Can a health warning label diminish the persuasive effects of health-oriented nutrition advertising on ready-to-drink alcohol product packaging? A randomized experiment

BACKGROUND AND AIMS

A health warning label (HWL) cautioning about the link between alcohol and cancer may be able to communicate alcohol risks to consumers and potentially counter health-oriented nutrition advertising on ready-to-drink alcoholic beverages. This study aimed to examine the independent and combined effects of nutrient content claims (e.g. 0 g sugar) and a HWL on perceived product characteristics and intentions to consume, and whether these effects differed by gender and age.

DESIGN

A between-subjects randomized experiment. Participants were randomized to view one of six experimental label conditions: nutrient content claims plus nutrition declaration (NCC + ND), ND only, NCC + ND + HWL, ND + HWL, HWL only and no NCC, ND or HWL, all on a ready-to-drink (RTD) vodka-based soda container.

SETTING AND PARTICIPANTS

Alcohol consumers (n = 5063; 52% women) in Canada aged 18-64 recruited through a national online panel.

MEASUREMENTS

Participants completed ratings of perceived product characteristics, perceived product health risks, and intentions to try, buy, binge and drink the product.

FINDINGS

Compared with the reference condition NCC + ND (current policy scenario in Canada), the other five experimental label conditions were associated with lower ratings for perceiving the product as healthy. All experimental conditions with a HWL were associated with lower product appeal, higher risk perceptions and reduced intentions to try, buy and binge. The experimental condition with a HWL only was associated with intentions to consume fewer cans in the next 7 days (β = -0.72, 95% confidence interval [CI] = -1.37,-0.08) versus the reference. Few interactions were observed, suggesting that label effects on outcomes were similar by gender and age.

CONCLUSIONS

Health warning labels on alcohol packaging appear to be associated with lower product appeal, higher perceived health risks and reduced consumption intentions, even in the presence of nutrient content claims.

Factors associated with stress about returning to pre-pandemic routines among Canadians

The COVID-19 pandemic continues to be a public health concern, with important impacts on individuals' mental health. Many people have experienced significant changes to their daily routines due to the pandemic and for some, returning to pre-pandemic routines could create elevated stress. The present study explored factors associated with stress about returning to pre-pandemic routines (SRPR). A web-based, cross-sectional survey of 1,001 Canadian adults aged 18 years and older was conducted on July 9-13, 2021. SRPR was assessed by asking the respondents how much stress they have been feeling about returning to their pre-pandemic routines. Sociodemographic variables, anxiety, depression, loneliness, and COVID-19-related worry were examined in relation to SRPR. Overall, 28.8% of respondents reported moderate to extreme SRPR. After adjusting for covariates, factors associated with elevated SRPR included: younger age (AOR = 2.29, 95%CI 1.30-4.03), higher education (AOR = 2.08, 95%CI 1.14-3.79), being very worried about getting COVID-19 (AOR = 4.14, 95%CI 2.46-6.95), switching to working from home (AOR = 2.43, 95%CI 1.44-4.11), having anxiety (AOR = 5.02, 95%CI 3.19-7.89), feeling depressed (AOR = 1.93, 95%CI 1.14-3.25), and feeling lonely (AOR = 1.74, 95%CI 1.07-2.83). The findings of this study suggest that individuals experiencing mental health concerns (anxiety, feeling depressed, feeling lonely) may be especially likely to feel elevated SRPR and may therefore need additional support in making the transition back to prior routines.

Effects of cannabis legalisation on patterns of cannabis consumption among adolescents in Ontario, Canada (2001-2019)

INTRODUCTION

Cannabis legalisation was enacted on 17 October 2018 in Canada. Accordingly, the effects of cannabis legalisation on patterns of cannabis consumption were examined among adolescents, including on cannabis initiation, any cannabis use, daily cannabis use and cannabis dependence.

METHODS

Data from a biennial population-based, cross-sectional survey of students in Ontario were pooled in a pre-post design (2001-2019; N = 89,238). Participants provided self-reports of cannabis initiation, any cannabis use, daily cannabis use and cannabis dependence. Long-term trends in these patterns of cannabis consumption over two decades of observation were characterised to provide a broader context of usage. The effects of cannabis legalisation on patterns of cannabis consumption were quantified using logistic regression analyses.

RESULTS

Long-term trends over the two decades of observation indicated that cannabis initiation decreased and then increased (p = 0.0220), any cannabis use decreased and daily cannabis use decreased (p < 0.0001 and p = 0.0001, respectively) and cannabis dependence remained unchanged (p = 0.1187). However, in comparisons between the pre-cannabis legalisation period (2001-2017) and the post-cannabis legalisation period (2019), cannabis legalisation was not associated with cannabis initiation (odds ratio; 95% confidence interval 1.00; 0.79-1.27), but it was associated with an increased likelihood of any cannabis use (1.31; 1.12-1.53), daily cannabis use (1.40; 1.09-1.80) and cannabis dependence (1.98; 1.29-3.04).

DISCUSSION AND CONCLUSIONS

Cannabis legalisation was not associated with cannabis initiation, but it was associated with an increased likelihood of any cannabis use, daily cannabis use and cannabis dependence.

U.S. cereal rye winter cover crop growth database

Winter cover crop performance metrics (i.e., vegetative biomass quantity and quality) affect ecosystem services provisions, but they vary widely due to differences in agronomic practices, soil properties, and climate. Cereal rye (Secale cereale) is the most common winter cover crop in the United States due to its winter hardiness, low seed cost, and high biomass production. We compiled data on cereal rye winter cover crop performance metrics, agronomic practices, and soil properties across the eastern half of the United States. The dataset includes a total of 5,695 cereal rye biomass observations across 208 site-years between 2001-2022 and encompasses a wide range of agronomic, soils, and climate conditions. Cereal rye biomass values had a mean of 3,428 kg ha-1, a median of 2,458 kg ha-1, and a standard deviation of 3,163 kg ha-1. The data can be used for empirical analyses, to calibrate, validate, and evaluate process-based models, and to develop decision support tools for management and policy decisions.

Cannabis legalization and driving under the influence of cannabis and driving under the influence of alcohol among adult and adolescent drivers in Ontario, Canada (2001-2019)

BACKGROUND

The impacts of cannabis legalization on driving under the influence of cannabis and driving under the influence of alcohol among adults and adolescents were examined in Ontario, Canada.

METHODS

Data were sourced from adult (N=38,479) and adolescent (N=23,216) populations-based surveys (2001-2019). The associations between cannabis legalization and driving within an hour of using cannabis and driving within an hour of drinking two or more drinks of alcohol were quantified using logistic regression, with testing of multiplicative interactions between cannabis legalization and age and sex. All analyses were conducted separately for adults and adolescents and restricted to participants with a valid driver's license.

RESULTS

Cannabis legalization was not associated with driving within an hour of using cannabis among adults (OR, 95% CI: 1.21, 0.69-2.11). However, a multiplicative interaction indicated that there was an increased likelihood of driving within an hour of using cannabis among adults ≥55 years of age (4.23, 1.85-9.71) pre-post cannabis legalization. Cannabis legalization was not associated with driving within an hour of using cannabis among adolescents (0.92, 0.72-1.16), or with driving within an hour of consuming two or more drinks of alcohol among adults (0.78, 0.51-1.20) or adolescents (0.87, 0.42-1.82).

CONCLUSIONS

An increased likelihood of driving under the influence of cannabis among adults ≥55 years of age was detected in the year following cannabis legalization, suggesting the need for greater public awareness and education and police monitoring and enforcement concerning driving under the influence of cannabis, particularly among older adults.

New perspectives on how to formulate alcohol drinking guidelines

BACKGROUND

Low-Risk Alcohol Drinking Guidelines (LRDGs) aim to reduce the harms caused by alcohol. However, considerable discrepancies exist in the 'low-risk' thresholds employed by different countries.

ARGUMENT/ANALYSIS

Drawing upon Canada's LRDGs update process, the current paper offers the following propositions for debate regarding the establishment of 'low-risk' thresholds in national guidelines: (1) as an indicator of health loss, years of life lost (YLL) has several advantages that could make it more suitable for setting guidelines than deaths, premature deaths or disability adjusted years of life (DALYs) lost. (2) Presenting age-specific guidelines may not be the most appropriate way of providing LRDGs. (3) Given past overemphasis on the so-called protective effects of alcohol on health, presenting cause-specific guidelines may not be appropriate compared with a 'whole health' effect derived from a weighted composite risk function comprising conditions that are causally related to alcohol consumption. (4) To help people reduce their alcohol use, presenting different risk zones associated with alcohol consumption instead of a single low risk threshold may be advantageous.

