Population Health and Optimal Health Practices Research Unit

Québec, Canada

Population Health and Optimal Health Practices Research Unit

Québec, Canada
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PubMed | Swasti Health Resource Center, University of Manitoba, Population Health and Optimal Health Practices Research Unit and India KHPT Office
Type: Journal Article | Journal: Archives of sexual behavior | Year: 2016

Despite their large numbers, and important role in the HIV epidemic in India, male clients of female sex workers (FSWs) are a difficult to reach population and little is known about their sexual behaviors. Using data from an integrated behavioral and biological assessment of 684 clients in Bangalore in 2012, we examined factors associated with their reports of having sex with three or more different female sex workers in the last month, and anal sex with sex workers. We included sociodemographic and sexual behavior factors and, for the first time in client studies in India, included data on the use of pornography and sexual enhancement products (SEPs) such as pills, oils, and sprays, in our multivariable analyses of client risk. Seventy-eight percent of clients had seen pornographic material and 8% reported ever having used SEPs. The profiles of men practicing the two risk behaviors examined were quite different. Travel in the past year, drunkenness in the past month, young age at first commercial sex, non-use of condoms at last sex, and finding sex workers in public places (but not use of pornography and SEPs) were independently associated with multiple partnering. Sex with a man or transsexual, being a white collar worker, seeking out FSWs at home, pornography and SEP use, and condom use at last FSW sex, were all independently associated with anal sex with an FSW. More research is needed to better understand the links between pornography and SEPs, and HIV risk behaviors, and HIV prevention programs need to be cognizant of the importance of ensuring that condom use is adequately promoted and supported in the context of anal sex in female sex worker-client interactions.


Pirkle C.M.,Population Health and Optimal Health Practices Research Unit | Lucas M.,Population Health and Optimal Health Practices Research Unit | Lucas M.,Laval University | Dallaire R.,Population Health and Optimal Health Practices Research Unit | And 7 more authors.
Canadian Journal of Public Health | Year: 2014

Objectives: Inuit in Canada experience alarming levels of food insecurity, but nutritional and physiological consequences are poorly documented, especially in school-age children. The objective of this study was to assess the relation of food insecurity to iron deficiency and stature in school-aged Inuit children from Nunavik (Northern Quebec). Methods: Food insecurity, iron deficiency, and stature were assessed in a cohort of children. Food insecurity was determined by interviewing the children's mothers. Multiple logistic regression was used to evaluate the association of food insecurity to iron deficiency and short stature. We defined short stature as a height in the lowest tertile for age and sex, based on Canadian growth charts. The relation of food insecurity to height (cm) was analyzed with a general linear model. Statistical models controlled for age, sex, normal/overweight/obese status, prenatal lead exposure and postnatal polychlorinated biphenyls exposure. Results: Half of the children (49.7%, n=145) were food insecure, while one third were iron depleted, 12.6% had anaemia, and 8.7% had irondeficiency anaemia. The multivariate odds ratio of anaemia was 1.82 (95% CI: 0.97, 3.42, p=0.06) for food-insecure children. Prevalence of short stature was 18.7%. Food-insecure children were an average of 2 cm shorter (95% CI:-0.48,-3.17) than food-secure children (p<0.01). Conclusion: In this population, food-insecure children have greater burdens of nutritional deficiencies and slower linear growth. Considering the high prevalence of food insecurity among Inuit children in Nunavik, nutritional deficiencies and adverse effects on development should be carefully monitored. © Canadian Public Health Association, 2014. All rights reserved.


PubMed | Wayne State University, Population Health and Optimal Health Practices Research Unit and Laval University
Type: Journal Article | Journal: Alcohol and alcoholism (Oxford, Oxfordshire) | Year: 2016

This study investigated trajectories of alcohol use and binge drinking among Inuit women starting from a year before pregnancy until a year after delivery, examined transition rates between time periods, and established whether specific factors could be identified as predictors of changes in alcohol behaviors.Drinking trajectories and movement among alcohol users and binge drinkers (i.e. non-binging and binging) were explored by Markov modeling across time periods. Two hundred and forty-eight Inuit women from Arctic Quebec were interviewed at mid-pregnancy, and at 1 and 11 months postpartum to obtain descriptive data on alcohol use during the year before pregnancy, the conception period, the pregnancy and the year after delivery.The proportions of drinkers and bingers were 73 and 54% during the year prior to pregnancy and 62 and 33% after delivery. Both alcohol use and binge drinking trajectories demonstrated a significant drop in prevalence between the year before conception to the conception period. We also noted high probabilities of becoming an abstainer or not binging at this time. However, up to 60% of women continued to drink alcohol during pregnancy. Women in couples and not consuming marijuana were more likely to decrease their binge drinking at conception.This study emphasizes the importance of including the period around conception in the definition of drinking patterns during pregnancy. The importance of considering alcohol consumption in a multidimensional way (personal, familial and social determinants) is also addressed while trying to minimize problems both for the fetus and the mother.


