Direct-to-participant feedback and awareness of bone mineral density testing results in a population-based sample of mid-aged Canadians.

UNLABELLED: This population-based study of mid-aged Canadians assessed awareness of diagnosis by bone mineral density (BMD) following dual-energy X-ray absorptiometry (DXA) testing and compared the effects of feedback only to the physician with direct-to-participant feedback. Poor recall of osteoporosis results was observed irrespective of the feedback destination, but direct-to-participant feedback improved recall of borderline or normal results. INTRODUCTION: BMD testing provides information about fracture risk. This study assessed whether awareness of results, in a random population sample of mid-aged Canadians, differed if results were provided to physicians only or directly to participants. METHODS: Prospective cohort study of 2,678 women and men aged 40-60 years from the Canadian Multicentre Osteoporosis Study. Participants completed hip and spine DXA and interviewer-administered questionnaires regarding demographics and osteoporosis risk factors. Lateral spine X-rays were conducted on those > or =50 years of age. All test results were reported to the participant, the family physician or both. Associations between BMD results, feedback destination and correct self-report results, 3 years later, were assessed using logistic regression while adjusting for potential confounders. RESULTS: Only 25% of men and 33% of women correctly reported their osteoporosis diagnoses. Direct-to-participant vs. physician-only reports did not improve recall of osteoporosis diagnosis but improved recall of borderline or normal BMD. Older (vs. younger) men and men with prevalent vertebral fractures demonstrated better recall of their osteoporosis diagnosis. CONCLUSIONS: Recall of low BMD results was poor, despite direct-to-participant feedback and even in the presence of other osteoporosis risk factors. Direct-to-participant feedback may improve awareness of borderline or normal BMD results.

An examination of the smoking identities and taxonomies of smoking behaviour of youth.

OBJECTIVE: To address observations that the smoking identities of youth are valid descriptors of their smoking behaviour, we examined the relationships between self-reported smoking identities, perceived levels of addiction, and established taxonomies of smoking behaviour of youth. METHOD: Cross-sectional data were collected on demographics, perceived extent of addiction to tobacco, smoking history, and self-reported smoking identity from questionnaires administered to 8225 students in British Columbia, Canada. A total of 7246 participants were categorised according to four smoking taxonomies established in the literature. Differences in perceived physical and mental addiction between smoking identity groups were calculated. The strength of the associations between the taxonomies of smoking and the smoking identity groups was also assessed. RESULTS: There were significant differences in perceived levels of physical (Kruskal-Wallis chi(2) = 3985.02, p<0.001) and mental (Kruskal-Wallis chi(2) = 4046.09, p<0.001) addiction to tobacco by the participants' self-reported smoking identity. Youth smoking identities were modestly associated with the established smoking taxonomies (Pearson C contingency coefficient = 0.64-0.72). CONCLUSION: Self-reported smoking identities appear to provide valid characterisation of the smoking behaviour of youths that complement and elaborate existing taxonomies of smoking behaviour. Questions about self-reported smoking identity should be used in conjunction with smoking behaviour taxonomies when investigating youth smoking behaviours.

Setting the stage for health impact assessment.

Defining health impact assessment as any combination of procedures or methods by which a proposed policy or program may be judged as to the effect(s) it may have on the health of a population, we make recommendations about how to evaluate the health impact of all government-initiated policies. Such health impact cannot be assessed in the absence of a conceptual or organizing framework that provides the requisite guideposts--population health goals and targets. Health impact assessment offers an approach to ensuring that governments' program and policy initiatives align, or are congruent with, the agreed-upon health goals. It suggests that proposed national policies should be supported or resisted on the basis of their probable influence on the health of populations. In the current Canadian national policy framework, however, there are no underpinnings on which to situate such a process. The specification of consensus goals and objectives with measurable targets can provide the requisite guideposts and benchmarks for health impact assessment. Such an undertaking can set the stage and provide the necessary foundation for an effective health impact assessment process.

Examining emotional, physical, social, and spiritual health as determinants of self-rated health status.

