Andrew W. Tu

The relationship between minimum alcohol prices, outlet densities and alcohol‐attributable deaths in British Columbia, 2002–09

AIM To investigate relationships between periodic increases in minimum alcohol prices, changing densities of liquor stores and alcohol-attributable (AA) deaths in British Columbia, Canada. DESIGN Cross-section (16 geographic areas) versus time-series (32 annual quarters) panel analyses were conducted with AA deaths as dependent variables and price, outlet densities and socio-demographic characteristics as independent variables. SETTING AND PARTICIPANTS Populations of 16 Health Service Delivery Areas in British Columbia, Canada. MEASUREMENTS Age-sex-standardized rates of acute, chronic and wholly AA mortality; population densities of restaurants, bars, government and private liquor stores; minimum prices of alcohol in dollars per standard drink. FINDINGS A 10% increase in average minimum price for all alcoholic beverages was associated with a 31.72% [95% confidence interval (CI): ± 25.73%, P < 0.05] reduction in wholly AA deaths. Significantly negative lagged associations were also detected up to 12 months after minimum price increases for wholly but not for acute or chronic AA deaths. Significant reductions in chronic and total AA deaths were detected between 2 and 3 years after minimum price increases. Significant but inconsistent lagged associations were detected for acute AA deaths. A 10% increase in private liquor stores was associated with a 2.45% (95% CI: ± 2.39%, P < 0.05), 2.36% (95% CI: ± 1.57%, P < 0.05) and 1.99% (95% CI: ± 1.76%, P < 0.05) increase in acute, chronic and total AA mortality rates. CONCLUSION Increases in the minimum price of alcohol in British Columbia, Canada, between 2002 and 2009 were associated with immediate and delayed decreases in alcohol-attributable mortality. By contrast, increases in the density of private liquor stores were associated with increases in alcohol-attributable mortality.

Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions

OBJECTIVES We investigated whether periodic increases in minimum alcohol prices were associated with reduced alcohol-attributable hospital admissions in British Columbia. METHODS The longitudinal panel study (2002-2009) incorporated minimum alcohol prices, density of alcohol outlets, and age- and gender-standardized rates of acute, chronic, and 100% alcohol-attributable admissions. We applied mixed-method regression models to data from 89 geographic areas of British Columbia across 32 time periods, adjusting for spatial and temporal autocorrelation, moving average effects, season, and a range of economic and social variables. RESULTS A 10% increase in the average minimum price of all alcoholic beverages was associated with an 8.95% decrease in acute alcohol-attributable admissions and a 9.22% reduction in chronic alcohol-attributable admissions 2 years later. A Can

Myocardial infarction symptom recognition by the lay public: the role of gender and ethnicity

0.10 increase in average minimum price would prevent 166 acute admissions in the 1st year and 275 chronic admissions 2 years later. We also estimated significant, though smaller, adverse impacts of increased private liquor store density on hospital admission rates for all types of alcohol-attributable admissions. CONCLUSIONS Significant health benefits were observed when minimum alcohol prices in British Columbia were increased. By contrast, adverse health outcomes were associated with an expansion of private liquor stores.

Prevalence and incidence of hepatitis C virus in hemodialysis patients in British Columbia: Follow-up after a possible breach in hemodialysis machines

Study objective: To find out if gender and ethnicity are associated with acute myocardial infarction (AMI) symptom recognition and the recommendation of enlisting emergency medical services. Design: In an experiment, a random sample of the public was provided a scenario of a person experiencing symptoms of AMI; the gender of the character (male, female, or indeterminate) was manipulated. Setting: Vancouver, Canada Participants: 976 people from a population based random sample of 3419 people, 40 years of age and older, participated in a telephone survey given in English, Cantonese, Mandarin, and Punjabi. Main results: 78% of the respondents identified the symptoms as heart related. Unadjusted analyses showed that ethnicity, education, income, and AMI knowledge were significantly associated with symptom recognition (Chinese respondents were least likely to identify the symptoms as heart related). Thirty seven per cent recommended calling emergency services, which was associated with symptom recognition, ethnicity (Chinese respondents were least likely to make the recommendation), AMI knowledge, having an immediate family member with AMI, and having talked with a health professional about the signs and symptoms of AMI. Neither the gender of the respondent nor of the affected person in the scenario was associated with symptom recognition. Conclusions: Heart health education must be targeted to and tailored for ethnic communities. Health professionals must discuss the signs and symptoms of AMI, and the correct course of action, with their patients.

