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Publications (13)13.75 Total impact

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    ABSTRACT: 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 Methods: We performed a systematic literature review to identify published or unpublished papers between January 01, 1980 and December 02, 2007 that reviewed the long-term effectiveness (1 year or longer) of school-based marijuana and alcohol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.
    01/2010; 18(1):84-96.
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    ABSTRACT: 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. 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. 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. 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.
    Canadian journal of psychiatry. Revue canadienne de psychiatrie 09/2009; 54(9):589-95. · 2.48 Impact Factor
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    ABSTRACT: A number of reports suggest that Aboriginal cultural status is a major risk indicator for drug and alcohol use. The primary purpose of the present paper was to determine whether Aboriginal cultural status is independently associated with risk behaviours, such as marijuana use and alcohol abuse, among youth after multivariate adjustment for other factors, such as socioeconomic status. Every student between grades 5 and 8 in Saskatoon, Saskatchewan, was asked to complete a questionnaire in February 2007. Logistic regression was used to determine the independent risk indicators associated with alcohol abuse and marijuana use. Four thousand ninety-three youth participated in the school health survey. At the cross-tabulation level, cultural status and neighbourhood income were both strongly associated with alcohol and marijuana use. After multivariate adjustment, the association between Aboriginal cultural status and alcohol abuse was not statistically significant (crude OR=3.52 to adjusted OR=0.80). For marijuana use, the association was significantly reduced (crude OR=9.91 to adjusted OR=2.79). After controlling for all other variables, results showed that low-income youth were 103% more likely to get drunk at least once and were 163% more likely to have tried marijuana at least once. To be more successful, future policies directed toward reducing risk behaviours among youth should consider neighbourhood income characteristics.
    Paediatrics & child health 04/2009; 14(4):225-30. · 1.03 Impact Factor
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    ABSTRACT: A majority of population-based studies suggest prevalence of drug and alcohol risk behaviour increases during late adolescence to early adulthood. The purpose of this systematic literature review is to clarify if socio-economic status (SES) is a determinant of marijuana and alcohol risk behaviour in adolescents between the ages of 10-15 years. We performed a meta-analysis to identify published or unpublished papers between January 1, 1980 and February 9, 2007 that reviewed marijuana and alcohol risk behaviour by SES in adolescents aged 10-15 years. We found nine studies that fulfilled our inclusion criteria and passed the methodological quality review. The prevalence of marijuana and alcohol risk behaviour was 22% higher (RR = 1.22; 95% CI 1.14-1.31) in adolescents with low SES in comparison to adolescents with higher SES. Stratification by country of origin revealed that American and New Zealand studies had statistically significant variability in the reported effects as compared to European and UK studies. The evidence suggests that low SES has an inverse association with the prevalence of marijuana and alcohol risk behaviour in adolescents between the ages of 10-15 years. Higher rates of marijuana and alcohol risk behaviour among lower SES adolescents may impact emotional development, limit future educational and occupational achievement, and increase the likelihood for adult marijuana and alcohol addiction. Lower SES adolescents have higher rates of marijuana and alcohol risk behaviour than higher SES adolescents.
    Canadian journal of public health. Revue canadienne de santé publique 01/2009; 99(3):172-7. · 1.02 Impact Factor
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    ABSTRACT: Smoking prevalence in the Saskatoon Health Region (SHR) went from 23.9% in 2003 to 23.3% in 2005 to 26.2% in 2007. The prevalence of smoking within the SHR Aboriginal population is substantially higher than the rest of the population. The purpose of the current study was to determine the independent effects of Aboriginal cultural status and income status on daily smoking status. Data from three cycles of the Canadian Community Health Survey (2001, 2003, 2005) were merged with identical data collected by the SHR in 2007. All four cycles were random telephone survey samples. 5948 participants (81.1% response rate) completed the survey. After cross-tabulation, Aboriginal cultural status and income were strongly associated with daily smoking status. Using logistic regression, the odds of daily smoking for residents of Aboriginal cultural status was reduced substantially from the initial odds of 3.43 to 2.26 after adjusting for income alone, and reduced further to 1.57 after full multivariate adjustment. Given the association between smoking status and income status, future policies to reduce smoking prevalence should include generic policies to reduce income disparity as well as targeted strategies to improve the social conditions of Aboriginal people.
