Browsing by Author "Cooke, Martin"

Now showing 1 - 9 of 9

Determining Knowledge, Understanding, Perception and Attitudes Towards Climate Change-related Health Risks by Public Health Actors in Ontario to Better Inform Climate Mitigation, Adaptation and Risk Communication Strategies
(University of Waterloo, 2021-09-08) Bhalla, Manvi; Cooke, Martin
While majority of Canadians believe that climate change has the potential to harm them, many have a limited understanding of the associated health risks. Public health actors play an important role in communicating these risks alongside mitigation and adaptation strategies to the public. However, public health actors’ knowledge, understanding, perception and attitudes surrounding this issue across Ontario is not well known. As such, this study aims to address the following research questions: (1) “How does knowledge, understanding, perception and attitudes towards climate change-related health risks differ amongst public health sector actors in Ontario?” (2) “What mitigation, adaptation and risk communication strategies are public health units implementing or proposing for climate change-related health risks, and to what degree are they locally contextualized?”. Semi-structured interviews of Ontario public health actors (n=17) were conducted over six weeks. NVivo 12 was used for a combination of deductive and inductive thematic analyses; the former informed by theory of mental models (Westbrook, 2016, pp. 563-579). This study identified beliefs held by Ontario public health actors surrounding climate-related health risks, alongside motivators associated with increased engagement in environmental health work. Secondary findings elucidated emerging opportunities for key policy changes to address organizational and behavioural barriers towards the implementation of effective climate mitigation, adaptation, and effective risk communication strategies in the Ontario public health sector.
Diabetes among Aboriginal Peoples in Canada: Prevalence and Predictors, 1991-2011
(University of Waterloo, 2016-08-17) Guo, Yanling; Cooke, Martin
Introduction: Diabetes mellitus is one of several prevalent chronic diseases that has severely impacted Aboriginal Canadians. In addition to high prevalence rates, the characteristics of diabetes among Aboriginal peoples also include early disease onset and severe complications. In general, type 2 diabetes (T2DM) accounts for 90% of all types of diabetes and is recognized to be preventable by improving modifiable factors such as obesity, physical inactivity, unhealthy diet, cigarette smoking and alcohol consumption. Social determinants of health such as low social economic status, household food insecurity, and other cultural factors also play an important role in predicting the development of T2DM by affecting modifiable factors. It is necessary to apply a comprehensive framework that includes both modifiable factors and social determinants in understanding the risk factors of T2DM. Objective: There are two main objectives in this study. The first is to measure trends in diabetes prevalence and related factors from 1991 to 2012 among Aboriginal adults who were classified as Treaty Indians or Registered Indians. The second objective is to examine the associations between modifiable factors and social determinants and T2DM among off-reserve First Nations and Métis adults. Method: In the first part of this study, four cycles (1991, 2001, 2006 and 2012) of the Aboriginal Peoples Survey (APS) were used to examine the changes in prevalence rates of diabetes and related factors during the past twenty years. All rates were age-standardized using the age distribution of 2011 census. The second part of this study focused on the most recent 2012 APS. A set of binary multivariable logistic regression models were applied to examine the associations between independent variables and T2DM. Results: The prevalence rates of all types of diabetes among off-reserve living Registered Indian adults increased from 12.43% in 1991 to 14.54% in 2001, then declined slightly in 2012. The mean age of diabetes diagnosis also increased from 2001 to 2006, then declined in 2012. The prevalence of obesity and regular alcohol consumption has shown an increasing trend, while the prevalence of cigarette smoking has shown a decreasing trend. The percentage of people who have obtained a high school diploma and above increased largely from 1991 to 2012. The median personal income rose from $ 11,582 to $ 18,098. The employment rate increased from 1991 to 2001, and then declined sharply in 2012. Focused on the 2012 APS, the second part of this study found that being overweight or obese, consuming no alcohol or excessive amounts of alcohol, experiencing very low household food security, and having attended residential schools were significant factors that associated with T2DM. Conclusion: This study confirmed the high prevalence rates of diabetes among Aboriginal peoples in Canada. The prevalence rate of all types of diabetes among off-reserve living Registered Indian adults was still at least two times higher than the national average in 2012. In addition, the pattern observed in diabetes and age onset of diabetes is not evident for the major modifiable factors. This study also found that obesity was an important modifiable factor for T2DM. In addition to modifiable factors, social determinants such as education, income, and household food insecurity, and residential school exposure are also important in predicting T2DM among Aboriginal adults. Therefore, a comprehensive framework including modifiable lifestyle factors, social determinants and cultural factors is needed to be applied in understanding factors of T2DM among Aboriginal peoples. It is also urgent to call upon policy changes on improving household food security, healing residential school trauma, and reducing poverty to provide extra social supports for vulnerable populations.
