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News and Publications from 2021

The following article was a collaboration between IHSP Faculty, an Associate Member and a former Research Assistant:

Impacts of Universal Childcare on Early Behavioral Development: Evidence from a Birth Cohort in Québec, Canada

Seungmi Yang, Thomas Charters, Daniel Weinstock, Arijit Nandi. Annals of Epidemiology. (2021)
ISSN 1047-2797
Published online on June 17, 2021


Purpose: To examine associations between universal pre-school childcare use and later behaviors among children at age 6 years.

Methods: Using annual follow-up data of a birth cohort (N=1450), we estimated differences in behavioral scores by primary childcare arrangement between ages 2 to 5 years – universal subsidized childcare program (CPE care), non-CPE childcare, and parental or family care (no regular care) – using propensity score inverse probability weights.

Results: Teachers reported slightly higher levels of hyperactivity (0.73, 95% CI: 0.32, 1.1) and indirect aggression (0.58, 95%CI: 0.24, 0.91) among children who attended a CPE than children in non-CPE care. However, these patterns were not observed from either maternal or paternal reports. Similarly, teachers’ assessments of slightly higher physical aggression (0.50, 95% CI: 0.11, 0.88) and opposition (0.63, 95% CI: 0.21, 1.05) scores among children in CPE care than children who did not have a regular childcare were not observed in parental assessments. Behavioral scores were similar between girls and boys and across family socioeconomic position.

Conclusion: Universal pre-school childcare does not appear to have substantial impacts on child behaviors at early school age, however teachers rated externalizing behaviors to be slightly higher among children who attended universal childcare.

Arijit Nandi co-authored the following article:

Impact of abortion law reforms on health services and health outcomes in low- and middle-income countries: a systematic review

Foluso Ishola, U Vivian Ukah, Babatunde Y Alli, Arijit Nandi. Health Policy and Planning (2021)
Published June 16, 2021


While restrictive abortion laws still prevail in most low- and middle-income countries (LMICs), many countries have reformed their abortion laws, expanding the grounds on which abortion can be performed legally. However, the implications of these reforms on women’s access to and use of health services, as well as their health outcomes, are uncertain. This systematic review aimed to evaluate and synthesize empirical research evidence concerning the effects of abortion law reforms on women’s health services and health outcomes in LMICs. We searched Medline, Embase, CINAHL and Web of Science databases, as well as grey literature and reference lists of included studies. We included pre–post and quasi-experimental studies that aimed to estimate the causal effect of a change in abortion law on at least one of four outcomes: (1) use of and access to abortion services, (2) fertility rates, (3) maternal and/or neonatal morbidity and mortality and (4) contraceptive use. We assessed the quality of studies using the quasi-experimental study design series checklist and synthesized evidence through a narrative description. Of the 2796 records identified by our search, we included 13 studies in the review, which covered reforms occurring in Uruguay, Ethiopia, Mexico, Nepal, Chile, Romania, India and Ghana. Studies employed pre–post, interrupted time series, difference-in-differences and synthetic control designs. Legislative reforms from highly restrictive to relatively liberal were associated with reductions in fertility, particularly among women from 20 to 34 years of age, as well as lower maternal mortality. Evidence regarding the impact of abortion reforms on other outcomes, as well as whether effects vary by socioeconomic status, is limited. Further research is required to strengthen the evidence base for informing abortion legislation in LMICs. This review explicitly points to the need for rigorous quasi-experimental studies with sensitivity analyses to assess underlying assumptions. The systematic review was registered in PROSPERO database CRD42019126927.

The following accepted manuscript was co-authored by Jill Baumgartner:

Spatial-temporal patterns of ambient fine particulate matter (PM2.5) and black carbon (BC) pollution in Accra

Alli AS, Clark SN, Hughes AF, et al. Environmental Research Letters. (2021)
Accepted online June 2, 2021