CONCLUSIONS

National LRDGs should be based on years of life lost and should be neither age-specific nor cause-specific. We recommend using risk zones rather than a single drinking threshold to help people assess their own risk and encourage the adoption of behaviours with positive health impacts across the alcohol use spectrum.

The mental health impacts of the COVID-19 pandemic among individuals with depressive, anxiety, and stressor-related disorders: A scoping review

OBJECTIVE

A scoping review of studies published in the first year of the COVID-19 pandemic focused on individuals with pre-existing symptoms of depression, anxiety, and specified stressor-related disorders, with the objective of mapping the research conducted.

ELIGIBILITY CRITERIA

(1) direct study of individuals with pre-existing depressive, anxiety, and/or specified stressor-related (i.e., posttraumatic stress, acute stress) disorders/issues; (2) focus on mental health-related pandemic effects, and; (3) direct study of mental health symptoms related to depression, anxiety, or psychological distress.

SOURCES OF EVIDENCE

Database-specific subject headings and natural language keywords were searched in Medline, Embase, APA PsycInfo, and Cumulative Index to Nursing & Allied Health Literature (CINAHL) up to March 3, 2021. Review of potentially relevant studies was conducted by two independent reviewers and proceeded in two stages: (1) title and abstract review, and; (2) full paper review.

DATA CHARTING

Study details (i.e., location, design and methodology, sample or population, outcome measures, and key findings) were extracted from included studies by one reviewer and confirmed by the Principal Investigator.

RESULTS

66 relevant articles from 26 countries were identified. Most studies adopted a cross-sectional design and were conducted via online survey. About half relied on general population samples, with the remainder assessing special populations, primarily mental health patients. The most commonly reported pre-existing category of disorders or symptoms was depression, followed closely by anxiety. Most studies included depressive and anxiety symptoms as outcome measures and demonstrated increased vulnerability to mental health symptoms among individuals with a pre-existing mental health issue.

CONCLUSION

These findings suggest that improved mental health supports are needed during the pandemic and point to future research needs, including reviews of other diagnostic categories and reviews of research published in subsequent years of the pandemic.

Client experiences using a new supervised consumption service in Sudbury, Ontario: A qualitative study

Overdoses are increasing in the province of Ontario, Canada, where northern communities such as Sudbury have witnessed disproportionately elevated rates, with opioid-related deaths double that of the provincial average. To address this issue, governments have implemented supervised consumption services (SCS) where people who use drugs (PWUD) can use their pre-obtained substances onsite under trained supervision. In September 2022, the city of Sudbury opened its first SCS, 'The Spot', but the site's sustainability is contingent on demonstrating benefit to PWUD and the neighboring community. We undertook a qualitative study exploring experiences among clients who used the consumption service inside The Spot. In December 2022, clients of The Spot were invited to participate in a brief survey which collected socio-demographic information and substance use profiles, followed by an in-person semi-structured qualitative interview. Participant survey and interview data were combined with administrative site utilization data provided by site staff of all clients who accessed the consumption service from September 2022 to August 2023 to examine overall service utilization and uptake. Qualitative data were analyzed using iterative thematic analysis techniques, and results were informed by common responses to research questions. The responses were narratively presented. Administrative site utilization data highlighted a relatively stable increase in uptake and utilization of the site since its inception. A total of 20 clients participated in the survey and semi-structured interviews. Participants described the importance of the site in preventing and responding to overdoses, providing a safe and comfortable environment to consume their drugs, and decreasing public drug use, which they suggested may potentially reduce stigmatization in the community. However, clients also suggested challenges, including issues regarding site operational policies that hindered consumption room utilization. Service suggestions made by clients to improve site utilization include the addition of inhalation services, relocating the site to a location in downtown Sudbury where PWUD commonly congregate, and extending operational hours. Positive impacts and recommendations can be drawn on and considered by other northern or rural communities interested in implementing similar harm reduction services.

Disease and Toxicity Outcomes after Salvage Radiotherapy (SRT) for Biochemically Recurrent Prostate Cancer (PC) for Patients Enrolled in a Phase II, Open Label Trial Investigating Neoadjuvant Chemohormonal Therapy Followed by Radical Prostatectomy (RP)

PURPOSE/OBJECTIVE(S)

Men with metastatic hormone sensitive prostate cancer have improved progression free and overall survival (PFS/OS) when treated with docetaxel and androgen deprivation therapy (ADT). Our institution conducted a phase II trial (UW17009) investigating the addition of three cycles of neoadjuvant docetaxel and ADT to RP in men with high-risk prostate cancer. Here we report toxicity and freedom from biochemical recurrence (FFBCR) for patients treated with SRT following participation in this trial.

MATERIALS/METHODS

Between January 17, 2018 and August 10, 2021, 28 patients enrolled on UW17009. Patients who had a recurrence and received SRT were identified. Toxicity was assessed using modified LENT (Late Effects of Normal Tissues)/RTOG (Radiation Therapy Oncology Group) criteria, and time to recurrence following SRT was determined for each patient. Additionally, the months of ADT received by each patient was recorded. FFBCR was then determined for this cohort using the method of Kaplan and Meier.

RESULTS

Of 28 patients enrolled on UW17009, 20 (71%) had BCR after RP. Of these, 19 received SRT, representing 68% of the patients enrolled on the trial. The rates of acute grade 1 and grade 2 GU toxicity with SRT were 37% (7) and 53% (10), respectively. The rates of acute grade 1 and grade 2 GI toxicity with SRT were 32% (6) and 37% (7), respectively. On patient experienced a grade 4 genitourinary toxicity during SRT. There were no acute grade 3 or grade 5 toxicities. The rates of late grade 1 and grade 2 GU toxicity were 16% (3) and 11% (2), respectively. The rates of late grade 1 and grade 2 GI toxicity were 11% (2) and 5% (1), respectively. There was 1 (5%) late grade 3 GU toxicity. There were no late grade 3-5 GI toxicities, or late grade 4-5 GU toxicities. The average duration of ADT after prostatectomy was 15 months (range: 0-37 months). According to the method of Kaplan and Meier, mean FFBCR after SRT was 34.0 months at a median of 37.8 months. Median FFBCR had not yet been reached. At the time of analysis, 13 patients remained free from biochemical recurrence after SRT.

CONCLUSION

Rates of biochemical recurrence and SRT following neoadjuvant docetaxel and ADT and then RP were consistent with historical data, as was the rate of successful SRT. Toxicities were also consistent with historical data, though there was notably one acute grade 4 GU toxicity.

Whānau Māori and Pacific peoples' knowledge, perceptions, expectations and solutions regarding antibiotic treatment of upper respiratory tract infections: a qualitative study

INTRODUCTION

The rate of community antibiotic use is high in Aotearoa New Zealand (NZ) when compared to other nations, and in NZ, as in most other nations, antibiotics are very commonly prescribed for self-limiting upper respiratory tract infections (URTIs). Resources that build knowledge, perceptions and understanding can potentially reduce unnecessary antibiotic consumption.

METHODS

To inform the content of educational resources, we conducted an in-depth qualitative study with 47 participants via 6 focus groups of the knowledge, attitudes, and expectations of whānau Māori and Pacific peoples about antibiotics and URTIs.

RESULTS

Focus groups with 47 participants identified four themes: Knowledge that might influence expectations to receive antibiotics for URTIs; Perceptions - the factors that influence when and why to seek medical care for URTI; Expectations - the features of successful medical care for URTI; Solutions - how to build community knowledge about URTI and their treatment and prevention. Knowledge that might reduce expectations to receive antibiotics for URTI included confidence in the use of alternative remedies, knowledge that URTI are usually caused by viruses, and concerns about antibiotic adverse effects. Participants commonly reported that they would confidently accept their doctor's recommendation that an antibiotic was not necessary for an URTI, provided that a thorough assessment had been performed and that treatment decisions were clearly communicated.