    Canadian journal of public health. Revue canadienne de santé publique 01/2009; 100(1):51-4. · 1.02 Impact Factor
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    ABSTRACT: There have been too few studies on urban Aboriginal youth to permit inferences about depressed mood in this subgroup. The purpose of the present study was to determine whether Aboriginal cultural status is independently associated with moderate or severe depressed mood in youth after controlling for other covariates, including socioeconomic status. Every student between grades 5 and 8 in the city of Saskatoon, Saskatchewan, was asked to complete a questionnaire in February of 2007. Depressed mood was measured with a 12-question depression scale derivative of the 20-question Center for Epidemiologic Studies Depression Scale. Four thousand ninety-three youth participated in the school health survey. For Aboriginal youth, the prevalence rate of moderate or severe depressed mood was 21.6% in comparison with 8.9% for Caucasian youth (rate ratio 2.43; 95% CI 1.92 to 3.08). Aboriginal cultural status was not associated with depressed mood after adjustment for other covariates in the final multivariate model (OR 1.132; 95% CI 0.682 to 1.881). Parental educational status and sex were confounders to the association between Aboriginal cultural status and depressed mood. The recognition that Aboriginal cultural status is not independently associated with moderate or severe depressed mood in youth after full multivariate adjustment allows policy makers to acknowledge that mental health disparity prevention is possible because the determinants of health (ie, education) are modifiable (in comparison with Aboriginal cultural status).
    Paediatrics & child health 05/2008; 13(4):285-90. · 1.03 Impact Factor
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    ABSTRACT: Incomplete immunization coverage is common in low-income families and Aboriginal children in Canada. To determine whether child immunization coverage rates at two years of age were lower in low-income neighbourhoods of Saskatoon, Saskatchewan. Parents who were and were not behind in child immunization coverage were contacted to determine differences in knowledge, beliefs and opinions on barriers and solutions. A multivariate regression model was designed to determine whether Aboriginal cultural status was associated with being behind in childhood immunizations after controlling for low-income status. Reviewing the past five years in Saskatoon, the six low-income neighbourhoods had complete child immunization coverage rates of 43.7% (95% CI 41.2 to 45.9) for measles-mumps-rubella, and 42.6% (95% CI 40.1 to 45.1) for diphtheria, pertussis, tetanus, polio and Haemophilus influenzae type B. The five affluent neighbourhoods had 90.6% (95% CI 88.9 to 92.3) immunization coverage rates for measles-mumps-rubella, and 78.6% (95% CI 76.2 to 81.0) for diphtheria, pertussis, tetanus, polio and H influenzae type B. Parents who were behind in immunization coverage for their children were more likely to be single, of Aboriginal or other (non-Caucasian or non-Aboriginal) cultural status, have lower family income and have significant differences in reported beliefs, barriers and potential solutions. In the final regression model, Aboriginal cultural status was no longer associated with lower immunization status. Child immunization coverage rates in Saskatoon's six low-income neighbourhoods were approximately one-half the rate of the affluent neighbourhoods. The covariates with the strongest independent association with complete childhood immunization status were low income and other cultural status. Aboriginal cultural status was not associated with low child immunization rates after controlling for income status.