Do we need a new perspective on chronic diseases? The combined effects of workplace stress and socioeconomic status as non-traditional disease risk factors in Canada
(University of Waterloo, 2020-01-22) Shah, Noor-Ul-Huda; Cooke, Martin
Background: Approximately 80% of Canadians over the age of 20 are at risk of developing a chronic disease (CD) such as cardiovascular disease (CVD) and type II diabetes (T2D) (Artham, Lavie, Milani, & Ventura, 2009; PHAC, 2017; Yach, 2004). The burden of CD is not distributed equally amongst Canadians either, with those from lower socioeconomic status (SES) backgrounds having higher CD outcomes and poorer health overall (Patra, 2007). Although the role of stress has often been implicated in the development of CVD and T2D, research on the combined effects of stress and SES is lacking in Canada (Cotter & Kelly, 2018; Crompton, 2011; Ferris, Kline, & Bourdage, 2012; Guan, Collet, Mazowita, & Claydon, 2018; Hughes, Lu, & Howard, 2018; Smith, Frank, & Mustard, 2008; Steptoe, Siegrist, Kirschbaum, & Marmot, 2004). The highest source of stress amongst Canadian adults is reported to be due to work instead of finances; therefore, workplace stress and SES might have cumulative effects that can increase the odds of developing CVD and T2D (Kivimaki & Kawachi, 2015). Objective: This study investigated if self-reported stress levels and measures of socioeconomic status (including household income, household education level, and occupational type) were significantly associated to self-reported diagnosis of CVD and T2D, even after controlling for traditional risk factors: smoking status, alcohol intake, fruit and vegetable intake, and physical activity (Pouwer, Kupper, & Adriaanse, 2010). Further analysis sought to investigate the combined effects of both SES and workplace stress on CD outcomes by calculating the magnitude of their multiplicative interaction and additive interaction via reporting the relative excess risk due to interaction (RERI). Methods: A cross-sectional analysis was conducted through multivariate logistic regression analysis using a bootstrapped weighted sample of 78,023 respondents from the Canadian Community Health Survey (2015-16). Models initially controlled for age, sex, race or cultural background, and body mass index (BMI), and subsequently the traditional risk factors to understand the true association between stress and SES on CD outcomes. Combined effects of both main variables were assessed using multiplicative and additive interaction analysis. Results: Outcomes from logistic regression analyses showed a significant association between perceived life stress and all aspects of SES for both CVD and T2D. Perceived life stress and SES remained significantly associated to both CD outcomes even after adjusting for traditional behaviour risk factors. A significant interaction between high life stress and low household income showed almost double the odds of reporting diabetes (OR=1.89, p=0.03), compared to the product of the individual factors alone. Results support that perceived stress and SES might have independent associations to CD outcome and together they might have cumulative effects on health. Conclusion: Our results corroborate other findings that stress and SES might have independent associations to CD outcomes, even in the absence of traditional disease risk factors. These results highlight the importance of understanding the cumulative effects social and economic factors in exascerbating CD outcomes. To our knowledge, this is the first Canadian study to show the cumulative effects of perceived stress and SES on outcomes of CVD and diabetes, and why we might need to change our approach to combat incidence of CDs.
