Alcohol consumption and injury among Canadian adolescents: variations by urban-rural geographic status

Alcohol Use Amongst Rural Adolescents and Young Adults: A Brief Review of the Literature

The sociodevelopmental periods of adolescence and young adulthood are rife with alcohol use. However, much of the literature demonstrating this comes from 'traditional' settings and college campuses (i.e., large suburban/urban campuses, or those containing their own infrastructure). Alcohol culture in rural areas has largely been understudied, which may be problematic given the unique stressors they face (e.g., economic hardship, lack of social activities, healthcare inequality). There has also been difficulty both within and across fields classifying rural versus urban geographical locations; no distinct system used broadly, making ittrea difficult to generalize and accurately collect data. The geographic categorizations are often viewed as homogenous identifiers; however, diversity occurs both within and outside of these classification systems. It appears that rurality may be a risk factor for increased drinking both earlier and later in life, but the research has failed to extend to the formative college years. This short review has two main focuses: attempting to disentangle the definition of rurality and reviewing the literature regarding alcohol use in rural areas, with a specific focus on adolescents and young adults. Identifying the mechanisms responsible for substance use in rural areas is a crucial component of prevention and treatment programs.

Clarifying rural-urban disparities in alcohol-related emergency department visits and hospitalizations in Ontario, Canada: A spatial analysis

PURPOSE

Rates of alcohol-related harm are higher in rural versus urban Canada. This study characterized the spatial distribution and regional determinants of alcohol-related emergency department (ED) visits and hospitalizations in Ontario to better understand this rural-urban disparity.

METHODS

This was a cross-sectional spatial analysis of rates of alcohol-related ED visits and hospitalizations by Ministry of Health subregion (n = 76) in Ontario, Canada between 2016 and 2019. Regional hot- and cold-spots of alcohol-related harm were identified using spatial autocorrelation methods. Rurality was measured as the population weighted geographic remoteness of a subregion. The associations between rurality and rates of alcohol-related ED visits and hospitalizations were evaluated using hierarchical Bayesian spatial regression models.

FINDINGS

Rates of alcohol-related ED visits and hospitalizations varied substantially between subregions, with high rates clustering in Northern Ontario. Overall, increasing rurality was associated with higher subregion-level rates of alcohol-related ED visits (males adjusted relative rate [aRR]: 1.67, 95% credible interval [CI]: 1.49-1.87; females aRR: 1.78, 95% CI: 1.60-1.98) and hospitalizations (males aRR: 1.34, 95% CI: 1.24-1.45; females aRR: 1.59, 95% CI: 1.45-1.74). However, after the province was separated into Northern and Southern strata, this association only held in Northern subregions. In contrast, increasing rurality was associated with lower rates of alcohol-related ED visits in Southern subregions (males aRR: 0.87, 95% CI: 0.79-0.96; females aRR: 0.88, 95% CI: 0.81-0.97).

CONCLUSIONS

There are regional differences in the association between rurality and alcohol-related health service use. This regional variation should be considered when developing health policies to minimize geographic disparities in alcohol-related harm.

Urban Health at a Glance in Italy by PASSI and PASSI d’Argento Surveillance Systems Data

(1) The percentage of the world’s urban population is 56% and is expected to reach 68% by 2050. In this study, we have investigated the dimensions of individual health by relating them to the type of residing municipality. (2) We also analyzed the health status, prevention, lifestyle, and elderly conditions in illustrated from PASSI and PASSI d’Argento (PdA) surveillance systems data by estimating the prevalence rates and adjusted odds ratios (ORs) for different municipal residences. (3) Urban areas negatively influence some health outcomes, such as respiratory system diseases (OR = 1.24; 95% CI 1.18–1.30). With regards to the spontaneous participation in screening programs from female adults residing in urban areas, we observed ORs of 1.24 (1.13–1.37) and 1.30 (1.12–1.39) for breast and uterine cervix cancers, respectively. Urban contexts seem to promote healthy lifestyles, as there is a lower consumption of alcohol in both adult (0.92; 0.88–0.95) and elderly populations (0.85; 0.77–0.94), although sedentary life is more widespread. Compared to elderly residents living in rural settings, urban individuals find their neighborhood less safe and are less considered as a “resource”. (4) Urban areas promote some unhealthy conditions but can also be a valuable source of services and perspectives. According to the increasing urban population, public health policies towards implementing sustainable development should be established.