CONCLUSION

These findings suggest that building patients' knowledge and skills about when antibiotics are necessary, and increasing doctors' confidence and willingness not to prescribe an antibiotic for patients with an URTI, could significantly reduce inappropriate antibiotic prescribing in NZ.

Development and validation of the C-SHADE Scale for measuring perpetration of common sexually harassing and aggressive behaviors in drinking environments

BACKGROUND

Sexual aggression (SA) is ubiquitous in drinking environments, often seen as normal and acceptable; yet, targets of SA experience many negative consequences. This research aimed to develop a valid measure of common acts of SA in drinking settings for estimating prevalence and evaluating prevention initiatives.

METHODS

We developed a questionnaire measure of common acts of sexual harassment and aggression in drinking environments (C-SHADE) based on descriptions of SA behavior from our own and others' research. The measure was validated in a cross-sectional survey of 335 men aged 19-25 using webpanels from an online survey company. Validation measures included: a modified version of the Sexual Experiences Survey (M-SES), measures of SA by peers in drinking environments, SA-related attitudes, expectancies about sexual effects of alcohol, and alcohol consumption.

RESULTS

The C-SHADE showed high internal consistency (alpha = .96) and was significantly correlated with M-SES (r = .52), SA by peers (r = .61 to .70), SA-related attitudes/expectations (r = .38 to .55), and measures of alcohol consumption (r = .22 to .36). Overall, 71.9% participants reported SA using the C-SHADE versus 24.7% with the M-SES. We compared the responses of participants who reported perpetration on both measures (N = 83), only the C-SHADE (N = 141), and non-perpetrators (N = 89) (excluding 4 participants who reported perpetration only on the M-SES). The M-SES/C-SHADE perpetrators scored significantly higher than C-SHADE-only perpetrators and non-perpetrators on most SA-related and drinking measures, while C-SHADE-only perpetrators scored significantly higher than non-perpetrators on peer SA and two attitude measures.

CONCLUSIONS

The C-SHADE is suitable for measuring prevalence and evaluating interventions in drinking settings. The C-SHADE confirmed high prevalence of SA in drinking settings and identified an important group of C-SHADE-only perpetrators for whom interventions that focus on situational precipitators of SA in drinking settings may be especially useful.

Overpoliced and Underrepresented: Perspectives on Cannabis Legalization From Members of Racialized Communities in Canada

Historically, overpolicing of some racialized and Indigenous groups in Canada has resulted in unequal application of drug laws contributing to disproportionate rates of charges and convictions in these populations. Criminal records severely and negatively impact an individual's life and can perpetuate cycles of poverty and socioeconomic disadvantage. On October 17, 2018, Canada legalized cannabis production, distribution, sale, and possession for non-medical purposes. Advocates of criminal justice reform have raised concerns that Indigenous and racialized people may not equitably benefit from legalization due to unequal police surveillance and drug enforcement. These groups are among priority populations for research on cannabis and mental health, but their views on cannabis regulation have been largely absent from research and policy-making. To address this gap, we asked self-identified members of these communities about their lived experiences and perspectives on cannabis legalization in Canada. Between September 2018 and July 2019, we conducted semistructured interviews and focus groups with 37 individuals in Québec, Ontario, Alberta and British Columbia. During this phase of early cannabis legalization, participants responded to questions about anticipated public health risks and benefits of legalization, how their jurisdiction is responding to legalization, and what community resources would be needed to address legalization impacts. We conducted a thematic analysis and identified five major themes in the data related to race and early cannabis legalization: overpolicing of racialized communities, severity of penalties in new cannabis legislation, increased police powers, and underrepresentation of racialized groups in the legal cannabis market and in cannabis research. Participants discussed opportunities to support cannabis justice, including establishing priority licenses, issuing pardons or expunging criminal records, and reinvesting cannabis revenue into impacted communities. This work begins to address the paucity of Indigenous and racialized voices in cannabis research and identifies potential solutions to injustices of cannabis prohibition.

Cannabis legalization and cannabis use, daily cannabis use and cannabis-related problems among adults in Ontario, Canada (2001-2019)

BACKGROUND

In the context of cannabis legalization in Canada, we examined the effects on cannabis patterns of consumption, including cannabis use, daily cannabis use and cannabis-related problems. In addition, we examined differential effects of cannabis legalization by age and sex.

METHODS

A pre-post design was operationalized by combining 19 iterations of the Centre for Addiction and Mental Health (CAMH) Monitor Surveys (N = 52,260; 2001-2019): repeated, population-based, cross-sectional surveys of adults in Ontario. Participants provided self-reports of cannabis use (past 12 months), daily cannabis use (past 12 months) and cannabis-related problems though telephone interviews. The effects of cannabis legalization on cannabis patterns of consumption were examined using logistic regression analyses, with testing of two-way interactions to determine differential effects by age and sex.

RESULTS

Cannabis use prevalence increased from 11 % to 26 % (p < 0.0001), daily cannabis use prevalence increased from 1 % to 6 % (p < 0.0001) and cannabis-related problems prevalence increased from 6 % to 14 % (p < 0.0001) between 2001 and 2019. Cannabis legalization was associated with an increased likelihood of cannabis use (OR, 95 % CI: 1.62, 1.40-1.86), daily cannabis use (1.59, 1.21-2.07) and cannabis-related problems (1.53, 1.20-1.95). For cannabis-related problems, a significant two-way interaction was observed between cannabis legalization and age (p = 0.0001), suggesting differential effects among adults ≥55 years.

CONCLUSIONS

Cannabis legalization was associated with an increased likelihood of cannabis use, daily cannabis use and cannabis-related problems. Given increases in these cannabis patterns of consumption, broader dissemination and uptake of targeted prevention tools is indicated.

Determinants of social distancing adherence

Introduction

Governments and public health authorities across many jurisdictions implemented social (physical) distancing measures to contain the spread of the 2019 novel coronavirus disease (COVID-19). Adherence to these measures is variable and likely influenced by various factors. This study aimed to 1) identify the individual sociodemographic, COVID-19 and social distancing related, and psychological determinants of social distancing adherence, and 2) explore regional differences in social distancing adherence in the United States (U.S.) and English-speaking Canada based on each region's discrepant response to social distancing restrictions.

Methods

A web-based repeated cross-sectional survey was conducted in 4,942 English-speaking participants from the four most populous U.S. states, specifically New York, California, Texas, and Florida, and Canada (www.covid19-database.com). The study was conducted at two timepoints, from May 1 to 5, 2020 (n = 1,019, Canadian participants only) and from July 6 to 10, 2020 (n = 3,923). Separate univariate models were computed for individual sociodemographic, COVID-19 and social distancing related, and psychological determinants of social distancing adherence. To determine the total variance explained, a univariate analysis including all of the determinants was performed. Regional differences in social distancing were compared between the four U.S. states and Canada, and between the U.S. as a whole and Canada.

Results

Adherence to social distancing was higher in May (mean = 4.4/5.0±0.7) compared to July (mean = 4.3/5.0±0.7) [t ₍₄₉₄₀₎ = 6.96, p < 0.001], likely a reflection of relaxing restrictions. There were no regional differences in adherence. Sociodemographic, COVID-19 and social distancing related, and psychological determinants explained 10, 36, and 23% of the variance of social distancing adherence, respectively. Higher perceived seriousness of COVID-19 [β (SE) = 0.39 (0.01), p < 0.001, partial η² = 0.22], lower risk propensity [β (SE) = -0.15 (0.01), p < 0.001, partial η² = 0.06], germ aversion [β (SE) = 0.12 (0.01), p < 0.001, partial η² = 0.03], age [β (SE) = 0.01 (0.00), p < 0.001, partial η² = 0.02], and greater social support [β (SE) = 0.03 (0.00), p < 0.001, partial η² = 0.02] had the largest effects on social distancing adherence.

Conclusion

Public service initiatives to emphasize the serious consequences of infection and targeted interventions toward certain sociodemographic groups, such as younger adults and vulnerable individuals in greater need of social support, may help enhance the public's adherence to social distancing measures during subsequent waves of COVID-19 and future pandemics.

