Efficacy of a Web-Based Tailored Intervention to Reduce Cannabis Use Among Young People Attending Adult Education Centers in Quebec.

BACKGROUND: Cannabis use is common among young adults. Web-based interventions are an increasingly popular way to reach this population. The aim of this study was to evaluate the efficacy of a Web-based tailored intervention, developed on theoretical and empirical grounds, to reduce cannabis use among young people by promoting a more positive intention to abstain. METHODS: An experimental design was employed to evaluate the efficacy of the intervention in reducing cannabis use (primary outcome) by bolstering intention (secondary outcome) to abstain from use. Participants were randomly assigned either to an experimental group that received the Web-based tailored intervention or to a control group that did not. RESULTS: Of 588 young adults (18-24 years of age) recruited, 295 were randomly assigned to the experimental group and 293 to the control group. At baseline, 343 reported using cannabis at least once in the past year. An intention-to-treat analysis showed that, at postintervention, a higher proportion of participants in the experimental group had reduced their cannabis use compared with the control group [10.8% vs. 5.1%, χ2(2) = 9.89, p = 0.007]. A mixed model for repeated measures revealed a statistically significant difference in terms of change in intention to abstain from cannabis use in the coming month [Group × Time interaction, F(1,474) = 8.03, p = 0.005]: intention increased for the experimental group (5.07 ± 2.07 to 5.45 ± 1.88; p < 0.001), but stayed stable for the control group (5.32 ± 2.03 to 5.36 ± 1.99; p = 0.779). CONCLUSION: This study shows that the intervention can be efficacious in reducing cannabis use among young people attending adult education centers.

Distraction Kits for Pain Management of Children Undergoing Painful Procedures in the Emergency Department: A Pilot Study.

To assess the feasibility, usefulness, and acceptability of using distraction kits, tailored to age, for procedural pain management of young children visiting the emergency department and requiring a needle-related procedure. A pre-experimental design was piloted. A kit, tailored to age (infants-toddlers: 3 months-2 years; preschoolers: 3-5 years), was provided to parents before their child's needle-related procedure. Data was collected to assess feasibility, usefulness, and acceptability of the kits by parents and nurses. Pain was measured pre-, peri-, and postprocedure using the Face, Legs, Activity, Cry, Consolability scale. A total of 25 infants and toddlers (mean age: 1.4 ± .7 years) and 25 preschoolers (mean age: 4.0 ± .9) participated in the study. Parents and nurses considered the kits useful and acceptable for distraction in the emergency department, especially in the postprocedural period. Addition of more animated and interactive toys to the kits was suggested. In the infants-toddlers group, mean pain scores were 1.6 ± 2.5 preprocedure, 7.1 ± 3.0 periprocedure, and 2.5 ± 2.5 postprocedure. In the preschoolers group, mean pain scores were 1.6 ± 3.0 preprocedure, 4.8 ± 3.4 periprocedure, and 2.0 ± 3.2 postprocedure. Distraction kits were deemed useful and acceptable by parents and emergency nurses. They are an interesting nonpharmacologic option for nurses to distract children, giving them a sense of control over their pain and improving their hospital experience. Future research should address the feasibility of distraction kits for a broader population of patients and a variety of painful procedures.

Process evaluation of a task-shifting strategy in hormonal contraception: does training translate into practice?

OBJECTIVES: Since 2000, the Province of Quebec has experienced a shortage of physicians and a decrease in access to prescription contraceptives. A task-shifting strategy was launched in 2007 to allow trained nurses, in collaboration with community pharmacists, to start healthy women on hormonal contraception for a six-month period without a medical consultation. This study examined the proportion of trained nurses effectively involved in this innovative practice to determine which factors are associated with it. METHODS: We performed a cross-sectional study in which all nurses who had been trained in hormonal contraception since 2007, who were registered with the College of Nurses of Quebec, and who were employed as nurses in the Quebec Health System were asked to respond to a postal or electronic survey. RESULTS: A total of 3043 nurses were invited to participate in the study. Fifty-seven percent (57.3%) of 745 respondents were involved in this new practice. The major determinant was the adoption of the Collaborative Agreement in Hormonal Contraception by health organizations. The other influential factors were having been trained before 2011, being a permanent employee, working in a youth clinic of a centre for health and social services, and working in a rural or remote area. CONCLUSION: Despite a modest response rate, this study provides support for formalizing the training of nurses in hormonal contraception by integrating it into nursing education at all levels, and for implementing it in other health organizations such as family medicine groups, which are widespread in Quebec.

