Store patterns of availability and price of food and beverage products across a rural region of Newfoundland and Labrador Abstract Objectives Rural populations bear a disproportionate burden of diet-related risk, and one important explanation is retail food access disparities. Much existing literature has focused on subjective measures of the rural retail food environment, as well as urban-rural differences. The purpose of this paper is to examine how objectively measured food availability and prices vary within a rural region, and to explore how store features predict rural food availability and prices. Methods We conducted an observational audit of a census of rural food stores (n = 78) using a modified Nutrition Environment Measures Survey instrument. The study was conducted on the Avalon Peninsula in Newfoundland and Labrador. Observed prices in-store were matched to nutrient composition data and converted to three units of measure for all analyses: unit price ($/kg), serving price ($/serving), and energy price ($/kcal). We examined average availability and prices across the region, and how store features were associated with prices. Results Healthy food options were generally less available across the stores than regular items. However, with few exceptions, there were no clear or consistent patterns of difference in availability or pricing between stores of different types. No single product category stood out in terms of a clear price pattern. Store characteristics (including store type, size, ownership, or rurality) did not predict food prices. Conclusions Food availability and prices varied in this rural region, but with limited differences between stores of different types. More research is needed on measuring rural environmental determinants of diet in Canada.

Making sense of what exactly public health does: a typology of public health interventions Abstract Setting Montréal. Intervention The lack of common knowledge about what public health does is a hindrance to its recognition and capacity to act. Montréal’s regional public health department set an explicit goal to clarify and better communicate its specific contributions when it developed its 2016–2021 action plan. This article briefly describes the efforts made to classify public health practice, introduces a typology of public health interventions and discusses its application and benefits. Outcomes The typology that was developed defines 29 types of interventions grouped into four categories: direct action targeting the population; advocacy (persuading partners to take action); support (helping partners take action); collaboration (taking action with partners). The analysis of Montreal’s most recent action plan, completely drafted in terms of the typology, provides an insightful characterization of public health practice. Globally, four out of five interventions target partners (indirect), with more than half falling within the support category. Other indirect interventions are divided almost equally between advocacy and collaboration. Following a rigorous planning process and enforcing the use of the typology also had a significant structuring effect on the organization and its teams and enabled greater synergy with partners from other sectors. Implications Very few people are familiar with everything public health does, sometimes not even the responsible political decision-makers. This situation poses a threat to the survival of its prevention mission. The typology of public health interventions is an innovative tool that can be used to better inform the public and decision-makers.

Implementing public policy in a non-directive manner: capacities from an intermediary organization Abstract Setting We investigate the capacities of an organization responsible for bridging top-down instructions emanating from a law on public health with the bottom-up realities of health service providers working on population-based health. This article traces the implementation of this law, which requires service-provider organizations to base their actions (planning, prevention, and curative activities) upon the expressed and non-expressed needs of the local population. We investigate a case in the province of Québec that took place over more than 10 years. Intervention The state strategy involved a key structure: an intermediary organization named IPCDC/KSCDI. We first describe how the organization emerged; the expertise involved from the academic, service, and policy domains; the support provided to service-provider organizations; and the achievements. We then highlight the critical capacities the intermediary organization had to nurture. Outcomes We identify five critical capacities of the intermediary organization: the business intelligence to read and adjust to the given environment of certain organizations, a dedication to collective means, a win–win mentality, scientific connectivity, and the animation of safe havens. Implications It may be important to focus attention on a capacity approach to intermediary organizations. These capacities can potentially enable governmental organizations to compile a stock of resources that can be mobilized and transferred to support future implementations of other reforms. They could also benefit public health partners in the community who collaborate with service providers and actors who aspire to become intermediary organizations. Finally, the performance measurement of implementing reforms in a non-directive manner could be based on indicators related to these five critical capacities.