Variation in Time Between Testing Positive for COVID-19 and Hospital Admission by Race/Ethnicity and Insurance Status

Understanding the extent to which demographic and socioeconomic factors play a role in the disparities associated with duration between testing positive for COVID-19 and hospital admission will help in achieving equitable health outcomes. This project linked the statewide COVID-19 registry to administrative datasets to examine the variation in times between testing positive for COVID-19 and hospital admission by race/ethnicity and insurance. In 2020, there were 11,314 patients admitted for COVID-19 in Arkansas. Approximately 42.2% tested positive for COVID-19 on the same day as hospital admission. Black patients had 38% higher odds of hospitalization on the day of testing compared with White patients (p<.001). Medicaid and uninsured patients had 51% and 50% higher odds of admission on the day of testing compared with privately insured patients (both p<.001), respectively. This study highlights the implications of reduced access to testing with respect to equitable health outcomes.

Factors Associated with Unwanted Sexual Attention in Australian Nightlife Districts: An Exploratory Study of Nightlife Attendees

BACKGROUND

Experiences of unwanted sexual attention (UWSA) are commonplace within nightlife environments. While typically associated with aggression perpetration, literature has suggested that a history of childhood corporal punishment (CCP) may also be related to experiences of victimisation in nightlife environments. The current exploratory study aims to examine the associations between experiences of UWSA victimisation and a history of CCP, trait aggression, and conformity to masculine norms (Playboy and Winning), for males and females separately.

METHOD

Street intercept interviews in the Brisbane inner-city entertainment precincts were used to measure demographic details and participants' breath alcohol concentration. Online follow-up surveys were used to record participants' experiences of UWSA on the night of interview, history of CCP, and self-reported rates of trait aggression and conformity to masculine norms. The final sample consisted of 288 females, as there were not sufficient male UWSA experiences for analysis.

RESULTS

Approximately 20% of female nightlife patrons experienced some form of UWSA victimisation. Logistic regression analyses identified that after controlling for age and intoxication, a history of CCP, trait aggression and masculine norm conformity were unrelated to experiences of UWSA for female respondents.

CONCLUSIONS

The current study found that individual factors were unrelated to experiences of UWSA, indicating that simply being in the nightlife environment, especially as a female, increases the risk of UWSA victimisation. Understanding and exploring social and environmental risk factors, rather than individual factors, is needed to prevent victimisation in nightlife environments.

Daily cannabis use during the novel coronavirus disease (COVID-19) pandemic in Canada: a repeated cross-sectional study from May 2020 to December 2020

Background

Daily cannabis use is most strongly implicated in the cannabis-attributable burden of disease. In the context of the novel coronavirus disease (COVID-19) pandemic in Canada, we characterized trends in daily cannabis use in the overall sample and various population subgroups, and examined risk characteristics associated with daily cannabis use.

Methods

A cross-sectional design was operationalized using data from six waves of a national, online survey of adults residing in Canada who spoke English (N = 6,021; May-08 2020 to December-01 2020). Trends were characterized using the Cochran-Armitage test and risk characteristics were identified using chi-square test and logistic regression analysis.

Results

Daily cannabis use in the overall sample remained stable (5.34% – 6.10%; p = 0.30). This pattern of findings extended to various population subgroups as well. The odds of daily cannabis use were higher for those who: were males (Odds Ratio; 95% Confidence Interval: 1.46; 1.15 – 1.85), were between 18 – 29 years (2.36; 1.56 – 3.57), 30 – 39 years (2.65; 1.93 – 3.64) or 40–49 years (1.74; 1.19 – 2.54), self-identified as white (1.97; 1.47 – 2.64), had less than college or university completion (1.78; 1.39 – 2.28), engaged in heavy episodic drinking (2.05; 1.62 – 2.61), had a job that increased the risk of contracting COVID-19 (1.38; 1.01 – 1.88), experienced loneliness 5–7 days in the past week (1.86; 1.26 – 2.73) and felt very worried (2.08; 1.21 – 3.58) or somewhat worried (1.83; 1.11 – 3.01) about the pandemic’s impact on their financial situation.

Conclusions

Daily cannabis use did not change in the overall sample or various population subgroups during the pandemic. Pandemic-related risks and impacts were associated with daily cannabis use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13011-022-00441-x.

Navigating Paths to Wellness: A Strengths-Based Photovoice Study Conducted with One First Nation in Southern Ontario, Canada

Research on substance use challenges in First Nations communities is often deficit-focused and can reinforce paternalistic stereotypes that lead to further discrimination. In this article, we report on findings of a strengths-based Photovoice project done in collaboration with a First Nations' community in southern Ontario, Canada to better understand experiences with substance use challenges in the community. We analyzed interview data collected with seventeen individuals who have lived experience or are supporting a loved one with lived experience with a substance use challenge. Participants described sources of strength that characterized their path to wellness, including strong family and social connections, cultural practices, identity, spirituality, day-to-day activities, and helpful supports and services. Furthermore, participants made several suggestions for improving services, including the need for integrated and flexible systems of care and trustful client-provider relationships. At its core, nurturing wellness involved a transformative process involving social and/or cultural connections. The stories shared by participants demonstrate the unique and varied strengths drawn from by individuals dealing with a substance use challenge.

Embedding lived experience into mental health academic research organizations: Critical reflections

Background

As part of a growing emphasis on engaging people with lived experience of mental health conditions in mental health research, there are increasing calls to consider and embed lived experience throughout academic research institutes. This extends beyond the engagement of lay patients and also considers the potential roles of academic researchers with lived experience. When the lived experience of academic researchers is applied to academic work, there is the potential to improve the relevance of the research, while destigmatizing mental illness within academia. However, there are different and often contrasting perspectives on the way a lived experience academic researcher initiative should be implemented.

Objectives

This article describes some of the key issues to be considered when planning an initiative that leverages and values the lived experience of academic researchers, including the advantages and disadvantages of each potential approach.

Discussion & Recommendations

Institutions are encouraged to reflect on the ways that they might support and value lived experience among academic researchers. In developing any such initiative, institutions are encouraged to be transparent about their objectives and values, undertake a careful planning process, involve researchers with lived experience from the outset and consistently challenge the stigma experienced by academic researchers with lived experience.

Patient or Public Contribution

Multiple authors are academic researchers with lived experience of mental health conditions.

Self-reported mental health during the COVID-19 pandemic and its association with alcohol and cannabis use: a latent class analysis

BACKGROUND

Mental health problems and substance use co-morbidities during and after the COVID-19 pandemic are a public health priority. Identifying individuals at high-risk of developing mental health problems and potential sequela can inform mitigating strategies. We aimed to identify distinct groups of individuals (i.e., latent classes) based on patterns of self-reported mental health symptoms and investigate their associations with alcohol and cannabis use.

METHODS

We used data from six successive waves of a web-based cross-sectional survey of adults aged 18 years and older living in Canada (6,021 participants). We applied latent class analysis to three domains of self-reported mental health most likely linked to effects of the pandemic: anxiety, depression, and loneliness. Logistic regression was used to characterize latent class membership, estimate the association of class membership with alcohol and cannabis use, and perform sex-based analyses.

RESULTS

We identified two distinct classes: (1) individuals with low scores on all three mental health indicators (no/low-symptoms) and (2) those reporting high scores across the three measures (high-symptoms). Between 73.9 and 77.1% of participants were in the no/low-symptoms class and 22.9-26.1% of participants were in the high-symptom class. We consistently found across all six waves that individuals at greater risk of being in the high-symptom class were more likely to report worrying about getting COVID-19 with adjusted odds ratios (aORs) between 1.72 (95%CI:1.17-2.51) and 3.51 (95%CI:2.20-5.60). Those aged 60 + were less likely to be in this group with aORs (95%CI) between 0.26 (0.15-0.44) and 0.48 (0.29-0.77) across waves. We also found some factors associated with class membership varied at different time points. Individuals in the high-symptom class were more likely to use cannabis at least once a week (aOR = 2.28, 95%CI:1.92-2.70), drink alcohol heavily (aOR = 1.71, 95%CI:1.49-1.96); and increase the use of cannabis (aOR = 3.50, 95%CI:2.80-4.37) and alcohol (aOR = 2.37, 95%CI:2.06-2.74) during the pandemic. Women in the high-symptom class had lower odds of drinking more alcohol during the pandemic than men.

CONCLUSIONS

We identified the determinants of experiencing high anxiety, depression, and loneliness symptoms and found a significant association with alcohol and cannabis consumption. This suggests that initiatives and supports are needed to address mental health and substance use multi-morbidities.

