Mélissa Généreux

Neighbourhood socioeconomic status, maternal education and adverse birth outcomes among mothers living near highways

Background: Residential proximity to highways is a potential proxy for exposure to traffic-related pollution that has been linked to adverse birth outcomes. We evaluated whether proximity to highway interacts with individual and neighbourhood socioeconomic status (SES) to influence birth outcomes. Methods: The study population consisted of all live singleton births in Montréal, Canada, from 1997 to 2001 (n = 99 819). Proximity was defined as residing within 200 m of a highway. Neighbourhood SES was measured for census tracts as the proportion of families below the low-income threshold. Individual SES was represented by maternal education. Using multilevel logistic regression, the odds of preterm birth (PTB), low birthweight (LBW) and small-for-gestational-age (SGA) birth were calculated for mothers residing in proximity to highways, accounting for individual and neighbourhood SES. Effect modification between SES and proximity to highway was tested for each outcome. Results: In wealthy neighbourhoods, proximity to highway was associated with an elevated odds of PTB (OR 1.58, 95% CI 1.23 to 2.04), LBW (OR 1.81, 95% CI 1.36 to 2.41) and SGA birth (OR 1.32, 95% CI 1.05 to 1.66). For highly educated mothers, proximity to highway was associated with PTB (OR 1.25, 95% CI 1.07 to 1.46) and LBW (OR 1.24, 95% CI 1.03 to 1.49), but the association was borderline for SGA birth (OR 1.15, 95% CI 1.00 to 1.32). Proximity to highway was not associated with birth outcomes in other maternal and neighbourhood SES categories. Conclusion: Counterintuitively, high SES mothers may be more likely than low SES mothers to experience adverse births associated with residential proximity to highway.

Associations between HIV-related injection behaviour and distance to and patterns of utilisation of syringe-supply programmes

Background: Studies indicate that needle-exchange programmes (NEPs) can reduce the incidence of HIV infection; however, a positive impact of syringe-supply programmes has not been consistently demonstrated. The associations between high-risk injection behaviour and distance to and patterns of utilisation of syringe-supply programmes in injection drug users (IDUs) were investigated. Methods: Participants in a cohort of IDUs (n = 456) residing in Montreal were interviewed between 2004 and 2006. Behavioural questionnaires were administered by trained interviewers, and venous blood samples were drawn and tested for HIV antibodies. The distance from regular IDU dwelling places to nearest NEP or pharmacy was calculated using a Geographic Information System. Logistic regression was used to assess relations with high-risk injection behaviour. Results: Associations between high-risk injection behaviour and distance to syringe-supply source were not linear. The odds of high-risk behaviour grew modestly as distance from the NEP site increased to 1600 m, followed by a flat trend to 3000 m, and thereafter decreased with distance beyond this point. The odds of high-risk behaviour dropped sharply for the relatively few IDUs residing 1 km or more from the nearest pharmacy but this measure was not strongly associated with the outcome. IDUs who exclusively acquired syringes at NEPs or pharmacies had less than half the odds of reporting high-risk injection behaviour than IDUs with inconsistent syringe-access patterns. Conclusions: The study confirms that Montreal NEPs were implemented where they are most needed. These results also suggest that sterile syringe acquisition patterns might influence high-risk injection behaviour.

Association between neighbourhood socioeconomic characteristics and high-risk injection behaviour amongst injection drug users living in inner and other city areas in Montréal, Canada

BACKGROUND Area-level socioeconomic conditions are associated with epidemic rates of viral hepatitis and HIV amongst urban injection drug users (IDUs), but whether specific socioeconomic markers are uniformly related to IDU outcomes across different urban environments is unclear. We evaluated whether injection behaviour is differentially related to neighbourhood socioeconomic characteristics for IDUs in inner city vs. surrounding urban areas. METHODS The study population was 468 active IDUs on the Island of Montréal. Neighbourhoods were represented as 500m radius buffers around individual IDU dwelling places. High-risk injection behaviour (HRIB) was defined dichotomously. Relations between neighbourhood socioeconomic disadvantage (percentage households below low-income cutoff), neighbourhood educational attainment (percentage adults with university degree), and HRIB were assessed using multivariate logistic regression. Stratified analyses were conducted for inner city IDUs (n=219), and those in surrounding areas (n=249). RESULTS Similar proportions of IDUs in inner city and surrounding areas reported HRIB. Neighbourhood socioeconomic characteristics were not associated with HRIB for IDUs in surrounding areas. For inner city IDUs, those in socioeconomically disadvantaged neighbourhoods were more likely to practice HRIB (OR 4.34; 95% CI 1.15-16.35). Conversely, inner city IDUs residing in lower educational attainment neighbourhoods had a lower odds of HRIB (OR 0.41; 95% CI 0.21-0.80). CONCLUSION HRIB did not vary according to urban environment but for inner-city IDUs was differentially related to socioeconomic markers. Associations between HRIB and neighbourhood socioeconomic disadvantage and lower educational attainment, positive and negative, respectively, indicate that adverse socioeconomic circumstances are not related to a uniformly greater likelihood of HRIB.