Background: Sub-Saharan Africa (SSA) is rapidly urbanizing, and ambient air pollution has emerged as a major environmental health concern in SSA cities. Yet, effective air quality management is hindered by limited data. We deployed robust, low-cost and low-power devices in a large-scale measurement campaign and characterized within-city variations in fine particulate matter (PM2.5) and black carbon (BC) pollution in Accra, Ghana. Methods: Between April 2019 and June 2020, we measured weekly gravimetric (filter-based) and minute-by-minute PM2.5 concentrations at 146 unique locations, comprising of 10 fixed (~1-year) and 136 rotating (7-day) sites covering a range of land-use and source influences. Filters were weighed for mass, and light absorbance (10−5m−1) of the filters was used as proxy for BC concentration. Year-long data at four fixed sites that were monitored in a previous study (2006-2007) were compared to assess change in PM2.5 concentrations. Results: The mean annual PM2.5 across the fixed sites ranged from 26 μg/m3 at a peri-urban site to 40 μg/m3 at commercial, business, and industrial (CBI) areas. CBI areas had the highest PM2.5 levels (mean: 37 μg/m3), followed by high-density residential neighborhoods (mean: 36 μg/m3), while peri-urban areas recorded the lowest (mean: 26 μg/m3). Both PM2.5 and BC levels were highest during the dry dusty Harmattan period (mean PM2.5: 89 μg/m3) compared to non-Harmattan season (mean PM2.5: 23 μg/m3). PM2.5 at all sites peaked at dawn and dusk, coinciding with morning and evening heavy traffic. We found about a ~50% reduction (71 vs 37 μg/m3) in mean annual PM2.5 concentrations when compared to measurements in 2006-2007 in Accra. Conclusion: Ambient PM2.5 concentrations in Accra may have plateaued at levels lower than those seen in large Asian megacities. However, levels are still 2- to 4-fold higher than the WHO guideline. Effective and equitable policies are needed to reduce pollution levels and protect public health.

Natalie Stoljar contributed a chapter to the following book:

The Cambridge Handbook of Health Research Regulation Book coverLaurie, G., Dove, E., Ganguli-Mitra, A., McMillan, C., Postan, E., Sethi, N., & Sorbie, A. (Eds.). (June 2021). The Cambridge Handbook of Health Research Regulation (Cambridge Law Handbooks). Cambridge: Cambridge University Press. doi:10.1017/9781108620024

Part I - Concepts, Tools, Processes
Section IA - Concepts
2. Autonomy: Relational Conceptions
by Natalie Stoljar


This chapter argues that the conception of autonomy implicit in the current health research ethics guidelines is an individualistic one. On this model, people are autonomous when they voluntarily exercise their deliberative capacities to make choices based on their values. They can fail to be autonomous either for psychological reasons, when their deliberative capacities are impaired; or for epistemic reasons, when they do not have access to all the information that is relevant to a decision. The chapter outlines a contrasting 'relational' approach to autonomy. On the relational model, people can fail to be autonomous for social reasons. The social conditions that a person inhabits, including their available options, and the interpersonal context – such as family relationships and social expectations – all affect the ability to make autonomous decisions. The chapter also identifies some of the implications of the relational model for health research ethics. It examines two issues implicit in the guidelines: the relationship between autonomy and vulnerability, and the claim that informed consent is sufficient for autonomy.

Jill Baumgartner co-authored the following article:

Space-time characterization of community noise and sound sources in Accra, Ghana.

Clark, S.N., Alli, A.S., Nathvani, R. et al. Sci Rep 11, 11113 (2021).
Published on May 27, 2021


Urban noise pollution is an emerging public health concern in growing cities in sub-Saharan Africa (SSA), but the sound environment in SSA cities is understudied. We leveraged a large-scale measurement campaign to characterize the spatial and temporal patterns of measured sound levels and sound sources in Accra, Ghana. We measured sound levels and recorded audio clips at 146 representative locations, involving 7-days (136 locations) and 1-year measurements between 2019 and 2020. We calculated metrics of noise levels and intermittency and analyzed audio recordings using a pre-trained neural network to identify sources. Commercial, business, and industrial areas and areas near major roads had the highest median daily sound levels (LAeq24hr: 69 dBA and 72 dBA) and the lowest percentage of intermittent sound; the vice-versa was found for peri urban areas. Road-transport sounds dominated the overall sound environment but mixtures of other sound sources, including animals, human speech, and outdoor music, dominated in various locations and at different times. Environmental noise levels in Accra exceeded both international and national health-based guidelines. Detailed information on the acoustical environmental quality (including sound levels and types) in Accra may guide environmental policy formulation and evaluation to improve the health of urban residents.