PURPOSE: To determine whether individuals' perceptions of their emotional, physical, social, and spiritual health constitute elements of their self-rated health status operationalized with a commonly employed single indicator. DESIGN: Secondary analysis of cross-sectional survey data. Structural equation modeling with LISREL was used. SETTING: The Yukon Health Promotion Survey, Yukon Territory, Canada, 1993. SUBJECTS: The population-based sample was made up of 742 women and 713 men between 15 and 90 years of age; 80.3% responded. MEASURES: Self-rated health status was operationalized with the "excellent, good, fair, poor" indicator derived from the question: "In general, compared to other people your age, would you say your health is...." Social, spiritual, emotional, and physical health status were also self-rated from excellent to poor. RESULTS: The model's fit of the data was acceptable. Only physical health status significantly contributed to the variance in self-rated health status (55.1% of the variance was explained). Emotional, social, and spiritual health were found to have no effect on individuals' ratings of their health status. CONCLUSIONS: Although recent conceptualizations have broadened in much of the theoretical and political discourse about health, especially in health promotion, the self-rated health status indicator measures only physical health status.

Communicating cancer risk information: the challenges of uncertainty.

Developments in predictive testing for inherited cancers have focused attention on the accurate and sensitive communication of risk information. Although sharing risk information is often equated with genetic testing, it is important to acknowledge that the need for risk information related to familial cancer is also relevant to those not eligible for, or interested in, testing. Communicating cancer risk information is germane to a number of health professions including physicians, geneticists, genetic counsellors, psychologists, nurses, health educators and social workers. Based on a literature review of 75 research reports, expert opinion papers and clinical protocols, we provide a synthesis of what is known about the communication of cancer risk information and make recommendations for the enhancement of knowledge and practice in the field.

Twelve-month follow-up of a smoking relapse prevention intervention for postpartum women.

This study examined the long-term effectiveness of a postpartum smoking relapse prevention intervention by evaluating the smoking status and smoking cessation self-efficacy of original study participants at 12 months following delivery. Two hundred and thirty-eight women who had participated in a randomized clinical trial, a nurse-delivered relapse prevention intervention, were visited in their homes. Data were collected on smoking status, self-efficacy, mental health, alcohol use, breast feeding, social support, smoking in the social environment, and sociodemographics. Smoking status was verified with measures of carbon monoxide in expired air. The 12-month continuous smoking abstinence rate was 21.0% in the treatment group and 18.5% in the control group; odds ratio (OR) = 1.17, 95% confidence interval (CI) = 0.62-2.22. One half (50.4%) of the control group and 41.2% of the treatment group reported smoking daily at 12 months; OR = 1.45, 95% CI = 0.87-2.43. The treatment group attained higher self-efficacy. Four variables were associated with relapse to daily smoking; breast feeding and mental health had protective effects, while partners who smoked and greater amount smoked prior to pregnancy had adverse effects.

The incidence of wife abuse and mental health status in abused wives in Edmonton, Alberta.

To determine the incidence and type of wife abuse in relation to mental health status, a survey was undertaken in a community-based sample of wives. The incidence rate of physical abuse was 10.6%, psychological abuse 13.1%. Nearly all physically abused wives were psychologically abused. Wives at highest risk of abuse were those: 1) separated from their husbands in the previous year; 2) aged 18-44 years; 3) in relatively new relationships; 4) whose husbands were unemployed, in school or working part-time. Physically and psychologically abused wives had more somatic complaints, higher levels of anxiety and insomnia, greater social dysfunction and more symptoms of depression than non-abused wives. Alcohol dependency was associated with abuse; 16.3% of physically abused and 11.3% of psychologically abused wives were alcohol-dependent, compared to 2.4% of non-abused wives.

Urban-rural differences in the health-promoting behaviours of Albertans.

Few investigators have examined whether the behaviours undertaken to promote health differ with respect to geographic location. On the basis of data from a telephone survey of a probability sample of 853 Albertans, respondents were divided into groups according to residence in one of four geographic locations: large cities, small cities, towns, or rural settings, including villages and farms. When the confounding effects of sex, age, income and education were controlled for, those living in rural settings, compared with those living in large cities, were found to engage in healthier behaviours, including sleeping seven or more hours a day, eating three meals a day, and avoiding the excessive consumption of alcohol. A significantly greater proportion of individuals in geographic locations other than large cities reported that they frequently consumed fried and fatty foods. Although no geographic differences were noted in smoking, more town and rural dwellers placed smoking cessation as a priority for health improvement.

