The Influence of Individuals' Vulnerabilities and Their Interactions on the Assessment of a Primary Care Experience.

This study examines the relationship between the vulnerabilities of individuals and their assessments of their primary care experiences in the setting of a universal care system. It focuses on 2 specific objectives: (1) evaluating the influence of each of the 5 vulnerabilities on the assessment of the care experience; (2) evaluating the influence of the interactions between the different types of vulnerabilities on the assessment of the care experience. The study identifies the primary care experience of 9,206 people.

Conceptual and operational considerations in identifying socioenvironmental factors associated with disability among community-dwelling adults.

Disability is conceived as a person-context interaction. Physical and social environments are identified as intervention targets for improving social participation and independence. In comparison to the body of research on place and health, relatively few reports have been published on residential environments and disability in the health sciences literature.

Interactions between neighborhood characteristics and individual functional status in relation to disability among Québec urbanites.

Background: Disability is conceived as a person-context interaction. Neighborhoods are among the contexts potentially influencing disability. It is thus expected that neighborhood characteristics will be associated with disability prevalence and that such associations will be moderated by individual-level functional status.

Association between activity space exposure to food establishments and individual risk of overweight.

Objective: Environmental exposure to food sources may underpin area level differences in individual risk for overweight. Place of residence is generally used to assess neighbourhood exposure. Yet, because people are mobile, multiple exposures should be accounted for to assess the relation between food environments and overweight.

Weighing the contributions of material and social area deprivation to preterm birth.

Evidence suggests that individual socioeconomic status is a better predictor of preterm birth (PTB) than other individual social characteristics, but it is not clear if socioeconomic (material) area context is likewise more strongly related to PTB than social area characteristics. We compared material and social area deprivation to determine which was more strongly associated with PTB. Live singleton births from Québec, Canada were obtained for 1999-2006 (N = 581,898).

Investigating maternal risk factors as potential targets of intervention to reduce socioeconomic inequality in small for gestational age: a population-based study.

Background: The major aim of this study was to investigate whether maternal risk factors associated with socioeconomic status and small for gestational age (SGA) might be viable targets of interventions to reduce differential risk of SGA by socioeconomic status (socioeconomic SGA inequality) in the metropolitan area of Vancouver, Canada.

Methods: This study included 59,039 live, singleton births in the Vancouver Census Metropolitan Area (Vancouver) from January 1, 2006 to September 17, 2009. To identify an indicator of socioeconomic SGA inequality, we used hierarchical logistic regression to model SGA by area-level variables from the Canadian census.

Local context influence, activity space, and foodscape exposure in two canadian metropolitan settings: is daily mobility exposure associated with overweight?

It has become increasingly common to attribute part of the obesity epidemic to changes in the environment. Identification of a clear and obvious role for contextual risk factors has not yet been demonstrated. The objectives of this study were to explain differences in local overweight risk in two different urban settings and to explore sex-specific associations with estimated mobility patterns.

An area-based material and social deprivation index for public health in Québec and Canada.

Objectives: To overcome the absence of socio-economic information in administrative databases and to monitor social inequalities in health, a material and social deprivation index was developed for Québec and Canada.

Methods: The index is based on the smallest area unit used in Canadian censuses, with 400 to 700 persons on average. It includes six socio-economic indicators grouped along two dimensions - material and social - produced from principal component analyses.

Health inequalities, deprivation, immigration and aboriginality in Canada: a geographic perspective.

Objective: This study explores the contribution of deprivation, immigration and Aboriginal status to survival in various parts of Canada. It is hypothesized that differences in the magnitude of survival inequalities according to deprivation across Canada are attenuated when immigration and Aboriginal status are accounted for.

Methods: The study is based on a file linking the 1991 census and a follow-up of mortality from 1991 to 2001.

Concept mapping of diet and physical activity: uncovering local stakeholders perception in the Quebec City region.

Overweight and obesity are major public health concerns that are neither evenly distributed among the population nor between regions. Many studies suggest that beyond individual characteristics, the place where one lives influences lifestyle choices that underpin overweight and obesity. We observed such a situation in the province of Quebec (Canada), and because data availability from surveys was limited to a local level, the observed overweight disparities between local communities could not be entirely explained.

Using experienced activity spaces to measure foodscape exposure.

Researchers are increasingly interested in understanding how food environments influence eating behavior and weight-related health outcomes. Little is known about the dose-response relationship between foodscapes and behavior or weight, with measures of food exposure having mainly focused on fixed anchor points including residential neighborhoods, schools, or workplaces. Recent calls have been made to extend the consideration of environmental influences beyond local neighborhoods and also to shift away from place-based, to people-based, measures of exposure.

The geography of overweight in Quebec: analyzing and visualizing spatial inequalities using second-level residuals.