    Paediatrics & child health 01/2008; 12(10):847-52. · 1.03 Impact Factor
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    Mark Lemstra, Cory Neudorf, Gary Beaudin
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    ABSTRACT: A number of reports suggest that we need to determine public understanding about the broad determinants of health and also determine public support for actions to reduce health disparities in Canada. A cross-sectional random survey of 5,000 Saskatoon residents was used to determine knowledge about health determinants and health disparity and then determine public support for various interventions to address health disparity. Saskatoon residents understand most of the determinants of health except they understate the importance of social class and gender. Saskatoon residents do not have a good understanding of the magnitude of health disparity between income groups. A majority believe risk behaviours are mostly individual choices and are not associated with income status. Most residents believe even small differences in health status between income groups is unacceptable and a majority believe that something can be done to address health disparity by income status. Interventions proposed by residents to alleviate health disparity were evidence-based, including work-earning supplements and strengthening early intervention programs. Logistic regression revealed that greatest support for transferring money from health care treatment to health creation services (like affordable housing and education) came from young Aboriginal males with low income. Saskatoon residents have knowledge of health determinants and have a strong desire to support health disparity intervention. More knowledge transfer is required on the magnitude of health disparity based on income status. Broad-based health disparity intervention in Saskatoon appears possible.
    Canadian journal of public health. Revue canadienne de santé publique 01/2007; 98(6):484-8. · 1.02 Impact Factor
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    Mark Lemstra, Cory Neudorf, Johnmark Opondo
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    ABSTRACT: Legislation to ban smoking in public places is currently a major area of interest across Canada. The main objectives of the study were to 1) determine the effect of the smoking ban on incidence of acute myocardial infarction, 2) determine if the new legislation altered population-based smoking prevalence, and 3) measure public support for the public smoking ban. The city of Saskatoon initiated a public smoking ban on July 1, 2004. We retrospectively reviewed all hospital discharges for acute MI from July 2000 to June 2005. We reviewed CCHS survey information on smoking prevalence for Saskatoon, Saskatchewan and Canada from 2003 to 2005. We prospectively contacted 1,255 Saskatoon residents by telephone to determine support for the public smoking ban. The age-standardized incidence rate of acute MI fell from 176.1 (95% CI 165.3-186.8) cases per 100,000 population (July 1, 2000 to June 30, 2004) to 152.4 (95% CI 135.3-169.3) cases per 100,000 population (July 1, 2004 to June 30, 2005). Smoking prevalence in Saskatoon fell from 24.1% in 2003 (95% CI 20.4-27.7) to 18.2% in 2005 (95% CI 15.7-20.9) while smoking prevalence in Saskatchewan remained unchanged at 23.8% (95% CI 22.6-25.3) and Canada reduced from 22.9% (95% CI 22.5-23.3) to 21.3% (95% CI 20.8-21.8). Seventy-nine percent of Saskatoon residents believed the smoking ban was a good idea. The public smoking ban in Saskatoon, Canada, is associated with reduced incidence rates of acute MI, lower smoking prevalence and high levels of public support.
    Canadian journal of public health. Revue canadienne de santé publique 99(1):62-5. · 1.02 Impact Factor
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    ABSTRACT: The purpose of this paper was to use a linked dataset to compare health care utilization rates and costs between income groups in Saskatoon, Canada. The Canadian Community Health Survey was linked to hospital, physician and medication data in Saskatoon. Of 3,688 eligible participants, 3,433 agreed to the health survey and data linkage with health records (83.7% overall response). Low-income residents were 27-33% more likely to be hospitalized and 36-45% more likely to receive a medication than middle- and higher-income residents, but were 5-7% less likely to visit a physician over a one-year period. In comparison to middle-income residents, low-income residents had 56% more high users of hospitals, 166% more high users of physicians and 90% more high users of medications. Low-income residents had 34-35% higher health care costs overall than middle- and high-income residents. After multivariate adjustment for increased disease prevalence, low income had a reduced association with high health care utilization. The results demonstrate that residents with lower income are responsible for disproportionate usage of hospitals, physicians and medications; due mainly (but not entirely) to higher disease prevalence.