Stress, social support, and sense of coherence.

In the Salutogenic Model, Aaron Antonovsky suggested that a sense of coherence (SOC) is the key determinant in the maintenance of health. He theorized that individuals with a strong SOC have the ability to (a) define life events as less stressful (comprehensibility), (b) mobilize resources to deal with encountered stressors (manageability), and (c) possess the motivation, desire, and commitment to cope (meaningfulness). To determine the effects of SOC on health outcomes, a greater understanding of the development and maintenance of SOC is necessary. Data from the 1994 Canadian National Population Health Survey were analyzed to investigate the effects of stress, social support, and recent traumatic life events on SOC. As predicted, stress and recent traumatic events were found to be inversely related to SOC, and social support was positively related. Traumatic events encountered in childhood were stronger predictors of SOC than traumatic life events experienced in adulthood.

Indicators of exposure to wife abuse.

Data collected via a telephone survey of 406 randomly selected married (including common-law) women were analyzed with respect to 30 potential indicators of exposure to wife abuse. Women who reported exposure to wife abuse within the previous year were more likely than women free of abuse to have terminated their marriage, to have visited an emergency room, to have been hospitalized, and to have contacted public health nurses, psychiatrists, and psychologists, in the preceding year. They also were more likely to have sustained large bruises, lacerations, sprains or strains, and to have more frequent headaches and backaches, psychiatric morbidity, and alcoholism than women free of abuse. The abused women were likely to have more education than their partners, relatively lower total household incomes, and partners who were unemployed. Knowledge of significant indicators can facilitate the identification of women who have experienced wife abuse and lead to the development of more effective screening protocols.

Survey of nursing quality assurance programs in selected hospitals in Alberta, Canada.

This study represents a survey of the nursing quality assurance programs in 12 hospitals in Alberta. The objectives of the study were: to identify the nature, content and costs of the programs, to determine the extent of nurse involvement in the design and operation of the programs, and the value and importance nurses place on their programs. The major findings of the study tend to support the view that the principles of organizational change theory have not been adequately addressed in terms of nursing quality assurance programs. Generally, nurses reported that they were insufficiently informed concerning their programs. Among the study recommendations is a call for improvements in the audit tools used, with greater emphasis being placed on the patient and the nurse providing the care and more decentralization of programs to the unit level to improve staff involvement and program relevancy.

Smokers who fail to identify smoking cessation as a health priority.

BACKGROUND: Smokers who identified smoking cessation as the primary activity they could undertake to improve their health were compared with smokers who did not identify smoking cessation. Examined factors included personal characteristics, health status, smoking attitudes and behaviors, and social factors. METHODS: Subjects were 225 smokers who participated in a telephone survey of 853 randomly selected adults. RESULTS: Fifty-six percent of smokers did not identify smoking cessation as a priority. Nonidentifiers were more likely than identifiers to have minimal personal income, no paid employment, poor or fair health, dissatisfaction with their overall physical condition, less energy than others, little perceived control over their health, smoked fewer cigarettes per day, and reported no previous quit attempts. They were less likely to agree that they lacked the willpower to quit or that smoking helped them deal with stress. CONCLUSIONS: Smokers who fail to identify smoking cessation as a priority strategy for health improvement are unlikely to be exposed to workplace and social censures and should be targeted by health professionals.

Using structural equation modeling to examine factors that influence sunburn frequency and severity among adults living in Canada.

This study uses structural equation modeling to examine hypothesized relationships between sunburn and physical characteristics and potentially modifiable behavior. The analysis was based on self-reported data collected from a randomly selected national sample of Canadian adults. An initial model was tested with 50% of the cases (n = 1,408); the remaining cases (n = 1,298) were reserved for confirmatory testing. After the initial model failed, theoretically plausible effects were added incrementally to improve overall model fit. The initial model yielded: chi2(68 d.f.) = 3199.41 (P < .001) and the AGFI = .56. With 32 added effects, a fit model resulted in: chi2(36 d.f.) = 394.35 (P < .001), AGFI = 0.87, and IFI = 0.91 (the Critical-N was 210). Model fit was confirmed. Suntanning, failure to wear protective clothing, and sun exposure were associated with the frequency of severity-adjusted sunburns. Sunscreen use was not associated with sunburn frequency-severity.