Legume Cover Crop Contributions to Ecological Nutrient Management in Upper Midwest Vegetable Systems

Cover cropping, especially with legumes, is a critical approach to ecological soil nutrient management as a means to meet Sustainable Development Goal (SDG) 2, addressing food security issues via sustainable agriculture approaches. However, cover cropping in some of the most intensified food production regions of the northern U.S. is challenged by short growing seasons and harsh winters with variable temperatures and increasingly erratic snowfall. In this study, we explore the potential of winter annual legume cover crops to augment soil organic carbon (C) and nitrogen (N) stocks within a horticultural cropping system under climate conditions that allow only modest cover crop biomass production. We compared hairy vetch, cereal rye, red clover, and a hairy vetch/rye biculture in a randomized complete block design at two sites (North Central and Southwest Research and Outreach Centers in Minnesota) over 2 years. Cover crops were established in fall and terminated in spring prior to sweet corn planting, and soils sampled both at pre-cover crop termination and 2 weeks post-termination. We determined several indicators of C and N dynamics, including microbial biomass C (MBC), permanganate-oxidizable C (POXC), particulate organic matter C and N (POMC and POMN, respectively), extractable soil N (EXTN), and potentially mineralizable N (PMN). Out of all treatments evaluated, vetch production increased soil EXTN the greatest after 2 weeks, contributing two to 11 times more EXTN to soils compared to non-vetch treatments, meeting N requirements for sweet corn in three out of four site-years. Overall, time of sampling, either pre-or post-termination, consistently impacted soil measurements, with p &lt; 0.05 in 20 out of 24 soil parameter × site-year combinations. Study results suggest that cover crops planted in colder northern climates during winter fallow periods can supply valuable N following spring termination, but termination effects on labile C and N pools are mixed. Our findings advance understanding of how cover cropping can support SDG 2 outcomes by assessing cover crop legume systems under biophysical conditions that challenge cover crop integration in agroecosystems.

Changes in alcohol use during the COVID-19 pandemic and previous pandemics: A systematic review

The objective of this study is to summarize the research on the relationships between exposure to the COVID-19 pandemic or previous pandemics and changes in alcohol use. A systematic search of Medline and Embase was performed to identify cohort and cross-sectional population studies that examined changes in alcohol use during or following a pandemic compared to before a pandemic occurred. Outcomes examined included differences in the volume and frequency of alcohol consumption and the frequencies of heavy episodic drinking (HED) and alcohol-related problems during a pandemic compared to before a pandemic. Quality assessment was performed using the Cochrane Risk of Bias Tool for Nonrandomized Studies. This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search yielded 672 articles; 27 were included in the narrative review, of which 6 were cohort studies (all from high-income countries). A total of 259,188 participants were included. All cohort studies examined the impact of COVID-19 and associated pandemic-related policies, including social distancing and alcohol-specific policies, on alcohol use. Cohort studies demonstrated a consistent significant decrease in total alcohol consumption (Australia) and a significant increase in the frequency of alcohol use (United States). A significant decrease in the frequency of HED was observed in Australia and Spain but not in the United States. A significant increase in the proportion of people with problematic alcohol use was observed in the United Kingdom. Initial insights into changes in alcohol use indicate substantial heterogeneity. Alcohol use may have decreased in some countries, while HED and the proportion of people with problematic alcohol use may have increased. The lack of high-quality studies from low- and middle-income countries reflects a dearth of information from countries inhabited by most of the world's population.

Age differences in the association between loneliness and anxiety symptoms during the COVID-19 pandemic

Loneliness and associated mental health problems are of particular concern during the COVID-19 pandemic due to physical distancing and lockdown restrictions. Loneliness is most common among young adults and women during the pandemic, but it is unclear if the association between loneliness and mental health problems, notably anxiety, is strongest in these groups. The objective of this study was to examine whether the association between loneliness and anxiety differed by age and/or gender during the pandemic. We analyzed data from a multi-wave national online survey of Canadians aged 18+ years from May 2020 to March 2021 (n = 7,021). Multivariable modified least-squares regression was used to examine whether the association between loneliness and moderate to severe anxiety symptoms (GAD-7 10+) differed by age and/or gender on the additive scale, controlling for socio-demographic factors, depression, hopefulness, and survey wave. Age significantly moderated the association between loneliness and anxiety symptoms while gender did not. Loneliness was associated with anxiety symptoms for all age groups, but the association was not as strong among those aged 70+ years compared to other age groups. Evidence-based loneliness interventions that target younger adults are needed to mitigate the mental health effects of infectious disease events such as COVID-19.

Alcohol and cannabis use during the COVID-19 pandemic among transgender, gender-diverse, and cisgender adults in Canada

BACKGROUND

This study examined whether heavy episodic drinking (HED), cannabis use, and subjective changes in alcohol and cannabis use during the COVID-19 pandemic differ between transgender and gender-diverse (TGD) and cisgender adults.

METHODS

Successive waves of web-based cross-sectional surveys.

SETTING

Canada, May 2020 to March 2021.

PARTICIPANTS

6,016 adults (39 TGD, 2,980 cisgender men, 2,984 cisgender women, and 13 preferred not to answer), aged ≥18 years.

MEASUREMENTS

Measures included self-reported HED (≥5 drinks on one or more occasions in the previous week for TGD and cisgender men and ≥4 for cisgender women) and any cannabis use in the previous week. Subjective changes in alcohol and cannabis use in the past week compared to before the pandemic were measured on a five-point Likert scale (1: much less to 5: much more). Binary and ordinal logistic regressions quantified differences between TGD and cisgender participants in alcohol and cannabis use, controlling for age, ethnoracial background, marital status, education, geographic location, and living arrangement.

RESULTS

Compared to cisgender participants, TGD participants were more likely to use cannabis (adjusted odds ratio (aOR)=3.78, 95%CI: 1.89, 7.53) and to have reported subjective increases in alcohol (adjusted proportional odds ratios (aPOR)= 2.00, 95%CI: 1.01, 3.95) and cannabis use (aPOR=4.56, 95%CI: 2.13, 9.78) relative to before the pandemic. Compared to cisgender women, TGD participants were more likely to use cannabis (aOR=4.43, 95%CI: 2.21, 8.87) and increase their consumption of alcohol (aPOR=2.05, 95%CI: 1.03, 4.05) and cannabis (aPOR=4.71, 95%CI: 2.18, 10.13). Compared to cisgender men, TGD participants were more likely to use cannabis (aOR=3.20, 95%CI: 1.60, 6.41) and increase their use of cannabis (aPOR=4.40, 95%CI: 2.04, 9.49). There were no significant differences in HED between TGD and cisgender participants and in subjective change in alcohol between TGD and cisgender men; however, the odds ratios were greater than one as expected.

CONCLUSIONS

Increased alcohol and cannabis use among TGD populations compared to before the pandemic may lead to increased health disparities. Accordingly, programs targeting the specific needs of TGD individuals should be prioritized.

Deployment of Health Equity Strike Teams to Address COVID-19 Vaccine Disparities in Arkansas, 2021

Minority populations have been disproportionately affected by the COVID-19 pandemic, and disparities have been noted in vaccine uptake. In the state of Arkansas, health equity strike teams (HESTs) were deployed to address vaccine disparities. A total of 13 470 vaccinations were administered by HESTs to 10 047 eligible people at 45 events. Among these individuals, 5645 (56.2%) were African American, 2547 (25.3%) were White, and 1068 (10.6%) were Hispanic. Vaccination efforts must specifically target populations that have been disproportionately affected by the pandemic. (Am J Public Health. 2022;112(1):29-33. https://doi.org/10.2105/AJPH.2021.306564).

Plant Breeding for Intercropping in Temperate Field Crop Systems: A Review

Monoculture cropping systems currently dominate temperate agroecosystems. However, intercropping can provide valuable benefits, including greater yield stability, increased total productivity, and resilience in the face of pest and disease outbreaks. Plant breeding efforts in temperate field crops are largely focused on monoculture production, but as intercropping becomes more widespread, there is a need for cultivars adapted to these cropping systems. Cultivar development for intercropping systems requires a systems approach, from the decision to breed for intercropping systems through the final stages of variety testing and release. Design of a breeding scheme should include information about species variation for performance in intercropping, presence of genotype × management interaction, observation of key traits conferring success in intercropping systems, and the specificity of intercropping performance. Together this information can help to identify an optimal selection scheme. Agronomic and ecological knowledge are critical in the design of selection schemes in cropping systems with greater complexity, and interaction with other researchers and key stakeholders inform breeding decisions throughout the process. This review explores the above considerations through three case studies: (1) forage mixtures, (2) perennial groundcover systems (PGC), and (3) soybean-pennycress intercropping. We provide an overview of each cropping system, identify relevant considerations for plant breeding efforts, describe previous breeding focused on the cropping system, examine the extent to which proposed theoretical approaches have been implemented in breeding programs, and identify areas for future development.

