Using the intervention ladder to examine policy influencer and general public support for potential tobacco control policies in Alberta and Quebec. / Utilisation d'une échelle d'intervention pour analyser le soutien à d'éventuelles politiques de lutte contre le tabagisme de la part du grand public et d'influenceurs en matière de politiques en Alberta et au Québec.

OBJECTIVE: To assess general public and policy influencer support for population-level tobacco control policies in two Canadian provinces. METHODS: We implemented the Chronic Disease Prevention Survey in 2016 to a census sample of policy influencers (n = 302) and a random sample of members of the public (n = 2400) in Alberta and Quebec, Canada. Survey respondents ranked their support for tobacco control policy options using a Likert-style scale, with aggregate responses presented as net favourable percentages. Levels of support were further analyzed by coding each policy option using the Nuffield Council on Bioethics intervention ladder framework, to assess its level of intrusiveness on personal autonomy. RESULTS: Policy influencers and the public considered the vast majority of tobacco control policy options as "extremely" or "very" favourable, although policy influencers in Alberta and Quebec differed on over half the policies, with stronger support in Quebec. Policy influencers and the public strongly supported more intrusive tobacco control policy options, despite anticipated effects on personal autonomy (i.e. for policies targeting children/youth and emerging tobacco products like electronic cigarettes). They indicated less support for fiscally based tobacco control policies (i.e. taxation), despite these policies being highly effective. CONCLUSION: Overall, policy influencers and the general public strongly supported more restrictive tobacco control policies. This study further highlights policies where support among both population groups was unanimous (potential "quick wins" for health advocates). It also highlights areas where additional advocacy work is required to communicate the population-health benefit of tobacco control policies.

Letramento nutricional: desempenho de dois grupos populacionais brasileiros / Nutrition literacy: performance of two Brazilian population groups

In this study, we aimed to compare the level of nutritional literacy of twodifferent population groups. It is a cross-sectional quantitative study withsecondary data analysis. We investigated 140 individuals, both maleand female, divided in two groups: 70 were customers of a mall (Group1) and 70 were patients of the National Health System - NHS (Group 2)in Fortaleza, Ceará state, Brazil. The level of nutritional literacy wasdetermined by the Nutritional Literacy Scale (NLS) questionnaire, whichwas translated into Portuguese. The two groups were compared usingChi-square test or Fisher exact test and Student?s t test, adopting p<0.05as significance level. Adequate performance was found in the NLS evaluation, which was different from the literature results. Group 2 showed worse performance (p<0.05) when compared with Group 1 for both male and female participants. The educational background of participants also influenced this performance. There were significant statistical differences according to most groups of questions considering the total female individuals. Male participants presented the best performance. The present study demonstrated that there are different performances considering various issues related to nutrition and the population groups evaluated. Further investigation should be carried out for the design of educational activities. It is suggested that the instruments of nutritional literacy assessment be validated for the Brazilian population.

Comparar el grado de letramento nutricional de dos grupos de población diferentes. Estudio transversal, de naturaleza cuantitativa, con análisis de datos secundarios. Participaron del mismo 140 individuos de ambos sexos, siendo 70 visitantes de un centro comercial (grupo 1) y 70 pacientes de la Seguridad Social - SS (grupo 2) de la ciudad de Fortaleza, Ceará. El grado de letramento nutricional se determinó mediante un cuestionario Escala de Letramento nutricional (NLS), traducido al portugués. Los grupos se compararon mediante el test de Chi-cuadrado o el test exacto de Fisher y el test t-Student, adoptándose una p<0,05 como nivel de significación. A diferencia de lo expuesto en la literatura, en el presente estudio el desempeño de los entrevistados en el NLS fue equivalente a un letramento nutricional adecuado, siendo, sin embargo, inferior entre los miembros del grupo 2 (p<0,05) para ambos sexos. La escolaridad también influenció el desempeño en el referido instrumento. Al analizar los bloques de preguntas que formaban parte del NLS, hubo diferencias estadísticamente significativas entre las respuestas conferidas, para la mayoría de las preguntas, por las mujeres pertenecientes al grupo 1, cuando fueron comparadas a las del grupo 2. Ya entre los hombres, al comparar las respuestas entre los dos grupos (1 y 2) la diferencia no resultó significativa. El presente estudio demostró que existen desempeños diferenciados teniendo en cuenta tanto los diversos temas ligados a lanutrición como el grupo poblacional evaluado, y que dicho aspecto debe ser investigado para el delineamiento de las acciones educativas. Sesugiere realizar la validación de instrumentos que midan el letramento nutricional para la población brasileña.

