00604-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/15/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE With the advancements in technology, dental pedagogy has also evolved, and new learning technologies have emerged. Virtual reality (VR) as an education tool in dentistry is underutilised. VR as an adjunct in local anaesthesia (LA) teaching in paediatric dentistry has not been investigated. The study aimed to investigate dental student's perception of dental LA VR simulation on a paediatric patient and to determine whether this can improve students learning experience. METHODS Seventy-one students participated in a self-administered questionnaire before and after the use of dental LA VR simulator. Descriptive analysis was performed to determine the perceptions of experience gained through VR. The data were tabulated, graphed, and analysed using SPSS and GraphPad Prism software. RESULTS The study noted that 89.9% of participants perceived that it would improve their LA skills. After using dental LA VR, 83.1% of participants experienced more engaged in the learning activity, and 55.0% of participants agreed/strongly agreed that it improved their understanding of anatomical landmarks. Around 56.4% of participants agreed/strongly agreed that it added value compared with traditional LA teaching methods. CONCLUSION It can be concluded that the use of VR simulation can enhance students engagement and learning experience in paediatric dentistry settings and can be used as an additional means of LA training.
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Affiliation(s)
- S Zafar
- School of Dentistry, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia.
| | - A Siddiqi
- School of Dentistry and Oral Health, Griffith University, Cnr Parkland Drive and Olsen Avenue, Southport, QLD, 4222, Australia
| | - M Yasir
- Department of Information Science, University of Otago, New Zealand, 362 Leith Street, Dunedin, Otago, 9016, New Zealand
| | - J J Zachar
- School of Dentistry, The University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
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Blair A, Parnia A, Siddiqi A. A time-series analysis of testing and COVID-19 outbreaks in Canadian federal prisons to inform prevention and surveillance efforts. Can Commun Dis Rep 2021; 47:66-76. [PMID: 33679249 PMCID: PMC7919778 DOI: 10.14745/ccdr.v47i01a10] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Approximately 14,000 adults are currently incarcerated in federal prisons in Canada. These facilities are vulnerable to disease outbreaks and an assessment of coronavirus disease 2019 (COVID-19) testing and outcomes is needed. The objective of this study was to examine outcomes of COVID-19 testing, prevalence, case recovery and death within federal prisons and to contrast these data with those of the general population. METHODS Public time-series outcome data for prisoners and the general population were obtained on-line from the Correctional Service of Canada and the Public Health Agency of Canada, respectively, from March 30 to May 27, 2020. Prison, province and sex-specific frequency statistics for each outcome were calculated. A total of 50 facilities were included in this study. RESULTS Of these 50 facilities, 64% reported fewer individuals tested per 1,000 population than observed in the general population and 12% reported zero tests in the study period. Testing tended to be reactive, increasing only once prisons had recorded positive tests. Six prisons reported viral outbreaks, with three recording over 20% cumulative COVID-19 prevalence among prisoners. Cumulatively, in prisons, 29% of individuals tested received a positive result, compared to 6% in the general population. Two of the 360 cases died (0.6% fatality). Four outbreaks appeared to be under control (more than 80% of cases recovered); however, sizeable susceptible populations remain at risk of infection. Female prisoners (5% of the total prisoner population) were over-represented among cases (17% of cases overall). CONCLUSION Findings suggest that prison environments are vulnerable to widespread severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Gaps in testing merit public health attention. Symptom-based testing alone may not be optimal in prisons, given observations of widespread transmission. Increased sentinel or universal testing may be appropriate. Increased testing, along with rigorous infection prevention practices and the potential release of prisoners, will be needed to curb future outbreaks.