Vaccine Hesitancy Is a Barrier to Achieving Equitable Herd Immunity Among Racial Minorities

Introduction: Racial minority groups have been disproportionately affected by the 2019 novel coronavirus disease (COVID-19). Vaccine hesitancy may be a major barrier to achieving equitable herd immunity and must be addressed to reduce the excess morbidity and mortality of COVID-19 in disproportionately affected communities. This study aimed to determine if COVID-19 vaccine hesitancy, and its factors vaccine complacency and confidence, are more prominent among disproportionately affected racial minority groups.

Methods:We collected data from participants aged 18 years or older from the four most populous U.S. states, including New York, California, Florida, and Texas, and Canada. Data were collected using a web-based survey platform. Data are available at http://www.covid19-database.com.

Results:Data from 4,434 participants were included [mean (SD) age = 48.7 (17.2) and 50.4% women]. Vaccine hesitancy was higher in Black, Indigenous (Native American and Indigenous People of Canada, including First Nations, Inuit and Métis), and Latinx compared to White participants, while no difference was found between East Asian and White participants. The group differences in vaccine hesitancy for Indigenous and Black compared to White participants remained after controlling for sociodemographic factors. Determinants of vaccine complacency were equivalent between disproportionately affected racial groups and white participants. Vaccine confidence (i.e., trust in vaccine benefit) was generally lower in all racial groups compared to White participants. Differences in vaccine mistrust comparing Black and East Asian to White participants remained after controlling for sociodemographic factors.

Discussion:Disproportionately affected racial minorities may have higher vaccine hesitancy and lower confidence in COVID-19 vaccines. Public health and other relevant government services should address vaccine hesitancy among racial minorities using a culturally sensitive, community-centered approach to attain equitable herd immunity.

Machine Learning-Based Predictive Modeling of Anxiety and Depressive Symptoms During 8 Months of the COVID-19 Global Pandemic: Repeated Cross-sectional Survey Study

BACKGROUND

The COVID-19 global pandemic has increased the burden of mental illness on Canadian adults. However, the complex combination of demographic, economic, and lifestyle factors and perceived health risks contributing to patterns of anxiety and depression has not been explored.

OBJECTIVE

The aim of this study is to harness flexible machine learning methods to identify constellations of factors related to symptoms of mental illness and to understand their changes over time during the COVID-19 pandemic.

METHODS

Cross-sectional samples of Canadian adults (aged ≥18 years) completed web-based surveys in 6 waves from May to December 2020 (N=6021), and quota sampling strategies were used to match the English-speaking Canadian population in age, gender, and region. The surveys measured anxiety and depression symptoms, sociodemographic characteristics, substance use, and perceived COVID-19 risks and worries. First, principal component analysis was used to condense highly comorbid anxiety and depression symptoms into a single data-driven measure of emotional distress. Second, eXtreme Gradient Boosting (XGBoost), a machine learning algorithm that can model nonlinear and interactive relationships, was used to regress this measure on all included explanatory variables. Variable importance and effects across time were explored using SHapley Additive exPlanations (SHAP).

RESULTS

Principal component analysis of responses to 9 anxiety and depression questions on an ordinal scale revealed a primary latent factor, termed "emotional distress," that explained 76% of the variation in all 9 measures. Our XGBoost model explained a substantial proportion of variance in emotional distress (r2=0.39). The 3 most important items predicting elevated emotional distress were increased worries about finances (SHAP=0.17), worries about getting COVID-19 (SHAP=0.17), and younger age (SHAP=0.13). Hopefulness was associated with emotional distress and moderated the impacts of several other factors. Predicted emotional distress exhibited a nonlinear pattern over time, with the highest predicted symptoms in May and November and the lowest in June.

CONCLUSIONS

Our results highlight factors that may exacerbate emotional distress during the current pandemic and possible future pandemics, including a role of hopefulness in moderating distressing effects of other factors. The pandemic disproportionately affected emotional distress among younger adults and those economically impacted.

Importing genetically altered animals: ensuring quality

The reproducibility of research using laboratory animals requires reliable management of their quality, in particular of their genetics, health and environment, all of which contribute to their phenotypes. The point at which these biological materials are transferred between researchers is particularly sensitive, as it may result in a loss of integrity of the animals and/or their documentation. Here, we describe the various aspects of laboratory animal quality that should be confirmed when sharing rodent research models. We also discuss how repositories of biological materials support the scientific community to ensure the continuity of the quality of laboratory animals. Both the concept of quality and the role of repositories themselves extend to all exchanges of biological materials and all networks that support the sharing of these reagents.

Changes in Alcohol Consumption in Canada During the COVID-19 Pandemic: Associations With Anxiety and Self-Perception of Depression and Loneliness

Aim

To examine whether changes in alcohol consumption in Canada since the start of the novel coronavirus disease (COVID-19) pandemic are associated with feelings of anxiety, depression, loneliness and/or with changes in employment due to COVID-19.

Methods

Data collection occurred between 29 May 2020 and 23 March 2021 via a web panel, AskingCanadians, which sampled 5892 adults (≥18 years of age). Data were collected on changes in alcohol consumption compared to before the pandemic (ordinal variable ranging from 1=‘much less alcohol’ to 5=‘much more alcohol’), anxiety (General Anxiety Disorder-7), self-perceived depression (Center for Epidemiologic Studies Depression Scale), self-perceived loneliness, changes in employment status due to COVID-19 and socio-demographic variables (age, gender, living situation, household income and urban vs rural residence). Multivariate associations were assessed using ordinal logistic regression. Effect modification by gender was tested using likelihood-ratio tests.

Results

Changes in alcohol consumption were positively associated with anxiety, feeling depressed and loneliness. In particular, people with mild to moderate (ordered Odds Ratio (OR):1.23, 95% Confidence Interval (CI):1.07, 1.62) or severe anxiety (ordered OR:1.49, 95% CI:1.15, 1.93) had a greater odds of increased drinking than did people with no to low levels of anxiety. Gender, age, household income, living situation and survey wave were also associated with changes in drinking. No effect modifications by gender were observed.

Conclusion

Given the health harms caused by alcohol use, public health practitioners and primary care physicians should focus health messaging to identify and support individuals at risk of increased alcohol consumption, especially people experiencing depression, loneliness or anxiety.

Associations of antidepressant use with alcohol use and problem drinking: Ontario population data from 1999 to 2017

OBJECTIVE

This study investigated the rates of and change in past-year antidepressant use from 1999 to 2017 among a representative sample of Ontario adults and past-year alcohol users and problem drinkers. It examined whether alcohol use and problem drinking are associated with antidepressant use over time, whether gender moderated the effect of problem drinking on antidepressant use, and the potential correlates of past-year antidepressant use.

METHOD

This study utilized data from the Centre for Addiction and Mental Health Monitor study, a repeat cross-sectional telephone survey of the Ontario general adult population. Data are from 15 annual cycles of the survey 1999-2017 (where relevant variables were included), resulting in a sample size of N = 35,210. Variables of interest included demographic variables, past-year antidepressant use, past-year alcohol use, and past-year problem drinking (e.g., 8+ on the Alcohol Use Disorders Identification Test).

RESULTS

Past-year antidepressant use increased from 1999 to 2017 similarly among the full sample, past-year alcohol users, and past-year problem drinkers. Approximately 9% of Ontarians reported past-year antidepressant use in 2017. Overall, past-year problem drinkers were 1.5 times more likely to use antidepressants than non-problem drinkers. Past-year alcohol use was not associated with antidepressant use. Gender moderated the association between past-year problem drinking and antidepressant use.

