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Background: Self-rated health (SRH) is a globally recognized measure of health status. Both impaired sleep (IS) and the presence of multimorbidity are related to poorer SRH, but the precise nature of these associations remains unclear. This study explored the association between IS, multimorbidity, and SRH among Canadian adults. Method: We used 2017-18 Canadian Community Health Survey (CCHS) data for this study. The main variable of interest, self-rated health (SRH), measured participants' health on a 5-point Likert scale, later categorized as "good or better" vs. "fair or poor". The primary predictor, IS, was derived from two variables and categorized into four groups: no sleep issues; fewer sleeping hours (<7 hours) only; trouble sleeping only; and fewer hours & trouble sleeping. Multimorbidity was present (yes/no) if a participant indicated being diagnosed with two or more chronic conditions. Results: Just over one in ten Canadians reported fair/poor SRH and approximately one-quarter had multimorbidity or experienced few sleep hours in combination with trouble sleeping. The adjusted model indicated greater odds of fair/poor SRH associated with the 40-64 years age group, male sex, and lower socio-economic status. It also suggested the presence of multimorbidity (AOR= 4.63, 95% CI: 4.06-5.28) and a combination of fewer sleep hours and troubled sleep (AOR= 4.05, 95% CI: 2.86-5.74) is responsible for poor SRH. Forty-four percent of the total effect of IS on SRH was mediated by multimorbidity. Conclusion: This unique finding highlights the mediating role of multimorbidity, emphasizing the importance of addressing it alongside sleep issues for optimal health outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine among rural-dwelling on-reserve Saskatchewan First Nations people whether racial discrimination is associated with depression, and in turn, if this relationship is moderated by gender. METHODS: As a component of a community-based participatory research project, a cross-sectional, interviewer-administered survey of 874 adults living on 2 Cree First Nation reserves in rural north-central Saskatchewan was conducted during May-August in 2012 and 2013. Self-reported, health-provider diagnosis of depression was the dependent variable and experiences of interpersonal racial discrimination was the primary exposure. Chi-square and multiple logistic regression were the main analytic techniques. Generalized estimating equations were applied to account for clustering within households. RESULTS: Overall, 64% of participants reported being treated unfairly in 1 or more situations because of their ethnicity; 38% indicated discrimination occurring in 3 or more situations. Nineteen percent reported a diagnosis of depression. Adjusted analyses indicated that compared to those with no experience of racial discrimination, those reporting 1-2 and 3 or more situations were 1.77 times (95% CI: 1.06-2.95) and 1.91 times (95% CI: 1.19- 3.04) more likely to have diagnosed depression respectively. The relationship between racial discrimination and depression was not modified by gender, although women were 1.85 times (95% CI: 1.24-2.76) more likely to report depression than men. CONCLUSION: Interpersonal racial discrimination was associated with depression among First Nations women and men in rural Saskatchewan. Research directed at identifying the most efficacious interventions, programs and policies to combat racism is required to advance the goal of health equity. KEY WORDS: Racial discrimination; First Nations; depression OBJECTIFS : Determiner, chez les membres des Premieres Nations de la Saskatchewan vivant dans des reserves en zone rurale, si la discrimination raciale est associee a la depression et si, en retour, cette relation est modulee par le sexe. METHODE : Dans le cadre d'un projet de recherche participative communautaire, nous avons mene une enquete transversale administree par un intervieweur aupres de 874 adultes vivant dans deux reserves de la Premiere Nation crie dans le centre-nord rural de la Saskatchewan entre mai et aout en 2012 et en 2013. La variable dependante etait un diagnostic de depression autodeclare pose par un dispensateur de soins de sante, et l'exposition directe etait l'experience de la discrimination raciale interpersonnelle. Nos principales techniques etaient l'analyse du khi-carre et l'analyse de regression logistique multiple. Nous avons applique des equations d'estimation generalisees pour tenir compte des regroupements au sein des menages. RESULTATS : Dans l'ensemble, 64% des participants ont declare avoir ete traites injustement dans une situation ou plus en raison de leur ethnicite; 38% ont fait etat de discrimination dans trois situations ou plus. Dix-neuf p. cent ont dit avoir un diagnostic de depression. Les analyses ajustees ont indique que comparativement aux repondants n'ayant aucune experience de discrimination raciale, ceux qui ont declare une ou deux situations et trois situations ou plus etaient 1,77 fois (IC de 95% : 1,06-2,95) et 1,91 fois (IC de 95% : 1,19-3,04) plus susceptibles d'avoir un diagnostic de depression, respectivement. La relation entre la discrimination raciale et la depression n'etait pas modulee par le sexe, mais les femmes etaient 1,85 fois (IC de 95% : 1,24-2,76) plus susceptibles de declarer un diagnostic de depression que les hommes. CONCLUSION : La discrimination raciale interpersonnelle etait associee a la depression chez les femmes et les hommes des Premieres nations vivant en zone rurale en Saskatchewan. Pour atteindre l'objectif de l'equite en sante, il faut faire de la recherche pour determiner quels sont les interventions, les programmes et les politiques les plus efficaces pour combattre le racisme. MOTS CLES : discrimination raciale; Premieres Nations; depression, Racial discrimination is increasingly recognized within the population health literature as an important determinant of health inequities. Different levels of racial discrimination exist, ranging from structural to interpersonal, the latter [...]