Alissa Koski was interviewed on CBC Radio - The Current

Child marriage is 'a hidden crime,' and it's happening in Western nations, says survivor and advocate

Posted on May 22, 2021

Alissa Koski was interviewed by Matt Galloway about her research on child marriage:

CBC RADIO ONE - The Current (May 17, 2021)

Daniel Weinstock was quoted in the following article in the McGill Newsroom - Institutional Communications

Experts: Scottish National Party promise independence referendum after election win

Published on May 11, 2021 by Frederique Mazerolle

Kristin Voigt co-authored the following article:

Flashing red lights: the global implications of COVID-19 vaccination passports

Voigt K, et al. BMJ Global Health 2021;6:e006209.
Accepted on May 8, 2021

Christopher Barrington-Leigh was quoted in the following article in the McGill Newsroom - Institutional Communications

Experts: Earth Day | April 22

Published on April 20, 2021 by Frederique Mazerolle

Myette E, Riva M.

Surveying the complex social-ecological pathways between resource extraction and Indigenous Peoples’ health in Canada: A scoping review with a realist perspective

The Extractive Industries and Society. 2021 (June): 8(2), 100901.
Available online April 8th, 2021


Resource extraction can influence a range of determinants of health for Indigenous communities directly and indirectly, through various complex social-ecological pathways. However, research on these pathways is lacking, which prevents a comprehensive understanding of how Indigenous Peoples are affected by resource development. The objective of this scoping review was to understand pathways connecting extraction to Indigenous Peoples’ health. Adopting a realist perspective, we identified mechanisms from the reviewed articles with the capacity to be activated in an extraction context and produce health outcomes. Eight mechanisms were related to changes stemming from extraction sites: engagement in assessment and consultation processes; interaction with government and industry officials; presence and nature of new work and training opportunities; changes to the economy and influx of new money; changing social structures and new inequalities; environmental degradation and dispossession; new and longstanding changes to the economy; and lasting effects on land. These mechanisms affect physical, mental, emotional, and spiritual health in myriad ways. We situate these findings within a historical context of extractive activities in Canada and Indigenous health ontologies and provide implications for future resource governance. We conclude that only by comprehensively understanding the context of extraction is it possible to determine potential local health impacts.

A former Postdoctoral Fellow of Daniel Weinstock's, Michael Da Silva, co-authored the following:

Da Silva M, St-Hilare M.

Towards a New Intergovernmental Agreement on Early Pandemic Management

National Journal of Constitutional Law. 2021 (April): 41(2): 77-105.

Christopher Barrington-Leigh posted the following Briefing Note:

How does the science of wellbeing inform an education strategy across the life course?

April 1, 2021

On April 1st, our IHSP Policy Talks Webinar Homelessness Prevention: Framework, Examples and Evidence was discussed in La Presse+, section DÉBATS, écran 5.


Des données pour changer le portrait de l’itinérance

Written by Michèle Chappaz
Directrice générale, Mouvement pour mettre fin à l’itinérance à Montréal

Daniel Weinstock wrote a chapter in this book:

Proeschel, C., Koussens, D., & Piraino, F. (Eds.). (2021). Religion, Law and the Politics of Ethical Diversity: Conscientious Objection and Contestation of Civil Norms (1st ed.).
eBook ISBN 9781003131083
Published March 31, 2021

Chapter 3Are there consequentialist grounds for exempting religious health care professionals from medical assistance in dying?


A common assumption undergirds much of the literature of the past few years, despite the appearances of quite substantial disagreement. Some exemptions are, on the other hand, made on religious grounds. Those who make them view certain professional obligations as incompatible with their religious obligations. In a liberal democracy, no one forces anyone to become a physician, a nurse or anything else, and so it can rightly be assumed that people who have chosen those professions, and the norms that accompany them, have done so freely. The foregoing considerations smack of amoral realpolitik. “Rather than having a powerful group make use of its political and social capital in order to block desired legislation altogether”, the argument seems to be saying, “let’s give in to their blackmail and provide them with a morally unjustified benefit so that they will not get in the way of desired legislation”.