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Affiliation(s)
- Alexandra Blair
- Dalla Lana School of Public Health, University of Toronto, TorontoON
| | - Abtin Parnia
- Dalla Lana School of Public Health, University of Toronto, TorontoON
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, TorontoON
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, US
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Lee-Foon NK, Logie CH, Siddiqi A, Grace D. “I just trust what Google says, it’s the Bible”: Exploring young, Black gay and other men who have sex with men’s evaluation of sexual health information sources in Toronto, Canada. The Canadian Journal of Human Sexuality 2020. [DOI: 10.3138/cjhs.2020-0026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
While sexual health literature identifies youths’ sexual health information sources and its impact on their sexual practices, little is known about the way youth evaluate the credibility of this information. This knowledge gap is significant among young, Black gay and other men who have sex with men (YBGM) who belong to intersectional populations disproportionately impacted by HIV and other STIs. We conducted a qualitative study using constructivist grounded theory to explore YBGM’s approaches to evaluating sexual health information sources’ credibility. Intersectionality and the socioecological model informed our analysis. We explored connections between social locations (e.g., race, sexual orientation) and socio-ecological environments and how their impact shaped YBGM’s evaluation of sexual health information. Findings revealed evaluation strategies varied by source: friends, the internet and healthcare providers. Friends’ information was deemed credible if they were older, shared social locations and provided embodied testimonials. Testimonials mirrored oral-traditions specific to Black populations where oral narratives help disseminate sensitive information in a culturally relevant way. Website selection was informed by YBGM’s social locations and ranged from being implicitly trusted to assessed by its association with established healthcare organizations. Many participants’ acceptance of healthcare providers’ information revealed patient-client power imbalances and a perception that providers’ actions reflected their institutions’ sexual health policies. Findings highlight a need for sexual health services to create culturally effective ways to disseminate information that accounts for the histories, contexts, and approaches YBGM use to identify credible sources of sexual health information.
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Affiliation(s)
- Nakia K. Lee-Foon
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Carmen H. Logie
- Factor-Inwentash School of Social Work, University of Toronto, Toronto, ON
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Siddiqi A. M259 A YOUNG GIRL WITH FEVER THAT WON’T GO AWAY. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fuller A, Siddiqi A, Shahidi F, Anderson L, Keown-Stoneman C, Maguire J, Birken C. 114 Distributional Decomposition: A Novel Method for Understanding Inequities in Child Growth, Behavior and Development. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxaa068.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Income related inequities in child health are well-established, with children from lower income households showing increased risk of obesity, behavior problems, and delayed development. To facilitate clinical diagnosis, outcomes are conventionally measured in dichotomous terms. However, inequities may exist along the entire range of distribution, with implications for population health.
Objectives
Our primary objective was to examine differences in the distribution of three measures of child health by income: body mass index (BMI), behavior difficulties and development.
Design/Methods
This was a cross sectional study of children enrolled in a primary care practice-based research cohort. Our study included generally healthy children recruited from age 0-5 years. Dependent variables were 1) BMI z-score (zBMI) at 5 years; 2) behavior: total score on the Strengths and Difficulties Questionnaire (SDQ), measured at 3-5 years; 3) development: total score on the Infant Toddler Checklist (ITC), measured at 18-24 months. Independent variable was parent-reported annual household income (< $100,000 vs ≥ $100000). We then used distributional decomposition, which uses mathematical re-weighting to construct a counterfactual distribution that describes the distribution of the lower income group based on the predictor profile (child age, sex, birthweight, prematurity, breastfeeding duration; maternal age, education, immigration status, ethnicity) of the higher income group.
Results
Our study samples consisted of 1649 (zBMI), 764 (SDQ) and 761 (ITC) children. Mean BMI z-score was 0.16, median total difficulties score was 7, median ITC score was 48. Comparing distributions graphically (Figure 1), children with low income have a higher risk distribution for all outcomes; for example, children with low income were more likely to have BMI z-scores in the underweight and obese ranges. For each outcome, the counterfactual curve lower income children with the predictor profile of their higher income counterparts reduced inequities somewhat, particularly in the normal or low risk range, but not in the high-risk range. However, there were notable unexplained portions of inequity remaining.