Objectifs : Depuis 2000, la province de Québec connaît une pénurie de médecins et une baisse de l'accès aux contraceptifs d'ordonnance. Une stratégie de partage des tâches a été lancée en 2007 pour permettre à des infirmières formées de distribuer, en collaboration avec des pharmaciens communautaires, des contraceptifs hormonaux à des femmes en santé pour une période de six mois, sans passer par une consultation médicale. Cette étude s'est penchée sur la proportion d'infirmières formées participant réellement à cette pratique novatrice, et ce, en vue de déterminer les facteurs qui lui sont associés. Méthodes : Nous avons mené une étude transversale dans le cadre de laquelle nous avons demandé à toutes les infirmières qui avaient reçu une formation en matière de contraception hormonale depuis 2007, qui faisaient partie des membres en règle de l'Ordre des infirmières et des infirmiers du Québec, et qui occupaient un poste d'infirmière au sein du système de santé québécois de répondre à un sondage par voie postale ou électronique. Résultats : Au total, 3 043 infirmières ont été conviées à participer à l'étude. Cinquante-sept pour cent (57,3 %) des 745 répondantes participaient à cette nouvelle pratique. Le principal facteur déterminant était l'adoption de l'Ordonnance collective de contraception hormonale par les organisations de santé. Parmi les autres facteurs d'influence, on trouvait le fait d'avoir été formée avant 2011, le fait d'être une employée permanente, le fait de travailler dans une clinique jeunesse d'un centre de santé et de services sociaux, et le fait de travailler en région rurale ou éloignée. Conclusion : Malgré un taux de réponse modeste, cette étude s'ajoute aux éléments qui soutiennent l'officialisation de la formation des infirmières dans le domaine de la contraception hormonale, en l'intégrant à la formation en sciences infirmières à tous les niveaux et en la mettant en œuvre dans d'autres organisations de santé (tels que les groupes de médecine familiale, lesquels sont très répandus au Québec).

[Health education in Quebec: developments over the past decade and current prospects]. / L'evolution du champ de l'education a la santé au Québec ces dix dernières années et perspectives actuelles.

This study examines the views of five university professors in the province of Quebec on recent trends and developments in health education, the relative importance of health education as a health promotion strategy, and future prospects. Interviews were conducted and the participants were asked to validate the findings. Despite minor differences, the participants were found to have similar views on health education. The interviews also pointed to a significant emphasis on recent developments in our understanding of the factors influencing health behaviors and the theoretical foundations underlying processes of change. However, much remains to be done to put this knowledge into practice. In Quebec, the field of health education has involved an increasingly diverse range of actors in recent years, although nurses continue to play an important role. Some feel that the emphasis on creating supportive environments for health and public policies has had a negative impact on the development of health education in Quebec. For others, we are witnessing the emergence of a more integrated system combining different health promotion strategies. In terms of future prospects, some remain pessimistic, emphasizing the potential effects of the current economic climate or the potential negative impact of the rise of therapeutic education, which may be at the expense of a more systemic approach. Others are more optimistic, arguing that the future of health education will be a matter of political will and that it will depend on the efforts of stakeholders to promote consistent and complementary measures.

Psychosocial factors and beliefs related to intention to not binge drink among young adults.

AIMS: The objective of the study was to identify psychosocial factors and salient beliefs associated with the intention of young people to not binge drink in the next month, applying an extended version of the theory of planned behavior. METHODS: Among 200 youths randomly recruited from adult education centers in the province of Quebec, Canada, 150 completed a questionnaire. Of these, 141 youths reported having used alcohol in the last year-analyses were performed on this sub-sample. RESULTS: The prediction model demonstrated that perceived behavioral control (odds ratio, OR = 2.60, 95% confidence interval, CI 1.59-4.23; P = 0.0001), attitude (OR = 2.49, 95% CI 1.14-5.43; P = 0.02) and moral norm (OR = 1.88, 95% CI 1.23-2.88; P = 0.004) are three determinant variables of intention to not binge drink in the next month. The intention is also related to cannabis use in the last month (OR = 0.17 95% CI 0.05-0.53; P = 0.002). Young people who believe that if they do not binge drink in the next month, they will have a lower risk of getting depressed (OR = 1.53, 95% CI 1.23-1.90; P = 0.0001), and those who believe they will be able to not binge drink even if they are at a party (OR = 1.58, 95% CI 1.29-1.94; P < 0.0001), are more likely to have a positive intention. CONCLUSION: Despite some methodological limitations, this study revealed several options for helping young people to not binge drink during their school career.