    Canadian journal of public health. Revue canadienne de santé publique 100(3):180-3. · 1.02 Impact Factor
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    ABSTRACT: The incidence rates of Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (GC) in Saskatoon Health Region are approximately double the national average. A descriptive study was designed to try to determine why. The objectives of the study were: (1) to determine whether or not the introduction of a new detection method that is less invasive and more sensitive led to more tests being ordered and a higher percentage of positive cases; (2) to determine what percentage of physicians and STI clinic nurses notified Public Health within 72 hours of suspected Ct or GC; (3) to determine what percentage of physicians and STI clinic nurses listed sexual contact information; and (4) to compare recurrence rates between patients treated by physicians and STI clinic nurses. The number of tests ordered for Ct and GC increased substantially from 10,425 in 1998 to 28,885 in 2003, while the percentage of positive cases decreased from 7.2% to 3.6%. Only 1.3% of physicians and 9.1% of STI clinic nurses notified Public Health within 72 hours of a suspected case. 51.2% of physicians listed sexual contact information in comparison to 85.4% of STI clinic nurses. Recurrence rates of Ct or GC within one year of initial treatment were 26% lower for patients treated by STI clinic nurses (5.7%) than for physicians (7.2%). There is a need for additional education for health care providers in the management of sexually transmitted infections in Saskatoon Health Region.
    Canadian journal of public health. Revue canadienne de santé publique 98(2):134-7. · 1.02 Impact Factor
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    ABSTRACT: A majority of population-based studies suggest prevalence of depressed mood and anxiety is most common during late adolescence to early adulthood. Mental health status has been linked previously to socio-economic status in adults. The purpose of this systematic literature review is to clarify if socio-economic status (SES) is a risk indicator of depressed mood or anxiety in youth between the ages of 10 to 15 years old. We performed a systematic literature review to identify published or unpublished papers between January 1, 1980 and October 31, 2006 that reviewed depressed mood or anxiety by SES in youth aged 10-15 years. We found nine studies that fulfilled our inclusion criteria and passed the methodological quality review. The prevalence of depressed mood or anxiety was 2.49 times higher (95% CI 2.33-2.67) in youth with low SES in comparison to youth with higher SES. The evidence suggests that low SES has an inverse association with the prevalence of depressed mood and anxiety in youth between the ages of 10 to 15 years old. Higher rates of depressed mood and anxiety among lower socio-economic status youth may impact emotional development and limit future educational and occupational achievement. Lower socio-economic status is associated with higher rates of depressed mood and anxiety in youth.
    Canadian journal of public health. Revue canadienne de santé publique 99(2):125-9. · 1.02 Impact Factor
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    Mark Lemstra, Cory Neudorf, Johnmark Opondo
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    ABSTRACT: Canadian cities are becoming more segregated by income. As such, investigation is required into the magnitude of health disparity between low-, average- and high-income neighbourhoods in order to quantify the level of health disparity at the scale of an urban city. A cross-sectional ecological study design was used to review all hospital discharges, physician visits, medication utilization, public health information and vital statistics for an entire city by neighbourhood income status. Postal code information was used to identify six existing contiguous residential neighbourhoods in the city of Saskatoon that were defined as low-income cut-off neighbourhoods (N=1 8,228). There were two comparison groups: all other Saskatoon residents (N=184,284) and the five most affluent neighbourhoods in Saskatoon (N=1 6,683). Statistically significant differences in health care utilization by neighbourhood income status were observed for suicide attempts, mental disorders, injuries and poisonings, diabetes, chronic obstructive pulmonary disease, coronary heart disease, chlamydia, gonorrhea, hepatitis C, teen birth, low birthweight, infant mortality and all-cause mortality. The rate ratios increased in size when comparing low-income neighbourhoods to high-income neighbourhoods. No clear trend was observed for stroke or cancer.
    Canadian journal of public health. Revue canadienne de santé publique 97(6):435-9. · 1.02 Impact Factor