Conclusion
In a cohort of generally healthy children, we found evidence of meaningful income-related inequities in the distribution of child zBMI, behavior difficulties, and development. Population health interventions aiming to mitigate these inequities by addressing common predictors may improve outcomes in the normal range; however targeted clinical interventions are likely required for those in the high-risk range.
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Affiliation(s)
- Anne Fuller
- Division of Paediatric Medicine, The Hospital for Sick Children, Department of Paediatrics, University of Toronto
| | | | | | - Laura Anderson
- Department of Health Research Methods, Evidence and Impact, McMaster University
| | - Charles Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute, Unity Health Toronto (St. Michael’s Hospital)
| | - Jonathon Maguire
- Li Ka Shing Knowledge Institute
- Department of Paediatrics, University of Toronto
| | - Catherine Birken
- Department of Paediatrics, University of Toronto
- Child Health Evaluative Sciences, SickKids Research Institute
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Chiang J, Arons A, Pomeranz JL, Siddiqi A, Hamad R. Geographic and Longitudinal Trends in Media Framing of Obesity in the United States. Obesity (Silver Spring) 2020; 28:1351-1357. [PMID: 32475076 PMCID: PMC7311269 DOI: 10.1002/oby.22845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/02/2020] [Accepted: 04/17/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The media's framing of public health issues is closely linked to public opinion on these issues and support for interventions to address them. This study characterized geographic and temporal variation in the US media's framing of obesity across states from 2006 to 2015. METHODS Newspaper articles that mentioned the term obesity were drawn from Access World News (NewsBank, Inc., Naples, Florida), a comprehensive online database (N = 364,288). This study employed automated content analysis, a machine learning technique, to categorize articles as (1) attributing obesity to individual-level causes (e.g., lifestyle behaviors), (2) attributing obesity to environmental/systemic causes (e.g., neighborhood walkability), (3) attributing obesity to both individual-level causes and environmental/systemic causes, or (4) articles without any such attribution framework. RESULTS Nationwide across all years, a higher proportion of articles focused on individual-level attribution of obesity than environmental-level attribution or both. Missouri and Idaho had the highest proportions of articles with an individual framework, and Nevada, Arkansas, and Wisconsin had the highest proportions of articles with an environmental framework. CONCLUSIONS This analysis demonstrates that US media sources heavily focus on an individual framing of obesity, which may be informing public perceptions of obesity. By highlighting differences in obesity media portrayal, this study could inform research to understand why particular states represent outliers and how this may affect obesity policy making.
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Affiliation(s)
- Jonathan Chiang
- Stanford University, Department of Medicine, Stanford, California
| | - Abigail Arons
- University of California Los Angeles, Departments of Internal Medicine and Pediatrics, Los Angeles, California
| | - Jennifer L. Pomeranz
- New York University College of Global Public Health, Department of Public Health Policy and Management, New York, NY
| | - Arjumand Siddiqi
- University of Toronto, Dalla Lana School of Public Health, Division of Epidemiology, Toronto, Ontario, Canada and University of North Carolina – Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Chapel Hill, North Carolina
| | - Rita Hamad
- University of California San Francisco, Philip R. Lee Institute for Health Policy Studies, Department of Family & Community Medicine, San Francisco, California
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Tait CA, Parnia A, Zewge-Abubaker N, Wong WH, Smith-Cannoy H, Siddiqi A. Did the UN convention on the rights of the child reduce child mortality around the world? An interrupted time series analysis. BMC Public Health 2020; 20:707. [PMID: 32423476 PMCID: PMC7236469 DOI: 10.1186/s12889-020-08720-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Child mortality has been reduced by more than 50 % over the past 30 years. A range of secular economic and social developments have been considered to explain this phenomenon. In this paper, we examine the association between ratification of the Convention on the Rights of the Child (CRC), which was specifically put in place to ensure the well-being of children, and declines in child mortality. METHODS Data come from three sources: the United Nations Treaty Series Database, the World Bank World Development Indicators database and, the Polity IV database. Because CRC was widely ratified, leaving few control cases, we used interrupted times series analyses, which uses the trend in the health outcome before policy exposure to mathematically determine what the trend in the health outcome would have been after the policy exposure, if it had continued 'as is' - meaning, if the policy exposure had not occurred. RESULTS CRC ratification was associated with declining child mortality. CRC ratification was associated with a significant change in shorter-term child mortality trends in all groups except high-income, non-democratic countries and low-imcome democratic countries. CRC ratification was associated with long-term child mortality trends in all groups except middle-income, non-democratic countries. CONCLUSIONS Child mortality rates would likely have declined even in the absence of CRC ratification, but CRC is associated with a larger decline. Our findings provide a way to assess the effects of widely-held societal norms on health and demonstrate the moderating effects of democracy and income level.
