Abstract

Background: The factors influencing the oral microbiome during childhood and adolescence remain under-explored at the population level. Furthermore, details on how the oral microbiome differs with age, varies between individuals of different ethnicities, or is associated with socioeconomic factors and diet in children and adolescents are almost entirely unknown. Saliva samples and detailed demographic, health, diet and socioeconomic data were collected from children and adolescents that attended the Ontario Science Centre (Toronto, Canada) and were enrolled in the Spit for Science cohort. We characterised the bacterial microbiota of 4812 samples using 16S rRNA gene sequencing to make this the largest population cohort of the paediatric oral microbiome to date.

Results: Exploration of limited participant genotyping information and more than 50 variables encompassing the demographics, health, diet, socioeconomic status and living environment of participants revealed that almost all of the investigated variables were associated with overall community structure and/or the abundance of specific bacterial genera. However, most of these associations were modest (R²â€‰< 0.01) and the correlation between genetic relatedness and salivary bacteriome similarity was weak (R²â€‰= -0.014), while the strongest determinants of oral bacteriome composition were shared family/household environment (R²â€‰= 0.61 in the subset of participants from multi-child households), age (R²â€‰= 0.014) and ethnicity (R²â€‰= 0.01). We show that older children and adolescents have higher richness but lower evenness than younger children, suggesting that their oral bacteriome changes as they are exposed to more influences outside the home, and that the oral bacteriome is more consistent with more core taxa among children and adolescents than adults. We also find that diet variables related to the frequency of sugar consumption have the largest impact on the oral bacteriome of children and adolescents, and that microbial differences attributed to ethnicity and diet are likely intertwined.

Conclusions: This study provides an atlas of the demographic, health and lifestyle factors that are associated with the salivary bacteriome of children and adolescents. These findings highlight the complex interplay between social, environmental, and biological factors in shaping the developing oral microbiome and underscore the importance of inclusive, demographically diverse cohorts in microbiome research. This presents a reference for the variables that are important to account for in paediatric oral microbiome studies.

Citation

Wright, R.J., DeClercq, V., Burton, C.L. et al. Population-based characterisation of child and adolescent oral bacterial microbiomes. MicrobiomeĚý(2026). 

The post New Article: Population-based characterisation of child and adolescent oral bacterial microbiomes appeared first on Determinants.

Abstract

Rurality and remoteness are policy-relevant concepts for planning and evaluating equitable access to services across Canada, yet existing measures rely on categorical, urban-centric, and coarse spatial definitions that obscure variation in accessibility across the rural-urban continuum. The Canadian Accessibility and Remoteness Index Plus (CARI+) is a small-area accessibility index at the dissemination-area level. It is based on road-network travel to stratified service centres, including population centres and 24-hour emergency departments stratified by settlement size. Category-specific scores are capped at 3, summed to produce an overall score, then normalized.

We examined the CARI+ values against socio-demographic indicators and compared them with the Index of Remoteness (IOR). CARI+ yields a more even population distribution than the IOR (39% vs 77% in the most accessible category) and reveals socio-demographic gradients: material deprivation and Indigenous identity increase with remoteness, while educational attainment and immigrant representation decline. In very remote areas, CARI+ identifies 25% of Indigenous residents and 27% of the population with less than high school education, versus 78% and over 50% respectively under the IOR. The CARI+ provides a transparent, service-specific, high-resolution measure of accessibility that addresses key limitations of existing Canadian indices and supports nuanced analysis for health and social service planning.

This article is part of our , which aims to make disaggregated data on health and social service access available for researchers and planners in Canada.

Read the Article:

Citation

McGaughey, T., & P. A. Peters. 202670:. Introducing the Canadian Accessibility and Remoteness Index (CARI+). Canadian Geographies / GĂ©ographies canadiennes, 70, e70082. 

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Epidemiology and public health are grounded by the use of core demographic statistics, such as mortality rates and life expectancy. Indicators such as mortality rates are usually presented as tables or basic charts; however, there is significant potential in data visualization techniques to improve understanding and dissemination of these statistics. This project aims to use interactive visualizations to interpret Canadian mortality indicators by age, sex, socioeconomic status, and cause of death. 

