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BACKGROUND: Adverse childhood experiences (ACEs) are potentially traumatic exposures experienced during childhood, for example, neglect. There is growing evidence that the coronavirus disease 2019 (COVID-19) pandemic and related socioeconomic conditions contributed to an increased risk of ACEs. As public health programs/services are re-evaluated and restored following the state of emergency, it is important to plan using an ACEs-informed lens. The aim of this study was to identify and prioritize initiatives or activities that Public Health Ontario (PHO) could undertake to support Ontario public health units' work towards ACEs-informed pandemic recovery plans. METHODS: The Child Health and Nutrition Research Initiative method was adapted to conduct a priority-setting exercise (May-October 2022). Two online surveys were administered with members of the Healthy Growth and Development (HGD) Evidence Network, comprised of public health unit staff working in child and family health/HGD from Ontario's 34 public health units. In the first survey, participants were asked to propose activities or initiatives that PHO could undertake to support Ontario public health units' work towards ACEs-informed planning. In the second survey, participants were asked to score the final list of options against pre-determined prioritization criteria (for example, relevance). Responses were numerically coded and used to calculate prioritization scores, which were used to rank the options. RESULTS: In all, 76% of public health units (n = 26) responded to the first survey to identify options. The 168 proposed ideas were consolidated into a final list of 13 options, which fall under PHO's scientific and technical support mandate areas (data and surveillance, evidence synthesis, collaboration and networking, knowledge exchange and research). A total of 79% of public health units (n = 27) responded to the follow-up survey to prioritize options. Prioritization scores ranged from 76.4% to 88.6%. The top-ranked option was the establishment of a new provincial ACEs community of practice. CONCLUSIONS: Over three quarters of public health units contributed to identifying and ranking 13 options for PHO to support public health units in considering and addressing ACEs through pandemic recovery planning. In consultation with the ACEs and Resilience Community of Practice, recently formed on the basis of this exercise, PHO will continue to use the ranked list of options to inform work-planning activities/priorities.

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BACKGROUND: The COVID-19 pandemic policy response dramatically changed local transportation patterns. This project investigated the impact of COVID-19 policies on motor vehicle collision (MVC)-related emergency department (ED) visits and hospitalisations in Ontario. METHODS: Data were collected on MVC-related ED visits and hospitalisations in Ontario between March 2016 and December 2022. Using an interrupted time series design, negative binomial regression models were fitted to the pre-pandemic data, including monthly indicator variables for seasonality and accounting for autocorrelation. Extrapolations simulated expected outcome trajectories during the pandemic, which were compared with actual observed outcome counts using the overall per cent change and mean monthly difference. Data were modelled separately for vehicle occupants, pedestrians and cyclists (MVC and non-MVC injuries). RESULTS: There was a 31.5% decrease in observed ED visits (95% CI -35.4 to -27.3) and a 6.0% decrease in hospitalisations (95% CI -13.2 to 1.6) among vehicle occupants, relative to expected counts during the pandemic. Results were similar for pedestrians. Among cyclist MVCs, there was an increase in ED visits (12.8%, 95% CI -8.2 to 39.4) and hospitalisations (46.0%, 95% CI 11.6 to 93.6). Among non-MVC cyclists, there was also an increase in ED visits (47.0%, 95% CI 12.5 to 86.8) and hospitalisations (50.1%, 95% CI 8.2 to 101.2). CONCLUSIONS: We observed fewer vehicle occupant and pedestrian collision injuries than expected during the pandemic. By contrast, we observed more cycling injuries than expected, especially in cycling injuries not involving motor vehicles. These observations may be attributable to changes in transportation patterns during the pandemic and increased uptake of recreational cycling.

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(1) Background: To explore factors contributing to the Healthy Kids Community Challenge (HKCC) program implementation; (2) Methods: Data were collected through a quantitative survey (n = 124) and in-depth telephone interviews (n = 16) with program providers. Interviews were recorded and transcribed for thematic analysis using NVivo; (3) Results: Provincial funding and in-kind support from community partners were key. Initiatives were feasible to implement, and key messages were well-received by communities. Specific practices and process were commonly discussed, and strong local program leadership was crucial to implementation; (4) Conclusions: Results have implications for planning and implementing future multi-component, community-based health promotion programs that include similar partnerships.

