Cory Neudorf

A systematic review of school-based marijuana and alcohol prevention programs targeting adolescents aged 10-15

Aims: The purpose of this systematic review was to determine if school-based marijuana and alcohol prevention programs are effective in preventing marijuana and alcohol use in adolescents between the ages of 10–15 years. In particular, we examined knowledge versus comprehensive type prevention programs in order to better understand the inconsistency of results in school-based marijuana and alcohol prevention programs found in the literature. Methods: We performed a systematic literature review to identify published or unpublished papers between January 01, 1980 and December 02, 2007 that reviewed the long-term effectiveness (1 year or longer) of school-based marijuana and alcohol primary prevention programs targeting adolescents aged 10–15 years. Results: Long-term marijuana and alcohol prevention programs that utilized a “comprehensive” program content resulted in: (a) a mean absolute reduction of 12 days of alcohol usage per month and (b) a mean absolute reduction of 7 days of marijuana usage per month among adolescents aged 10–15 years old. In comparison, school-based marijuana and alcohol prevention programs that utilized “knowledge only” program content resulted in a mean absolute decrease of 2 days of alcohol usage per month among adolescents aged 10–15 years old. Only one study used knowledge-based content and marijuana use as an outcome measure and as such statistical pooling was not possible. Conclusions: The most effective primary prevention programs for reducing marijuana and alcohol use among adolescents aged 10–15 years in the long-term were comprehensive programs that included anti-drug information combined with refusal skills, self-management skills and social-skills training.

Suicidal ideation: the role of economic and aboriginal cultural status after multivariate adjustment.

Objective: To determine if Aboriginal (in this paper, First Nations and Métis people) cultural status is independently associated with lifetime suicidal ideation in the Saskatoon Health Region after controlling for other covariates, particularly income status. Methods: Data collected by Statistics Canada in all 3 cycles of the Canadian Community Health Survey (CCHS) were merged with identical questions asked in February 2007 by the Saskatoon Health Region. The health outcome was lifetime suicidal ideation. The risk indicators included demographics, socioeconomic status, cultural status, behaviours, life stress, health care use, and other health problems. Results: Participants (n = 5948) completed the survey with a response rate of 81.1%. The prevalence of lifetime suicidal ideation was 11.9%. After stratification, it was found that high-income Aboriginal people have similar low levels of suicidal ideation, compared with high-income Caucasian people. The risk–hazard model demonstrated a larger independent effect of income status in explaining the association between Aboriginal cultural status and lifetime suicidal ideation, compared with the independent effect of age. After full multivariate adjustment, Aboriginal cultural status had a substantially reduced association with lifetime suicidal ideation. The odds of lifetime suicidal ideation for Aboriginal people reduced from 3.28 to 1.99 after multivariate adjustment for household income alone. Conclusion: The results of this study suggest reductions in lifetime suicidal ideation can be observed in Aboriginal people in Canada by adjusting levels of household income.

The population health approach: A qualitative study of conceptual and operational definitions for leaders in Canadian healthcare

Objectives: The population health approach is increasingly recognized for its role in health system reform; however, its broad scope and definition have been criticized for being a barrier to clear communication. This qualitative study examined the way senior healthcare leaders in Canada conceptualize and operationalize the population health approach in planning and decision-making. Findings: Core elements of the population health approach included focusing on health and wellness rather than illness, taking a population rather than individual orientation, understanding needs and solutions through community outreach, addressing health disparities/health in vulnerable groups, addressing the social determinants of health and inter-sectoral action and partnerships. Conclusion: The population health approach is increasingly recognized for its role in reducing healthcare demand and contributing to health system sustainability. This study demonstrated the growing need to clarify terminology among multiform partners to establish a foundation for future healthcare integration and inter-sectoral action.

Classifying the population by socioeconomic factors associated with support for policies to reduce social inequalities in health

associated with support for policies to reduce social inequalities in health Daniel Fuller1, Josh Neudorf2, Silvia Bermedo-Carrasco2, Cory Neudorf2 School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5E5 Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5E5 Address correspondence to Daniel Fuller, E-mail: daniel.fuller@usask.ca

Suicidal ideation in a community-based sample of elementary school children: A multilevel and spatial analysis.