Methods: Visualizations were developed using compositional Lexis surface diagrams, age-wise plots, and plots of small-multiples. Recent and historical data on deaths by age, sex, and selected cause and population counts were sourced from the Human Mortality Database and Statistics Canada Vital Statistics files. Data cleaning and analysis were conducted using R and RStudio, with open-source code shared via GitHub. For each visualization type, interactive applications were developed using Shiny and made available publicly online via open access.

Results: Four interactive Shiny applications were produced: (1) a Lexis Surface Plot from 1921-2022; (2) Small Multiples Plot from 1950-2019; (3) Multiple Lexis Surface Plots from 2002-2021; and (4) Age-Wise Plots 1950-2019 and 2002-2021. Each plot includes written evidence-based descriptions on the association between mortality and other factors. These tools will be useful to provide insight into longitudinal mortality patterns for students, researchers, public health agencies, and the general public. 

Conclusion: Interactive visualizations provide enhanced insight into mortality analysis. Visualizations can be modified to include features that improve accessibility for diverse audiences. Future research can expand the use of Lexis diagrams to create applications at disaggregated levels to support health research and policy.

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Report: Data Visualization of Complex Health Information

Interactive applications are available via the following links:

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This scoping review will examine epidemiologic studies assessing associations between ambient air pollution exposure and neurodevelopmental disorder symptoms for three childhood neurodevelopmental disorders: ADHD, ASD, and OCD. It will also characterize the modifying roles of socioeconomic and neighbourhood characteristics.

This protocol has been registered with Open Science Foundation: .

Background

Neurodevelopmental disorders in children and adolescents

There is established evidence for the interaction between childhood neurodevelopmental disorders (NDDs) and genetic, social, and environmental factors (1–5). Attention Deficit Hyperactivity Disorder (ADHD; prevalence 5-11%), Autism Spectrum Disorder (ASD; 1-3%), and Obsessive-Compulsive Disorder (OCD; 0.5-2%) are among the most common NDDs, affecting children and adolescents globally (6). Childhood NDDs are often co-occurrent with other NDDs (homotypic comorbidity) and with additional psychiatric pathologies (heterotypic comorbidity) such as anxiety and mood disorders (6).

Measuring the mental health burden in children and young people requires looking beyond clinical samples to dimensional symptom scores from population-based cohorts (7). Symptom rating scales implemented in community-based samples capture children who meet threshold criteria for an NDD but have not received a formal diagnosis given various healthcare disparities related to low income, race/ethnicity, etc. (8)

Note on OCD classification: In DSM-5, OCD is classified under “Obsessive-Compulsive and Related Disorders” rather than the Neurodevelopmental Disorders chapter. Its inclusion in this review is justified by its childhood onset, high co-occurrence with ADHD and ASD, and its established use as a neurodevelopmental outcome in the environmental epidemiology literature (5).

Environmental exposures and neurodevelopmental outcomes

Air pollution is a significant and increasing global risk factor for children and youth (9). Several ambient environmental exposures are associated with ADHD, ASD, and OCD incidence, acting as either risk or protective factors depending on exposure level and timing (10–14). Prenatal and early-life PM2.5 exposure is reported in multiple cohort studies to raise ASD risk and impair cognitive development (11,15). NO2, a marker of traffic-related pollution, is linked to psychomotor delays and attention difficulties in children (13). Children with greater greenspace access score lower on NDD symptom measures including OCD, plausibly because greenspace reduces pollutant exposure, supports physical activity, and lowers physiological stress (14,16,17).

Most of this evidence concerns clinical diagnosis rather than dimensional symptom severity, with some exceptions (18,19). Prior systematic reviews and meta-analyses have predominantly treated ASD or ADHD diagnosis as a binary outcome, rather than examining scale scores that capture sub-threshold and severity variation (10). Most prior reviews have also been confined to a single NDD and a single exposure type, which limits understanding of multi-exposure effects and cross-diagnostic patterns. Clarifying how environmental exposures shape NDD trait severity, rather than diagnosis incidence, could directly inform community intervention priorities and strengthen the case for urban environmental standards protective of child neurodevelopment.