Environmental Factors Associated With Social Participation of Older Adults Living in Metropolitan, Urban, and Rural Areas: The NuAge Study

OBJECTIVES We compared the social participation of older adults living in metropolitan, urban, and rural areas, and identified associated environmental factors. METHODS From 2004 to 2006, we conducted a cross-sectional study using an age-, gender-, and area-stratified random sample of 1198 adults (aged 67-82 years). We collected data via interviewer-administered questionnaires and derived from Canadian censuses. RESULTS Social participation did not differ across living areas (P = .09), but after controlling for potential confounding variables, we identified associated area-specific environmental variables. In metropolitan areas, higher social participation was associated with greater proximity to neighborhood resources, having a drivers license, transit use, and better quality social network (R(2) = 0.18). In urban areas, higher social participation was associated with greater proximity to neighborhood resources and having a drivers license (R(2) = 0.11). Finally, in rural areas, higher social participation was associated with greater accessibility to key resources, having a drivers license, children living in the neighborhood, and more years lived in the current dwelling (R(2) = 0.18). CONCLUSIONS To enhance social participation of older adults, public health interventions need to address different environmental factors according to living areas.

Surveillance of social and geographic inequalities in housing-related issues: the case of the Eastern Townships, Quebec (Canada).

Even though health inequalities are conditioned by many aspects of the environment, much of the existing research focuses on the social environment. This emphasis has the effect to neglect other environmental aspects such as its physical dimension. The physical environment, which is linked to housing conditions, may contribute to the uneven distribution of health. In this study, we examined 19 housing-related issues among a representative sample of 2,000 adults residing in a Quebec (Canada) health region characterized by a mix of rural, semi-rural, and urban areas. The distribution of these issues was examined according to socioeconomic and geographic indicators of social position. Summary measures of inequalities were assessed. Our results showed that the prevalence of nearly all housing-related issues was higher among low-income households compared to more affluent ones. Highly educated individuals showed better housing conditions, whereas different issues tended to cluster in deprived or densely populated areas. To conclude, we observed steep gradients between social class and poor housing conditions. This may explain a substantial part of health inequality on the regional scale. The surveillance of housing-related issues is therefore essential to properly inform and mobilize local stakeholders and to develop interventions that target vulnerable groups on this level.

Respiratory Diseases in University Students Associated with Exposure to Residential Dampness or Mold.

University students are frequently exposed to residential dampness or mold (i.e., visible mold, mold odor, dampness, or water leaks), a well-known contributor to asthma, allergic rhinitis, and respiratory infections. This study aims to: (a) describe the prevalence of these respiratory diseases among university students; and (b) examine the independent contribution of residential dampness or mold to these diseases. An online survey was conducted in March 2014 among the 26,676 students registered at the Université de Sherbrooke (Quebec, Canada). Validated questions and scores were used to assess self-reported respiratory diseases (i.e., asthma-like symptoms, allergic rhinitis, and respiratory infections), residential dampness or mold, and covariates (e.g., student characteristics). Using logistic regressions, the crude and adjusted odd ratios between residential dampness or mold and self-reported respiratory diseases were examined. Results from the participating students (n = 2097; response rate: 8.1%) showed high prevalence of allergic rhinitis (32.6%; 95% CI: 30.6–34.7), asthma-like symptoms (24.0%; 95% CI: 22.1–25.8) and respiratory infections (19.4%; 95% CI: 17.7–21.2). After adjustment, exposure to residential dampness or mold was associated with allergic rhinitis (OR: 1.25; 95% CI: 1.01–1.55) and asthma-like symptoms (OR: 1.70; 95% CI: 1.37–2.11), but not with respiratory infections (OR: 1.07; 95% CI: 0.85–1.36). Among symptomatic students, this exposure was also associated with uncontrolled and burdensome respiratory symptoms (p < 0.01). University students report a high prevalence of allergic rhinitis, asthma-like symptoms and respiratory infections. A common indoor hazard, residential dampness or mold, may play a role in increasing atopic respiratory diseases and their suboptimal control in young adults. These results emphasize the importance for public health organizations to tackle poor housing conditions, especially amongst university students who should be considered “at-risk”.