Objective: To discuss critically the contribution of using second-level residuals from multilevel analyses to further the understanding of how place relates to health and to visualize areas, in the province of Quebec (Canada), with above- and below-average levels of overweight.

Methods: Data on 20,449 individuals are from the Canadian Community Health Survey (CCHS Cycle 2.1) and were linked to 51 spatial units.

A comparison of individual and area-based socio-economic data for monitoring social inequalities in health.

Background: Area-based indicators are commonly used to measure and track health outcomes by socioeconomic group. This is largely because of the absence of socio-economic information about individuals in health administrative databases. The literature shows that the magnitude of differences in health outcomes varies depending on whether the socio-economic indicators are at the individual level or are area-based.

Health inequalities in urban and rural Canada: comparing inequalities in survival according to an individual and area-based deprivation index.

Social health inequalities are smaller in rural than urban areas because, some argue, people's social conditions are estimated at a small-area level, hiding variability at the individual or household level. This paper compares inequalities in survival according to an individual and area-based version of a deprivation index among a large sample of Canadians living in various urban and rural settings. Results show that survival inequalities in small towns and rural areas are lower than elsewhere when an area-based index is used, except in the remote hinterland, but of equal magnitude when the individual version of this index is considered.

The geography of overweight in Quebec: a multilevel perspective.

Objectives: Explore the contextual aspects of overweight in Quebec through multilevel modelling, using a purposely designed set of spatial units and a few area-based characteristics.

Methods: Data came from the Canadian Community Health Survey (CCHS Cycle 2.1).

Recent changes in the geography of social disparities in premature mortality in Québec.

Most recent research reveals that social inequalities in premature mortality are widening. Such findings mainly apply to countries as a whole. In this study, we model recent changes in the association between premature mortality and a deprivation index (a small area-based index) in four geographic settings in Québec, namely the Montréal metropolitan area, other Québec metropolitan areas, mid-size cities, and small towns and rural areas.

Living environments and health at the local level: the case of three localities in the Québec city region.

Background: To arrive at a better understanding of the combined impact of social health determinants on health inequities a research project was carried out in three localities in the Québec city region. This paper aims to show how residents' health status and health determinants can be explored through various data sources and analytic perspectives, and how these can then be combined to create a more comprehensive picture of health status at the local level.

Methods: A multidisciplinary approach was adopted.

A multi-perspective approach for defining neighbourhood units in the context of a study on health inequalities in the Quebec City region.

Background: Identification of socioeconomic and health inequalities at the local scale is facilitated by using relevant small geographical sectors. Although these places are routinely defined according to administrative boundaries on the basis of statistical criteria, it is important to carefully consider the way they are circumscribed as they can create spatial analysis problems and produce misleading information. This article introduces a new approach to defining neighbourhood units which is based on the integration of elements stemming from the socioeconomic situation of the area, its history, and how it is perceived by local key actors.

Exploring rural health inequalities at a local scale: the case of Portneuf, Québec.

Background: The most common way of accounting for the countryside in health studies has been to compare it, as a whole, to the city. Furthermore, most of the work on small area health inequalities has been confined to major urban centres. To counter this trend, in this paper, we explore small area health inequalities in the predominantly rural county of Portneuf (population = 44,545), Québec.

Perception of place and health: differences between neighbourhoods in the Québec City region.

This paper addresses two questions: (1) Can people's perceptions of problems and social cohesion in the neighbourhood be considered as contextual variables; and (2) are these perceptions related to people's health? Data come from a general health survey carried out in 2004 among 1634 individuals living in three localities of the region of Québec City, namely a downtown, a suburban and a rural area, which were further subdivided into 34 smaller spatial units, hereafter called neighbourhoods. The survey included questions on individuals' perception of problems (social and environmental) and social cohesion (attraction to neighbourhood, neighbouring and psychological sense of community) in the neighbourhood, as well as questions on self-rated health, long-term disability and self-mastery. A first set of logistic multilevel models was performed to ascertain the existence of neighbourhood variations in the perception of problems and social cohesion, after accounting for individual attributes.

Does living in rural areas make a difference for health in Québec?

This study offers an overview of the health status of rural populations and its major determinants in Québec. A wide range of indicators are examined along a spatial grid that allows rural-urban as well as intrarural comparisons. Differences between urban and rural populations mainly concern specific health problems and determinants, while notable variations on these are noted within rural areas.

Deprivation and stroke mortality in Quebec.

Cerebrovascular accidents (CVAs) constitute an important cause of disability and death in Quebec. Among the primary CVA risk factors, certain socioeconomic characteristics of individuals and living environments appear to play a central role. The purpose of this article is to examine the links between material/social forms of deprivation and CVA mortality in a group of 4,339 individuals aged 25 to 74 years who died between 1994 and 1998.