Roman Pabayo

Climate change and air pollution are known to cause adverse pregnancy and birth outcomes. Asia continues to experience significant levels of air pollution and changes in weather, which has negative consequences for maternal and newborn health. Adaptation strategies are needed to minimize the impact of climate change and air pollution, however, research pertaining to the impact of adaptation strategies on maternal and newborn health is lacking. This review aims to map the current literature on climate change, weather, and air pollution adaptation in regard to women’s and newborn health in the Asia region. A search was conducted in five databases using relevant keywords related to climate change/air pollution/weather, adaptation, and pregnancy/birth outcomes. The search was limited geographically to the region of Asia. Two independent reviewers conducted abstract and full-text screening. Data was extracted from the final articles and synthesized. Ten studies were included in the final review. All but one of the studies focused on air pollution as an exposure, mainly in China. The most commonly studied adaptation measure was greenness. Exposure to greenness was associated with reduced risks of preterm birth, low birth weight, and gestational diabetes mellitus among pregnant women and newborns in Asia. Greenness was also found to mediate the relationship between pollutants and adverse pregnancy outcomes. Folic acid supplementation (air pollution exposures) and shifting the location of the maternity ward (heat exposures) were similarly found to reduce maternal and newborn health risks. The adaptation measures mentioned in this review reduce adverse pregnancy and birth outcomes through reducing exposure to pollutants. However, studies focusing on climate change as an exposure were limited. Additionally, all but two of the included studies were conducted in China, reflecting a significant gap in the literature across the rest of the Asian continent. Future research should focus on adaptation to climate change, understudied countries, and diverse adaptation strategies to increase knowledge around the impacts of climate change and air pollution adaptation strategies among pregnant women and newborns.

Objective: This study examined whether schools’ engagement with their local public health unit (PHU) regarding mental health was associated with adolescent anxiety and depression. Methods: Linked longitudinal data from 2017−18 and 2018−19 of the COMPASS study was used. Adolescent (n = 27 473) anxiety and depressive symptoms were self-reported via questionnaire. School (n = 112) engagement with their local PHU regarding mental health was reported via administrative survey. Multilevel logistic regression was used to model the association between school PHU engagement and adolescent anxiety and depression. Results: Adolescents attending schools that engaged with their local PHU had greater odds of anxiety at baseline (OR = 1.30, 95%CI: 1.10, 1.53) and the probability was higher over time compared to adolescents who attended schools with no PHU engagement. Similar results were found regarding the odds of depression at baseline (OR = 1.18, 95%CI: 1.02, 1.36). No differences in the likelihood of depression over time were observed. Conclusion: Based on these findings, school engagement with their local PHU may be associated with student anxiety and depression. However, more research over a longer time frame and with more detailed measures of PHU engagement is needed.

This paper examined local public health strategies to promote COVID-19 vaccination equity in Ontario, Canada between 2020 and 2023. Our descriptive mixed-m

Context: The COVID-19 pandemic required a major response from local public health to reduce infections and manage inequities in COVID-19 outcomes. It is important to consider lessons learned from the COVID-19 pandemic response across local public health in order to prepare for future public health emergencies. Objective: This study examined how local public health units (PHUs) in Ontario, Canada, addressed inequities in COVID-19 outcomes in their pandemic response. Design: We contacted all 34 Ontario PHUs to participate in a survey on priorities, actions, and barriers to address health inequities in their COVID-19 response and conducted inductive content analysis on responses to identify themes. Setting: Ontario, Canada. Participants: A total of 25 out of 34 local Ontario PHUs completed the survey. Main Outcome Measure: Public health unit-reported priorities and actions in addressing health inequities in their COVID-19 response. Results: PHUs reported varied priorities in addressing health inequities. PHUs played a key role in coordinating an equity-focused response, including data analysis and reporting, engaging with community groups, and making cross-sector connections. However, important barriers remained, including a lack of community trust, frequent changes in guidance, lack of access to data on the social determinants of health, and a shortage of staffing and resources. Conclusion: Findings suggest ways to prioritize health equity in a public health emergency, including through properly resourcing PHUs, early planning and trust building, and improved equity-based data collection.

Growing evidence suggests that income inequality is associated with adolescent substance use behaviors, prompting the presumption that it may also be associated with poly-substance use. This study examined the association between income inequality and poly-substance use and tested whether anxiety indirectly affects this relationship. We used cross-sectional survey data from the 2018–2019 Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behavior (COMPASS) project. The analytical sample comprised 71,396 students from 136 secondary schools and 43 census divisions across four Canadian provinces. Using multilevel path analyses, we examined the direct and indirect association between income inequality and poly-substance use. Students in neighborhoods with moderate income inequality relative to those in low-income inequality neighborhoods had higher odds of poly-substance use, with similar odds observed for both females (OR _mod = 1.34; 95% confidence interval [CI] = [1.02, 1.66]) and males (OR _mod = 1.38; 95% CI = [1.05, 1.72]). In relation to the indirect association through anxiety, gender-stratified results showed that attending schools in neighborhoods with moderate- and high-income inequality was associated with slightly higher odds of poly-substance use among females (OR _mod = 1.09; 95% CI = [1.01, 1.18] and OR _high = 1.10; 95% CI = [1.00, 1.21]). Income inequality is associated with poly-substance use, and this relationship is also indirectly influenced by anxiety among females. Reducing neighborhood income inequality may contribute to lowering poly-substance use among adolescents. In addition, anxiety management in schools located in highly unequal neighborhoods may be an effective intervention approach in reducing poly-substance use among female adolescents.