Prevalence of Residential Dampness and Mold Exposure in a University Student Population

The impact of residential dampness or mold on respiratory health is well established but few studies have focused on university students. This study aims to: (a) describe the prevalence of exposure to residential dampness or mold in university students according to socio-geographic factors and (b) identify associated housing characteristics. A web survey was conducted in 2014 among the 26,676 students registered at the Université de Sherbrooke (QC, Canada). Residential dampness and mold being closely intertwined, they were considered as a single exposure and assessed using a validated questionnaire. Exposure was compared according to socio-geographic and housing characteristics using chi-square tests and logistic regressions. Among the 2097 participants included in the study (response rate: 8.1%), over 80% were tenants. Residential exposure to dampness or mold was frequent (36.0%, 95% CI: 33.9–38.1). Marked differences for this exposure were noted according to home ownership (39.7% vs. 25.5% among tenants and owners respectively; OR = 1.92%, 95% CI: 1.54–2.38). Campus affiliation, household composition and the number of residents per building were associated with exposure to dampness or mold (p < 0.01), while sex and age were not. Exposure was also associated with older buildings, and buildings in need of renovations and lacking proper ventilation (p < 0.001). This study highlights the potential risk of university students suffering from mold-related health effects given their frequent exposure to this agent. Further research is needed to fully evaluate the mold-related health impact in this at risk group.

Effectiveness of rotavirus vaccine in preventing severe gastroenteritis in young children according to socioeconomic status

ABSTRACT In 2011, the monovalent rotavirus vaccine was introduced into a universal immunization program in Quebec (Canada). This retrospective cohort study assessed vaccine effectiveness (VE) in preventing acute gastroenteritis (AGE) and rotavirus gastroenteritis (RVGE) hospitalizations among children <3 y living in the Quebec Eastern Townships region according to socioeconomic status (SES). Data were gathered from a tertiary hospital database paired with a regional immunization registry. Three cohorts of children were followed: (1) vaccinated children born in post-universal vaccination period (2011–2013, n = 5,033), (2) unvaccinated children born in post-universal vaccination period (n = 1,239), and (3) unvaccinated children born in pre-universal vaccination period (2008–2010, n = 6,436). In each cohort, AGE and RVGE hospitalizations were identified during equivalent follow-up periods to calculate VE globally and according to neighborhood-level SES. Using multivariable logistic regression, adjusted odds ratios (OR) were computed to obtain VE (1-OR). Adjusted VE of 2 doses was 62% (95% confidence interval [CI]: 37%–77%) and 94% (95%CI: 52%–99%) in preventing AGE and RVGE hospitalization, respectively. Stratified analyses according to SES showed that children living in neighborhoods with higher rates of low-income families had significantly lower VE against AGE hospitalizations compared to neighborhoods with lower rates of low-income families (30% vs. 78%, p = 0.027). Our results suggest that the rotavirus vaccine is highly effective in preventing severe gastroenteritis in young children, particularly among the most well-off. SES seems to influence rotavirus VE, even in a high-income country like Canada. Further studies are needed to determine factors related to lower rotavirus VE among socioeconomically disadvantaged groups.

Prevalence of risk and protective factors associated with heat-related outcomes in Southern Quebec: A secondary analysis of the NuAge study