The research of Christopher Barrington-Leigh was discussed in an article in CBC News:

Feeling blue? Try forcing yourself to laugh

Laughter yoga classes force Montrealers to laugh, despite difficult year

Written by Jennifer Yoon
March 27, 2021

A Postdoctoral Fellow working with Daniel Weinstock, Mary Bartram, and her two IHSP Interns (Winter 2019) published the following article:

Victoria Ford, Alyssa Wooster, Mary Bartram

Work Hard, Party Hard: Harm Reduction in a Postsecondary Setting

Canadian Journal of Higher Education. (2021)
Published March 23, 2021


In the context of the increasing focus on harms, psychological safety, and mental health in post-secondary settings, this qualitative study explores the challenges and opportunities for harm reduction through focus groups with student leaders, service providers, and administrators in one large Canadian university. Key themes explored by participants include a pervasive work hard, party culture, clashes regarding how to define and operationalize harm reduction, broad approaches to harm reduction in tension with the risk of becoming a band-aid solution, and knowledge transfer and privilege in an academic context. These findings suggest possible avenues for harm reduction that could be implemented as part of the new post-secondary standard, as well as in society as a whole.

Christopher Barrington-Leigh was quoted in the following article in McGill Newsroom - Institutional Communications:

Expert: Canada ranks 15th in latest World Happiness Report

Published March 19th, 2021

Arijit Nandi and his two Research Assistants, Efe Atabay and Ilona Vincent, co-authored the following article:

Raub A, Sprague A, Waisath W, et al.

Utilizing a Comparative Policy Resource from the WORLD Policy Analysis Center Covering Constitutional Rights, Laws, and Policies across 193 Countries for Outcome Analysis, Monitoring, and Accountability

Journal of Comparative Policy Analysis: Research and Practice. (2021)
DOI: 10.1080/13876988.2021.1894073
Published online March 16, 2021


Historically, a lack of comparable data on the laws and policies that shape health, education, poverty, and other outcomes has hindered researchers’ ability to provide rigorous evidence on the effectiveness of different policy designs. This article describes public-use downloadable data built by the WORLD Policy Analysis Center to fill this gap. Over 2,000 quantitatively comparable measures of national laws and policies across 193 countries were assembled. This open-access data source provides a tool for monitoring the adoption of evidence-based laws and policies, identifying policy gaps, and rigorously evaluating how policies shape outcomes across different regions and socioeconomic contexts.

Daniel Weinstock was quoted in the following article:

Longer days could reduce support for Quebec curfew

The Canadian Press
by Jacob Serebrin
Sunday, March 14th, 2021

Christopher Barrington-Leigh was interviewed in The McGill Tribune - Fact or Fiction, Science & Technology

Fact or Fiction: Does money really buy happiness?

Written by Margaret Wdowiak on March 9th, 2021.

Elgar FJ, Sen A, Gariépy G, Pickett W, Davison C, Georgiades K, Hammami N, Azevedo Da Silva M, Gordon D, Ramiro Melgar-Quiñonez H

Food insecurity, state fragility and youth mental health: A global perspective

SSM - Population Health. 2021 (June):14, 100764, ISSN 2352-8273,
Available online March 3rd, 2021


Youth in fragile settings face disproportionate risks of experiencing food insecurity and poor mental health. Cross-national evidence is lacking on the association between food insecurity and mental health in youth populations, and on state fragility as a social determinant of these experiences. We analysed data from six cycles of the Gallup World Poll (2014–2019), an annual survey that contains multi-item scales of food insecurity, mental health problems and positive wellbeing. The analytic sample included 164,118 youth aged 15–24 years in 160 states. We linked individual responses to state-level data from the Fragile States Index—an aggregate measure of state vulnerability to collapse or conflict (coded: sustainable, stable, warning, or alert) and estimated adjusted relative risk (RR) of food insecurity as a function of state fragility. We then used linear regression to examine associations of state fragility and food insecurity with mental health and wellbeing. The prevalence of moderate or severe food insecurity rose from 22.93% in 2014 to 37.34% in 2019. State fragility (alert vs. sustainable) was related to an increased risk of food insecurity (RR = 2.28 [95% CI 1.30 to 4.01]), more mental health symptoms (b = 6.36 [95% CI 1.79 to 10.93]), and lower wellbeing (b = −4.49 [95% CI -8.28 to −0.70]) after controlling for state wealth and household income. Increased food insecurity (severe vs. none or mild) was uniquely related to more mental health symptoms (b = 18.44 [95% CI 17.24 to 19.64]) and reduced wellbeing (b = −9.85 [95% CI -10.88 to −8.83]) after state fragility was also controlled. Globally, youth experience better mental health where states are more robust and food access is more secure. The findings underscore the importance of strong governance and coordinated policy actions that may improve youth mental health.