The unique contribution of a local response group in the field investigation and management of a trichinellosis outbreak in Nunavik (Québec, Canada) Abstract Setting Consumption of raw game meats is important for Inuit health and well-being but may sometimes increase risk of exposure to parasites. In Nunavik, following trichinellosis outbreaks in the 1980s caused by raw walrus consumption, a diagnostic test was developed for the region and offered to all Inuit communities by 1997. Despite this prevention program, an important trichinellosis outbreak occurred in 2013, affecting 18 inhabitants of Inukjuak. Intervention Because the classical outbreak investigation did not rapidly converge toward a common food source or specific event, a local response group, composed of four community members appointed by the Municipal Council as well as the regional public health physician, nurse and wildlife parasitologist, was created. Their objective was to investigate potential sources of infection related to the outbreak, hence the investigation of the types of meats consumed, the movement of meats between and within the community, and the local practices of processing game meat. Outcomes Though the source of infection was not fully confirmed, this local investigation identified the distribution of transformed polar bear meat as the most probable source of infection. The creation of this unique, intersectoral and intercultural local response group fostered the use of local knowledge to better understand aspects of the modern food system, and is one of the most innovative outcomes of this investigation. Implications Integrating multiple ways of knowing was critical for the management of this important public health issue and contributed to community members’ mobilization and empowerment with respect to local food safety issues.

Smoking behaviour among nurses in Ontario: cross-sectional results from the Champlain Nurses’ Study Abstract Objective Nurses comprise the largest professional group within the Canadian health care workforce. We aimed to assess the prevalence and correlates of smoking among nurses. Methods The Champlain Nurses’ Study was a multi-centre, observational study that evaluated the physical activity levels and health of hospital-based nurses. Participants completed a series of self-report questionnaires addressing a variety of health indicators including smoking status and smoking history. Multi-level modelling was used to examine variability in smoking status across hospital sites and to identify correlates of current smoking. Results A total of 406 nurses, from 14 urban and rural hospitals, were included in this analysis. On average, the nurses were 42.9 (standard deviation (SD), 11.9) years old, had a waist circumference of 78.7 (95% confidence interval (CI): 77.5, 80.2) cm and body mass index of 25.9 (95% CI: 25.3, 26.5) kg/m2, worked in urban hospitals (81.3%), and had either a university bachelor’s (46.9%) or college (39.6%) education. Most participants (92.0%) reported that they are not current smokers, 4.0% reported that they currently smoke occasionally, and 4.0% reported that they are current daily smokers. Smokers were more likely to be working in rural hospitals than urban hospitals (34.4% versus 17.4% respectively, p = 0.018), associated with having a higher waist circumference (mean difference = 4.5 (SD, 2.1), p = 0.035), a college but not university education (71.9% versus 36.9%, respectively, p < 0.001), lower scores for the Barriers Specific Self-Efficacy Scale (mean difference = − 9.7 (SD, 4.6), p = 0.038), and higher scores for the Profile of Mood States scale (mean difference = 2.0 (SD, 3.3), p = 0.007). The only correlate that remained statistically significant in the final, multivariate model was marital status; however, this analysis may be underpowered. Conclusions The prevalence of nurse smokers in our population is lower than previous estimates, and consistent with global declines in cigarette smoking. However, smoking was still prominent and associated with several other risk factors. Given the important relationship between smoking and health, and the critical role that nurses play in health care delivery, they should be an important focus for smoking cessation initiatives and other health education initiatives.

Risk factors associated with group A Streptococcus acquisition in a large, urban homeless shelter outbreak Abstract Objective Group A Streptococcus (GAS) is a frequent cause of outbreaks in healthcare institutions, yet outbreak reports in the literature from homeless shelters are less common, despite an increased risk of severe GAS infection in homeless populations. In 2016, we conducted a case-control study to identify significant risk factors associated with GAS acquisition in a protracted, 19-month outbreak of GAS in a large, urban men’s homeless shelter in Ontario, Canada. Methods Cases (individuals with either clinical GAS emm74 infection or asymptomatic carriers of GAS emm74) and controls were identified from shelter residents from February to September 2016. Information on demographics, clinical presentation, pre-existing health conditions, and risk factors for GAS transmission were collected for all study participants from a variety of sources, including the public health notifiable disease information system, electronic health records, the shelter electronic information system, and interviews with client services workers. Results From the multivariable logistic regression model, younger individuals (OR 9.1; 95% CI 1.57–52.9), those with previous skin conditions (OR 56.2; 95% CI 2.73–1160), and those with recent wounds (with wound care: OR 51.5, 95% CI 8.86–299, and without wound care: OR 77.4, 95% CI 7.38–812) were found to be at increased risk of acquiring GAS in this outbreak. Conclusion The outbreak investigation clearly demonstrated the need for improved wound care and infection prevention and control practices, for early screening and detection of skin and soft tissue infections, and for a comprehensive, integrated electronic information system in homeless shelters.