Rural-Urban Differences in Suicide Mortality: An Observational Study in Newfoundland and Labrador, Canada: Différences de la Mortalité Par Suicide en Milieu Rural-Urbain: Une Étude Observationnelle à Terre-Neuve et Labrador, Canada

BACKGROUND

Suicide rates are higher in rural compared to urban areas. Although this pattern appears to be driven by higher rates among men, there is limited evidence about the characteristics of rural people who die by suicide in Canada. The objective of this study was to examine the demographics, manner of death, and social and clinical antecedents of people who died by suicide in rural areas compared to urban areas.

METHODS

We conducted an observational study of all suicide deaths that occurred among Newfoundland and Labrador residents between 1997 and 2016 using a linked data set derived from a comprehensive review of provincial medical examiner records. We used t tests and χ² to assess associations between rural/urban status and variables related to demographics, circumstances, and manner of death, as well as social and medical history. Logistic regression was utilized to assess the independent contribution of any variable found to be significant in univariate analysis.

RESULTS

Rural people who died by suicide accounted for 54.8% of all deaths over a 20-year period. Overall, 81.6% of people who died were male. Compared to urban, rural people who died by suicide were younger, more likely to use firearms or hanging, and had a higher mean blood alcohol content at the time of death (27.69 vs. 22.95 mmol/L). Rural people were also less likely to have had a known history of a prior suicide attempt, psychiatric disorder, alcohol or substance abuse, or chronic pain.

DISCUSSION

The demographic and clinical differences between rural and urban people who died by suicide underscore the need for suicide prevention approaches that account for place-based differences. A key challenge for suicide prevention in rural communities is to ensure that interventions are developed and implemented in a manner that fits local contexts.

Contextual Determinants in Alcohol, Tobacco and Cannabis Consumption, Mood and Bullying during Adolescence

The present study aimed to explore the differences in the consumption of alcohol, tobacco and cannabis, mood and bullying between adolescents. A cross-sectional study was carried out in five regions of Northern Spain (one in Galiza and four in central Catalonia) that share similar socioeconomic characteristics and encompass around 10,000 inhabitants each. Students living in Burela, Galiza (N = 71) were compared to those of Central Catalonia (N = 193). The independent variable was the municipality of residence. The dependent variables encompassed: weekly available pocket money, Family Affluence Scale, self-classified academic qualification, place of origin, alcohol consumption, tobacco and cannabis smoking, negative mood and bullying. The mean age and their 95% confidence intervals (95% CI) of participants were similar between the regions (Burela: 15.90 years (15.68-16.13) and Central Catalonia: 15.36 years (15.28-15.44)). More than half of the participants were females (Burela, Galiza (53.5%) and Catalonia (54.9%)). Prevalence ratios (PR) and their 95% CI were estimated using Poisson regression models. In comparison with adolescents from Burela (Galiza), those living in Central Catalonia had higher prevalence of diverse academic levels (adjusted PR = 3.92 (1.78-8.66)), tobacco consumption (adjusted PR = 2.41 (1.47-3.97)) and negative mood (adjusted PR = 5.97 (3.05-11.70)). Even when dealing with regions with similar socioeconomic characteristics and number of inhabitants, differences exist in terms of the socioeconomic level, tobacco consumption, mood and bullying, as reported by adolescents.

Alcohol use and alcohol-related harm in rural and remote communities: protocol for a scoping review

INTRODUCTION

Alcohol-related harm is a major public health concern and appears to be particularly problematic in rural and remote communities. Evidence from several countries has shown that the prevalence of harmful alcohol use and alcohol-attributable hospitalisations and emergency department visits are higher in rural and remote communities than in urban centres. The extents of this rural-urban disparity in alcohol-related harm as well as the factors that mediate it are poorly understood. The objective of this scoping review is to synthesise the international research on the factors that influence the prevalence or risk of alcohol-related harm in rural and remote communities. This will help to clarify the conceptual landscape of rural and remote alcohol research and identify the gaps in knowledge that need to be addressed.