Body mass index trajectories from ages 1 to 20: Results from two nationally representative canadian longitudinal cohorts

BACKGROUND A possible breach of the transducer protector in specific dialysis machines was reported in June 2004 in British Columbia (BC), which led to testing of hemodialysis patients for hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV. This testing provided an opportunity to examine HCV incidence, prevalence and coinfection with HBV and HIV, and to compare anti-HCV and HCV polymerase chain reaction (PCR). METHODS The results of hemodialysis patients who were dialyzed on the implicated machines (65% of BC dialysis patients), and tested for HCV, HBV and HIV, between June 1, 2004, and December 31, 2004, were reviewed and compared with available previous results. RESULTS Of 1286 hemodialysis patients with anti-HCV and/or HCV-PCR testing, 69 (5.4%) tested positive. Two HCV genotype 4 seroconversions were identified. HCV incidence rate on dialysis was 78.8 cases per 100,000 person-years. Younger age, history of renal transplant and past HBV infection were associated with HCV infection. No occult infection was identified using HCV-PCR. INTERPRETATION Hemodialysis patients had three times the HCV prevalence rate of the general BC population, and more than 20 times the incident rate of the general Canadian population. One of the two seroconversions occurred before the testing campaign; the patient was likely infected during hemodialysis in South Asia. The other was plausibly a late seroconversion following renal transplant in South Asia. Nosocomial transmission cannot be ruled out because both patients were dialyzed in the same centre. Baseline and annual anti-HCV testing is recommended. HCV-PCR should be considered at baseline for persons with HCV risk factors, and for returning travellers who received dialysis in HCV-endemic countries to identify HCV infection occurring outside the hemodialysis unit.

The British Columbia Alcohol and Other Drug Monitoring System: Overview and Early Progress

In this study, unique body mass index (BMI) trajectories from ages 1 to 20 years were identified; each trajectory according to socio demographic and family characteristics was described.

Publicly Funded, Pegylated Interferon-Alpha Treatment in British Columbia: Disparities in Treatment Patterns for People with Hepatitis C

This pilot project is a province-wide and nationally=supported collaboration intended to add value to existing monitoring and surveillance exercises that currently exist and are being developed in Canada. The fundamental aim is to create a system that generates a timely flow of data on hazardous patterns of substance use and related harms so as to inform public debate, to support effective policy, and to facilitate policy-relevant epidemiological research. Pilot and feasibility exercises have been conducted in relation to developing consistent questions in surveys of general and special populations, treatment system data, data on the contents of drugs seized by police, interviews with police, rates of alcohol and other drug mortality and morbidity, alcohol sales data, and data from the emergency departments. Wherever possible, links with the equivalent national data collection processes have been established to create consistencies. This article provides a general overview of the BC pilot monitoring system and discusses some potential advantages of planning and designing a comprehensive system with built-in consistencies across data collection elements.

Parent-Adolescent Patterns of Physical Activity, Sedentary Behaviors and Sleep Among a Sample of Overweight and Obese Adolescents.