Background Research has shown that workers in non-standard (eg, temporary and part-time) employment experience poorer health outcomes than their permanent, full-time counterparts. However, previous studies have overlooked important differences in the quality of non-standard employment. To address this gap, we examined associations between a diverse typology of employment quality and mortality in Canada. Methods The 2006 Canadian Health and Environment Cohort (n=2 805 550) was linked to death records from 2006 to 2019. Employment quality was assessed according to an empirical typology describing five distinct employment arrangements: standard (secure and gainful), portfolio (demanding but gainful), marginal (limited hours and earnings), intermittent (sporadic and unstable) and precarious (insecure and low paying). Poisson regression models estimated covariate-adjusted associations between employment quality, all-cause and cause-specific (cancer, cardiovascular and unintentional injury) mortality, by sex/gender. Results We observed a graded association between employment quality and mortality. Mortality rates were lowest among workers in standard and portfolio employment. Mortality rates were highest among workers in precarious employment, with workers in marginal and intermittent employment occupying intermediate positions along the risk gradient. Associations varied by sex/gender, with larger absolute and relative mortality inequalities among men. Conclusions Our findings reinforce the need to move away from a binary view of jobs as either ‘standard’ or ‘precarious’, encouraging a more nuanced understanding of contemporary employment arrangements and their health-related consequences. Policy interventions that promote access to high-quality jobs and protect workers exposed to precarious employment may yield substantial improvements in population health, including longevity.

Purpose To estimate the association between regional level income inequality (a relative measure of socioeconomic disparity) and deaths of despair and assess whether this association is moderated by age, gender, racialized minority status, and income. Methods Data from the 2006 Canadian Census Health and Environment Cohort (CanCHEC) study were used. A cohort of Canadian adults (n = 19,436,790) within 288 CDs were followed from May 2006 to December 2019. Multilevel Cox-proportional hazard regression was used to estimate the association between income inequality and time to deaths attributed to suicide, drug overdose, and alcohol. Results In models adjusted for confounders, income inequality was associated with time to death due to alcohol (HR = 1.14; 95% CI: 1.05, 1.25), drug overdose (HR = 1.19; 95% CI: 1.06, 1.33), and deaths of despair (HR = 1.05; 95% CI: 1.00, 1.11). Significant interactions were primarily observed in cases of deaths attributed to drug overdose. The association between income inequality and the hazards for drug overdose deaths was stronger for individuals aged 40–49 (HR = 1.71; 95% CI: 1.24, 2.37), males (HR = 1.69; 95% CI: 1.22, 2.35), from low-income households (HR = 1.69; 95% CI: 1.22, 2.35), self identified as White (HR = 1.69; 95% CI: 1.22, 2.35) and those living in low-income areas (HR = 1.69; 95% CI: 1.22, 2.35). Conclusion Income inequality is associated with high risk of deaths of despair. Additionally, this association is significantly moderated by age, gender, racialized minority status and income at the household and area levels. As such, our findings suggest the need to address income inequality in interventions for reducing deaths of despair among Canadian adults.

Background There is a paucity of literature regarding income inequality and adolescent movement behaviours (physical activity, sedentary behaviours, sleep). This study examined whether income inequality was associated with meeting Canadian 24-Hour Movement Guidelines (24HMG) recommendations among adolescents over time. Methods Longitudinal data from adolescents (n=9299) in the Cannabis, Obesity, Mental health, Physical activity, Sedentary behaviour and Smoking study (2016–2017 to 2018–2019) were linked with income data at the census division (CD) level from the 2016 Canadian Census. Adolescents (aged 13–19 years) reported on their physical activity, sleep duration and screen time via questionnaire. Gini coefficients were calculated at the CD level using after-tax household income from the 2016 Canadian Census. Multilevel logistic regression analyses were performed to test the association between income inequality and meeting several 24HMG recommendations. Results The joint effect (income inequality*time) was significant for meeting the sleep duration recommendation (2017–2018 OR=0.83, 95% CI 0.74, 0.92; 2018–2019 OR=0.77, 95% CI 0.70, 0.86; p0.05) for screen time or physical activity independently of sleep. Conclusion Adolescents attending schools in areas with greater income inequality may be at higher risk for inadequate sleep and combined short sleep and physical inactivity.