The research of Alissa Koski was mentioned in an article in the McGill Newsroom - Institutional Communications

Experts: International Women's Day | March 8

Published on March 5, 2021.

The Disable Contract: Severe Intellectual Disability, Justice and Morality book coverThe Disabled Contract
Severe Intellectual Disability, Justice and Morality

by Jonas-Sébastien Beaudry
published by Cambridge University Press
ISBN: 9781107152854
Available March 2021


Social contract theories generally predicate the authority of rules that govern society on the idea that these rules are the product of a contractual agreement struck between members of society. These theories embody values, such as equality, reciprocity and rationality, that are highly prized within our culture. Yet a closer inspection reveals that these features exclude other important values, relations and even persons from the realm of contractual morality and justice, especially people with severe intellectual disabilities. Jonas-Sébastien Beaudry explores the moral status of intellectually disabled people in social contract thought and argues that this tradition needs to be revisited to include the most vulnerable. Addressing this problem will have concrete repercussions in law and policy, because many issues that people with disabilities face are connected to deeply rooted assumptions about their status as full citizens or full members of our moral, political and legal communities.

More information

David Wright co-authored an article with Jocelyn Downie and Mona Gupta in the IRPP's Policy Options Politiques Magazine:

What's the relationship between suicide and MAiD?

Parliament needs to decide whether the mentally ill should have access to assisted dying. But being mentally ill doesn’t mean being just suicidal.

Published on February 15th, 2021.

Men F, Elgar FJ, Tarasuk V

Food insecurity is associated with mental health problems among Canadian youth

J Epidemiol Community Health. 2021 Feb 12;jech-2020-216149
PMID: 33579754 doi: 10.1136/jech-2020-216149
Published Online First: 12 February 2021.


Background: Research has linked food insecurity to mental health problems, though little is known about this relationship among Canadian youth. We investigate the association between food insecurity severity and mental illnesses in a nationally representative youth sample.

Methods: We sampled 55 700 youth 12–24 years from recent cycles of Canadian Community Health Survey. Household food insecurity was measured using a standard 18-item questionnaire. We fitted Poisson regressions on self-rated mental health and diagnosed mood and anxiety disorders, controlling for sociodemographic confounders. Clinical assessments of emotional distress, major depression and suicidal ideation were examined in subsamples with available data. We stratified the sample by gender, age and survey cycle to test potential demographic heterogeneity.

Results: One in seven youth lived in marginal (5.30%), moderate (8.08%) or severe (1.44%) food insecurity. Results showed that food insecurity was associated with higher likelihood of every mental health problem examined. The association was graded, with more severe food insecurity linked to progressively worse mental health. Notably, marginal, moderate and severe food insecurity were associated with 1.77, 2.44 and 6.49 times higher risk of suicidal thoughts, respectively. The corresponding relative risk for mood disorders were 1.57, 2.00 and 2.89; those for anxiety disorders were 1.41, 1.65 and 2.58. Moderate food insecurity was more closely associated with mental health problems in 18–24 year olds than in 12–17 year olds.

Conclusions: Food insecurity severity was associated with poorer mental health among Canadian youth independent of household income and other socioeconomic differences. Targeted policy intervention alleviating food insecurity may improve youth mental health.

The research of Christopher Barrington-Leigh was mentioned in an article in The McGill Reporter:

Happiness really does come for free

People in societies where money plays a minimal role can have very high levels of happiness

by Katherine Gombay on February 10, 2021. 

Alissa Koski was interviewed on TVO on February 9th, 2021.