CONCLUSION

This study determined that past-year antidepressant use increased from 1999 to 2017, that past-year problem drinkers are more likely to use antidepressants than non-problem drinkers, and that past-year problem drinking is associated with past-year antidepressant use among women but not among men.

Children, Parental Alcohol Consumption, and Intimate Partner Violence: A Multicountry Analysis by Perpetration Versus Victimization and Sex

Both living with children and alcohol consumption are positively associated with intimate partner violence (IPV). We assessed their combined relationship with physical IPV (P-IPV) victimization and perpetration, and explored possible moderating roles of sex and culture. Data included 15 surveys of 13,716 men and 17,832 women in 14 countries from the GENACIS (Gender, Alcohol, and Culture: An International Study) collaboration. P-IPV was measured as victim of physical aggression by an intimate partner (Vic-Only), perpetrator of physical aggression toward a partner (Perp-Only), or both victim and perpetrator (i.e., bidirectional) (Bi-Dir). Participants reported whether they lived with children below 18 years of age, whether the participant was a drinker/abstainer, and, among drinkers, usual frequency and quantity of alcohol consumed. Multilevel multinomial logistic regression, controlling for age and nesting of data within countries, indicated that Vic-Only, Perp-Only, and Bi-Dir (compared with no P-IPV) were positively associated with living with children, being a drinker, and quantity/frequency of drinking among drinkers (especially higher quantity). The positive association of P-IPV with living with children and being a drinker was evident within most countries. Significant interactions with sex were found, with (a) living with children more strongly associated with Perp-Only for men and Vic-Only for women, and (b) Perp-Only and Bi-Dir more strongly associated with being a drinker for men but with quantity consumed for women. Also, alcohol consumption was more strongly related to Perp-Only and Bi-Dir than with Vic-Only. In conclusion, higher risk of P-IPV with alcohol consumption is compounded when living with children-putting children who live with drinkers, especially drinkers who consume large amounts per occasion, at special risk of exposure to P-IPV. This is an important area for future research and prevention.

The association between COVID-19 diagnosis or having symptoms and anxiety among Canadians: A repeated cross-sectional study

BACKGROUND

The mental health effects of being diagnosed with COVID-19 are unknown. The present study examined whether individuals or those with someone close to them with a COVID-19 diagnosis differentially experienced anxiety during the pandemic.

METHODS

Four web-based repeated cross-sectional surveys were conducted among Canadians aged 18 and older (n = 4015) regarding the impact of COVID-19 on mental health between May 8th and July 14th, 2020. Data on sociodemographic, COVID-19 symptoms/diagnoses for self or someone close, and anxiety were collected. Multiple logistic regression analyses were performed controlling for potential confounders.

RESULTS

Anxiety among individuals affected by the pandemic remained stable over time. Individuals or those with someone close diagnosed with COVID-19 had greater odds of having anxiety (OR = 1.55; 95%CI 1.12, 2.14) compared to those who had not been diagnosed (self or close other) with COVID-19. Individuals or those with someone close to them who had symptoms of COVID-19 had greater odds of having anxiety (OR = 2.08; 95%CI 1.51, 2.87) compared to those who did not report symptoms (self or close other).

CONCLUSIONS

This evidence highlights the importance of targeted psychosocial interventions for those directly impacted by the COVID-19 virus.

Loneliness in the COVID-19 pandemic: Associations with age, gender and their interaction

Loneliness is associated with mental health and thus is of particular concern in the COVID-19 pandemic, due to physical distancing restrictions and shelter-in-place orders. The current study assessed the associations of age, gender and their interaction with loneliness during the COVID-19 pandemic, controlling for other sociodemographic variables. A pooled sample of 3,012 English-speaking Canadian adults aged 18+ years completed a web-based survey in one of three waves between May 8 and June 23, 2020. Multivariable logistic regression was used to examine the associations of loneliness with age and gender controlling for marital status, household income, education, living alone, employment situation, and survey wave. A likelihood ratio test assessed the model with interaction between age and gender included. Approximately 8.4% of the sample reported feeling lonely 5+ days in the past week. The regression model with main effects found greater odds of loneliness among women than men (AOR = 1.76, 95%CI = 1.32, 2.34) and among all age groups younger than 60 years compared to those aged 60+ years (p = 0.002). In the final regression model, a significant interaction effect between age and gender on loneliness was found. The interaction showed that women had greater odds of loneliness than men among those aged 18-29 years (AOR = 3.53, 95%CI = 1.69, 7.37) and 60+ years (AOR = 2.62, 95%CI = 1.33, 5.17). Special consideration of loneliness among younger and older adult women is needed in service planning. Given inconsistencies with pre-pandemic studies, detailed data collected during the current crisis is essential to inform proactive resource allocation to prevent and treat mental health consequences of the pandemic.

A scoping review of evaluated Indigenous community-based mental wellness initiatives

INTRODUCTION

Many Indigenous peoples around the world are disproportionately affected by mental health challenges, due to intergenerational and collective trauma stemming from historical losses and ongoing colonialism. A growing body of literature suggests that mental wellness initiatives are more culturally safe and result in more successful and sustainable outcomes when they are developed by, for and with Indigenous communities using community-driven approaches that prioritize and privilege Indigenous leadership, knowledge systems, beliefs and practices. However, knowledge has not been synthesized on mental wellness initiatives and the extent of community engagement during the development, implementation, and evaluation stages of these initiatives.

METHODS

The authors conducted a scoping review of studies on Indigenous community-based mental wellness initiatives to identify the (1) characteristics of these initiatives, (2) types of evaluation approaches (specific measures and assessment tools), (3) level of community engagement from inception to the evaluation stage of the initiative, and (4) lessons learned as identified by the authors. Published and grey literature were searched across several electronic databases. Inclusion criteria required that each study was published between January 2008 and June 2018, focused on Indigenous peoples and their communities in Canada, USA, Australia, and/or New Zealand, focused on a community-based mental wellness initiative, was meaningfully co-led or co-designed by the community, described the initiative and how it was evaluated, and was printed in English.

RESULTS

The search yielded 1491 unique articles, and 22 of these articles met all of the inclusion criteria. All included studies took place in Canada, the USA, or Australia. Most mental wellness initiatives addressed general mental wellness, substance use, suicide prevention, and/or co-occurring conditions, and many were tailored for Indigenous youth. Culture-based initiatives were emphasized in most studies, with cultural adaptation and relevance prioritized in all initiatives. Approaches to evaluation ranged from process evaluations to outcome evaluations. Most studies used a mixed methods approach and a wide range of assessment tools, including questionnaires and indicators of community capacity building. Many evaluations used a shared leadership model between community leaders and researchers and had combinations of community members, families, Elders, Knowledge Keepers, and leaders involved in the development, implementation, and evaluation of the mental wellness initiative. Common challenges in conducting evaluation research included limitations of funding structures and the burden on community staff and leaders during the project.

CONCLUSION

Overall, across all studies, culture stood out as a major theme for community-based mental wellness initiatives among rural and remote Indigenous communities, with cultural teachings, cultural activities, appropriate use of culture, land-based programming and knowledge sharing integrated into community programming. However, culture and Indigenous leadership throughout were lacking in many of the research studies. Thus, as more Indigenous communities and leaders govern and guide the development of evidence-based mental wellness programming, culture as a form of healing needs to be incorporated into the development of the program, and culture should be a core competency in any evaluation research.

Household- and employment-related risk factors for depressive symptoms during the COVID-19 pandemic

OBJECTIVES

The COVID-19 pandemic has generated multiple psychological stressors, which may increase the prevalence of depressive symptoms. Utilizing Canadian survey data, this study assessed household- and employment-related risk factors for depressive symptoms during the pandemic.

METHODS

A sample of 1005 English-speaking Canadian adults aged 18+ years completed a web-based survey after physical distancing measures were implemented across Canada. Hierarchical binary logistic regression analyses were conducted to examine the associations of depressive symptoms with household- (household size, presence of children, residence locale) and employment-related (job with high risk of COVID-19 exposure, working from home, laid off/not working, financial worry) risk factors, controlling for demographic factors (gender, age, education, income).