METHODS AND ANALYSIS

This scoping review will access published literature through search strategies developed for Medline, PsycINFO, Embase, CINAHL and Sociological Abstracts. There will be no date, country or language restrictions placed on the search. Title and abstract, followed by full-text screening, will be conducted by two independent reviewers to evaluate all identified articles against a set of prespecified inclusion and exclusion criteria. Data from selected articles will be extracted and compiled into a final manuscript that adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist guidelines.

ETHICS AND DISSEMINATION

The results of this review will be helpful in guiding future research on rural and remote alcohol use and alcohol-related harm, which will inform more effective, evidence-based public health strategies to reduce alcohol-related harm in rural and remote communities. The results will be disseminated via field-specific conference presentations and peer-reviewed publication.

Alcohol Misuse and Injury Outcomes in Young People Aged 10-24

PURPOSE

The burden of alcohol-attributable disease is a global problem. Young people often present to emergency health-care services with alcohol intoxication but little is known about how best to intervene at that point to improve future health outcomes. This study aimed to assess whether young people with an alcohol-specific hospital admission are at increased risk of injury following discharge.

METHODS

A cohort study was conducted using a general population of 10- to 24-year-olds identified using primary care medical records with linked hospital admission records between 1998 and 2013. Exposed individuals had an alcohol-specific admission. Unexposed individuals did not and were frequency matched by age (±5 years) and general practice (ratio 10:1). Incidence rates of injury-related hospital admission post discharge were calculated, and hazard ratios (HR) were estimated by Cox regression.

RESULTS

The cohort comprised 11,042 exposed and 110,656 unexposed individuals with 4,944 injury-related admissions during follow-up (2,092 in exposed). Injury rates were six times higher in those with a prior alcohol admission (73.92 per 1,000 person-years, 95% confidence interval (CI) 70.82-77.16 vs. 12.36, 11.91-12.81). The risk of an injury admission was highest in the month following an alcohol-specific admission (adjusted HR = 15.62, 95% CI 14.08-17.34), and remained higher compared to those with no previous alcohol-specific admission at 1 year (HR 5.28 (95% CI 4.97-5.60)) and throughout follow-up.

CONCLUSIONS

Young people with an alcohol-specific admission are at increased risk of subsequent injury requiring hospitalization, especially immediately post discharge, indicating a need for prompt intervention as soon as alcohol misuse behaviors are identified.

Trends in Medically Attended Injuries in Czech Adolescents

OBJECTIVE

Due to the importance of surveillance of injuries and accidents in the Czech Republic, the purpose of this study was to report the temporal trends of injuries of Czech adolescents between 2002 and 2014.

METHODS

Adolescents (N=20,038) from the Czech Republic, that took part in the 2002, 2006, 2010 and 2014 HBSC study, reported the frequency of medically attended injuries in the past 12 months. Repeated binary logistic regressions with different years as reference categories were performed.

RESULTS

Less than half (44.7%) of all Czech adolescents reported they had experienced at least one medically attended injuries in the past 12 months, with boys experiencing more injuries than girls (p<0.001), and the injuries were more common in older adolescents. Fewer boys reported injury in 2014 when compared to 2002 (OR, CI: 0.81, 0.72-0.90), there was also a significant decrease in injuries among girls between 2014 and 2006 (OR, CI: 0.77, 0.69-0.86).

CONCLUSIONS

The trend was not linear amongst boys. Along with improved safety promotion education, the rate of injuries decreased among adolescents between the years 2002 and 2014.

Geographical variation in the prevalence of heavy drinking in young Swiss men

BACKGROUND

Not much is known about how much geographical units matter for heavy alcohol consumption and how much of the geographical variations are explained by characteristics such as institutional alcohol policies and regional economic conditions. The study aim was to address these gaps considering three types of heavy alcohol consumption.

METHODS

Analyses were based on data collected on 5879 men (age: 20.0 years, standard deviation: 1.2) years participating in the Cohort Study on Substance Use Risk Factors in Switzerland. Generalized linear mixed models were used to assess overall prevalence, geographical variations in prevalence across geographical units (institutional units, economic micro regions, linguistic regions, urban/rural status), and explanatory variables in three different types of heavy alcohol consumption (heavy weekend drinking, heavy workweek drinking, heavy volume drinking).