Is Child Marriage a Problem in Canada?
The Agenda with Steve Paikin

Researchers at McGill University have found that child marriage is not only legal in Canada but has been happening across the country for decades, even in spite of efforts by the federal government to clamp down on the practice overseas. Why does it persist and what can be done about it? We discuss the scope of the problem and potential solutions with Alissa Koski, assistant professor in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University; Samra Zafar, author of "The Good Wife: Escaping a Life I Never Chose;" and Rowena Pinto, chief program officer at UNICEF Canada.


Does Canada Have a Child Marriage Problem?

Batomen B, Sweet E, Nandi A

Social inequalities, debt, and health in the United States

SSM - Population Health. 2021. 100736, ISSN 2352-8273
Published online January 23, 2021



Household financial debt has more than tripled since the 1980s in the United States. The experience of indebtedness is socially structured and there is mounting evidence that debt is linked to decrements in health. However, it is unclear whether debt contributes to social disparities in health.


We examined whether household debt, measured by debt in excess of income and wealth, mediated education-based social inequalities in health, including cardiovascular risk factors (hypertension) and chronic conditions (diabetes, coronary heart disease, and psychiatric problems).


We used longitudinal data from a sample of over 10,500 adults aged 18 years and older surveyed biennially between 1999 and 2015 as part of the Panel Study of Income Dynamics (PSID). We estimated the total effect of education on our health outcomes. To assess mediation by levels of household debt, we then estimated the controlled direct effect of education through pathways not mediated by levels of household debt, after accounting for lagged time-varying confounders and loss to follow-up using marginal structural models.


Compared to respondents with at least a high school education, respondents with less than a high school education reported higher household debts in excess of income and wealth; they also reported a higher incidence of hypertension [risk ratio (RR)=1.25, 95%CI=1.13, 1.39), coronary heart disease (RR=1.42, 95%CI: 1.25, 1.62), diabetes (RR=1.50, 95%CI: 1.34, 1.68), and psychiatric problems (RR=1.39, 95%CI: 1.24, 1.56). Compared to the total effects, the controlled direct effects of education on health were attenuated, particularly for death or first onset of hypertension and coronary heart disease, after fixing levels of household debt-to-income and debt-to-wealth.


Our results provide early evidence that household debt in excess of wealth partly mediates education-based inequalities in hypertension and coronary heart disease in the United States, with less consistent evidence for other chronic conditions.

Alissa Koski was interviewed on CTV News on January 23rd, 2021:

McGill study: Child marriage persists in Canada | CTV News

McGill professor Alissa Koski & bestselling author Samra Zafra talk to Angie Seth about concerning new data on child marriage in Canada.

Christopher Barrington-Leigh was quoted in the following article in the McGill Newsroom: Institutional Communications

Experts: United States set to rejoin the Paris Climate Agreement

Published January 21st, 2021.

A Postdoctoral Fellow working with Daniel Weinstock published the following article:

Michael Da Silva

The Traces Left Behind: On Appropriate Responses to Right Acts with Wrong Features

Social Theory and Practice. 2021.
Published on January 20th, 2021.


Fulfilling one’s all-things-considered duty sometimes requires violating pro tanto duties. According to W. D. Ross and Robert Nozick, the pro tanto-duty-violating, wrong-making features of acts in these cases can leave ‘traces’ of wrongfulness that require specific responses: feeling compunction for the wrongfulness and/or providing compensation to the negatively affected person. Failure to respond in the appropriate way to lingering wrong-making features can itself be wrongful. Unfortunately, criteria for determining when traces remain are largely lacking. In this piece, I argue for three necessary conditions for the existence of a trace: ‘The Non-Consequentialist Duty Condition,’ ‘The Identity Condition,’ and ‘The Ratio Condition.’

Daniel Weinstock's work on Harm Reduction was mentioned in the following article:

Amid rising COVID-19 deaths, why isn’t Santa Clara County shutting down like it did in March?

San Jose Spotlight
by Mauricio La Plante
Published January 19th, 2021.

Arijit Nandi co-authored and article in the Canadian Journal of Surgery:

Batomen B, Moore L, Carabali M, et al.

