A single-item measure of self-rated mental health (SRMH) asks respondents to rate their mental health on a 5-point scale from ‘excellent’ to ‘poor’. SRMH is being used increasingly in research and on population health surveys. However, little is known about this item, as there are no literature reviews and few formal validation studies. The aim of this study is to understand what SRMH measures by conducting the first known systematic review of SRMH literature, followed by analysis of the Canadian Community Health Survey (CCHS 1.2). Results of the systematic review reveal SRMH has relationships with mental health scales, mental disorders, self-rated health, health problems, service utilization, and service satisfaction. Analysis of CCHS 1.2 data finds SRMH is associated with psychiatric diagnoses, distress, physical health, and sociodemographic characteristics. Both studies conclude SRMH is measuring mental health and more; however, there needs to be more research to understand the specifics of these relationships.

A single-item measure of self-rated mental health (SRMH) asks respondents to rate their mental health on a 5-point scale from ‘excellent’ to ‘poor’. SRMH is being used increasingly in research and on population health surveys. However, little is known about this item, as there are no literature reviews and few formal validation studies. The aim of this study is to understand what SRMH measures by conducting the first known systematic review of SRMH literature, followed by analysis of the Canadian Community Health Survey (CCHS 1.2). Results of the systematic review reveal SRMH has relationships with mental health scales, mental disorders, self-rated health, health problems, service utilization, and service satisfaction. Analysis of CCHS 1.2 data finds SRMH is associated with psychiatric diagnoses, distress, physical health, and sociodemographic characteristics. Both studies conclude SRMH is measuring mental health and more; however, there needs to be more research to understand the specifics of these relationships.

Introduction: The benefits of leisure-time physical activity on mental and physical health among older adults are well documented, but few studies have explored the association between depression and leisure-time physical activity within a theoretical framework. Objective: The purpose of the present study was to identify the association between depression and leisure-time physical activity among community-dwelling, Canadian adults aged 65 and older, using a modified version of the International Classification of Functioning, Disability and Health (ICF) framework. Method: The present study included a weighted sample of 3,785,145 community- dwelling, seniors aged 65 years or older who participated in the Canadian Community Health Survey (Cycle 2.1). Univariate and multiple logistic regressions were used to examine the cross-sectional association between depression-related disorders and leisure-time physical activity in the context of chronic physical conditions and psychosocial factors. Results: Older adults reporting depression-related disorders were less likely to participate in leisure-time physical activity after adjusting for relevant psychosocial factors (odds ratios (ORs) ranged from 0.76 to 0.79, p < 0.001). This association was partially mediated by activity limitations associated with depression-related disorders. Similar results were observed between chronic physical conditions and participation in leisure-time physical activity. Conclusion: Although the present study was unable to identify the temporal relationships among study variables, the results provide clinicians who care for older adults with depression and/or chronic physical diseases with potentially useful information on the benefits of physical activity. They also provide evidence in support of community-based exercise or leisure-time physical activity program for seniors who are physically inactive to prevent chronic mental or physical illnesses and reduced quality of life

Introduction: The benefits of leisure-time physical activity on mental and physical health among older adults are well documented, but few studies have explored the association between depression and leisure-time physical activity within a theoretical framework. Objective: The purpose of the present study was to identify the association between depression and leisure-time physical activity among community-dwelling, Canadian adults aged 65 and older, using a modified version of the International Classification of Functioning, Disability and Health (ICF) framework. Method: The present study included a weighted sample of 3,785,145 community- dwelling, seniors aged 65 years or older who participated in the Canadian Community Health Survey (Cycle 2.1). Univariate and multiple logistic regressions were used to examine the cross-sectional association between depression-related disorders and leisure-time physical activity in the context of chronic physical conditions and psychosocial factors. Results: Older adults reporting depression-related disorders were less likely to participate in leisure-time physical activity after adjusting for relevant psychosocial factors (odds ratios (ORs) ranged from 0.76 to 0.79, p < 0.001). This association was partially mediated by activity limitations associated with depression-related disorders. Similar results were observed between chronic physical conditions and participation in leisure-time physical activity. Conclusion: Although the present study was unable to identify the temporal relationships among study variables, the results provide clinicians who care for older adults with depression and/or chronic physical diseases with potentially useful information on the benefits of physical activity. They also provide evidence in support of community-based exercise or leisure-time physical activity program for seniors who are physically inactive to prevent chronic mental or physical illnesses and reduced quality of life

This thesis is an investigation of the self-reported health behaviour changes made by adults in the Canadian Community Health Survey 2007, categorized by BMI category. Descriptive analyses and forward stepwise regression were performed to determine variables associated with HBC. The final sample n = 111,449. Overall, 58% of individuals had made a HBC in the past year. Increased exercise was the most common HBC (29%), followed by improved eating habits (10%) and losing weight (7%). Only 51% experienced barriers to HBC; lack of will power was most commonly cited. Overweight and obese individuals were more likely to undertake HBC. In the regression model, opinion of own weight was the strongest predictor of HBC, followed by fruit and vegetable consumption, number of consultations with doctor, smoking status, and perceived health.