RESULTS

The overall prevalence for heavy weekend drinking was 46.8%, 10.8% for heavy volume drinking and 3.6% for heavy workweek drinking. The extent and locations of geographical variation in prevalence rates were contingent upon the type of alcohol consumption. Institutional alcohol policies explained substantial geographical variations in heavy weekend drinking, but not in heavy workweek or heavy volume drinking. Regional economic conditions were not related to alcohol consumption.

CONCLUSIONS

Different types of heavy alcohol consumption are determined by different geographical units. Alcohol policies protectively impact the major drinking style of heavy weekend drinking, but not other low prevalence forms of heavy drinking. Research and public health efforts must take into account these differences between types of alcohol consumption.

Alcohol, Isolation, and Access to Treatment: Family Physician Experiences of Alcohol Consumption and Access to Health Care in Rural British Columbia

OBJECTIVE

The purpose of this project was to study the experiences of physicians who treat persons with alcohol-attributed diseases in rural areas of British Columbia, Canada.

METHOD

A cross-sectional survey was distributed to primary health care physicians that had a family practice in a designated rural community using the Rural Coordination Centre of British Columbia's community isolation rating system. Data were collected through a mail and online survey sent to primary health care physicians. Purposeful sampling was used to select participants that had a primary health care practice in a designated rural community.

RESULTS

Surveys were returned by 22% of potential participants (N = 67) that had an average of 15.8 years in family practice. The majority of participants (95.4%) reported that alcohol had a negative impact on population health, and physicians expressed particular concern for alcohol consumption in relation to mental health (85.1%) and physical illness (82.1%). Most participants had referred patients out of the community for treatment; however, 76.4% reported difficulty with referrals, including long wait-lists, limited services, and issues related to transportation and leaving the community for substance use treatment.

CONCLUSION

Rural physicians showed an awareness and concern for alcohol consumption in their community, but they also reported difficulties referring patients for substance use treatment. Additional study is required to understand how to improve the continuity of care provided to persons with alcohol-related issues in rural British Columbia.

Elevated depressive symptoms and adolescent injury: examining associations by injury frequency, injury type, and gender

BACKGROUND

Key risk factors for adolescent injury have been well documented, and include structural, behavioural, and psychosocial indicators. While psychiatric distress has been associated with suicidal behaviour and related self-harm, very little research has examined the role of depression in shaping adolescent injury. This study examines the association of elevated depressive symptoms with injury, including total number of injuries and injury type. Gender differences are also considered.

METHODS

Data were drawn in 2010-11 from a representative sample of 2,989 high school students (14 to18 years of age) from Nova Scotia, Canada. Self-reported injury outcomes were examined using the 17-item Adolescent Injury Checklist, which captures past six-month injuries. Elevated depressive symptoms were assessed using the Centers for Epidemiological Studies Depression scale. Associations of elevated depressive symptoms with total number of injuries were estimated with negative binomial regression, while associations with specific injury types were estimated with logistic regression. Analyses were conducted in 2012.

RESULTS

Adolescents with elevated depressive symptoms experienced a 40% increase in the total number of injury events occurring in the past six months. The association of elevated depressive symptoms with injury was consistent across injury type; violence-related (OR 2.21, 95% CI 1.61 to 3.03), transport-related (OR 1.53, 95% CI 1.10 to 2.13), and unintentional injuries (OR 1.65, 95% CI 1.20 to 2.27). Gender differences were also observed.

CONCLUSION

Elevated depressive symptoms play a role in shaping adolescent injury. Interventions aimed at reducing adolescent injury should look to minimize psychosocial antecedents, such as poor mental health, that put adolescents at an elevated risk.

Injury and social correlates among in-school adolescents in four Southeast Asian countries

The aim of this study was to determine estimates of the prevalence and social correlates of injury among adolescents in four Southeast Asian countries. Cross-sectional national data from the Global School-based Health Survey (GSHS) included 9,333 students at the ages from 13 to 15 years inclusive from Indonesia, Myanmar, Sri Lanka and Thailand is chosen by a two-stage cluster sample design to represent all students in grades 6, 7, 8, 9, and 10 in each country. The percentage of adolescents reporting one or more serious injuries within the past 12 months was 42.2% for all countries, ranging from 27.0% in Myanmar to 46.8% in Thailand. By major activity, “fall” (14.6%) was the leading external cause of injury, followed by playing or training for a sport (9.9%) and vehicle accident (6.1%). In multivariate regression analysis Thailand and Indonesia, being male, substance use (smoking and drinking alcohol) and psychological distress were associated with annual injury prevalence. Risk factors of substance use and psychological distress should be considered in an integrated approach to injury etiology in planning injury prevention and safety promotion activities among school children.