Rationale and justification for a scoping review

This review examines studies assessing associations between environmental exposures and NDD trait scores, and characterizes the modifying roles of social, neighbourhood, and genetic factors (20). Given the heterogeneity of NDD outcome measures, exposure types, and study designs in this area, a scoping review is more appropriate than a systematic review or meta-analysis. It maps evidence across multiple exposures and NDD outcomes without requiring pooling of effect estimates from incompatible measurement scales.

Prior meta-analyses have typically been restricted to a single exposure-outcome pair: Shang et al. (2020) for NO2 and psychomotor development; Lin et al. (2022) for particulate matter and NDDs; Alter et al. (2024) for PM2.5 and IQ (2–4). The present review takes a broader mapping approach to characterize the breadth of measurement approaches across multiple exposures (environmental and social) and NDD types, and to identify evidence gaps and research priorities.

The format is also appropriate because the use of psychometric outcomes in environmental NDD research is still emerging. A scoping review lays the groundwork for subsequent systematic reviews with more precisely defined questions.

Prior reviews

Current systematic and scoping reviews in this area examine studies that measure only the incidence rate or clinical diagnosis of NDDs in relation to environmental exposures (2–4,10–12,21–23). From an initial search of systematic and scoping reviews in December 2025, a search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis was conducted. No current or in-progress scoping reviews or systematic reviews were identified that specifically address trait scores and NDD symptoms for childhood NDDs in relation to multiple environmental and social exposures.

Gao et. al. (2025) conducted an umbrella review of environmental pollutant exposure and neurodevelopmental outcomes, including collection of assessment criteria or tools used (10). However, this review didn’t provide a discussion of included studies or the relationship between NDD symptoms and environmental exposures.

Numerous reviews have examined individual neurodevelopmental disorders or specific environmental exposures, but most focus on clinical incidence for a single NDD and do not address symptom severity or multi-morbidity. Prior reviews also rarely examine multiple environmental and social exposures and simultaneously. This review addresses both gaps.

Primary research question(s) 

The objective of this review is to map epidemiologic studies that assess the associations between ambient air pollution and neighbourhood environmental exposures (ambient air pollution and greenspace) and neurodevelopmental disorders (ADHD, ASD, and OCD) symptoms in children and adolescents, and to characterize the modifying roles of neighbourhood-level socioeconomic characteristics.

The following questions operationalize the review objective and guide the inclusion criteria and data extraction:

1. What validated ADHD, ASD, and OCD-related behavioural and/or cognitive measures have been used to (Concept) in children and adolescents aged 0-18 years (Population) exposed to ambient air pollution or greenspace, across any geographic setting (Context)?
2. What types of environmental exposures (PM2.5, PM10, NO2, O3, SO2, greenspace, and other ambient exposures) and what exposure measurement methods (ground monitoring, satellite-derived estimates, land-use regression, NDVI) have been employed in included studies?
3. 3) What socioeconomic and neighbourhood-level characteristics have been examined as potential modifiers of the exposure-NDD symptom score relationship?

Secondary research question(s) 

1. What exposure windows (prenatal, early childhood, school-age, cumulative) have been examined, and how have studies operationalized these windows?
2. What evidence gaps exist regarding multi-exposure designs, under-studied NDD types, and under-represented populations or geographic settings?

The post Protocol: Neurodevelopmental Disorder Symptoms In Children And Adolescents Exposed To Ambient Air Pollution: A Scoping Review Protocol appeared first on Determinants.

What do we know? Rural obstetrical care in Canada has limited local access, meaning many women must travel, sometimes over two hours, to give birth. Care is often provided by fewer specialists and more family physicians, and services vary widely between communities. These gaps can affect outcomes and reflect that rurality is a key social determinant of health. There are fewer obstetrical specialists in rural areas, so care depends heavily on family physicians and limited staff, which affects consistency of care.

What do we want to know? We want to know whether access to rural maternity care has improved since 2011, how to reduce travel and service gaps, and whether some maternal health risks and deaths are preventable with better access and resources.

How does it affect people? Limited access to rural OB care can lead to worse birth outcomes, increased stress, and financial strain due to travel. It also impacts overall health because rurality acts as a social determinant of health, affecting both mothers and newborns. Long travel times can lead to delayed care, emergency deliveries, and higher stress, which can affect outcomes.