<p>Background</p> <p>Adults with cerebral palsy (CP) may have special health care considerations related to an increased prevalence of risk factors for chronic diseases. In particular, disability-related sedentary time may increase the risk of cardiovascular disease and the related major adverse cardiovascular events (MACE) in this population.</p> <p>Methods</p> <p>Part I: A systematic review of major databases, trial registries, and conference abstracts identified randomized trials and observational studies exploring the prevalence and evaluating the prevention of MACE and risk factors for MACE in adults with CP. Title and abstract, data extraction, and quality of reporting assessment were completed in duplicate.</p> <p>Part II: A secondary analysis of Canadian census data evaluated the crude and adjusted risk of stroke in adults with CP and compared the crude risk with other Canadian adults with spinal cord injury, acquired brain injury, and epilepsy. All risks were reported as an odds ratio (OR) with 95% confidence intervals.</p> <p>Results</p> <p>Part I: 2281 unique articles were screened to provide 10 cross-sectional studies. No studies evaluated any interventions for MACE or risk factors for MACE. The most common risk factor studied was obesity. Two studies showed an increased in death due to circulatory diseases.</p> <p>Part II: Crude risk of stroke to CP was OR=12.5 (12.2-12.9). Mediation effects or multicollinearity was not observed. The adjusted risk of stroke was OR=7.9 (1.8-34.2). Elevated crude risk of stroke was also noted in patients with acquired brain injury (OR=16.2 [16.0-16.5]), spinal cord injury (OR=6.1 [6.0-6.3]), and epilepsy (OR=6.2 [6.0-6.3]).</p> <p>Conclusions</p> <p>This thesis provides a preliminary overview of the risk of MACE in adults with CP and hypothesis generating evidence for further research in this population. A prospective cohort study is urgently needed assess the implications of these findings. Adults with CP should minimize exposure to modifiable risk factors as much as possible.</p> / Master of Science (MSc)

This dissertation examined health care utilization patterns across conventional health care (CHC), complementary and alternative medicine (CAM), and public health care (PHC) systems among Canadians aged fifty and older. I argued that utilization research is currently limited by a primary focus on discrete use of health care services, largely within the CHC system (i.e., medical doctors, specialists, hospitals). However substantial growth in use of CAM and PHC, particularly among late middle-age cohorts, suggests the need to widen the research lens from discretionary service use within health care systems to include medical pluralism or use across health care systems. To address the lack of research on medical pluralism and the need for a comprehensive overview of service use, I used two different strategies to create discrete patterns of service use and non-use. To frame the predictors of these patterns, a medical pluralism paradigm was proposed, which suggests that there are distinct social location and health characteristics that may explain use across health care systems. Five hypotheses were tested using data pooled from two cycles of the Canadian Community Health Survey (Cycles 2.1 [2003] and 3.1 [2005]) to create an overall sample (n=117,824). Results from the deductive (variable oriented) and inductive (person centred) strategies were compared. Differences in both the number and form of patterns are apparent. Across both strategies, the most common pattern is dual use of CHC (medical visits, specialist visits) and PHC (flu shots, sex-specific screening) but not CAM (chiropractors, other CAM providers). Consistent with the literature, women use more types of services overall than do men. The gender effect is significantly mediated by age: older men are less likely to use services across the three health care systems than older women. Strong evidence for a socioeconomic gradient in medical pluralism is also found. Higher levels of income and education increase the likelihood of using services across the three health care systems compared to low and middle levels of both income and education. The relationship between race and health service use was much less significant. Long-term immigrants demonstrate tri-use patterns close to those of Canadian born individuals; however, service differentials remain even after controlling for health needs, in favour of native-born Canadians. Medical pluralism is also associated with health related-need as support was found for both illness and wellness care. Lastly, regional differences point to a greater likelihood of medical pluralism in western Canada, but not always in urban areas. In future, a longitudinal examination of medical pluralism is necessary and would help establish the sequencing of services and how services are used in relation to the disablement process. Health policy would thus benefit from insight into the extent of service duplication for specific conditions and clarify the role of medical doctors in referral processes. / Graduate