Socioeconomic status, urbanicity and risk behaviors in Mexican youth: an analysis of three cross-sectional surveys

Background

The relationship between urbanicity and adolescent health is a critical issue for which little empirical evidence has been reported. Although an association has been suggested, a dichotomous rural versus urban comparison may not succeed in identifying differences between adolescent contexts. This study aims to assess the influence of locality size on risk behaviors in a national sample of young Mexicans living in low-income households, while considering the moderating effect of socioeconomic status (SES).

Methods

This is a secondary analysis of three national surveys of low-income households in Mexico in different settings: rural, semi-urban and urban areas. We analyzed risk behaviors in 15-21-year-olds and their potential relation to urbanicity. The risk behaviors explored were: tobacco and alcohol consumption, sexual initiation and condom use. The adolescents' localities of residence were classified according to the number of inhabitants in each locality. We used a logistical model to identify an association between locality size and risk behaviors, including an interaction term with SES.

Results

The final sample included 17,974 adolescents from 704 localities in Mexico. Locality size was associated with tobacco and alcohol consumption, showing a similar effect throughout all SES levels: the larger the size of the locality, the lower the risk of consuming tobacco or alcohol compared with rural settings. The effect of locality size on sexual behavior was more complex. The odds of adolescent condom use were higher in larger localities only among adolescents in the lowest SES levels. We found no statically significant association between locality size and sexual initiation.

Conclusions

The results suggest that in this sample of adolescents from low-income areas in Mexico, risk behaviors are related to locality size (number of inhabitants). Furthermore, for condom use, this relation is moderated by SES. Such heterogeneity suggests the need for more detailed analyses of both the effects of urbanicity on behavior, and the responses--which are also heterogeneous--required to address this situation.

Perceptions of community trust and safety - consequences for children's well-being in rural and urban contexts

AIM

To explore the associations between subjective well-being and perceptions of community trust and safety amongst children in rural and urban areas.

METHODS

The study used self-reported data from the 2001/2002 Swedish cross-national WHO study Health Behaviour in School-aged Children. The sample consisted of 3852 children aged 11-15 years, living in different residential areas. Bivariate analyses and multivariate logistic regression were performed.

RESULTS

The results indicated that a greater proportion of children in urban areas perceived low community trust and safety, compared with children in rural areas. Further, the multivariate analysis revealed that perceived community trust and safety significantly impacts upon children's subjective well-being in both rural and urban contexts.

CONCLUSION

Children's perceptions of trust and safety have different magnitudes in urban and rural areas. The associations of perceptions of community trust and safety for children's subjective well-being are relevant in both urban and rural areas. As perceptions of low trust and safety in the community seem to be related to low subjective well-being, efforts to encourage community trust and safety should be included amongst the key priorities in community health promotion.

Urban and rural differences in sedentary behavior among American and Canadian youth

We examined relationships between urban-rural status and three screen time behaviors (television, computer, video games), and the potential mediating effect of parent and peer support on these relationships. Findings are based on American (n = 8563) and Canadian (n = 8990) youth in grades 6-10 from the 2005/06 Health Behavior in School-Aged Children Survey. Weekly hours of individual screen time behaviors were calculated. Urban-rural status was defined using the Beale coding system. Parent and peer support variables were derived from principal component analysis. In comparison to the referent group (non-metro adjacent), American youth in the most rural areas were more likely to be high television users and less likely to be high computer users. Conversely, Canadian youth in medium and large metropolitan areas were less likely to be high television users and more likely to be high computer users. Parent and peer support did not strongly mediate the relationships between urban-rural status and screen time. These findings suggest that interventions aiming to reduce screen time may be most effective if they consider residential location and the specific screen time behavior.