ArcGIS StoryMap

An is a web-based digital storytelling tool created by that combines interactive maps and 3D scenes with multimedia content—like text, photos, audio, and video. It allows anyone to build immersive, visual narratives without needing prior GIS () experience.

View the complete ArcGIS StoryMap at: .

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This project aims to map existing research on the internal migration, spatial mobility or residential relocation of older adults in Canada. It focuses especially on the determinants of internal migration between urban and non-urban regions of Canada that are motivated or driven by health, health care needs, or other health-related reasons reasons.

This protocol has been registered with Open Science Foundation: .

Increasing life expectancy and declining birth rates have led to increases in the median age for many countries, including Canada. In this context, preparing for and meeting the needs of an aging population is a growing challenge [1]. While older age is not a direct indicator of poor health, older adults are disproportionally represented among those with chronic diseases and have a greater probability of suffering falls and injuries and having age-related decreases in immunity [2][3]. As such, they are more likely to be high users of the health system when compared to their younger counterparts [4][5].

Problems in accessing health care for this age group are often exacerbated in areas with less healthcare resources [6][7]. Rural and remote regions, for instance, often contend with scarcity of services and difficulties in retaining health workers [8][9]. Rural communities in Canada have low population density and less diversified services compared to urban communities [10]. Additionally, compared to urban areas, they have been shown to have a trend of out-migration of young people, in-migration of older individuals [11], and consequently, a higher proportion of older adults [12].

Existing studies cite a wide array of motivations for older adults’ migration within Canadian borders, including health-related issues [13][14][15]. In Canada, usually this group’s motivations to migrate include the search for lower cost of living, the wish to be closer to nature, or to live in age-friendly neighbourhoods after retirement [13]. Edmonston and Lee [13] identified health as one of the five most common reasons for the relocation of older adults.

This review seeks to quantify and describe research on the internal mobility of older adults in Canada for health-related reasons, with a special focus on relocations across the rural-urban axis.

We use the terms “older adults”, “rural” and “internal mobility” and their synonyms to describe the different ways in which studies in the area define each of these concepts. The definition of “rural” is complex and can be based on a variety of indicators, from idealized conceptions [16] to objective measures such as concentration of services and population density [17]. In Canada, rurality is often operationally defined as region with population density of less than 400 habitants per square kilometer [12], but many studies offer their own definitions. The concept of “older adults” as well does not have a clear definition in the literature, with initial age cut points ranging from approximately 45 to 65 years. “Internal mobility” is generally understood as residential relocation within national borders, but it can also include changes of residence within shorter distances such as the same neighbourhood, or the same city, for instance, and long-distance relocations or migrations. Different conceptualizations of “rural”, “mobility”, “older adults”, as well as “health”, will be categorized and described in the review.

A preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis was conducted. The economic [18] and health-related [19] consequences of older adult migration were discussed in some reviews, as well as the specific healthcare challenges of aging in rural areas of Canada for older adults [20]. However, to our knowledge no current or in-progress scoping reviews or systematic reviews about the specific topic of health or healthcare influence on migration for older adults in Canada were identified.

Given the disparities in the distribution of health services in Canada, especially between rural and urban areas, fully understanding the patterns of internal migration of older adults within Canadian borders is important for attaining a more equitable distribution of resources, and especially relevant for the promotion of aging-in-place policies.

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Robyn Wright, Vanessa DeClercq, Christie Burton, Nicole Roslin, Alex Chan, Paul Arnold, Paul Peters, Russell Schachar, Jennifer Crosbie, Morgan Langille

Abstract

The factors influencing the oral microbiome during childhood and adolescence remain under-explored at the population level. We characterised the saliva microbiomes of 4,812 children aged 5-18 years within the Spit for Science cohort collected at the Ontario Science Centre (Toronto, Canada), making this the largest population cohort of the paediatric oral microbiome to date. Exploration of participant genotyping and more than 50 variables encompassing the demographics, health, diet, socioeconomic status and living environment of participants revealed that almost all of the investigated variables were associated with overall community structure and/or the abundance of specific bacterial genera. However, most of these associations were modest, while the strongest determinants of oral microbiome composition were shared household environment, age, and ethnicity. We further show that the oral microbiome is more consistent with more core taxa among children than adults, and that microbial differences attributed to ethnicity and diet are likely intertwined. These findings highlight the complex interplay between social, environmental, and biological factors in shaping the developing oral microbiome. This underscores the importance of inclusive, demographically diverse cohorts in microbiome research and presents a reference for the variables that are important to account for in paediatric oral microbiome studies.