The 2004 Canadian Community Health Survey (CCHS) revealed many indicators of poor diet quality in Canada which, together with the high rates of obesity and diet-related chronic disease, suggest that shifts in dietary patterns are urgently needed. Given the widespread promotion of foods on the basis of nutrition and health, the aim of this work was to explore the population health implications of voluntary food fortification and nutrition-related marketing in Canada. Using the CCHS, the potential impact of a proposed discretionary food fortification policy on nutrient inadequacies and excesses was examined, in addition to the relationship between consumption of foods eligible to be fortified under this policy and indicators of dietary quality. To better understand the potential risk associated with liberal fortification practices, the National Health and Nutrition Examination Survey (2007-08) was used to examine potential for risk of excess associated with voluntarily fortified food consumption in the US, where these practices have long been permitted. The results suggest that proposed changes to voluntary fortification may reduce inadequacy and increase excess, and may reinforce poor diet patterns. Excessive nutrient intakes were also found to be associated with consumption of voluntarily fortified foods in the US, particularly among children. Therefore, there appears to be real potential for risk associated with voluntary fortification practices in Canada. The extent, nature, and population health implications of nutrition marketing in Canada was examined, using a survey of front-of-package nutrition-related marketing on foods within three large grocery stores in Toronto. Nutrition-related marketing was found on 41% of all foods surveyed, and was widely found on highly processed, often fortified foods. References to nutrients of public health concern (e.g. sodium, vitamin D) were infrequently found. Overall, this practice provides limited nutritional guidance. Current directions in nutrition policy in Canada should be re-evaluated, to ensure that they support healthy diet patterns.

The 2004 Canadian Community Health Survey (CCHS) revealed many indicators of poor diet quality in Canada which, together with the high rates of obesity and diet-related chronic disease, suggest that shifts in dietary patterns are urgently needed. Given the widespread promotion of foods on the basis of nutrition and health, the aim of this work was to explore the population health implications of voluntary food fortification and nutrition-related marketing in Canada. Using the CCHS, the potential impact of a proposed discretionary food fortification policy on nutrient inadequacies and excesses was examined, in addition to the relationship between consumption of foods eligible to be fortified under this policy and indicators of dietary quality. To better understand the potential risk associated with liberal fortification practices, the National Health and Nutrition Examination Survey (2007-08) was used to examine potential for risk of excess associated with voluntarily fortified food consumption in the US, where these practices have long been permitted. The results suggest that proposed changes to voluntary fortification may reduce inadequacy and increase excess, and may reinforce poor diet patterns. Excessive nutrient intakes were also found to be associated with consumption of voluntarily fortified foods in the US, particularly among children. Therefore, there appears to be real potential for risk associated with voluntary fortification practices in Canada. The extent, nature, and population health implications of nutrition marketing in Canada was examined, using a survey of front-of-package nutrition-related marketing on foods within three large grocery stores in Toronto. Nutrition-related marketing was found on 41% of all foods surveyed, and was widely found on highly processed, often fortified foods. References to nutrients of public health concern (e.g. sodium, vitamin D) were infrequently found. Overall, this practice provides limited nutritional guidance. Current directions in nutrition policy in Canada should be re-evaluated, to ensure that they support healthy diet patterns.

Background: Suicidal behaviour is a major public health problem that has not abated over the past decade. Adopting machine learning algorithms that allow for combining risk factors that may increase the predictive accuracy of models of suicide behaviour is one promising avenue toward effective prevention and treatment. Methods: We used Canadian Community Health Survey – Mental Health and Canadian Forces Mental Health Survey to build conditional inference random forests models of suicidal behaviour in Canadian general population and Canadian Armed Forces. We generated risk algorithms for suicidal behaviour in each sample. We performed within- and between-sample validation and reported the corresponding performance metrics. Results: Only a handful of variables were important in predicting suicidal behaviour in Canadian general population and Canadian Armed Forces. Each model’s performance on within-sample validation was satisfactory, with moderate to high sensitivity and high specificity, while the performance on between-sample validation was conditional on the size and heterogeneity of the training sample. Conclusion: Using conditional inference random forest methodology on large nationally representative mental health surveys has the potential of generating models of suicidal behaviour that not only reflect its complex nature, but indicate that the true positive cases are likely to be captured by this approach.