Johnson-Down L.,McGill University | Labonte M.E.,Laval University | Martin I.D.,University of Waterloo | Tsuji L.J.S.,University of Waterloo | And 8 more authors.
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2015

Background and aims: Indigenous people worldwide have a greater disease burden than their non-aboriginal counterparts with health challenges that include increased obesity and higher prevalence of diabetes. We investigate the relationships of dietary patterns with nutritional biomarkers, selected environmental contaminants and measures of insulin resistance in the Cree (Eeyouch) of northern Québec Canada. Methods and results: The cross-sectional 'Nituuchischaayihitaau Aschii: A Multi-Community Environment-and-Health Study in Eeyou Istchee' recruited 835 adult participants (≥18y) from 7 communities in the James Bay region of northern Québec. The three dietary patterns identified by principal component analysis (PCA) were: inland and coastal patterns with loadings on traditional foods, and a junk food pattern with high-fat and high-sugar foods. We investigated dietary patterns scores (in quantiles) in relation with nutritional biomarkers, environmental contaminants, anthropometry, blood pressure, fasting plasma glucose and insulin, and insulin resistance. Homeostatic model assessment (HOMA-IR) was used as surrogate markers of insulin resistance. ANCOVA ascertained relationships between dietary patterns relationship and outcomes. Greater scores for the traditional patterns were associated with higher levels of n-3 fatty acids, mercury and polychlorinated biphenyls (PCBs) (P trend <0.001). Higher scores for the junk food pattern were associated with lower levels of PCBs and Vitamin D, but higher fasting plasma insulin and HOMA-IR. Conclusion: Our results suggest that poor diet quality accompanied greater insulin resistance. Impacts of diet quality on insulin resistance, as a sign of metabolism perturbation, deserve more attention in this indigenous population with high rates of obesity and diabetes. © 2014 Elsevier B.V.


Riva M.,Laval University | Riva M.,Population Health and Optimal Health Practices Research Unit | Larsen C.V.L.,University of Southern Denmark | Bjerregaard P.,University of Southern Denmark | Bjerregaard P.,University of Greenland
International Journal of Public Health | Year: 2014

Objectives: Poor housing conditions experienced by many Indigenous peoples threaten their health and well-being. This study examines whether household crowding is associated with poorer psychosocial health among Greenlanders, and the mediating role of social support. It also assesses whether Inuit men and women are differently influenced by their housing conditions.Methods: Data on more than 3,000 Inuit aged 18 years and older are from the Inuit health in transition Greenland survey. Associations between household crowding and composition, and mental well-being and binge drinking were examined using logistic regression models, adjusting for individuals’ characteristics.Results: Household crowding was associated with poorer mental well-being. Binge drinking was more common among people living in households without children. These effects were more important for women than for men. The association between household crowding and mental well-being was significantly mediated by social support. This suggests that having a strong social network may buffer the deleterious impacts of household crowding.Conclusions: Targeting housing conditions and fostering social support as part of population health interventions might contribute to improving psychosocial health and well-being in Greenland. © 2014, Swiss School of Public Health.


Diorio C.,Oncology Research Unit | Diorio C.,Saint Sacrement Hospital | Diorio C.,Laval University | Dumas I.,Oncology Research Unit | And 4 more authors.
Anticancer Research | Year: 2013

Background: Polychlorinated biphenyls (PCBs) are ubiquitous chemicals found in the environment that accumulate in body fat and exhibit endocrine-disrupting properties. These compounds are therefore suspected of influencing breast cancer risk, but results from studies are inconsistent. To further clarify the role of PCBs in the etiology of breast cancer, the present study aimed to examine the relation of 24 PCB congener levels, which were considered individually and in combinations, with mammographic density, one of the risk factors most strongly associated with breast cancer. Materials and Methods: Plasma PCB levels were measured by gas chromatography coupled to mass spectrometry in 106 post-menopausal women for whom mammographic density was measured using a computer-assisted method. Results: Spearman correlation coefficients adjusted for potentially confounding factors (rs) show that while levels of total PCBs do not appear to be correlated with the percentage mammographic density (rs=- 0.19, p=0.08), an increase in the plasma levels of congeners nos. 153, 183, 196 and combined Wolff group 3 PCBs is negatively correlated with the percentage mammographic density (r s =-0.24, p=0.03; rs =-0.30, p=0.004; rs =-0.22, p=0.04; and rs=-0.22, p=0.04 respectively). Conclusion: Our results suggest that an increase in the plasma levels of some PCB congeners, in particular cytochrome P450 1A1 inducers, is associated with lower mammographic density in post-menopausal women.


