Air pollution and general practitioner access and utilization: a population based study in Sarnia, 'Chemical Valley,' Ontario

<p>Abstract</p> <p>Background</p> <p>Health impacts of poor environmental quality have been identified in studies around the world and in Canada. While many of the studies have identified associations between air pollution and mortality or morbidity, few have focused on the role of health care as a potential moderator of impacts. This study assessed the determinants of health care access and utilization in the context of ambient air pollution in Sarnia, Ontario, Canada.</p> <p>Methods</p> <p>Residents of Sarnia participated in a Community Health Study administered by phone, while several ambient air pollutants including nitrogen dioxide (NO₂), sulphur dioxide (SO₂) and the volatile organic compounds benzene, toluene, ethylbenzene, mp- and o-xylene (BTEX) were monitored across the city. Land Use Regression models were used to estimate individual exposures to the measured pollutants and logistic regression models were utilized to assess the relative influence of environmental, socioeconomic and health related covariates on general practitioner access and utilization outcomes.</p> <p>Results</p> <p>The results show that general practitioner use increased with levels of exposure to nitrogen dioxide (NO₂- Odds Ratio [OR]: 1.16, <it>p </it>< 0.05) and sulphur dioxide (SO₂- OR: 1.61, <it>p </it>< 0.05). Low household income was a stronger predictor of having no family doctor in areas exposed to high concentrations of NO₂and SO₂. Respondents without regular care living in high pollution areas were also more likely to report travelling or waiting for care in excess of 20 minutes (OR: 3.28, <it>p </it>< 0.05) than their low exposure counterparts (OR: 1.11, <it>p </it>> 0.05).</p> <p>Conclusions</p> <p>This study provides evidence for inequitable health care access and utilization in Sarnia, with particular relevance to its situation as a sentinel high exposure environment. Levels of exposure to pollution appears to influence utilization of health care services, but poor access to primary health care services additionally burden certain groups in Sarnia, Ontario, Canada.</p

The prevalence and contextual correlates of non-communicable diseases among inter-provincial migrants and non-migrants in South Africa

BACKGROUND: The socioeconomic conditions of different environments manifest in varying experiences of illnesses. Even as migrants do transit across these different environments for various reasons, including settlement, they are bound to have peculiar experiences of diseases, which could be traced to lifestyle, gender, adaptation, and reactions to specific social, economic, psychological and climatic conditions. Paying attention to such unique scenarios, our study examines the prevalence and contextual correlates of non-communicable diseases among inter-provincial migrants and non-migrants in South Africa. METHODS: Data was from the National Income Dynamics Study (NIDS), waves 5 of 2017, which comprised of 28,055 respondents aged 15–64 years made up of 22,849 inter-provincial non-migrants and 5206 inter-provincial migrants. A composite dependent/outcome variable of non-communicable diseases (NCDs) was generated for the study and data analysis involved descriptive statistics, chi Square analysis and multilevel logistic regression analysis. RESULTS: More migrants (19.81%) than non-migrants (16.69%) reported prevalence of NCDs. With the exception of household size for migrants and smoking for non-migrants, the prevalence of NCDs showed significant differences in all the community, behavioral, and individual variables. The factors in the full model, which significantly increased odds of NCDs among the migrants and the non-migrants, were older populations, the non-Blacks, and those with higher education levels. On the one hand, being married, having a household with 4–6 persons, and being residents of urban areas significantly increased odds of NCDs among the migrant population. While on the other, living in coastal provinces, being a female, and belonging to the category of those who earn more than 10,000 Rands were significantly associated with increased odds of NCDs among the non-migrants. CONCLUSIONS: These findings, therefore, among other things underscore the need for increased education and awareness campaigns, especially among the older populations on the preventive and mitigative strategies for NCDs. In addition, changes in lifestyles with regard to smoking and physical exercises should be more emphasized in specific contextual situations for the migrant and non-migrant populations, as highlighted by the results of this study

Assessing the distribution of volatile organic compounds using land use regression in Sarnia, "Chemical Valley", Ontario, Canada