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Affiliation(s)
- Christopher A Tait
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Abtin Parnia
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Nishan Zewge-Abubaker
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Wendy H Wong
- Department of Political Science, University of Toronto, 100 St. George Street, Toronto, ON, M5S 3G3, Canada.,Canada Research Chair, Global Governance and Civil Society; and Schwartz Reisman Research Lead, Toronto, Canada
| | - Heather Smith-Cannoy
- School of Social and Behavioral Sciences, Arizona State University, 4701 West Thunderbird Rd, MC, Glendale, AZ, 3051, USA
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. .,Department of Heatlh Behavior, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
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Merckx J, Siddiqi A, Kaufman JS. Unjustified assertions regarding race and ethnicity in clinical decision-making. Can Urol Assoc J 2020; 14:143. [DOI: 10.5489/cuaj.6265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Shahidi FV, Muntaner C, Shankardass K, Quiñonez C, Siddiqi A. The effect of welfare reform on the health of the unemployed: evidence from a natural experiment in Germany. J Epidemiol Community Health 2020; 74:211-218. [PMID: 31915239 DOI: 10.1136/jech-2019-213151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/18/2019] [Accepted: 12/21/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Over the past several decades, governments have enacted far-reaching reforms aimed at reducing the generosity and coverage of welfare benefits. Prior literature suggests that these policy measures may have deleterious effects on the health of populations. In this study, we evaluate the impact of one of the largest welfare reforms in recent history-the 2005 Hartz IV reform in Germany-with a focus on estimating its effect on the health of the unemployed. METHODS We employed a quasi-experimental difference-in-differences (DID) design using population-based data from the German Socio-Economic Panel Study, covering the period between 1994 and 2016. We applied DID linear probability modelling to examine the association between the Hartz IV reform and poor self-rated health, adjusting for a range of demographic and socioeconomic confounders. RESULTS The Hartz IV reform was associated with a 3.6 (95% CI 0.9 to 6.2) percentage point increase in the prevalence of poor self-rated health among unemployed persons affected by the reform relative to similar but unaffected controls. This negative association appeared immediately following the implementation of the reform and has persisted over time. CONCLUSION Governments in numerous European and North American jurisdictions have introduced measures to further diminish the generosity and coverage of welfare benefits. In line with growing concerns over the potential consequences of austerity and associated policy measures, our findings suggest that these reform efforts pose a threat to the health of socioeconomically disadvantaged populations.