Effectiveness of trauma centre verification: a systematic review and meta-analysis

Canadian Journal of Surgery. Journal Canadien de Chirurgie. 2021 Jan;64(1):E25-E38.
DOI: 10.1503/cjs.016219. MID: 33450148. 
Published January 14th, 2020



There is a growing trend toward verification of trauma centres, but its impact remains unclear. This systematic review aimed to synthesize available evidence on the effectiveness of trauma centre verification.


We conducted a systematic search of the CINAHL, Embase, HealthStar, MEDLINE and ProQuest databases, as well as the websites of key injury organizations for grey literature, from inception to June 2019, without language restrictions. Our population consisted of injured patients treated at trauma centres. The intervention was trauma centre verification. Comparison groups comprised nonverified trauma centres, or the same centre before it was first verified or re-verified. The primary outcome was in-hospital mortality; secondary outcomes included adverse events, resource use and processes of care. We computed pooled summary estimates using random-effects meta-analysis.


Of 5125 citations identified, 29, all conducted in the United States, satisfied our inclusion criteria. Mortality was the most frequently investigated outcome (n = 20), followed by processes of care (n = 12), resource use (n = 12) and adverse events (n = 7). The risk of bias was serious to critical in 22 studies. We observed an imprecise association between verification and decreased mortality (relative risk 0.74, 95% confidence interval 0.52 to 1.06) in severely injured patients.


Our review showed mixed and inconsistent associations between verification and processes of care or patient outcomes. The validity of the published literature is limited by the lack of robust controls, as well as any evidence from outside the US, which precludes extrapolation to other health care jurisdictions. Quasiexperimental studies are needed to assess the impact of trauma centre verification.

Miñarro S, Reyes-García V, Aswani S, Selim S, Barrington-Leigh CP, Galbraith ED

Happy without money: Minimally monetized societies can exhibit high subjective well-being

PLoS ONE. 2021; 16(1): e0244569.
Published January 13th, 2021


Economic growth is often assumed to improve happiness for people in low income countries, although the association between monetary income and subjective well-being has been a subject of debate. We test this assumption by comparing three different measures of subjective well-being in very low-income communities with different levels of monetization. Contrary to expectations, all three measures of subjective well-being were very high in the least-monetized sites and comparable to those found among citizens of wealthy nations. The reported drivers of happiness shifted with increasing monetization: from enjoying experiential activities in contact with nature at the less monetized sites, to social and economic factors at the more monetized sites. Our results suggest that high levels of subjective well-being can be achieved with minimal monetization, challenging the perception that economic growth will raise life satisfaction among low income populations.

Koski A and Clark S.

Child in wedding dressChild Marriage in Canada

Population and Development Review (2021).
Published January 8th, 2021

View article written in McGill Newsroom - Institutional Communications - Child marriage is legal and persists across Canada on January 8th, 2021.
View article written in - Child marriage persists across Canada, rural communities, study finds by Brooklyn Neustaeter on January 10th, 2021.
View article written in the Globe and Mail - Thousands of child marriages in Canada lead to questions over global leadership by Matthew Lavietes on January 11th, 2021.
View article in Science BlogChild marriage is legal and persists across Canada on January 11th, 2021.
View article written in the McGill Reporter - Child marriage is legal and persists across Canada by Shirley Cardenas, Media Relations Officer, Communications and External Relations on January 12th, 2021.
View article written in Tampa Dispatch - Child marriage in Canada: Over 3,600 marriage certificates were issued to children under the age of 18 between 2000 and 2018.
View article written in -  Canada must amend its marriage laws to end child marriage by Daphne Bramham on January 13th, 2021.


Child marriage, defined as formal or informal marriage before the age of 18, is a globally recognized indicator of gender inequality. Canada has placed itself at the forefront of global efforts to end child marriage as part of its commitment to the United Nations Sustainable Development Goals. Despite these global aspirations, child marriage remains legal throughout Canada. Data from vital statistics agencies and recent censuses indicate that child marriage, although rare, is practiced across the country. In 2016, nearly 2,300 children between 15 and 17 years of age were in union, a prevalence of 0.2 percent. The vast majority (98 percent) of these were informal, common‐law unions. Demographic patterns of child marriage in Canada are similar to those observed in many low‐ and middle‐income countries. Girls were far more likely to be married as children than boys and typically wed much older spouses. There were marked differences in the prevalence of child marriage across the country, with the highest estimates found in Alberta, Manitoba, Saskatchewan, and the territories. These findings draw attention to the discrepancy between Canada's domestic law and its foreign policy. They also highlight thorny challenges inherent in efforts to eradicate this practice in Canada and elsewhere.