Does the Cost Barrier to Contraception Differentially Affect Racialized and Indigenous Women? An Intersectional Quantitative Investigation
(University of Waterloo, 2022-08-11) Lamberti, Nina; Cooke, Martin
Background: In Canada, 15% of sexually active women of reproductive age do not use any form of contraception (Black et al., 2009; Black, Guilbert, Costescu, et al., 2015; Black, Guilbert, Hassan, et al., 2015). The majority of women who do use contraception rely on methods with high failure rates such as condoms only and withdrawal (Black, Guilbert, Costescu, et al., 2015). The most effective forms of birth control, long-acting reversible contraception (LARCs), are underutilized and often the most expensive per unit (Black, Guilbert, Costescu, et al., 2015; Di Meglio & Yorke, 2019). Research has shown that racialized and Indigenous women often have different experiences and barriers to reproductive health care compared to non-racialized and non-Indigenous women (Sutton et al., 2021; Wilson et al., 2013). One factor, cost, has been identified as the most important barrier to using effective contraception (Black, Guilbert, Hassan, et al., 2015; Hulme et al., 2015). Specific Aims: Using data from the 2020 Annual Component of the Canadian Community Health Survey (CCHS), this thesis investigates two major questions (1) “Are racialized and Indigenous women less likely to use more expensive and effective forms of birth control than non-racialized and non-Indigenous women?” and (2) “Do differences in contraception use by racialized and Indigenous women, compared to non-racialized non-Indigenous women, appear to be due primarily to financial or cost barriers?”. Methods: Exploratory data analysis was first conducted in order to present univariate and bivariate distributions of predictor and outcome variables. Bivariate associations included Chi-square tests to examine significance at p >0.05. Three sets of multi-variable binary logistic regression models were then used to assess relationships between outcome and predictor variables. The first set of models examined the binary outcome of Use vs. Non-use, while the second set of models examined LARC contraception use from the sample of women who did use birth control. The last model investigated Use vs. Non-use of contraceptives among specific racial categories. Results: A large proportion (52.85%) of racialized women reported not using any form of birth control compared to 22.68% of white women and 20.97% of Indigenous women. Higher proportions of racialized women relied on condoms (62.03%) compared to Indigenous (32.91%) and white (35.15%) women. In the first group of binary regression models, racialized women were found to be significantly less likely (OR = 0.766, CI = 0.617, 0.951) to use contraception of any kind regardless of income, education or provincial location. Of the women who reported using contraception, racialized women were found to be significantly less likely (OR = 0.546, CI = 0.365, 0.816) to use LARC forms of birth control. In both sets of models, Indigenous women were not significantly different from white women. In a sub-analysis of only racialized women, Filipino women were found to be significantly less likely (OR = 0.297, CI = 0.129, 0.683) to use birth control of any kind. Conclusion: The findings suggest that the relationship between identity category and contraception use is not fully explained or even impacted by socioeconomic elements such as income and education. These results emphasize the need for further exploration of disaggregated race data pertaining to reproductive health inequities. The results also provide recommendations for Canadian health policy modifications in order to improve contraception access and use among potentially vulnerable populations.
Immigrant women’s perceptions of cervical cancer prevention strategies in Ontario, Canada: A framework-informed qualitative analysis
(University of Waterloo, 2021-09-01) Benjamin, Kayla Alexandra; Cooke, Martin
Background: In Ontario, it is recommended that people with a cervix who are sexually active and over the age of 21 have a Papanicolaou (Pap) test every three years and that students in grade seven receive the human papillomavirus (HPV) vaccine. The extent to which eligible Canadians engage in regular Pap smear examinations and obtain the HPV vaccination are significant public health issues. Importantly, immigration status is largely associated with being underscreened for cervical cancer (Bacal et al., 2019; Datta et al., 2018). Canadian immigrants are less likely to be screened for cervical cancer and have higher rates of HPV infection compared to non-immigrants (Datta et al., 2018; Lofters et al., 2007; Wilson et al., 2021). To develop targeted public health interventions that encourage screening and vaccination among eligible immigrants in Canada, public health practitioners must explore the behavioural influences that produce screening inequities between immigrants and non-immigrants. Methods: Using a semi-structured theoretically-informed qualitative interview study, this thesis examined two major questions: (1) “What are the experiences and perceptions of cervical cancer prevention strategies among immigrant women in Ontario?” and (2) “How might targeted public health programs improve Pap test adherence and HPV vaccination among immigrant women and their children in Ontario?”. The interview guide was based on Version 1 of the Theoretical Domains Framework (TDF). Interviews were coded inductively to explore barriers and enablers to cervical cancer prevention programs. Using previously published criteria, the behavioural influences identified in the inductive stage were then allocated to relevant TDF domains. Results: The behavioural influences identified in this study were allocated to nine of the 12 TDF domains, including Knowledge, Skills, Beliefs about capabilities, Beliefs about consequences, Motivation and goals, Environmental context and resources, Social influences, Emotion, and Behavioural regulation. Conclusion: The findings from this study informed five recommendations for targeted public health programs aiming to increase screening adherence and vaccination rates within immigrant communities. The recommendations are to (1) improve access to multilingual health resources, (2) disseminate health information to immigrant communities through effective media, (3) provide physicians with educational resources to improve the cultural sensitivity and safety of their approaches to care delivery, (4) increase access to low-barrier healthcare and (5) incorporate self-administered tests into provincial screening programs.