Download at Research Square: .

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Evaluating the impacts of the Tłı̨chǫ Highway on food security and other determinants of health in Whatì, NWT.

Sarah Jones, PhD

Abstract

Many Indigenous populations across Canada experience inequalities in the determinants of health and well-being and health outcomes compared to non-Indigenous populations. These inequalities are related to historic and contemporary structural and systemic inequities linked to processes of colonization. In Canada, inequities are compounded in isolated and remote communities by large geographic distances to the nearest administrative and service centres and, in many cases, socio-economic marginalization. The development of new transportation infrastructure is often used as an instrument for government policy to bridge this distance and improve determinants of health and well-being for isolated communities. 

In 2021, the Tłı̨chÇ« community of Whatì in northern Canada was fundamentally transformed by one such development, the Tłı̨chÇ« Highway, which connected the isolated community of Whatì to other communities in Northwest Territories (NWT) and to southern Canada. The objective of this research was to investigate the ways in which the Tłı̨chÇ« Highway has changed the community of Whatì. Through a community-based participatory research methodological approach in partnership with Tłı̨chÇ« Government (TG) Department of Culture and Lands Protection (DCLP), this research investigated the impacts of the highway on food security and food sovereignty, mobility, and economic, social, and cultural determinants of health and well-being for community members in Whatì. It also investigated how impacts may be experienced differently across sub-populations in the community and identified programs and initiatives that could address negative impacts of the highway and improve determinants of health and well-being for community members in Whatì. 

Using dirt research as a research method, the researcher took up research residence in Whatì for several months in 2023, and conducted follow-up visits throughout 2024 and 2025. Together with two community research coordinators from Whatì, the researcher conducted a total of 50 semi-structured interviews with 55 community members, a focus group, and a workshop with high school students in 2023. This research also employed an analysis of documents submitted to the Mackenzie Valley Environmental Impact Review Board (MVEIRB) for the environmental assessment review process of the Tłı̨chÇ« Highway to compare predicted and post-construction impacts of the highway specific to the market food system in Whatì. The methods used to conduct this research then shifted from observational to action-oriented to facilitate conversations between key stakeholders regarding the eligibility of the Whatì Community Store to receive a retail subsidy through the Nutrition North Canada (NNC) program, which depends on lack of year-round surface transportation to a community. This shift was grounded in t community-based participatory research methodology and driven by the researcher’s commitment to reciprocity and responsibility for ethical community engagement. 

This thesis presents a scoping review to map the extent, nature, and distribution of studies on the impacts of transportation infrastructure development on the determinants of health and well-being for remote communities in the circumpolar north, Australia, and New Zealand. It also presents the results of community-based participatory research, document analysis, and engagement with key stakeholders. Key findings of community-based participatory research illustrate the importance of situating food security in place and, that while the highway has improved dimensions of food security at the individual and household levels, it has negatively impacted food sovereignty at the community level in Whatì. The highway has provided marked increases in the mobility of community members in Whatì, limited short-term economic benefits, and the potential for medium- and long-term economic development and employment opportunities. However, increased connectivity has also resulted in a substantial increase in substance use in the community and changes to community safety, and has the potential to contribute to the erosion of Tłı̨chǫ Nàowo, or way of life, in Whatì. These impacts were assessed alongside efforts to mitigate food insecurity of community members and negative impacts of the highway, and to improve food sovereignty and the determinants of health and well-being in Whatì. 