Comparar o grau de letramento nutricional de dois diferentes grupos populacionais. Estudo transversal, de natureza quantitativa, com análise de dados secundários. Participaram do mesmo 140 indivíduos de ambos os gêneros, sendo 70 frequentadores de um shopping center (grupo 1) e 70 pacientes do Sistema Único de Saúde ? SUS (grupo 2) da cidade de Fortaleza, Ceará. O grau de letramento nutricional foi determinado por meio do questionário Nutritional Literacy Scale (NLS), traduzido para o português. Os grupos foram comparados por meio dos testes Qui-quadrado ou Exato de Fisher e do teste t de Student, adotando-se p<0,05 como nível de significância. Diferentemente do exposto na literatura,no presente estudo, o desempenho dos entrevistados no NLS foi equivalente a um letramento nutricional adequado, sendo, no entanto,inferior entre os integrantes do grupo 2 (p<0,05), para ambos os gêneros. A escolaridade também influenciou o desempenho no referido instrumento.Ao se analisarem os blocos de questões que integravam o NLS, houve diferenças estatisticamente significativas entre as respostas conferidas,para a maioria das questões, pelas mulheres pertencentes ao grupo 1, quando comparadas às do grupo 2. Já entre os homens, a maioria dascomparações de respostas entre os dois grupos (1 e 2) não foi estatisticamente significativa. O presente estudo demonstrou que há desempenhos diferenciados, considerando-se diversos temas ligados à Nutrição e o grupo populacional avaliado; assim, tal aspecto deve ser investigado para o delineamento de ações educativas. Sugere-se arealização de validação de instrumentos de aferição de letramento nutricional para a população brasileira.

Reconstructing population exposures to environmental chemicals from biomarkers: challenges and opportunities.

A conceptual/computational framework for exposure reconstruction from biomarker data combined with auxiliary exposure-related data is presented, evaluated with example applications, and examined in the context of future needs and opportunities. This framework employs physiologically based toxicokinetic (PBTK) modeling in conjunction with numerical "inversion" techniques. To quantify the value of different types of exposure data "accompanying" biomarker data, a study was conducted focusing on reconstructing exposures to chlorpyrifos, from measurements of its metabolite levels in urine. The study employed biomarker data as well as supporting exposure-related information from the National Human Exposure Assessment Survey (NHEXAS), Maryland, while the MENTOR-3P system (Modeling ENvironment for TOtal Risk with Physiologically based Pharmacokinetic modeling for Populations) was used for PBTK modeling. Recently proposed, simple numerical reconstruction methods were applied in this study, in conjunction with PBTK models. Two types of reconstructions were studied using (a) just the available biomarker and supporting exposure data and (b) synthetic data developed via augmenting available observations. Reconstruction using only available data resulted in a wide range of variation in estimated exposures. Reconstruction using synthetic data facilitated evaluation of numerical inversion methods and characterization of the value of additional information, such as study-specific data that can be collected in conjunction with the biomarker data. Although the NHEXAS data set provides a significant amount of supporting exposure-related information, especially when compared to national studies such as the National Health and Nutrition Examination Survey (NHANES), this information is still not adequate for detailed reconstruction of exposures under several conditions, as demonstrated here. The analysis presented here provides a starting point for introducing improved designs for future biomonitoring studies, from the perspective of exposure reconstruction; identifies specific limitations in existing exposure reconstruction methods that can be applied to population biomarker data; and suggests potential approaches for addressing exposure reconstruction from such data.

Cross classification of the New Zealand population by ethnicity and deprivation: trends from 1996 to 2006.

OBJECTIVES: To describe trends in the distribution of New Zealand's major ethnic groups by small area deprivation and trends in the ethnic composition of each deprivation category. METHODS: Data sources were the 1996, 2001 and 2006 New Zealand Census of Population and Dwellings. Ethnicity (Maori, Pacific, Asian or European/Other) was defined using total response output. Each person was assigned a deprivation score by geocoding their usual residence (as recorded in the census) to meshblock level. For each time period (1996, 2001 and 2006) the deprivation score for each meshblock was calculated by principal components analysis from nine socio-economic variables included in the corresponding census (the New Zealand Index of Deprivation). RESULTS: Throughout the observation period, Maori and Pacific ethnic groups were over-represented at the more deprived and under-represented at the less deprived end of the deprivation spectrum. The European ethnic group displayed less-marked skewing, and in the opposite direction, while the Asian ethnic group showed close to the expected uniform distribution. Neither the deprivation distribution of any ethnic group, nor the ethnic composition of any deprivation decile, showed any statistically significant change over the 10-year observation period. CONCLUSIONS: Monitoring trends in the relative deprivation distributions of the ethnic groups helps assess progress towards social justice. Similarly, monitoring trends in the ethnic compositions of the different deprivation deciles is important in the formulation of social policy. Little change was found in either of these distributions over the relatively short observation period.

Management of trauma in special populations after a disaster.

Special populations are particularly vulnerable to mental health problems in the aftermath of a disaster. Efficient delivery of mental health services, the integrated use of psychosocial services and mental health facilities, and the active intervention of trained community health care workers can offer effective management of the psychosocial problems of special populations. Women, children, adolescents, the poor, the elderly, and individuals with preexisting health problems have been identified as special populations who often suffer psychological morbidity as a result of a catastrophic disaster. Understanding the cultural, ethnic, and socioeconomic factors in a postdisaster situation is crucial to helping special populations overcome debilitating mental illness and declining quality of life. Planning the delivery of mental health services is critical and includes hazard mapping to identify vulnerable geographic and social areas, screening instruments to identify at-risk populations, and education of community leaders and health care workers. An integrated approach using psychosocial and institutionalized interventions can provide better outcomes than either approach alone. A community-based approach with trained grassroots health care workers can provide effective psychosocial support and rehabilitation services.