Incorporating sex, gender and vulnerable populations in a large multisite health research programme: The Ontario Pharmacy Evidence Network as a case study
(BioMed Central, 2017-03-20) Cooke, Martin; Waite, Nancy; Cook, Katie; Milne, Emily; Chang, Feng; McCarthy, Lisa; Sproule, Beth
Background: Funders now frequently require that sex and gender be considered in research programmes, but provide little guidance about how this can be accomplished, especially in large research programmes. The purpose of this study is to present and evaluate a model for promoting sex-and gender-based analysis (SGBA) in a large health service research programme, the Ontario Pharmacy Evidence Network (OPEN). Methods: A mixed method study incorporating (1) team members' critical reflection, (2) surveys (n = 37) and interviews (n = 23) at programme midpoint, and (3) an end-of-study survey in 2016 with OPEN research project teams (n = 6). Results: Incorporating gender and vulnerable populations (GVP) as a cross-cutting theme, with a dedicated team and resources to promote GVP research across the programme, was effective and well received. Team members felt their knowledge was improved, and the programme produced several sex-and gender-related research outputs. Not all resources were well used, however, and better communication of the purposes and roles of the team could increase effectiveness. Conclusions: The experience of OPEN suggests that dedicating resources for sex and gender research can be effective in promoting SGBA research, but that research programmes should also focus on communicating the importance of SGBA to their members.
Is Social Capital Mediating the Relationship Between Ethnicity and Health in Canada?
(University of Waterloo, 2015-12-04T16:40:37Z) Sriranganathan, Gobika; Cooke, Martin
Ethnic minorities in Canada experience poorer health compared to their Canadian counterparts, on several important health outcomes. This study examines whether social capital – measured by social networks, civic engagement and trust – may offer an explanation for the continued persistence of these health inequities. Bivariate and logistic regression analysis was performed using the 2008 General Social Survey to investigate whether ethnicity and/or social capital are associated with self-reported health and if social capital is mediating the relationship between ethnicity and health. The study found that ethnicity was significantly associated with self-reported health with respondents identifying as South Asian, Aboriginal or Chinese, being significantly more likely to report poorer health compared to other Canadians. Furthermore, measures of civic engagement and generalized trust were positively and significantly associated with health. Although this study was unable to conclude that social capital is mediating the relationship between ethnicity and health, it explored the operationalization of social capital measures that could have policy or program evaluation implications. Further research is needed to confirm the findings of this study.
Reinvestigating Access to Healthcare Services and Unmet Healthcare Needs Among Immigrants in Canada: Results from the 2014 Canadian Community Health Survey
(University of Waterloo, 2019-12-17) Puran, Allan; Cooke, Martin
Objective: To compare the differences in the reported experience of unmet healthcare needs of recent immigrants (i.e. immigrants living in Canada for five years or less) and Canadian-born adults and to determine if the factors that contribute to unmet healthcare needs risk have changed from 2000/01 to 2014. Methods: Data used are from the 2014 Canadian Community Health Survey, conducted by Statistics Canada. The study sample includes 6,710 immigrants and 50,227 Canadian-born adults aged 18 and older living in Canada. For the analysis, a number of multivariate binary logistic regression models were created. Results: That the risk of a recent immigrant reporting unmet healthcare needs was 9.5% lower than a Canadian-born adult’s risk (OR=0.905, p=0.8310) after adjusting for immigrant status, age, gender, and other variables identified in the Andersen Behavioural Model of Healthcare Utilization. The factors that contributed to the unmet healthcare needs risk remained similar to those previously identified by Wu et al. (2005), however their effect on reporting an unmet healthcare need has changed slightly since 2000/01. Additionally, this study found that an immigrant’s length of residence in Canada was also associated with their risk of reporting an unmet healthcare need. After adjusting for individual population-based factors, the risk of reporting an unmet healthcare need by a long-term immigrant (i.e. an immigrant who has lived in Canada for 15 years or more) was similar to a Canadian-born adult’s risk; higher than a recent immigrant. However, immigrants living in Canada between 5 and 9 years had the highest risk of reporting an unmet healthcare need when compared those in Canada for 5 years or less. Conclusions: This study found that differences in UHN experiences by immigrants and Canadian-born adults in 2014 declined from 2000/01. While immigrant status was not significantly associated with UHNs risk during 2014, their risk of experiencing UHN was 9.5% lower than Canadian-born adults’ risk, findings similar to other studies (e.g. Wu et al. 2005). After adjusting for immigrant status, age, sex, and individual factors, 11 variables were identified that significantly contributed to unmet healthcare need experiences in 2014. These include age, sex, highest level of education; sense of community belonging, access to regular sources of care (e.g. family and general practitioners) or specialist services; income; and self-rated health status and stress levels. Furthermore, although immigrants’ risk of experiencing unmet healthcare needs do change over time, their length of time in Canada was not significantly associated with this change. This research highlights the importance of understanding how individual factors can affect access to healthcare services and UHN experiences.