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Affiliation(s)
- Faraz V Shahidi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada .,Institute for Work and Health, Toronto, Ontario, Canada
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Ketan Shankardass
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Carlos Quiñonez
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
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Parnia A, Siddiqi A. Socioeconomic disparities in smoking are partially explained by chronic financial stress: marginal structural model of older US adults. J Epidemiol Community Health 2019; 74:248-254. [PMID: 31871017 DOI: 10.1136/jech-2019-213357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/18/2019] [Accepted: 12/05/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND A persistent socioeconomic gradient in smoking has been observed in a variety of populations. While stress is hypothesised to play a mediating role, the extent of this mediation is unclear. We used marginal structural models (MSMs) to estimate the proportion of the effect of socioeconomic status (SES) on smoking, which can be explained by an indicator of stress related to SES, experiences of chronic financial stress. METHODS Using the Health and Retirement Study (waves 7-12, 2004-2014), a survey of older adults in the USA, we analysed a total sample of 15 260 people. A latent variable corresponding to adult SES was created using several indicators of socioeconomic position (wealth, income, education, occupation and labour force status). The main analysis was adjusted for other factors that influence the pathway from adult SES to stress and smoking, including personal coping resources, health-related factors, early-life SES indicators and other demographic variables to estimate the proportion of the effect explained by these pathways. RESULTS Compared with those in the top SES quartile, those in the bottom quartile were more than four times as likely to be current smokers (rate ratio 4.37, 95% CI 3.35 to 5.68). The estimate for the MSM attenuated the effect size to 3.34 (95% CI 2.47 to 4.52). Chronic financial stress explained 30.4% of the association between adult SES and current smoking (95% CI 13 to 48). CONCLUSION While chronic financial stress accounts for part of the socioeconomic gradient in smoking, much remains unexplained.
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Affiliation(s)
- Abtin Parnia
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Fafard St-Germain AA, Siddiqi A. The Relation Between Household Food Insecurity and Children's Height in Canada and the United States: A Scoping Review. Adv Nutr 2019; 10:1126-1137. [PMID: 31075160 PMCID: PMC6855965 DOI: 10.1093/advances/nmz034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/08/2018] [Accepted: 03/18/2019] [Indexed: 01/14/2023] Open
Abstract
Household food insecurity is a determinant of health and marker of material deprivation. Although research has shown that food insecurity is associated with numerous adverse health, developmental and nutritional outcomes among children in high-income countries, little is known about its impact on children's height, an important marker of nutritional status and physical development. We reviewed evidence on the relation between experience-based measures of food insecurity and the height of children aged 0-18 y in Canada and the United States. The search, conducted in Embase, Medline, CINAHL, ProQuest, Web of Science, and EconLit from the inception of the databases to October 2017, identified 811 records that were screened for relevance. A total of 8 peer-reviewed studies, 2 from Canada and 6 from the United States, met the inclusion criteria and were summarized. Five studies found no association between food insecurity and children's height. One study found that having taller children in the household predicted more severe food insecurity, whereas 2 studies found that more severe experiences of food insecurity were associated with shorter height among children from ethnic minority populations. These results suggest that household food insecurity may not be associated with height inequalities among children in Canada and the United States, except perhaps in certain high-risk populations. However, the few studies identified for review provide insufficient evidence to determine whether food insecurity is or is not associated with children's height in these countries. Given the importance of optimal linear growth for current and future well-being, it is critical to understand how different modifiable environmental circumstances relate to children's height to help establish priorities for intervention. Families with children are disproportionately affected by food insecurity, and more research explicitly designed to examine the association between household food insecurity and children's height in high-income countries is needed.
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Affiliation(s)
| | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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Hauk M, Siddiqi A, McGoey B, Weinberger T. M039 A CASE OF TRIMETHOPRIM – SULFAMETHOXAZOLE INDUCED ASEPTIC MENINGITIS. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Siddiqi A, Arja S, Lo R, Fernandez-Becker N, McGhee S. M404 INCIDENTAL IMPROVEMENT IN EOSINOPHILIC GASTROINTESTINAL DISEASE WHILE ON TREATMENT WITH DUPILUMAB FOR ASTHMA. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hauk M, Siddiqi A, McGoey B, Younus M. M043 TWO DAY 20-STEP DESENSITIZATION FOR GALSULFASE IN A PATIENT WITH MUCOPOLYSACCHARIDOSIS TYPE VI. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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