Baron M, Riva M, Fletcher C, et al.

Conceptualisation and Operationalisation of a Holistic Indicator of Health for Older Inuit: Results of a Sequential Mixed-Methods Project

Social Indicators Research (2021).
Published January 4th, 2021


Elder Inuit define health as holistic and multifaceted, which contrasts with health-related research where single factor indicators are usually used to measure health in an Inuit context. As the number of Inuit elders is growing, indicators derived from an Inuit definition of health are important if health systems are to be inclusive of the realities of Indigenous Peoples and culture. This study explored and operationalised a model of Inuit health in aging that draws from physical, emotional, spiritual, and interpersonal components identified as salient by participants in this research. Qualitative data gathered through two workshops with 21 participants were analysed to identify key dimensions of health from an Inuit perspective. Quantitative data were retrieved from Statistics Canada Aboriginal Peoples Survey (APS; 2006) with a weighted sample of 4450 Inuit aged ≥ 50 years residing across Inuit Nunangat. Using measures corresponding to the dimensions identified previously, Latent Class Analyses were applied to group survey participants into health profiles to create a holistic indicator of health. Multinomial regressions were conducted with related health and social measures to assess the concurrent validity of the indicator. Health was conceptualised along eight themes: general health balance, mental health, spirituality, not experiencing many activity limitations, being loved and having positive relationships, speaking Inuktitut, and being free of addiction. The holistic indicator grouped participants into three health profiles: (1) good health for most variables; (2) very good perceived and physical health, but poor mental health; and (3) poor health for most variables. Using mixed methods to bridge the concept of health defined in qualitative workshops with quantitative health indicators can contribute to the definition and description of a culturally relevant and sociologically complex understanding of healthy aging in an Inuit context.

Jill Baumgartner co-authored an article in Environment International:

Lee M, Carter E, Yan L, et al.

Determinants of personal exposure to PM2.5 and black carbon in Chinese adults: A repeated-measures study in villages using solid fuel energy

Environment International. 2021 (Jan):146. 106297
Available online December 8th, 2020


Exposure to air pollution is a leading health risk factor. The variance components and contributions of indoor versus outdoor source determinants of personal exposure to air pollution are poorly understood, especially in settings of household solid fuel use. We conducted a panel study with up to 4 days of repeated measures of integrated gravimetric personal exposure to PM2.5 and black carbon in 787 men and women (ages 40–79) living in peri-urban villages in northern (Beijing and Shanxi) and southern (Guangxi) China. We simultaneously measured outdoor PM2.5 and collected questionnaire data on sociodemographic characteristics and indoor pollution sources including tobacco smoking and solid fuel stove use. We obtained over 2000 days of personal exposure monitoring which showed higher exposures in the heating season (geometric mean (GM): 108 versus 65 μg/m3 in the non-heating season for PM2.5) and among northern participants (GM: 90 versus 59 μg/m3 in southern China in the non-heating season for PM2.5). We used mixed-effects models to estimate within- and between-participant variance components and to assess the determinants of exposures. Within-participant variance in exposure dominated the total variability (68–95%). Outdoor PM2.5 was the dominant variable for explaining within-participant variance in exposure to PM2.5 (16%). Household fuel use (PM2.5: 8%; black carbon: 10%) and smoking status (PM2.5: 27%; black carbon: 5%) explained the most between-participant variance. Indoor sources (solid fuel stoves, tobacco smoking) were associated with 13–30% higher exposures to air pollution and each 10 μg/m3 increase in outdoor PM2.5 was associated with 6–8% higher exposure. Our findings indicate that repeated measurements of daily exposure are likely needed to capture longer-term exposures in settings of household solid fuel use, even within a single season, and that reducing air pollution from both outdoor and indoor sources is likely needed to achieve measurable reductions in exposures to air pollution.

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