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(1) Objective: To longitudinally assess food and beverages sold in vending machines in secondary schools (grades 9-12) participating in the COMPASS study (2015/2016 and 2018/2019) and (2) to examine if patterns and trends observed in previous years (2012/2013 to 2014/2015) are consistent with lack of policy compliance in Ontario and Alberta, Canada. (2) Methods: Policy compliance was assessed through comparing nutritional information on drink (e.g., sports drinks) and snack (e.g., chocolate bars) products in vending machines to Policy and Program Memorandum (P/PM) 150 in Ontario (required policy) and the Alberta Nutrition Guidelines for Children and Youth (recommended policy). Longitudinal results and descriptive statistics were calculated. (3) Results: Longitudinal results indicate that between Y4 (2015/2016) and Y7 (2018/2019), snack and drink vending machines remained mostly non-compliant in Ontario and Alberta, with a small proportion of Ontario drink machines changing from non-compliant to compliant. At the school level, descriptive results indicate the proportion of Ontario schools with policy-compliant snack and drink machines decreased between Y4 and Y7. Alberta schools were non-compliant for drink and snack machines. (4) Conclusions: Secondary schools continue to be non-compliant with provincial policies. School nutrition policies need to be simplified in order to make it easier for schools to be compliant. Enforcement of compliancy is also an area that deserves consideration.

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OBJECTIVES: The Healthy Kids Community Challenge is a large-scale, centrally-coordinated, community-based intervention in Ontario, Canada that promotes healthy behaviours towards improving healthy weights among children. With the goal of exploring tools available to evaluators, we leveraged electronic medical records from primary care physicians to assess child weights prior to launch of the Healthy Kids Community Challenge. This study compares the baseline (i.e. pre-intervention) prevalence of overweight and obesity in children 1-12 years of age living within and outside Healthy Kids Community Challenge communities. DESIGN: Cross-sectional analysis of a primary care patient cohort. SETTING: Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada. PARTICIPANTS: A cohort of 19 920 Ontario children who are rostered to an EMRALD physician. Children were 1-12 years of age at a primary care visit with recorded measured height and weight, between January 1, 2014 and December 31, 2015. OUTCOME MEASURE: Overweight and obesity as determined by age- and sex-standardized body mass index using World Health Organization's Growth Standards. RESULTS: In Healthy Kids Community Challenge communities, 25.6% (95% CI 24.6-26.6%) of children had zBMI above normal (i.e. >1) compared to 26.7% (95% CI 25.9-27.5%) for children living outside of Healthy Kids Community Challenge communities. CONCLUSIONS: Despite some differences in sociodemographic characteristics, zBMI of children aged 1-12 years were similar inside and outside of Healthy Kids Community Challenge community boundaries prior to program launch.

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Sports and recreation facilities provide places where children can be physically active. Previous research has shown that availability is often worse in lower-socioeconomic status (SES) areas, yet others have found inverse relationships, no relationships, or mixed findings. Since children's health behaviours are influenced by their parents, it is important to understand parents' perceived barriers to accessing sports and recreation facilities. Data from computer assisted telephone interviews with parents living in Ontario, Canada were merged via postal codes with neighbourhood deprivation data. Multivariable logistic regression modeling was used to estimate the likelihood that parents reported barriers to accessing local sports and recreation facilities. Parents with lower household incomes were more likely to report barriers to access. For each unit increase in deprivation score (i.e., more deprived), the likelihood of reporting a barrier increased 16% (95% CI: 1.04, 1.28). For parents, the relationships between household income, neighbourhood-level deprivation, and barriers are complex. Understanding these relationships is important for research, policy and planning, as parental barriers to opportunities for physical activity have implications for child health behaviours, and ultimately childhood overweight and obesity.

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Our objective was to explore the perceived risk of food allergies among students in Ontario, Canada. We analyzed blinding questions ("I am concerned about food allergies"; "food allergies are currently a big threat to my health") from three existing food safety surveys, given to high school and university undergraduate students (n = 3,451) circa February 2015, using descriptive analysis, and explored how concern related to demographics and self-reported cooking ability using linear regression. Overall, high school students were neutral in their concern, although Food and Nutrition students specifically were significantly less concerned (p = 0.002) than high school students overall. University undergraduates were moderately unconcerned about food allergies. Concern was highest in younger students, decreasing between 13 and 18 years of age and plateauing between 19 and 23 years. Among students aged 13-18 years, concern was higher among those who worked or volunteered in a daycare and who had previously taken a food preparation course. Among students aged 19-23 years, concern was higher among females and those with less advanced cooking abilities. Concern was significantly correlated with perceiving food allergies as a personal threat. This study offers a first exploration of perceived risk of food allergies among this demographic and can guide future, more rigorous assessments.