ObjectivesHeat vulnerability is increasing owing to climate change, aging and urbanization. This vulnerability may vary geographically. Our study examined the prevalence and distribution of risk and protective factors of heat-related outcomes among older adults across three health regions of Southern Quebec (Canada).MethodThis secondary cross-sectional study used data from the 1st follow-up of the NuAge longitudinal study, a cohort of community-dwelling older adults, aged 68–82 years at baseline, of three health regions: Eastern Townships, Montreal and Laval. Prevalence of factors, identified in Health Canada guidelines, was measured. An Older Adult Heat Vulnerability Index (OAHVI) simultaneously considering medical, social and environmental factors was constructed. The distribution of each factor and OAHVI was examined across the three regions. Results were weighted for age, sex (overall and region-specific analyses) and region (overall analyses).ResultsNinety percent of participants had ≥1 risk factor, the most prevalent being: cardiovascular medication (50.8%), hypertension (46.7%), living alone (39.2%), cardiovascular disease (36.9%), living in an urban heat island (34.7%) and needing help in activities of daily living (26.5%). Two thirds of participants had ≥1 protective factor, the most prevalent being talking on the phone daily (70.9%). Heat vulnerability varied greatly by region and this variation was mainly attributable to social and environmental rather than medical factors. According to the OAHVI, 87.2% of participants cumulated ≥2 factors (median = 3.0 factors/participant).ConclusionOur results support the need for small-scale assessment of heat vulnerability. This study could help stakeholders tackle heat-related illness and develop regionally tailored prevention programs.RésuméObjectifsLa vulnérabilité à la chaleur est en augmentation en raison des changements climatiques, du vieillissement de la population et de l’urbanisation. Cette vulnérabilité peut varier géographiquement. Notre étude examine la prévalence globale et la distribution des facteurs de risque et de protection des problèmes de santé liés à la chaleur chez les personnes âgées dans trois régions sociosanitaires du sud du Québec (Canada).MéthodesIl s’agit d’une étude transversale des données du 1er suivi de l’étude longitudinale NuAge, une cohorte de personnes âgées de 68–82 ans à l’inclusion et vivant dans la communauté, dans trois régions sociosanitaires: Estrie, Montréal et Laval. La prévalence des facteurs, identifiés dans les lignes directrices de Santé Canada, a été mesurée. Un indice de vulnérabilité à la chaleur des aînés (IVCA) considérant simultanément plusieurs facteurs médicaux, sociaux et environnementaux a été construit. La distribution de chaque facteur et de l’IVCA a été examinée dans chacune des trois régions. Les résultats ont été pondérés selon l’âge, le sexe (analyses globales et régionales) et les régions (analyses globales).RésultatsQuatre-vingt-dix pour cent des participants présentaient ≥1 facteur de risque, les plus fréquents étant la médication cardiovasculaire (50,8%), l’hypertension (46,7 % ), vivre seul (39,2 % ), les maladies cardiovasculaires (36,9 % ), vivre dans un îlot de chaleur urbain (34,7 % ) et le besoin d’aide dans les activités de la vie quotidienne (26,5 % ). Les deux tiers des participants présentaient ≥1 facteur de protection, le plus fréquent étant de parler au téléphone tous les jours (70,9 % ). La vulnérabilité à la chaleur variait grandement selon la région et cette variation était principalement attribuable à des facteurs sociaux et environnementaux plutôt qu’à des facteurs médicaux. Selon l’IVCA, 87,2 % des participants cumulaient ≥2 facteurs (médiane = 3,0 facteurs/participant).ConclusionNos résultats appuient la nécessité d’évaluer la vulnérabilité à la chaleur à une échelle régionale. Cette étude pourrait aider les parties prenantes à lutter contre les maladies liées à la chaleur et à développer des programmes de prévention adaptés aux différentes régions.

Capturing how age-friendly communities foster positive health, social participation and health equity: a study protocol of key components and processes that promote population health in aging Canadians

BackgroundTo address the challenges of the global aging population, the World Health Organization promoted age-friendly communities as a way to foster the development of active aging community initiatives. Accordingly, key components (i.e., policies, services and structures related to the communities’ physical and social environments) should be designed to be age-friendly and help all aging adults to live safely, enjoy good health and stay involved in their communities. Although age-friendly communities are believed to be a promising way to help aging Canadians lead healthy and active lives, little is known about which key components best foster positive health, social participation and health equity, and their underlying mechanisms.This study aims to better understand which and how key components of age-friendly communities best foster positive health, social participation and health equity in aging Canadians. Specifically, the research objectives are to:1)Describe and compare age-friendly key components of communities across Canada2)Identify key components best associated with positive health, social participation and health equity of aging adults3)Explore how these key components foster positive health, social participation and health equityMethodsA mixed-method sequential explanatory design will be used. The quantitative part will involve a survey of Canadian communities and secondary analysis of cross-sectional data from the Canadian Longitudinal Study on Aging (CLSA). The survey will include an age-friendly questionnaire targeting key components in seven domains: physical environment, housing options, social environment, opportunities for participation, community supports and healthcare services, transportation options, communication and information. The CLSA is a large, national prospective study representative of the Canadian aging population designed to examine health transitions and trajectories of adults as they age. In the qualitative part, a multiple case study will be conducted in five Canadian communities performing best on positive health, social participation and health equity.DiscussionBuilding on new and existing collaborations and generating evidence from real-world interventions, the results of this project will help communities to promote age-friendly policies, services and structures which foster positive health, social participation and health equity at a population level.