BACKGROUND An estimated 60,000 British Columbians are chronically infected with the hepatitis C virus (HCV); 10% to 20% will develop cirrhosis after 20 years and 5% to 10% of these will develop hepatocellular carcinoma. Although treatment may prevent cirrhosis and liver cancer, and improve quality of life, availability is limited. METHODS Individuals with HCV genotypes 1, 4, 5 and 6 who underwent baseline HCV-RNA tests between January 1, 2003 and December 31, 2005, and were eligible for publicly funded treatment through PharmaCare were linked to British Columbias reportable disease database. Patterns in treatment were examined, including age at treatment, sex, location, time to treatment from HCV diagnosis and seasonality of treatment. RESULTS When corrected for HCV prevalence, men were more likely to receive treatment than women (RR 1.16, 95% CI 1.02 to 1.31). Patients aged 35 to 54 years and 55 years or older were 3.45 times (95% CI 2.80 to 4.26 times) and 4.49 times (95% CI 3.55 to 5.69 times), respectively, more likely to initiate treatment than 15- to 34-year-olds. Differences were noted between health authorities. Patients in rural health service delivery areas (HSDAs) were 1.25 times (95% CI 1.10 to 1.42 times) more likely to receive treatment than those in urban HSDAs. Patients had an average lapse of four years between HCV diagnosis and receiving treatment. The highest proportion of patients initiated therapy between January and March (36.5%), with the lowest between October and December (less than 14%). CONCLUSIONS This data linkage enabled us to identify populations less likely to receive publicly funded treatment. Rural HSDAs have higher rates of therapy initiation; this pattern merits further research but may be a result of integrated prevention and care projects in rural areas. Policy changes to the current PharmaCare funding co-payment schedules could reduce seasonal variability of treatment initiations throughout the year.

Tracking Trends of Alcohol, Illicit Drugs and Tobacco through Morbidity Data

BACKGROUND The purpose of this study was to examine the association between parent and adolescent levels of physical activity, sedentary behaviors, and sleep among a group of overweight and obese adolescents. METHODS Baseline data of parent-adolescent pairs who enrolled in a lifestyle modification intervention were analyzed for this study (n = 176). Participants completed questionnaires about their screen time (TV, video game, and computer time), wore an accelerometer for 8 days, and completed a sleep diary for 1 week. In total, 98 parent-adolescent dyads provided valid data for the analyses. Multivariable regression analyses were conducted to assess the relationship between parent and adolescents moderate-to-vigorous activity (MVPA), step counts, sedentary behaviors, and sleep duration. Analyses were split by weekday, weekday evening and weekend. RESULTS Parent-adolescent MVPA was significantly associated on weekdays (b = 0.18; SE = 0.08; β = 0.26), weekday evenings (b = 0.21; SE = 0.08; β = 0.28), and weekends (b = 0.29; SE = 0.12; β = 0.27). This study found associations between parent-child video game time on weekends (b = 1.10; SE = 0.49; β = 0.24) and computer time on weekdays (b = 0.42; SE = 0.19; β = 0.23). Adolescent sleep was associated with parental sleep on weekdays only (b = 0.38; SE = 0.09; β = 0.46). CONCLUSION The findings warrant further investigation into the direction and mechanism of the relationship between parent and adolescent weight related behaviors.

Does parental and adolescent participation in an e-health lifestyle modification intervention improve weight outcomes?

Despite various national and provincial tobacco, alcohol, and illicit drug surveys in Canada, tracking trends and patterns of use is difficult. These surveys often target specific populations and are prone to sampling or respondent bias. This article describes a feasibility study to provide alcohol-, illicit drug- and tobacco-related morbidity using hospital separation data. Hospital episodes for diseases and conditions wholly or partially attributable to alcohol, illicit drugs, and tobacco by health authority, age group, sex, and specific ICD-10 codes for British Columbia (BC) were obtained. The most responsible diagnosis statistics were combined with aetiologic fractions for each ICD-10 code to estimate the total burden of substance use by health authority. Hospital admissions attributable to alcohol and tobacco each cause approximately 3 and 5 times respectively, that attributable to illicit drugs. The ongoing analysis of morbidity data will be used to inform the health authorities, and to assist policy makers in creating and evaluating policies.