Research Findings: The purpose of this study was to investigate how neighborhoods and neighborhood socioeconomic disadvantage impact school readiness over time. School readiness was measured using the Early Development Instrument (EDI) for 3 populations of kindergartners in 2001, 2003, and 2005 in Saskatoon, Saskatchewan, Canada. EDI results revealed that mean scores for the EDI domains of (a) physical health and well-being and (b) communication and general knowledge have been decreasing over time, although this varied according to neighborhood. A derived summary measure of socioeconomic disadvantage at the neighborhood level was significantly associated with declining scores in the EDI domain of physical health and well-being. Practice or Policy: These findings suggest a need for policy and programs that address the underlying determinants of poor school readiness scores, such as socioeconomic disadvantage at the neighborhood level. (Contains 8 tables, 4 footnotes, and 4 figures.)

The purpose of this research was to examine the characteristics of older Canadians with dementia (compared to those without dementia), their use of health care services, and the impact of place (rural/urban) on use of services. Andersen and Newman's Behavioural Model of Health Services Use (1973) guided the study. A cross-sectional design used data from the Canadian Community Health Survey (CCHS) Cycle 1.1 (N 1/4 49,995 older Canadians; those with dementia 1/4 313). Results indicated that among Canadian females between the ages of 50 and 64, those with dementia were more likely than those without dementia to live in rural areas. Among females 80 years of age and over, those with dementia had higher levels of education and income than those without dementia. In addition, a higher proportion of white than of visible minority Canadians was afflicted with dementia. The results further suggest that Canadians with dementia primarily required support services and that they were more likely than persons without dementia to report that their health care needs were unmet. It is recommended that publicly funded national home care programs be expanded to ensure that the supportive services needed by this population are available.

Abstract Background Respiratory disease can impose a significant burden on the health of rural populations. The Saskatchewan Rural Health Study (SRHS) is a new large prospective cohort study of ages 6 and over currently being conducted in farming and non-farming communities to evaluate potential health determinants associated with respiratory outcomes in rural populations. In this article, we describe the rationale and methodology for the adult component. The study is being conducted over 5 years (2009–15) in two phases, baseline and longitudinal. The baseline survey consists of two components, adults and children. The adult component consists of a questionnaire-based evaluation of individual and contextual factors of importance to respiratory health in two sub populations (a Farm Cohort and a Small Town Cohort) of rural families in Saskatchewan Rural Municipalities (RMs). Clinical studies of lung function and allergy tests are being conducted on selected sub-samples of the two cohorts based on the positive response to the last question on the baseline questionnaire: “Would you be willing to be contacted about having breathing and/or allergy tests at a nearby location?”. We adopted existing population health theory to evaluate individual factors, contextual factors, and principal covariates on the outcomes of chronic bronchitis, chronic obstructive pulmonary disease, asthma and obstructive sleep apnea. Findings Of the RMs selected to participate, 32 (89%) out of 36 RMs and 15 (94%) out of 16 small towns within the RMs agreed to participate. Using the mail out survey method developed by Dillman, we obtained completed questionnaires from 4264 households (8261 individuals). We obtained lung function measurements on 1609 adults, allergy skin test information on 1615 adults; both measurements were available on 1549 adults. We observed differences between farm and non-farm rural residents with respect to individual, contextual factors and covariates. Discussion There are differences between farm and non-farm rural residents with respect to individual and contextual factors and other variables of importance. The findings of the SRHS will improve knowledge of respiratory disease etiology, assist in the development and targeting of prevention programs, and in planning health services with farm and small town populations.