Task-shifting in the delivery of hormonal contraceptive methods: validation of a questionnaire and preliminary results.

In order to palliate the access problem to effective contraceptive methods in Quebec, Canada, as well as to legitimate nurses' practices in family planning, a collaborative agreement was developed that allow nurses, in conjunction with pharmacists, to give hormonal contraceptives to healthy women of reproductive age for a 6 month period. Training in hormonal contraception was offered to targeted nurses before they could begin this practice. A questionnaire, based on Rogers's theory of diffusion of innovations, was elaborated and validated to specifically evaluate this phenomenon. Preliminary results show that the translation of training into practice might be suboptimal. The validated questionnaire can now be used to fully understand the set of factors influencing this new practice.

A randomized trial to evaluate the efficacy of a computer-tailored intervention to promote safer injection practices among drug users.

The aim of this study was to evaluate the efficacy of a theory-based intervention to increase the use of a new syringe for each injection among injection drug users (IDUs). Users of two needle exchange programs (NEPs) were involved. At both sites, participants were assigned at random to either the experimental or the control group. Once a week for four weeks, users reported to the NEPs where they logged onto a computer and received an audiovisual message. A total of 260 IDUs were recruited. At baseline, 52.3% of participants reported that they had not always used new syringes in the previous week. The results indicate that it is possible for IDUs to adopt safer injection practices. One month after the intervention began, participants in the experimental group were using fewer dirty syringes compared to the control group (RR: 0.47 CI(95%) 0.28-0.79; P = .004). This short-term effect was no longer present 3 months later.

Association between neighborhood active living potential and walking.

This paper examines the association between neighborhood active living potential and walking among middle-aged and older adults. A sample of 2,614 (61.1% women) persons aged 45 years or older and living in one of 112 census tracts in Montreal, Canada, were recruited between February and May of 2005 to participate in a 20-minute telephone survey. Data were linked to observational data on neighborhood active living potential in the 112 census tracts and analyzed through multilevel modeling. Greater density of destinations in the census tract was associated with greater likelihoods of walking for any reason at least 5 days per week for at least 30 minutes (odds ratio = 1.53, 95% confidence interval: 1.21, 1.94). Associations were attenuated but remained statistically significant after controlling for socioeconomic, health, lifestyle, and other physical activity characteristics. Sensitivity analyses showed that associations were robust across smaller and larger volumes of walking. No associations were found between dimensions of neighborhood active living potential and walking for recreational reasons. The authors conclude that a larger number and variety of neighborhood destinations in one's residential environment are associated with more walking and possibly more utilitarian walking among middle-aged or older adults.

The Development of a Community Pharmacy-Based Intervention to Optimize Patients' Use of and Experience with Antidepressants: A Step-by-Step Demonstration of the Intervention Mapping Process.

Objective: To describe the development of a community pharmacy-based intervention aimed at optimizing experience and use of antidepressants (ADs) for patients with mood and anxiety disorders. Methods: Intervention Mapping (IM) was used for conducting needs assessment, formulating intervention objectives, selecting change methods and practical applications, designing the intervention, and planning intervention implementation. IM is based on a qualitative participatory approach and each step of the intervention development process was conducted through consultations with a pharmacists' committee. Results: A needs assessment was informed by qualitative and quantitative studies conducted with leaders, pharmacists, and patients. Intervention objectives and change methods were selected to target factors influencing patients' experience with and use of ADs. The intervention includes four brief consultations between the pharmacist and the patient: (1) provision of information (first AD claim); (2) management of side effects (15 days after first claim); (3) monitoring treatment efficacy (30-day renewal); (4) assessment of treatment persistence (2-month renewal, repeated every 6 months). A detailed implementation plan was also developed. Conclusion: IM provided a systematic and rigorous approach to the development of an intervention directly tied to empirical data on patients' and pharmacists' experiences and recommendations. The thorough description of this intervention may facilitate the development of new pharmacy-based interventions or the adaptation of this intervention to other illnesses and settings.