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BACKGROUND: Parents can influence the health behaviors of their children by engaging in supportive behaviors (e.g., playing outside with their child, limiting recreational screen time). How, and the extent to which parents engage in supportive behaviors may be influenced by perceived barriers. The purpose of this study is to explore whether the frequency, and types, of barriers to providing parental support are dependent on the type of child health behavior being supported (i.e., physical activity, recreational screen time reduction, healthy eating, and sleep). METHODS: Study participants were 1140 Ontario parents with at least one child under the age of 18 who completed a Computer Assisted Telephone Interview (CATI) survey about parental support behaviors. Open-ended responses about perceived barriers to parental support were coded, and aggregated to meta-categories adopted from the social-ecological model (i.e., individual child, individual parent, interpersonal, environmental). Freidman rank sum tests were used to assess differences across child behaviors. Wilcoxon rank sum tests with Bonferroni adjustments were used as a post hoc test for significant Freidman results. RESULTS: There were more barriers reported for supporting physical activity than for any other child behavior (ps < .01, As ≥ .53). Parents reported more parent level and environmental level barriers to supporting child physical activity versus other behaviors (ps < .001, As ≥ .55), child level barriers were more frequently reported for supporting healthy eating and sleep (ps < .001, As ≥ .57), and interpersonal barriers were more frequently reported for supporting recreational screen time reduction (ps < .001, As ≥ .52). Overall, parents reported more child and parent level barriers versus interpersonal and environmental barriers to supporting child health. CONCLUSIONS: Parents experience a variety of barriers to supporting their children's health behaviors. Differences in types of barriers across child health behaviors emerged; however, some frequently reported barriers (e.g., child preferences) were common across behaviors. Interventions promoting parental support should consider strategies that can accommodate parents' busy schedules, and relate to activities that children find enjoyable. Creating supportive environments that help facilitate support behaviors, while minimizing parent level barriers, may be of particular benefit. Future research should explore the impact of barriers on parental support behaviors, and effective strategies for overcoming common barriers.

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OBJECTIVES: We investigated the extent to which a sample of Ontario and Alberta secondary schools are being compliant with their respective provincial nutrition policies, in terms of the food and beverages sold in vending machines. METHODS: This observational study used objective data on drinks and snacks from vending machines, collected over three years of the COMPASS study (2012/2013-2014/2015 school years). Drink (e.g., sugar-containing carbonated/non-carbonated soft drinks, sports drinks, etc.) and snack (e.g., chips, crackers, etc.) data were coded by number of units available, price, and location of vending machine(s) in the school. Univariate and bivariate analyses were undertaken using R version 3.2.3. In order to assess policy compliancy over time, nutritional information of products in vending machines was compared to nutrition standards set out in P/PM 150 in Ontario, and those set out in the Alberta Nutrition Guidelines for Children and Youth (2012) in Alberta. RESULTS: Results reveal a decline over time in the proportion of schools selling sugar-containing carbonated soft drinks (9% in 2012/2013 vs. 3% in 2014/2015), crackers (26% vs. 17%) and cake products (12% vs. 5%) in vending machines, and inconsistent changes in the proportion selling chips (53%, 67% and 65% over the three school years). Conversely, results highlight increases in the proportion of vending machines selling chocolate bars (7% vs. 13%) and cookies (21% vs. 40%) between the 2012/2013 and 2014/2015 school years. CONCLUSION: Nutritional standard policies were not adhered to in the majority of schools with respect to vending machines. There is a need for investment in formal monitoring and evaluation of school policies, and the provision of information and tools to support nutrition policy implementation.