Decentralization as a determinant of autonomy, job satisfaction, and organizational commitment among nurse managers.

The purpose of this study was to test a theoretical model of the following variables, decentralization, professional autonomy, job satisfaction, and organizational commitment. Data were collected through a comprehensive survey of first-line nurse managers (N = 200) in acute care hospitals with more than 100 beds in British Columbia, Canada. The final model excluded all explored personal characteristics of the nurse manager-gender, health or vitality status, marital status, age, education, and years of supervisory or management experience. Job satisfaction was found to be an important predictor of organizational commitment. However, decentralization was most important because it affected organizational commitment directly, as well as indirectly, through professional autonomy and job satisfaction.

Smoking relapse and early weaning among postpartum women: is there an association?

BACKGROUND: Smoking in the postpartum period may contribute to early weaning, although the nature and temporal aspect of the relationship are poorly understood. The objective of this study was to examine the association between early weaning and smoking relapse among women who stopped smoking during pregnancy. METHODS: A secondary analysis of data from a randomized controlled trial was conducted. The participants were 228 women who had stopped smoking for pregnancy, who participated in a smoking relapse prevention trial, and who breastfed. Women who relapsed to daily smoking postpartum were compared with those who remained abstinent or smoked occasionally. The dependent variable was breastfeeding for less than 26 weeks (early weaning). Potential covariates included intended duration of breastfeeding, parity, partner's smoking, nicotine dependence, emotional health, return to paid employment, and various sociodemographic variables. RESULTS: Approximately two-thirds (65.1%) of the women who relapsed to daily smoking weaned before 26 weeks compared with 33.8 percent of the women who remained abstinent or smoked occasionally. Controlling for intended duration of breastfeeding, education, and return to paid employment, women who resumed daily smoking were almost four times more likely to wean early than those who abstained or smoked occasionally. CONCLUSIONS: Early weaning may result from psychological or physiological changes associated with tobacco use. Smoking relapse prevention in the postpartum period may be one of the most effective interventions in ensuring that women who stop smoking for pregnancy remain stopped and breastfeed their babies for the recommended duration.

Narratives of smoking relapse: the stories of postpartum women.

Many women who stop smoking during pregnancy relapse soon after the birth of their infants. Using narrative research, experiences of smoking relapse were explored using interviews with 27 postpartum women. The stories of relapse were analyzed to identify important components, paying attention to commonalities, differences, and areas of emphasis. Five general story lines were identified: (1) controlling one's smoking (starting with a "puff" and consciously restricting the amount smoked); (2) being vulnerable to smoking(relapsing because of an inability to resist cigarettes); (3) nostalgia for one's former self(relapsing to recapture feelings of freedom and happier times); (4) smoking for relief(relapsing to manage emotions and stress); and (5) never really having quit (relapsing because they did not quit for themselves). The findings of this study provide support for the claim that the experiences of smoking cessation and relapse among postpartum women may be unique and, consequently, may require specialized intervention.

The effects of cognitive-perceptual factors on health promotion behavior maintenance.

A causal model that examines the role of cognitive-perceptual factors (control over health, self-efficacy, and health status) in health-promoting behavior maintenance was tested using a sample of 1,339 women who participated in a two-wave national health survey. The sample was split to reserve half the data for an uncompromised validity test of the model. Initial tests of the causal model indicated that the model did not fit the data. A minimally modified model fit the observed covariance data and explained about one third of the variance in the health-promoting behaviors (self-actualization, health responsibility, exercise, and nutrition). Validation of the model with the uncompromised half of the data further supported the model. Although the cognitive-perceptual factors were an integral part of the model, their effects on particular health-promoting behaviors were small in magnitude and contributed little to the explanation of the specific health-promoting behaviors or their stability.