Rai Urvi, Patte Karen A, Smith Brendan T, Senthilselvan Ambikaipakan, Hyshka Elaine, Leatherdale Scott T, Pabayo Roman
School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada.
Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, L2S 3A1, St. Catharines, Ontario, Canada.
Heliyon. 2024 Dec 4;11(1):e40884. doi: 10.1016/j.heliyon.2024.e40884. eCollection 2025 Jan 15.
Based on the socio-ecological model of health, socioeconomic policy is an important determinant of population health. Spending decisions by public health units (PHU) have been shown to be associated with population health outcomes. Some studies have found greater PHU spending to be associated with improved population health, while others report mixed findings, warranting further research. The objective of this study was to investigate the association between per capita PHU spending and self-reported substance use among Canadian adolescents.
Cross-sectional, multilevel modelling was conducted using student data from the 7th wave (2018/19) of the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour (COMPASS) study, as well as spending data from the audited financial statements of Ontario's PHUs. The sample included 29,056 students in grades 9-12 attending 61 secondary schools in 15 PHUs across Ontario. Substance use was measured as the self-reported use of alcohol, cannabis, cigarettes and e-cigarettes, at least once per month on average.
Approximately 50 % of the study sample was female and the majority identified as being White. Per capita spending ranged from $54.07 to $224.95, with a median spending amount of $89.62. The highest quartile of PHU spending was significantly associated with higher alcohol use (adjusted odds ratio (AOR): 1.41, 95 % CI: 1.04, 1.91), binge drinking (AOR: 1.71, 95 % CI: 1.18, 2.48), and cigarette use (AOR: 2.19, 95 % CI: 1.23, 3.91) in adolescents, while the second highest quartile was associated with lower e-cigarette use (AOR: 0.74, 95 % CI: 0.56, 0.98), relative to the lowest quartile.
Public health spending is associated with adolescent substance use. The present study reports mixed results, warranting further prospective research to explore the directions and mechanisms of the associations found.
基于健康的社会生态模型，社会经济政策是人群健康的重要决定因素。公共卫生单位（PHU）的支出决策已被证明与人群健康结果相关。一些研究发现，公共卫生单位支出增加与人群健康改善相关，而其他研究结果不一，需要进一步研究。本研究的目的是调查加拿大青少年人均公共卫生单位支出与自我报告的物质使用之间的关联。
使用来自大麻使用、肥胖、心理健康、体育活动、酒精使用、吸烟和久坐行为（COMPASS）研究第7波（2018/19年）的学生数据以及安大略省公共卫生单位经审计财务报表中的支出数据进行横断面多层次建模。样本包括安大略省15个公共卫生单位61所中学的29,056名9至12年级学生。物质使用通过自我报告平均每月至少一次使用酒精、大麻、香烟和电子烟来衡量。
研究样本中约50%为女性，大多数人认定为白人。人均支出从54.07美元到224.95美元不等，支出中位数为89.62美元。公共卫生单位支出最高四分位数与青少年更高的酒精使用（调整优势比（AOR）：1.41，95%置信区间：1.04，1.91）、暴饮（AOR：1.71，95%置信区间：1.18，2.48）和香烟使用（AOR：2.19，95%置信区间：1.23，3.91）显著相关，而第二高四分位数与更低的电子烟使用（AOR：0.74，95%置信区间：0.56，0.98）相关，相对于最低四分位数。
公共卫生支出与青少年物质使用相关。本研究报告的结果不一，需要进一步进行前瞻性研究，以探索所发现关联的方向和机制。