Ngueta G.,Population Health and Optimal Health Practices Research Unit | Laouan-Sidi E.A.,Population Health and Optimal Health Practices Research Unit | Lucas M.,Population Health and Optimal Health Practices Research Unit | Lucas M.,Laval University
Journal of Epidemiology and Community Health | Year: 2014

Background: Estimation of relative contribution of Body Mass Index (BMI) and waist circumference (WC) on health outcomes requires a regression model that includes both obesity metrics. But, multicollinearity could yield biased estimates. Methods: To address the multicollinearity issue between BMI and WC, we used the residual model approach. The standard WC (Y-axis) was regressed on the BMI (X-axis) to obtain residual WC. Data from two adult population surveys (Nunavik Inuit and James Bay Cree) were analysed to evaluate relative effect of BMI and WC on four cardiometabolic risk factors: insulin, triglycerides, systolic blood pressure and high-density lipoprotein levels. Results: In multivariate models, standard WC and BMI were significantly associated with cardiometabolic outcomes. Residual WC was not linked with any outcomes. The BMI effect was weakened by including standard WC in the model, but its effect remained unchanged if residual WC was considered. Conclusions: The strong correlation between standard WC and BMI does not allow assessment of their relative contributions to health in the same model without a risk of making erroneous estimations. By contrast with BMI, fat distribution (residual WC) does not add valuable information to a model that already contains overall adiposity (BMI) in Inuit and Cree.


PubMed | Population Health and Optimal Health Practices Research Unit and Laval University
Type: Journal Article | Journal: Journal of epidemiology and community health | Year: 2014

Estimation of relative contribution of Body Mass Index (BMI) and waist circumference (WC) on health outcomes requires a regression model that includes both obesity metrics. But, multicollinearity could yield biased estimates.To address the multicollinearity issue between BMI and WC, we used the residual model approach. The standard WC (Y-axis) was regressed on the BMI (X-axis) to obtain residual WC. Data from two adult population surveys (Nunavik Inuit and James Bay Cree) were analysed to evaluate relative effect of BMI and WC on four cardiometabolic risk factors: insulin, triglycerides, systolic blood pressure and high-density lipoprotein levels.In multivariate models, standard WC and BMI were significantly associated with cardiometabolic outcomes. Residual WC was not linked with any outcomes. The BMI effect was weakened by including standard WC in the model, but its effect remained unchanged if residual WC was considered.The strong correlation between standard WC and BMI does not allow assessment of their relative contributions to health in the same model without a risk of making erroneous estimations. By contrast with BMI, fat distribution (residual WC) does not add valuable information to a model that already contains overall adiposity (BMI) in Inuit and Cree.


PubMed | Population Health and Optimal Health Practices Research Unit and Laval University
Type: | Journal: International journal of circumpolar health | Year: 2015

Alcohol and drug use is a serious health problem for many indigenous populations across Canada, including Inuit. The literature on substance use in these populations is too sparse to devise public health interventions.The present article portrays alcohol and drug use among Inuit living in Nunavik (Northern Quebec) between the 1990s and 2000s, and identifies socio-demographic characteristics related to substance use.The Sant Qubec Health Survey (1992) and the Nunavik Inuit Health Survey Qanuippitaa (2004) served as databases for this empirical work. Statistical comparisons were made of substance use variables in the 2 samples. Proportions were compared by chi-square tests (p0.05) with benchmarking of statistics for all of Quebec and, when available, all of Canada.Alcohol and drug use among Inuit increased significantly between 1992 and 2004, particularly among young adults. Alcohol users consumed significantly more alcohol per drinking episode than other Canadians in both time periods. Considerable cannabis use was widespread. In 2004, no significant differences in frequencies of heavy drinking episodes were observed by gender, with 60% of drug users consuming alcohol on a regular basis.As in other populations from North America, this study profiles the increase in substance use among Inuit from Nunavik in the first part of the last 20 years. We observed distinct substance use patterns among them in comparison to other Canadians. Such findings, if replicated in the coming years, emphasize the need for major, culturally-relevant public health interventions in this population.


Ngueta G.,Population Health and Optimal Health Practices Research Unit | Belanger R.E.,Population Health and Optimal Health Practices Research Unit | Laouan-Sidi E.A.,Population Health and Optimal Health Practices Research Unit | Lucas M.,Population Health and Optimal Health Practices Research Unit | And 2 more authors.
Obesity | Year: 2015

Objective To ascertain the relationship between cannabis use, obesity, and insulin resistance. Methods Data on 786 Inuit adults from the Nunavik Inuit Health Survey (2004) were analyzed. Information on cannabis use was obtained from a self-completed, confidential questionnaire. Fasting blood glucose and insulin and homeostasis model assessment of insulin resistance (HOMA-IR) served as surrogate markers of insulin resistance. Analysis of covariance and multivariate logistic regression ascertained relationships between cannabis use and outcomes. Results Cannabis use was highly prevalent in the study population (57.4%) and was statistically associated with lower body mass index (BMI) (P < 0.001), lower % fat mass (P < 0.001), lower fasting insulin (P = 0.04), and lower HOMA-IR (P = 0.01), after adjusting for numerous confounding variables. Further adjustment for BMI rendered fasting insulin and HOMA-IR differences statistically nonsignificant between past-year cannabis users and nonusers. Mediation analysis showed that the effect of cannabis use on insulin resistance was indirect, through BMI. In multivariate analysis, past-year cannabis use was associated with 0.56 lower likelihood of obesity (95% confidence interval 0.37-0.84). Conclusions Cannabis use was associated with lower BMI, and such an association did not occur through the glucose metabolic process or related inflammatory markers. The association between cannabis use and insulin resistance was mediated through its influence on weight. © 2014 The Obesity Society.

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