Prevalence of HIV and hepatitis C virus infections among inmates of Quebec provincial prisons.

BACKGROUND: To determine the prevalence of HIV and hepatitis C virus (HCV) infections and examine risk factors for these infections among inmates in Quebec provincial prisons. METHODS: Anonymous cross-sectional data were collected from January to June 2003 for men (n = 1357) and women (n = 250) who agreed to participate in the study and who completed a self-administrated questionnaire and provided saliva samples. RESULTS: The prevalence of HIV infection was 2.3% among the male participants and 8.8% among the female participants. The corresponding prevalence of HCV infection was 16.6% and 29.2%, respectively. The most important risk factor was injection drug use. The prevalence of HIV infection was 7.2% among the male injection drug users and 0.5% among the male non-users. Among the women, the rate was 20.6% among the injection drug users, whereas none of the non-users was HIV positive. The prevalence of HCV infection was 53.3% among the male injection drug users and 2.6% among the male non-users; the corresponding values among the women were 63.6% and 3.5%. INTERPRETATION: HIV and HCV infections constitute an important public health problem in prison, where the prevalence is affected mainly by a high percentage of injection drug use among inmates.

Prison inmates' intention to demand that bleach be used for cleaning tattooing and piercing equipment.

OBJECTIVE: The aim of this study was to document the phenomenon of tattooing and piercing in prisons in Quebec and to identify factors underlying the intention of inmates to demand that equipment used in prison for piercing and tattooing be cleaned with bleach. METHOD: A total of 1,434 inmates recruited in seven prisons completed a questionnaire with the help of a community worker. The questionnaire was developed using an integrative model based on the Theory of Planned Behaviour. RESULTS: One third of respondents had been tattooed in prison in the past and 2.6% had a piercing; 27.2% of the tattooing and 30.5% of the piercing were carried out using unsafe equipment. Three quarters of the respondents expressed a firm intention to demand that equipment used for tattooing or piercing be cleaned with bleach. Logistic regression analysis showed that personal normative beliefs (OR 5.09; 95% CI 3.54-7.32), perceived behavioural control (OR 3.55; 95% CI 2.48-5.08) and role beliefs (OR 3.23; 95% CI 1.72-6.06) were the significant determinants of intention. CONCLUSION: Interventions aimed at encouraging safer tattooing and piercing activities in prison should focus on inmates' sense of responsibility, obstacles impeding adoption of this behaviour and promotion of this behaviour as an integral part of the culture in the prison environment.

The degree of planning: an indicator of the potential success of health education programs.

Evaluation is a major challenge in the field of health promotion and health education. Since the degree to which a project is planned often guarantees its potential success, the evaluation process should make it possible to answer different questions related to stages of project implementation. The goal of this study was to develop a planning tool to help health professionals and community workers judge the potential success of health education interventions based on the extent to which they are planned and to test the tool in real intervention evaluations. Educational interventions examined in this study were targeted primarily at the promotion and adoption of behaviour reducing the risk of human immunodeficiency virus (HIV) transmission. The conceptual framework of "intervention mapping" served as the basis for developing the tool. Experts were consulted to identify criteria that would make it possible to evaluate the extent to which different stages of the model were accomplished. The tool was tested for reliability. Data from 123 projects were then collected and analyzed. The process for the development of the tool made it possible to identify 40 planning criteria, broken down into the 19 tasks of intervention mapping model. Reliability test results were highly satisfactory. The overall average score for project planning was 12.7 out of 40. The degree to which different stages were planned varied considerably. For example, only 15% of projects had developed their objective matrices properly, whereas 80% were assured proper support for their implementation. Thirty-nine percent of the projects were satisfactorily available for evaluation. This exercise made it possible to construct an interesting tool for identifying strengths and weaknesses of intervention planning. Various promoters might find this tool useful for increasing the potential success of their initiatives.