The geographic and demographic distribution of residential fires, related injuries, and deaths in four Canadian provinces Abstract Objective A considerable number of Canadians are injured or killed every year as a result of residential fires. Until recently, the absence of representative national data limited our understanding of the current situation. This study used a novel dataset to describe the geographic and demographic distribution of residential fires and related casualties across 4 Canadian provinces and to explore changes over time. Methods A cross-sectional study design was applied to data from the National Fire Information Database, which reported fire incidents, locations, and associated casualties attended by a fire service across 4 Canadian provinces between 2005 and 2015. Residential fire incident, injury, and death rates were described and compared between sex and age groups. Simple linear regressions were used to assess the trends of casualty rates per population and per fire incidents over time. Results A total of 145,252 residential fires were reported for the provinces of British Columbia, Alberta, Manitoba, and Ontario, of which 5.5% resulted in casualties. Death and severe injury rates per population decreased significantly between 2005 and 2015, while casualties per 1000 house fires did not change. Death rates per house fire incidents were generally higher in urban than in remote areas but tended to increase as distance from city centres increased and moved closer to suburban areas. Injury rates were higher than death rates for all age groups and significantly higher for males than for females. Conclusion These findings represent an important step forward in identifying the most vulnerable municipalities and populations to inform evidence-based cross-provincial efforts to reduce the societal burden of residential fires.

Correction to: A comparison of the observed and expected prevalence of HIV in persons released from Ontario provincial prisons in 2010 The Acknowledgements section was inadvertently omitted from this article; it appears in its entirety below.

Frontier injustice: the American threat to Canada’s drug supply Abstract “Import-from-Canada” strategies to address high prices for patented pharmaceuticals are gaining momentum in the United States. In the first two months of 2019 alone, five congressional bills incorporating such strategies were introduced; these bills have attracted bipartisan support across the fractious American political divide. At the same time, Canadian lawmakers continue their long-standing failure to take action in response to the looming threat of having Canada’s drug supply siphoned off by its more powerful neighbour. Unregulated bulk importation of pharmaceuticals originally intended for the Canadian market into the USA would lead to severe drug shortages that would undermine the Canadian health system, while also halting emerging moves towards universal Canadian pharmacare in their tracks. At the same time, this short-term approach to tackling American pricing woes would fail to heal the deep systemic issues that underpin unaffordable drug prices in the USA. This article underscores the need for Canada to take action to protect its supply of patented medicines, and suggests possible forms such action might take.

Racial/ethnic variations in gestational weight gain: a population-based study in Ontario Abstract Objective To explore inadequate and excessive gestational weight gain (GWG) among pregnant women of different racial/ethnic backgrounds in Ontario, Canada. Methods A population-based retrospective cohort study was conducted among women who had prenatal screening and had a singleton birth in an Ontario hospital between April 2016 and March 2017. We estimated adjusted risk ratios (aRR) of racial/ethnic differences for inadequate or excessive GWG using multinomial logistic regression models. Interaction effects were examined to determine whether racial/ethnic difference in GWG varied by pre-pregnancy body mass index (BMI). Results Among 74,424 women, the prevalence of inadequate GWG in White, Asian, and Black women was 15.7%, 25.8%, and 25.0%, and excessive GWG was 62.8%, 45.5%, and 54.7%, respectively. There were significant interaction effects between race/ethnicity and pre-pregnancy BMI for inadequate GWG (Wald p < 0.01) and excessive GWG (Wald p < 0.01). Compared with White women, Asian women had higher risk of inadequate GWG and lower risk of excessive GWG in all weight classes, and Black women had higher risk of inadequate GWG and lower risk of excessive GWG if their BMI was normal, overweight, or obese. Conclusion Variations in unhealthy GWG by pre-pregnancy weight classes among Ontario White, Asian and Black women were observed. Individualized counseling regarding appropriate GWG is universally recommended. Additional consideration of racial/ethnic variations by maternal weight classes may help to promote healthy GWG in Canada.