Results of document analysis found that the environmental assessment review process for the Tłı̨chǫ Highway lacked discussion on the predicted impacts of the highway on the Whatì Community Store in relation to the NNC retail subsidy. As a result of engagement with key stakeholders, the Whatì Community Store received an extension of the retail subsidy and contingency funding from the NNC Community Food Programs Fund to support its transition to a road-based supply chain using the Tłı̨chǫ Highway. Results of the investigation into the interactions between the environmental assessment review process and institutional supports or barriers for the market food system also yielded four policy recommendations. These, along with the results of community-based participatory research, can inform environmental assessment review processes for proposed new roads to isolated communities in Canada including mitigative strategies specific to sub‑populations that may be disproportionately impacted by this infrastructure. Results of community-based participatory research support TG’s regulatory reporting requirements for the Tłı̨chǫ Highway to the MVEIRB. Lastly, this thesis contributes to critical population health praxis and community-based participatory research as a methodological approach to research with communities, discussing the relationship between research and advocacy for researchers external to, but partnering with, communities.

Read the Dissertation: .

Citation

Jones S. Evaluating the Impacts of the Tłı̨chÇ« Highway on Food Security and other Determinants of Health and Well-Being in Whatì, NWT [dissertation on the Internet]. Ottawa (ON): ĐÓ°ÉÔ­´´ University; 2025 [cited 2025 Oct 1]. Available from: https://doi.org/10.22215/etd/2025-16782

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Tomoko McGaughey, George Kephart, Utkarsh J. Dang, and Paul A. Peters

Abstract

Multiple definitions have been used to identify individuals who are high system users (HSUs), through economic costs, frequency of use, or length of stay for inpatient care users. However, no definition has been validated to be representative of those residing in rural communities, who face unique service accessibility. This paper identifies an HSU definition for rural Canada that is inclusive of various levels of rurality, longitudinal patient experiences, and types of hospitalizations experienced. This study utilized the 2011 Canadian Census Health and Environment Cohort (CanCHEC) linkage profile to assess hospitalization experiences between 1 January 2009 and 31 December 2013. A range of common HSU indicators were compared using Cox proportional hazards modelling for multiple periods of assessment and types of admissions. The preferred definition for rural HSUs was individuals who are in the 90th percentile of unplanned hospitalization episodes for 2 of 3 consecutive years. This approach is innovative in that it includes longitudinal hospital experiences and multiple types of hospitalizations and assesses an individual’s rurality as a point of context for analysis, rather than a characteristic. These differences provide an opportunity for community characteristic needs assessment and subsequent adjustments to policy development and resource allocation to meet each rural community’s specific needs.

Read the Article: .

Citation

McGaughey, T.; Kephart, G.; Dang, U.J.; Peters, P.A. Creating an Inclusive Definition for High Users of Inpatient Hospital Systems That Considers Different Levels of Rurality. Int. J. Environ. Res. Public Health 2025, 22, 381. https://doi.org/10.3390/ijerph22030381

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Reyhaneh Golestani, Farideh Khalajabadi Farahani, and Paul Peters

Abstract

Background: The aim of this study is to explore young rural women’s perceived barriers in accessing healthcare services with a focus on the interrelation between three marginalization criteria: age (youth), gender (female), and place of residence (rural areas) in Australia, Canada, and Sweden.

Methods: Using a qualitative interpretive approach, we conducted semi-structured in-depth interviews with 31 young women aged 18 to 24 in selected rural communities. Data collection took place from May 2019 to January 2021, and the qualitative data were analyzed using NVivo software.

Results: Self-perceived barriers for access to healthcare services among young women living in rural and remote areas encompass various challenges across individual, institutional, and structural levels. Individual barriers include limited knowledge about available health services, negative attitudes toward healthcare, psychological discomfort when seeking assistance, and economic affordability issues. Institutional challenges involve limited healthcare resources, gender insensitivity among providers, judgmental attitudes from healthcare staff, inadequate time management of services, and a lack of privacy and confidentiality within facilities. Structural barriers further compound these issues through socio-cultural and gender norms, insufficient coverage of universal health insurance, low budget allocations for health facilities in rural and small urban areas, and the geographic distance to healthcare providers. Addressing these multifaceted barriers is crucial to improving healthcare access for rural population.

Conclusions: Appropriate strategies and policies must be introduced to promote access to healthcare services in rural and remote areas even in most high-income countries.

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Citation

Golestani, R., Farahani, F.K. & Peters, P. Exploring barriers to accessing health care services by young women in rural settings: a qualitative study in Australia, Canada, and Sweden. BMC Public Health 25, 213 (2025). https://doi.org/10.1186/s12889-025-21387-2

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