From walkability to active living potential: an "ecometric" validation study.

BACKGROUND: The purpose of this paper is to establish the reliability and validity of a neighborhood-level measure of active living potential by applying principles of ecometrics. METHODS: Following a 3-day training session, observers (n =8) were provided with a map of a predetermined walking route constructed through the joining of ten randomly selected street blocks. Then, using an 18-item observation grid, pairs of observers performed ratings of 112 neighborhoods. Resulting observations produced a hierarchically structured data set including 4032 observations nested within observers, which in turn were nested within neighborhoods. Data from the 2001 Canadian census were linked to the neighborhood data. RESULTS: Application of ecometric multilevel modeling analyses showed that once interitem and interobserver variability were statistically controlled, about one third of the variability in observations were at the between-neighborhood level. Reliability estimates were 0.78 for items measuring activity-friendliness, 0.76 for safety, and 0.83 for density of destinations. Assessment of the convergent validity of the instrument identified that safety of the environment was positively associated with neighborhood affluence. Density of destinations was negatively associated with affluence and positively associated with higher proportions of persons in the neighborhood walking to work. CONCLUSIONS: The three dimensions of the neighborhood active-living potential measure have good reliability and convergent validity and are able to capture between neighborhood differences. Measurement characteristics would have been difficult to ascertain without the ecometrics methodology.

Determinants of condom use among a random sample of single heterosexual adults.

OBJECTIVES: The aim of this study was to identify the determinants of single heterosexuals' use of condoms during each sexual intercourse. DESIGN: Cohort of individuals followed over a period of 2 years. METHODS: Respondents were 574 single heterosexual individuals who answered questions during a telephone interview. RESULTS: Attitude, perceived behavioural control, self-efficacy and moral norm explained 65% of the variance in intentions to use condoms ( p, .0001). The determinants of condom use at 1 year follow-up (27% explained variance) were perceived behavioural control, past behaviour, and the interaction between intention and intention stability. At 2 years follow-up, the significant determinants were past behaviour and intention by intention stability. In the present study, intentions to use condoms which remained stable across time were strong predictors of condom use (at 1 year: beta = .42, p < .0001; at 2 years: beta = .39, p, < .003), while unstable intentions were not (at 1 year: beta = .02, ns; at 2 years: beta = .19, ns). CONCLUSION: Intention stability is a major determinant of the accuracy of intention for the prediction of subsequent behaviour.

Evaluation of an HIV and STD prevention program for adolescents in juvenile rehabilitation centers.

The aim of this study was to evaluate a sexual and STD/AIDS prevention program tailored for adolescents with social adaptation difficulties in juvenile rehabilitation facilities. The impact of the intervention on the psychosocial determinants of condom use were assessed, using a pre-test post-test quasi-experimental design. A total of 296 adolescents participated in the program (experimental group) while 240 adolescents did not receive the intervention (control group). The program led to positive outcomes among participants with respect to several of the main psychosocial determinants of condom use for sexual intercourse with a new partner. The results suggest that interventions that draw upon a combination of theoretical knowledge and consideration of the specific characteristics of the milieu could be efficient in promoting safer sexual practices among adolescents in juvenile rehabilitation centers.

Factors associated with maintenance of regular condom use among single heterosexual adults: a longitudinal study.

OBJECTIVE: The aims of this study were to describe behavioural and psychosocial characteristics of single heterosexuals towards regular condom use, and to identify factors associated with the maintenance of this behaviour over time. METHOD: A cohort of 179 single heterosexual adults (83 men and 96 women, mean age: 32 years) was followed over a period of 2 years. The data were collected, by phone interviews, at baseline and 1 and 2 years later. The phone numbers were generated using a random digit strategy. RESULTS: The following changes were observed: over time fewer people were sexually active, but those who were, reported more often having had more than one sexual partner. No significant change was observed regarding condom use. The psychosocial variables remained stable during the study period. To have a favourable intention was the main factor associated with maintenance of condom use. Having had a STD, personal normative beliefs and positive attitude were also associated with regular condom use. DISCUSSION: Promotion strategies should highlight the importance of acting as a responsible person, reinforce the advantages of using condoms, and select strategies that favour the implementation of intention of using condoms.