Publications

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2018
Benmarhnia, T, Alexander S, Price K, Smargiassi A, King N, Kaufman JS.  2018.  The heterogeneity of vulnerability in public health: a heat wave action plan as a case study. Critical Public Health. 28:619-625.   10.1080/09581596.2017.1322176   AbstractWebsite

The concept of vulnerability is frequently used in public health policies to develop tailored interventions or dedicate proportionately more resources to certain sub-populations. However, once segments of the population are identified as vulnerable, they are rarely consulted regarding whether this label is acceptable before instituting interventions. Instead, it is implicitly assumed that the targeted individuals identify themselves as vulnerable and experience an unambiguous and consistent need for public health assistance. In this paper, using public health interventions during heat waves as a case study, we question such assumptions. A qualitative study was conducted in Montreal, Canada involving two focus groups among populations specifically targeted by the heat action plan as vulnerable: one composed of individuals diagnosed with schizophrenia, and one composed of individuals who have alcohol or drug addictions. Findings revealed significant heterogeneity in the definition and experience of vulnerability as it is used in the context of a heat action plan in Montreal. We found differences between the two focus groups in several areas including sources of information they had access to within the heat action plan measures and their perspectives regarding the appropriateness of specific measures in the heat action plan. We then observed differences within each of the focus groups in several areas including their social networks relationships. The concept of vulnerability is often used in public health policies. Yet, while this concept may be convenient for shaping policies to reduce inequalities in health, the heterogeneity of populations defined as vulnerable should not be underestimated.

2015
Benmarhnia, T, Grenier P, Brand A, Fournier M, Deguen S, Smargiassi A.  2015.  Quantifying Vulnerability to Extreme Heat in Time Series Analyses: A Novel Approach Applied to Neighborhood Social Disparities under Climate Change. International Journal of Environmental Research and Public Health. 12:11869-11879.   10.3390/ijerph120911869   AbstractWebsite

Objectives: We propose a novel approach to examine vulnerability in the relationship between heat and years of life lost and apply to neighborhood social disparities in Montreal and Paris. Methods: We used historical data from the summers of 1990 through 2007 for Montreal and from 2004 through 2009 for Paris to estimate daily years of life lost social disparities (DYLLD), summarizing social inequalities across groups. We used Generalized Linear Models to separately estimate relative risks (RR) for DYLLD in association with daily mean temperatures in both cities. We used 30 climate scenarios of daily mean temperature to estimate future temperature distributions (2021-2050). We performed random effect meta-analyses to assess the impact of climate change by climate scenario for each city and compared the impact of climate change for the two cities using a meta-regression analysis. Results: We show that an increase in ambient temperature leads to an increase in social disparities in daily years of life lost. The impact of climate change on DYLLD attributable to temperature was of 2.06 (95% CI: 1.90, 2.25) in Montreal and 1.77 (95% CI: 1.61, 1.94) in Paris. The city explained a difference of 0.31 (95% CI: 0.14, 0.49) on the impact of climate change. Conclusion: We propose a new analytical approach for estimating vulnerability in the relationship between heat and health. Our results suggest that in Paris and Montreal, health disparities related to heat impacts exist today and will increase in the future.

Juneau, C, Benmarhnia T, Poulin A, Cote S, Potvin L.  2015.  Socioeconomic position during childhood and physical activity during adulthood: a systematic review. International Journal of Public Health. 60:799-813.   10.1007/s00038-015-0710-y   AbstractWebsite

A growing body of evidence links socioeconomic position early in life and physical activity during adulthood. This systematic review aimed to summarize this evidence.Medline and EMBASE were searched for studies that assessed socioeconomic position before age 18 years and physical activity at age a parts per thousand yen18 years. Studies were rated according to three key methodological quality criteria: (1) was childhood socioeconomic position assessed prospectively? (2) Was socioeconomic position during adulthood included in the statistical analysis? (3) Was a validated instrument used to measure of physical activity?Forty-two publications were included. Twenty-six (61.9 %) found a significant association between socioeconomic position early in life and physical activity during adulthood. Twenty-one studies met at least two methodological quality criteria. Among those, the proportion was higher: 15/21 (71.4 %). Associations were of weak to moderate strength, positive for physical activity during leisure time, and negative for transports and work.The bulk of the evidence supports the notion that there is a life course association between socioeconomic position early in life and physical activity during adulthood. Studies using more rigorous methodology supported this conclusion more consistently.

Benmarhnia, T, Auger N, Stanislas V, Lo E, Kaufman JS.  2015.  The relationship between apparent temperature and daily number of live births in Montreal. Maternal and Child Health Journal. 19:2548-2551.   10.1007/s10995-015-1794-y   AbstractWebsite

Temperature is a hypothesized determinant of early delivery, but seasonal and long term trends, delayed effects of temperature, and the influence of extreme cold temperatures have not yet been addressed. We aim to study the influence of apparent temperature on daily number of births, considering lag structures, seasonality and long term trends.We used daily number of births in conjunction with apparent outdoor temperatures between 1981 and 2010 in Montreal. We used Poisson regression combined with a distributed lag nonlinear model to consider non-linear relationships between temperature and daily number of births across specific lag periods.We found that apparent temperature was associated with the daily number of births in Montreal, with a 1-day delay. We found an increase in births on hot days, and decrease on cold days, both offset by a harvesting effect after 4 and 5 days.This study suggests that the number of births is affected by extreme temperatures. Obstetric and perinatal service providers should be prepared for spikes in the number of births caused by extreme temperatures.