OBJECTIVES: To examine whether bullying victimization, psychological status, parental and peer relationships and other risk factors are associated with suicidal ideation and to identify high-risk neighbourhoods for suicidal ideation among the elementary school children in Saskatoon Health Region.METHODS: A sample of school students (n = 5340, grades 5–8; ages 9–14 years) from 109 elementary schools in Saskatoon Health Region, Saskatchewan completed the Student Health Survey in 2010–2011. A multilevel logistic regression model was used to investigate the hierarchical data structure at student, grade and school levels. Bayesian spatial analysis was conducted to examine the spatial disparity in the risk of suicidal ideation among residential neighbourhoods.RESULTS: Of 5,340 children, 340 (6.4%) indicated they had considered suicide at least once in the previous 12 months. Our findings indicated that school children who were frequently verbally or electronically bullied were more likely to report suicidal thoughts than those who were not bullied. Students who were more depressed or anxious, and those with lower self-esteem and poorer relationships with their parents were also more likely to report suicidal ideation. The Aboriginal elementary school students and those from the west side of the city were at a higher risk of having suicidal ideation.CONCLUSION: Our findings suggest the need for targeted intervention strategies on suicidal ideation among the elementary school children in Saskatoon Health Region, before they reach high school.RésuméOBJECTIFS: Examiner si le fait d’être victime d’intimidation, l’état psychologique, les relations avec les parents et les pairs et d’autres facteurs de risque sont associés à l’idéation suicidaire et repérer les quartiers à haut risque d’idéation suicidaire chez les élèves des écoles élémentaires de Saskatoon.MÉTHODE: Un échantillon d’écoliers (n = 5 340, 5e à 8e année; 9 à 14 ans) de 109 écoles élémentaires de Saskatoon (Saskatchewan) a répondu à un questionnaire sur la santé en 2010–2011. Nous avons utilisé un modèle de régression logistique multiniveaux pour étudier la structure hiérarchique des données au niveau des élèves, de l’année d’étude et des écoles. Nous avons mené une analyse bayésienne spatiale pour examiner la disparité spatiale du risque d’idéation suicidaire entre les quartiers résidentiels.RÉSULTATS: Sur 5 340 enfants, 340 (6,4 %) ont dit avoir songé au suicide au moins une fois au cours des 12 mois antérieurs. Nos constatations montrent que les enfants d’âge scolaire fréquemment intimidés verbalement ou par voie électronique étaient plus susceptibles de faire état d’idées suicidaires que ceux qui ne subissaient pas d’intimidation. Les élèves déprimés ou anxieux, et ceux dont l’estime de soi et les relations avec leurs parents étaient moins bonnes, étaient également plus susceptibles de faire état d’idées suicidaires. Les écoliers autochtones et ceux de l’ouest de la ville présentaient le plus grand risque d’idéation suicidaire.CONCLUSION: Nos constatations indiquent qu’il faut des stratégies d’intervention qui ciblent l’idéation suicidaire chez les enfants fréquentant l’école élémentaire à Saskatoon, avant leur entrée à l’école secondaire.

An analytic approach for describing and prioritizing health inequalities at the local level in Canada: a descriptive study

BACKGROUND We present the health inequalities analytic approach used by the Saskatoon Health Region to examine health equity. Our aim was to develop a method that will enable health regions to prioritize action on health inequalities. METHODS Data from admissions to hospital, physician billing, reportable diseases, vital statistics and childhood immunizations in the city of Saskatoon were analyzed for the years ranging from 1995 to 2011. Data were aggregated to the dissemination area level. The Pampalon deprivation index was used as the measure of socioeconomic status. We calculated annual rates per 1000 people for each outcome. Rate ratios, rate differences, area-level concentration curves and area-level concentration coefficients quantified inequality. An Inequalities Prioritization Matrix was developed to prioritize action for the outcomes showing the greatest inequality. The outcomes measured were cancer, intentional self-harm, chronic obstructive pulmonary disease, mental illness, heart disease, diabetes, injury, stroke, chlamydia, tuberculosis, gonorrhea, hepatitis C, high birth weight, low birth weight, teen abortion, teen pregnancy, infant mortality and all-cause mortality. RESULTS According to the Inequalities Prioritization Matrix, injuries and chronic obstructive pulmonary disease were the first and second priorities, respectively, that needed to be addressed related to inequalities in admissions to hospital. For physician billing, mental disorders and diabetes were high-priority areas. Differences in teen pregnancy and all-cause mortality were the most unequal in the vital statistics data. For communicable diseases, hepatitis C was the highest priority. INTERPRETATION Our findings show that health inequalities exist at the local level and that a method can be developed to prioritize action on these inequalities. Policies should consider health inequalities and adopt population-based and targeted actions to reduce inequalities.