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BACKGROUND: Studies suggest an increase in food allergy prevalence over the last decade, but the contributing factors remain unknown. The aim of this study was to evaluate the association between the most common food allergies and atopic history, sociodemographic characteristics and lifestyle habits. METHODS: We conducted a case-control study nested within the SPAACE study (Surveying Prevalence of Food Allergy in All Canadian Environments) ­ a cross-Canada, random telephone survey. Cases consisted of individuals with probable food allergy (self-report of convincing symptoms and/or physician diagnosis) to milk, egg, peanut, tree nut, shellfish, fish, wheat, soy, or sesame. Controls consisted of nonallergic individuals, matched for age. Cases and controls were queried on personal and family history of atopy, sociodemographic characteristics and lifestyle habits. Multivariate logistic regression was used to evaluate the association between atopy, sociodemographic characteristics and lifestyle habits with probable food allergy. RESULTS: Between September 2010 and September 2011, 480 cases and 4,950 controls completed the questionnaire. For all 9 allergens, factors associated with a higher risk of probable allergy were as follows: (1) personal history of eczema (in the first 2 years of life), asthma or hay fever (odds ratio, OR 2.3, 95% CI 1.6-3.5; OR 2.8, 95% CI 2.2-3.6, and OR 2.3, 95% CI 1.8-3.0, respectively), (2) maternal, paternal or sibling's food allergy (OR 3.7, 95% CI 2.5-5.6; OR 3.0, 95% CI 1.8-5.1, and OR 3.1, 95% CI 2.2-4.2), (3) high household income (top 20%; OR 1.5, 95% CI 1.2-2.0). Males and older individuals were less likely to have food allergy (OR 0.7, 95% CI 0.6-0.9, and OR 0.99, 95% CI 0.99-1.00). Eczema in the first 2 years of life was the strongest risk factor for egg, peanut, tree nut and fish allergy. CONCLUSIONS: This is the largest population-based nested case-control study exploring factors associated with food allergies. Our results reveal that, in addition to previously reported factors, eczema in the first 2 years of life is consistently associated with food allergies.

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BACKGROUND: Studies suggest that individuals of low education and/or income, new Canadians (immigrated <10 years ago), and individuals of Aboriginal identity may have fewer food allergies than the general population. However, given the difficulty in recruiting such populations (hereafter referred to as vulnerable populations), by using conventional survey methodologies, the prevalence of food allergy among these populations in Canada has not been estimated. OBJECTIVES: To estimate the prevalence of food allergy among vulnerable populations in Canada, to compare with the nonvulnerable populations and to identify demographic characteristics predictive of food allergy. METHODS: By using 2006 Canadian Census data, postal codes with high proportions of vulnerable populations were identified and households were randomly selected to participate in a telephone survey. Information on food allergies and demographics was collected. Prevalence estimates were weighted by using Census data to account for the targeted sampling. Multivariable logistic regression was used to identify predictors of food allergy. RESULTS: Of 12,762 eligible households contacted, 5734 households completed the questionnaire (45% response rate). Food allergy was less common among adults without postsecondary education versus those with postsecondary education (6.4% [95% CI, 5.5%-7.3%] vs 8.9% [95% CI, 7.7%-10%]) and new Canadians versus those born in Canada (3.2% [95% CI, 2.2%-4.3%] vs 8.2% [95% CI, 7.4%-9.1%]). There was no difference in prevalence between those of low and of high income or those with and without Aboriginal identity. CONCLUSION: Analysis of our data suggests that individuals of low education and new Canadians self-report fewer allergies, which may be due to genetics, environment, lack of appropriate health care, or lack of awareness of allergies, which reduces self-report.

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Food allergies are emerging as important public health risks in Canada, affecting 3-4% of adults and 6-7% of children. Despite much lower prevalence rates among recent immigrants (i.e. in the country less than 10 years), evidence has shown this population to be more concerned about the risks of food allergies than the general population and have unique experiences around purchasing foods for allergen-free environments. As a substantial and growing segment of the Canadian population, it is important to understand newcomers' perceptions and knowledge of food allergies and related policies developed to protect allergic children (e.g. nut-free schools and or classrooms). This paper draws upon the results of focus groups conducted with newcomers from food allergic households (i.e. directly affected), as well as those with school-aged children who have to prepare or buy foods for allergen-controlled classrooms or schools (i.e. indirectly affected) living in Mississauga, Ontario. Results indicate unique challenges and understandings of food allergies as a new and unfamiliar risk for most newcomers, particularly as the indirectly affected participants negotiate the policy landscape. The directly affected group highlights the supportive environment in Canada resulting from the same policies and increased awareness in the general population.