<p>Abstract</p> <p>Background</p> <p>Land use regression (LUR) modelling is proposed as a promising approach to meet some of the challenges of assessing the intra-urban spatial variability of ambient air pollutants in urban and industrial settings. However, most of the LUR models to date have focused on nitrogen oxides and particulate matter. This study aimed at developing LUR models to predict BTEX (benzene, toluene, ethylbenzene, m/p-xylene and o-xylene) concentrations in Sarnia, 'Chemical Valley', Ontario, and model the intra-urban variability of BTEX compounds in the city for a community health study.</p> <p>Method</p> <p>Using Organic Vapour Monitors, pollutants were monitored at 39 locations across the city of Sarnia for 2 weeks in October 2005. LUR models were developed to generate predictor variables that best estimate BTEX concentrations.</p> <p>Results</p> <p>Industrial area, dwelling counts, and highways adequately explained most of the variability of BTEX concentrations (<it>R</it>²: 0.78 – 0.81). Correlations between measured BTEX compounds were high (> 0.75). Although most of the predictor variables (e.g. land use) were similar in all the models, their individual contributions to the models were different.</p> <p>Conclusion</p> <p>Yielding potentially different health effects than nitrogen oxides and particulate matter, modelling other air pollutants is essential for a better understanding of the link between air pollution and health. The LUR models developed in these analyses will be used for estimating outdoor exposure to BTEX for a larger community health study aimed at examining the determinants of health in Sarnia.</p

Within- and between-city contrasts in nitrogen dioxide and mortality in 10 Canadian cities; A subset of the Canadian Census Health and Environment Cohort (CanCHEC)

The independent and joint effects of within- and between-city contrasts in air pollution on mortality have been investigated rarely. To examine the differential effects of between- versus within-city contrasts in pollution exposure, we used both ambient measurements and land use regression models to assess associations with mortality and exposure to nitrogen dioxide (NO<inf>2</inf>) among ∼735,600 adults in 10 of the largest Canadian cities. We estimated exposure contrasts partitioned into within- and between-city contrasts, and the sum of these as overall exposures, for every year from 1984 to 2006. Residential histories allowed us to follow subjects annually during the study period. We calculated hazard ratios (HRs) adjusted for many personal and contextual variables. In fully-adjusted, random-effects models, we found positive associations between overall NO<inf>2</inf> exposures and mortality from non-accidental causes (HR per 5 p.p.b.: 1.05; 95% confidence interval (CI): 1.03-1.07), cardiovascular disease (HR per 5 p.p.b.: 1.04; 95% CI: 1.01-1.06), ischaemic heart disease (HR per 5 p.p.b.: 1.05; 95% CI: 1.02-1.08) and respiratory disease (HR per 5 p.p.b.: 1.04; 95% CI: 0.99-1.08), but not from cerebrovascular disease (HR per 5 p.p.b.: 1.01; 95% CI: 0.96-1.06). We found that most of these associations were determined by within-city contrasts, as opposed to by between-city contrasts in NO<inf>2</inf>. Our results suggest that variation in NO<inf>2</inf> concentrations within a city may represent a more toxic mixture of pollution than variation between cities

Translation and Validation of a Brazilian Portuguese Version of the Body Appreciation Scale-2 in Brazilian Adults

We examined the psychometric properties of a Brazilian Portuguese translation of the Body Appreciation Scale-2 (BAS-2; Tylka & Wood-Barcalow, 2015). A sample of 990 Brazilian adults (560 women, 430 men; Mage = 31.10, SD = 8.94) completed the BAS-2 and measures of life satisfaction, self-esteem, actual-ideal weight discrepancy (women only), breast size dissatisfaction (women only), drive for muscularity (men only), and disordered eating behaviours. Exploratory factor analyses indicated that BAS-2 scores reduced to a single dimension with all 10 items in women and men. Confirmatory factor analysis supported the fit of this one-dimensional factor structure following freeing of error covariances between two pairs of items. BAS-2 scores achieved full scalar invariance across sex, and men had significantly higher BAS-2 scores than women. Internal consistency coefficients were adequate and test-retest reliability was supported up to three weeks in a subsample of 221 participants (140 women, 81 men). Evidence of construct validity was demonstrated through positive associations with indices of psychological well-being and negative associations with indices of negative body image and disordered eating behaviours. Availability of a Brazilian Portuguese translation of the BAS-2 should help to promote greater understanding of positive body image in the Brazilian context