Abstract Background A large body of international research reveals that single mothers experience poorer mental health than their partnered counterparts, with socioeconomic disadvantage identified as an important contributory factor in understanding this health disparity. Much less research, however, has focused specifically on the psychological well-being of single mothers who are employed, despite their growing presence in the labor force. Of the research which has considered employment, the focus has been on employment status per se rather than on other important work-related factors which may impact psychological health, such as psychosocial work quality and work-family conflict. The aim of this study was to: (1) compare employed single mothers and employed partnered mothers on measures of psychological distress, psychosocial work quality and work-family conflict; and (2) explore the potential role of work-family conflict and psychosocial work quality as explanations for any observed differences in psychological distress based on partner status. Method Analysis of data obtained from a cross-sectional telephone survey of employed parents in a mid-sized Western Canadian city. Analyses were based on 674 employed mothers (438 partnered and 236 single), who were 25-50 years old, with at least one child in the household. Results Compared to employed single mothers, employed partnered mothers were older, had more education and reported fewer hours of paid work. Single mothers reported higher levels of psychological distress, financial hardship, work-family conflict and poor psychosocial work quality. Statistical adjustment for income adequacy, psychosocial work quality and work-family conflict each independently resulted in single motherhood no longer being associated with psychological distress. Conclusions While single employed mothers did experience higher levels of psychological distress than their partnered counterparts, differences between these groups of women in income adequacy, psychosocial work quality, and work-family conflict were found to explain this relationship. Future research employing a longitudinal design and subject to lower selection biases is required to tease out the interrelationship of these three life strains and to point to the most appropriate economic and social policies to support single mothers in the workforce.

Background: Aboriginal peoples in Canada (First Nations, Metis and Inuit) are experiencing an epidemic of diabetes and its complications but little is known about the influence of factors attributed to colonization. The purpose of this study was to investigate the possible role of discrimination, residential school attendance and cultural disruption on diabetes occurrence among First Nations adults.Methods: This 2012/13 cross sectional survey was conducted in two Saskatchewan First Nations communities comprising 580 households and 1570 adults. In addition to self-reported diabetes, interviewer-administered questionnaires collected information on possible diabetes determinants including widely recognized (e.g. age, sex, lifestyle, social determinants) and colonization-related factors. Clustering effect within households was adjusted using Generalized Estimating Equations.Results: Responses were obtained from 874 (55.7 %) men and women aged 18 and older living in 406 (70.0 %) households. Diabetes prevalence was 15.8 % among women and 9.7 % among men. In the final models, increasing age and adiposity were significant risk factors for diabetes (e.g. OR 8.72 [95 % CI 4.62; 16.46] for those 50+, and OR 8.97 [95 % CI 3.58; 22.52] for BMI 30+) as was spending most time on-reserve. Residential school attendance and cultural disruption were not predictive of diabetes at an individual level but those experiencing the most discrimination had a lower prevalence of diabetes compared to those who experienced little discrimination (2.4 % versus 13.6 %; OR 0.11 [95 % CI 0.02; 0.50]). Those experiencing the most discrimination were significantly more likely to be married and to have higher incomes.Conclusions: Known diabetes risk factors were important determinants of diabetes among First Nations people, but residential school attendance and cultural disruption were not predictive of diabetes on an individual level. In contrast, those experiencing the highest levels of discrimination had a low prevalence of diabetes. Although the reasons underlying this latter finding are unclear, it appears to relate to increased engagement with society off-reserve which may lead to an improvement in the social determinants of health. While this may have physical health benefits for First Nations people due to improved socio-economic status and other undefined influences, our findings suggest that this comes at a high emotional price. [ABSTRACT FROM AUTHOR]