RESULTS

About 20.4% of the sample reported depressive symptoms at least 3 days per week. The odds of experiencing depressive symptoms 3+ days in the past week were higher among women (AOR = 1.67, p = 0.002) and younger adults (18-29 years AOR = 2.62, p < 0.001). After adjusting for demographic variables, the odds of experiencing depressive symptoms were higher in households with 4+ persons (AOR = 1.88, p = 0.01), in households with children aged 6 to 12 years (AOR = 1.98, p = 0.02), among those with a job at high risk for exposure to COVID-19 (AOR = 1.82, p = 0.01), and those experiencing financial worry due to COVID-19 ('very worried' AOR = 8.00, p < 0.001).

CONCLUSION

Pandemic responses must include resources for mental health interventions. Additionally, further research is needed to track mental health trajectories and inform the development, targeting, and implementation of appropriate mental health prevention and treatment interventions.

Developing an Innu framework for health research: The canoe trip as a metaphor for a collaborative approach centered on valuing Indigenous knowledges

Indigenous communities increasingly assert their right to self-determination by requiring that participatory research approaches be used, valuing and prioritizing Indigenous knowledges, for the purpose of improving Indigenous health. While frameworks that focus on Indigenous knowledges are being developed, these must be adapted or developed by Indigenous communities because their knowledge is specific to place and inherent to their lived experience. No community-based participatory research (CBPR) framework for health research has been developed with the Labrador Innu. In addition, while the literature emphasizes the importance of relationship in research with Indigenous communities, the process of establishing relationships is underspecified. Within this context, we describe our experience in developing a CBPR framework for health research in a study that is community-initiated and fitting within Innu self-determination. We highlight the importance of paying attention to the theoretical roots of CBPR, arguing that this helps researchers focus on the centrality of Indigenous knowledges (in this case, Innu knowledge). This requires that non-Indigenous researchers question assumptions of universality regarding their own knowledge and see all knowledges as equitable. Such posture of humility allows non-Indigenous researchers to enter relational spaces that join researchers and Indigenous communities. Within these spaces, a true collaborative approach is enabled and Indigenous knowledges are uncovered and become foundational in the inquiry process. We illustrate these ideas by describing a model for opening relational spaces that include Indigenous and non-Indigenous researchers. We then present a framework that uses the metaphor of canoeing together to capture our CBPR approach for use in Innu health research. We outline the behaviors of non-Indigenous researchers to build and solidify relationships with Indigenous community researchers over time. This article is useful for non-Indigenous researchers interested in relational approaches to research with Indigenous communities, and for Indigenous leaders and researchers who seek community solutions through research.

SARS-CoV-2 Seroprevalence among a Southern U.S. Population Indicates Limited Asymptomatic Spread under Physical Distancing Measures

Characterizing the asymptomatic spread of SARS-CoV-2 is important for understanding the COVID-19 pandemic. This study was aimed at determining asymptomatic spread of SARS-CoV-2 in a suburban, Southern U.S. population during a period of state restrictions and physical distancing mandates. This is one of the first published seroprevalence studies from North Carolina and included multicenter, primary care, and emergency care facilities serving a low-density, suburban and rural population since description of the North Carolina state index case introducing the SARS-CoV-2 respiratory pathogen to this population. To estimate point seroprevalence of SARS-CoV-2 among asymptomatic individuals over time, two cohort studies were examined. The first cohort study, named ScreenNC, was comprised of outpatient clinics, and the second cohort study, named ScreenNC2, was comprised of inpatients unrelated to COVID-19. Asymptomatic infection by SARS-CoV-2 (with no clinical symptoms) was examined using an Emergency Use Authorization (EUA)-approved antibody test (Abbott) for the presence of SARS-CoV-2 IgG. This assay as performed under CLIA had a reported specificity/sensitivity of 100%/99.6%. ScreenNC identified 24 out of 2,973 (0.8%) positive individuals among asymptomatic participants accessing health care during 28 April to 19 June 2020, which was increasing over time. A separate cohort, ScreenNC2, sampled from 3 March to 4 June 2020, identified 10 out of 1,449 (0.7%) positive participants.IMPORTANCE This study suggests limited but accelerating asymptomatic spread of SARS-CoV-2. Asymptomatic infections, like symptomatic infections, disproportionately affected vulnerable communities in this population, and seroprevalence was higher in African American participants than in White participants. The low, overall prevalence may reflect the success of shelter-in-place mandates at the time this study was performed and of maintaining effective physical distancing practices among suburban populations. Under these public health measures and aggressive case finding, outbreak clusters did not spread into the general population.

Do gender differences in the relationship between living with children and alcohol consumption vary by societal gender inequality?

INTRODUCTION AND AIMS

To better understand the relationship between alcohol consumption and living with children, we assessed whether the association varied for men and women across diverse countries and whether this relationship was moderated by country-level gender inequality.

DESIGN AND METHODS

We used Hierarchical Linear Modelling to analyse data from 32 surveys conducted in 27 countries. Measures included whether the participant was a drinker versus abstainer in past 12 months, annual number of drinks consumed, whether the respondent lived with children, gender (male/female) and age of respondent, and country-level gender inequality measured using the Gender Inequality Index.

RESULTS

Annual drinks consumed was significantly lower for women living with children. Men living with children were generally more likely to be drinkers, and the relationship between annual consumption and living with children was moderated by cultural gender equality: specifically, men in countries with higher gender equality drank less if they lived with children while the association for men in lower equality countries was nonsignificant.

DISCUSSION AND CONCLUSIONS

Although lower alcohol consumption was found generally for women living with children, this relationship was found only for men in countries where there was more gender equality. Given the high risk of harm to children from heavy consumption by adults with whom they live, prevention efforts need to strengthen prevention of heavy consumption by parents and other who live with children, especially for men who live with children in low gender equality countries.

A community-driven and evidence-based approach to developing mental wellness strategies in First Nations: a program protocol

BACKGROUND

Mental health, substance use/addiction and violence (MSV) are important issues affecting the well-being of Indigenous People in Canada. This paper outlines the protocol for a research-to-action program called the Mental Wellness Program (MWP). The MWP aims to increase community capacity, promote relationship-building among communities, and close gaps in services through processes that place value on and supports Indigenous communities' rights to self-determination and control. The MWP involves collecting and using local data to develop and implement community-specific mental wellness strategies in five First Nations in Ontario.

METHODS

The MWP has four key phases. Phase 1 (data collection) includes a community-wide survey to understand MSV issues, service needs and community strengths; in-depth interviews with individuals with lived experiences with MSV issues to understand, health system strengths, service gaps and challenges, as well as individual and community resilience factors; and focus groups with service providers to improve understanding of system weaknesses and strengths in addressing MSV. Phase 2 (review and synthesis) involves analysis of results from these local data sources and knowledge-sharing events to identify a priority area for strategic development based on local strengths and need. Phase 3 (participatory action research approach) involves community members, including persons with lived experience, working with the community and local service providers to develop, implement, and evaluate the MWP to address the selected priority area. Phase 4 (share) is focused on developing and implementing effective knowledge-sharing initiatives. Guidelines and models for building the MWP are shared regionally and provincially through forums, webinars, and social media, as well as cross-community mentoring.

DISCUSSION

MWP uses local community data to address MSV challenges by building on community supports and resilience factors. Drawing on local data and each community's system of formal and informal supports, the program includes sharing exemplary knowledge-to-action models and wellness strategies developed by and for First Nations people that can be used by other First Nations to identify shared wellness priorities in each community, and determine and execute next steps in addressing areas of main concern.

Buffering effects of social support for Indigenous males and females living with historical trauma and loss in 2 First Nation communities

Globally, Indigenous mental health research has increasingly focused on strengths-based theory to understand how positive factors influence wellness. However, few studies have examined how social support buffers the effects of trauma and stress on the mental health of Indigenous people. Using survey data from 207 males and 279 females in 2 Ontario First Nations we examined whether social support diminished the negative effects of perceived racism, historical trauma and loss on depression and/or anxiety. Among females, having more social supports was significantly related to a lower likelihood of depression/anxiety, whereas greater perceived racism and historical losses were associated with a greater likelihood of depression/anxiety. For both males and females, childhood adversity was significantly related to a greater likelihood of depression/anxiety. Among females, a significant interaction was found between social support and childhood adversities. For females with low social support, depression/anxiety was significantly higher among those who had experienced childhood adversities versus those with none; however, for those with high level of social support, the association was not significant. The same relationships were not found for males. Possible reasons are that males and females might experience depression/anxiety differently, or the social support measure might not adequately capture social support for First Nations males.