Associations between neighborhood safety, availability of recreational facilities, and adolescent physical activity among Canadian youth.

BACKGROUND: The safety of neighborhoods and availability of parks and facilities may influence adolescent physical activity independently or interactively. METHODS: 9114 Canadians in grades 6 to 10 completed the 2006 Health Behavior in School-Aged Children Survey. The outcome of interest was students' self-reported participation in moderate-to-vigorous physical activity outside of school. A composite scale based on questions measuring student perceptions of safety was used to capture individual perceptions of safety. In addition, schools were grouped into quintiles based on the mean of the perceived safety scale, used as a proxy for peer perceptions. The number of parks and recreational facilities within 5 km of schools was abstracted from a geographical information system. RESULTS: Moderate gradients in physical activity were observed according to individual and group perceptions of safety. Boys and girls with the highest perceptions of safety were 1.31 (95% CI: 1.17-1.45) and 1.45 (1.26-1.65) times more likely to be physically active, respectively, than those with the lowest perceptions. Compared with those who perceived the neighborhood as least safe, elementary students in higher quintiles were 1.31, 1.39, 1.37, and 1.56 times more likely to be physically active (P(trend) = 0.012). Increased numbers of recreational features were not related to physical activity irrespective of neighborhood safety. CONCLUSIONS: Individual and group perceptions of neighborhood safety were modestly associated with adolescents' physical activity.

Home blood pressure monitoring among Canadian adults with hypertension: results from the 2009 Survey on Living with Chronic Diseases in Canada.

BACKGROUND: Canadians with hypertension are recommended to use home blood pressure monitoring (HBPM) on a regular basis. OBJECTIVES: To characterize the use of HBPM among Canadian adults with hypertension. METHODS: Respondents to the 2009 Survey on Living with Chronic Diseases in Canada who reported diagnosis of hypertension by a health professional (n=6142) were asked about blood pressure monitoring practices, sociodemographic characteristics, management of hypertension and blood pressure control. RESULTS: Among Canadian adults with hypertension, 45.9% (95% CI 43.5% to 48.3%) monitor their own blood pressure at home, 29.7% (95% CI 41.1% to 46.3%) receive health professional instruction and 35.9% (95% CI 33.5% to 38.4%) share the results with their health professional. However, fewer than one in six Canadian adults diagnosed with hypertension monitor their own blood pressure at home regularly, with health professional instruction, and communicate results to a health professional. Regular HBPM was more likely among older adults (45 years of age and older); individuals who believed they had a plan for how to control their blood pressure; and those who had been shown how to perform HBPM by a health professional - with the latter factor most strongly associated with regular HBPM (prevalence rate ratio 2.8; 95% CI 2.4 to 3.4). CONCLUSIONS: Although many Canadians with hypertension measure their blood pressure between health care professional visits, a minority do so according to current recommendations. More effective knowledge translation strategies are required to support self-management of hypertension through home measurement of blood pressure.

Blood pressure in Canadian adults.

BACKGROUND: Hypertension is estimated to cause more than one-eighth of all deaths worldwide. In Canada, the last national surveys to include direct measures of blood pressure (BP) took place over the years 1985-1992; hypertension was estimated at 21%. DATA AND METHODS: Data are from cycle 1 of the Canadian Health Measures Survey, conducted from March 2007 through February 2009. The survey included direct BP measures using an automated device. Weighted frequencies, means and cross-tabulations were produced to estimate levels of hypertension awareness, treatment and control in the population aged 20 to 79 years. RESULTS: Among adults aged 20 to 79 years, hypertension (systolic BP higher than or equal to 140 or diastolic BP higher than or equal to 90 mm Hg, or self-reported recent medication use for high BP) was present in 19%. Another 20% had BP in the pre-hypertension range (systolic 120 to 139 or diastolic 80 to 89 mm Hg). Of those with hypertension, 83% were aware, 80% were taking antihypertensive drugs, and 66% were controlled. Uncontrolled hypertension was largely due to high systolic BP. INTERPRETATION: Hypertension prevalence is similar to that reported in 1992. Since then, the level of hypertension control has increased considerably.

Associations between school recreational environments and physical activity.

BACKGROUND: School environments may promote or hinder physical activity in young people. The purpose of this research was to examine relationships between school recreational environments and adolescent physical activity. METHODS: Using multilevel logistic regression, data from 7638 grade 6 to 10 students from 154 schools who participated in the 2005/06 Canadian Health Behaviour in School-Aged Children Survey were analyzed. Individual and cumulative effects of school policies, varsity and intramural athletics, presence and condition of fields, and condition of gymnasiums on students' self-reported physical activity (>or=2 h/wk vs <2 h/wk) were examined. RESULTS: Moderate gradients in physical activity were observed according to number of recreational features and opportunities. Overall, students at schools with more recreational features and opportunities reported higher rates of class-time and free-time physical activity; this was strongest among high school students. Boys' rates of class-time physical activity were 1.53 (95% confidence interval (CI) = 1.12-1.80) times as high at high schools with the most recreational features as at schools with the fewest. Similarly, girls' rates of free-time physical activity at school were 1.62 (95% CI: 0.96-2.21) times as high at high schools with the most opportunities and facilities as compared to schools with the fewest. Modest associations were observed between individual school characteristics and class-time and free-time physical activity. CONCLUSIONS: Taken together, the cumulative effect of school recreational features may be more important than any one characteristic individually.

The distribution and predictive validity of the stages of change for mammography adoption among Canadian women.

OBJECTIVE: To examine the predictive validity of the transtheoretical model (TTM) stages of change for mammography participation in Canadian women. METHOD: We examined the association between baseline TTM stage of mammography adoption and subsequent mammography participation in a representative sample of 3,125 Canadian women aged 40 and older from the longitudinal Canadian National Population Health Survey. RESULTS: The likelihood of having a mammogram at follow-up (1998/1999) increased with progressive stages of change at baseline (1996/1997) even after adjusting for potential confounders. Relative to women in maintenance, women in precontemplation, relapse, contemplation, relapse risk, and action were significantly less likely to report a recent mammogram during follow-up (adjusted RR of 0.41, 0.50, 0.63, 0.75, and 0.92, respectively; P(trend) < 0.01). This pattern held for women within and outside of the 50-69 target age range, and for urban and to a lesser degree rural-dwelling women. CONCLUSION: Our findings support the predictive validity of the TTM stages of mammography adoption construct and the inclusion of both relapse and relapse risk categories to improve the sensitivity of the predictive model. Interventions to promote the eventual maintenance of mammography screening should also benefit from further research that aims to understand the variables that promote progressive movement through the stages.