Sex and Gender, Socioeconomic Status, and Type 2 Diabetes Mellitus
(University of Waterloo, 2021-09-21) D'Costa, Lauren; Cooke, Martin
Background: Diabetes mellitus imposes challenges on health care systems, economies, and the individuals living with and at risk for this illness. Diabetes is a major chronic disease and affects more and more Canadians each year (Buysschaert & Bergman, 2011; Public Health Agency of Canada (PHAC), 2011). Type 2 diabetes mellitus (T2DM) potentially impacts all people, but it disproportionately affects those who are disadvantaged socially and materially (Brown, 2004). Low income groups have higher diabetes prevalence rates and are at greater risk of developing diabetes than higher income groups (Raphael, 2011). Literature has also indicated that diabetes is related to sex or gender and ethnicity or race (PHAC, 2011; Chiu, Austin, Manuel, & Tu, 2010). In the differences in diabetes risk between men and women, the social aspects of gender, including differences in behaviours and exposures, might play a role (Kautzky-Willer, Harreiter, & Pacini, 2016). Intersectionality describes how the social aspects of gender and other dimensions of risk, particularly low income, might interact (Dhamoon & Hankivsky, 2011; López & Gadsden, 2016). Sex and gender and socioeconomic status (SES) might be significantly associated with T2DM risk and may interact to affect the odds of developing T2DM. Objective: This study’s objective is to improve our understanding of the relationship between SES, sex and gender, and other sociodemographic and behavioural factors, with diabetes risk. Self-reported T2DM status and measures of SES (including household income, economic family household status, working status, education level, and occupational type) and behavioural factors (including type of smoker, alternative tobacco usage, alcohol intake, physical activity level, and fruit/vegetable daily consumption) and perceived stress level were included to investigate whether self-reported T2DM status was significantly associated with income and sex and gender, even after controlling for economic family household status, working status, education level, occupational type, behavioural risk factors and perceived stress level. Analysis aimed to investigate the risk for T2DM among men and women. Methods: A cross-sectional analysis was completed through multivariable logistic regression analysis with a bootstrapped weighted sample of 77,681 respondents from the Canadian Community Health Survey (CCHS 2015/16). The analytical strategy involved creating two sets of models; one for each of the dependent variables, whether diagnosed with diabetes and the age of diabetes. The first set of models used binary logistic regression to predict the log-odds that an individual was diagnosed with T2DM and included age as a control variable, as well as sex and income, in order to test whether sex and gender and income have independent effects. An interaction of sex and gender and income was included to test whether the effects of income are different for males and females. A second set of models predicted the age at diagnosis of diabetes, among those who had been so diagnosed. Results: Logistic regression analyses showed a significant association between T2DM and household income. Model 1 showed that females were significantly lower risk compared to males, and there was a clear age gradient, with risks higher among older age ranges. Model 2 presented clear evidence of a gradient in risk according to income, with those in the lowest income decile having nearly 75% higher risk than those in the median deciles and those in the highest income decile having about half the risk. Model 4 showed that females were less likely to report having T2DM than males and that age remained an important predictor of T2DM when other socioeconomic status, geographic, and demographic variables were included in the model. When health behaviours and stress were added (Model 5), along with the variables in the first models, both sex and gender and elements of SES (income, education, work, and family status) were associated with T2DM, although none of the SES variables, other than education, remained significant. Stratified analysis was conducted for Model 6 (males) and Model 7 (females). In the interaction models, the interaction of age and sex/gender was not significant. In the stratified models, the age dummies had a similar effect for males and females and reflected a generally linear relationship with T2DM risk. For Model 8 (men) and Model 9 (women), health behaviours and stress were added to the models for men and women. Overall, these effects of the demographic and socioeconomic variables in these models were similar to those in the stratified models without the behavioural and perceived life stress variables. Results support that sex and gender and SES may interact to affect T2DM risk. Conclusion: Our results suggest that the two dimensions of social identity¬-sex/gender and socioeconomic position may interact to structure the risk of T2DM and that there are differences in risk of diabetes for men and women. These results emphasize the importance of studying the observable processes that might be leading to and amplifying observed differences in diabetes risk, which are factors such as age, sex and gender, income, cultural/racial background, education, economic family household, occupation, working status, health behaviours, and stress variables. Our study shows why prevention strategies for T2DM should include approaches that combine healthful behaviours and public policy that identify the key role that SES and sex and gender have on the variations found in the prevalence and incidence of T2DM among the sexes.