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As leading barriers to specialist care, wait times are at the forefront of the Canadian healthcare policy agenda. However, knowledge is limited about how wait times affect patients' lives. We utilized the 2010 Canadian Community Health Survey to examine the experience of patients requiring a consultation with a medical specialist for a new condition. Multivariate logistic regression predicted the likelihood that a respondent self-reported his or her life was affected. Subsequent cross-tabulations determined the ways in which life was affected. Females, middle-aged respondents, new immigrants and those with low income and poor health status were more likely to report their life was affected. Worry, stress and anxiety were the most frequently reported impacts, followed by pain, stress on family/friends, deterioration of health and loss of work. Our research demonstrates a need to address the impacts of wait times on health and well-being, with a focus on particular subpopulation groups.

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BACKGROUND: In the Canadian context, health care services are governed by the Canada Health Act, which ensures that primary care doctors, specialists, hospitals and dental surgeries are covered through provincial health insurance plans. This ensures access to medically necessary health care services for all Canadians regardless of ability to pay. Despite this important piece of legislation, research has shown persistent inequalities in access between and within socio-demographic groups, and geographic areas. To date, most research has focused on access to primary care, with much less attention paid to specialist care as an important component of the health care continuum. Thus, the objectives of this research are to address this gap in knowledge by examining the factors associated with difficulty accessing specialist services, and the reasons why particular subpopulation groups report experiencing difficulties. METHODS: This research uses multivariate logistic regression to analyze data from the Canadian Community Health Surveys' optional content from the province of Ontario (n=21,526) related to accessing specialist health care services. The multivariate logistic regression model identifies several subpopulation groups that are more likely to report difficulty accessing specialist care when required. Cross-tabulations are subsequently used to establish the main reasons why difficulties are faced. RESULTS: Over 26% of respondents required a specialist visit in the 12 months preceding administration of the survey. Of these, 22% reported difficulty accessing specialist care. Those with difficulties were more likely to be immigrants, post-secondary educated, and have one or more chronic conditions. People living in urban health regions were also more likely to report difficulties accessing care. Primarily wait times were cited as reasons for these difficulties, followed by a perceived lack of availability. CONCLUSIONS: There are difficulties faced by the general population as a whole (e.g., wait times) as well as particular difficulties experienced more frequently by certain groups (e.g., transportation, language, and cost barriers for newcomers). These issues are important, as they may discourage individuals from using necessary health care services, and may contribute to feelings of dissatisfaction with the health care system.

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Food allergies are emerging health risks in much of the Western world, and some evidence suggests prevalence is increasing. Despite lacking scientific consensus around prevalence and management, policies and regulations are being implemented in public spaces (e.g., schools). These policies have been criticized as extreme in the literature, in the media, and by the non-allergic population. Backlash appears to be resulting from different perceptions of risk between different groups. This article uses a recently assembled national dataset (n = 3,666) to explore how Canadians perceive the risks of food allergy. Analyses revealed that almost 20% self-report having an allergic person in the household, while the average respondent estimated the prevalence of food allergies in Canada to be 30%. Both of these measures overestimate the true clinically defined prevalence (7.5%), indicating an inflated public understanding of the risks of food allergies. Seventy percent reported food allergies to be substantial risks to the Canadian population. Multivariate logistic regression models revealed important determinants of risk perception including demographic, experience-based, attitudinal, and regional predictors. Results are discussed in terms of understanding emerging health risks in the post-industrial era, and implications for both policy and risk communication.

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Access to health services research has traditionally focused on demographic, socioeconomic, and need-based factors, resulting in a relative lack of knowledge regarding place-based determinants. Further, much of what we know comes from international, national, and regional study. This study analyzes survey data (n=1635) to explore the relationship between neighbourhood-level potential access (i.e., availability) and realized access (i.e., use) in two Canadian cities. Controlling for predisposing, enabling and need factors, living in a well-served neighbourhood was a significant predictor of realized access, particularly in Saskatoon. This suggests that the relationship between potential and realized access may be modified by place-based factors.

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Food allergies are newly emerging health risks, and some evidence indicates that their prevalence is increasing. Public perception, however, is that the prevalence of food allergies is much greater than systematic estimates suggest. As food allergies increasingly permeate everyday life, this paper explores how associated risks are constructed through the mass media. In particular, nine years of media coverage of food allergies are analysed through the lens of issue framing and claims-making. Results show that advocates and affected individuals dominate discussions around policy action, while researchers and health professionals are diagnosing the causes of food allergy. Results also suggest that there is competition over the definition of food allergies, which may, in turn, be shaping public understanding of the related risks. There is also an indication that the framing of food allergies is evolving over time, and that the discussion is becoming increasingly one-sided with affected individuals leading the charge.