The relationship between socioeconomic status/income and prevalence of diabetes and associated conditions: A cross-sectional population-based study in Saskatchewan, Canada.

INTRODUCTION: The role that socioeconomic status/income play in accounting for the increased prevalence of type 2 diabetes has not been sufficiently studied in Canada. The primary purpose of the present study was to determine the unadjusted and adjusted effect of income on type 2 diabetes. The secondary purpose was to determine the adjusted effect of income on diabetes associated conditions such as high blood pressure and being overweight or obese, and its main behavioral factor of physical inactivity. METHODS: This is a cross-sectional, population-based study. Data was analyzed from four cycles of the Canadian Community Health Survey (CCHS). It was conducted by Statistics Canada and covered the time period of 2000-2008 in the province of Saskatchewan, Canada. In this study, four separate and distinct multivariate models were built to determine the independent effect of income on type 2 diabetes and the associated conditions of high blood pressure, being overweight or obese, and physical inactivity. RESULTS: The total sample size was comprised of 27,090 residents from Saskatchewan. After statistically controlling for age, only six covariates were independently associated with type 2 diabetes prevalence including: having high blood pressure (OR = 3.26), visible minority cultural status (OR = 2.17), being overweight or obese (OR = 1.97), being of male gender (OR = 1.76), having a household income of $29,999 per year (OR = 1.63) and being physically inactive (OR = 1.15). CONCLUSIONS: In this study, household income was strongly and independently associated with type 2 diabetes prevalence, its associated conditions of high blood pressure and being overweight or obese, and its main behavioral factor of physical inactivity. We suggest that income is an important but frequently overlooked factor for type 2 diabetes and worthy of further investigation, appropriate public debate and timely policy intervention.

Risk Indicators of Depressed Mood Among Sex-Trade Workers and Implications for HIV Risk Behaviour.

OBJECTIVES: To determine the prevalence of depressed mood among people who have traded sex for money in the Saskatoon Health Region (SHR), the adjusted risk factors for depressed mood among this sample, and if depressed mood was associated with decreased self-efficacy for safe sexual practices and injection drug use. METHODS: Two-hundred ninety-nine people who have traded sex for money were surveyed with validated instruments for measuring risk behaviours, depressed mood, and self-efficacy for safe sexual practices. RESULTS: The sample consisted primarily of low-income, poorly educated Aboriginal women, many of whom also indicated using injection drugs. Using the 16-point score cut-off for the Center for Epidemiologic Studies Depression Scale, 84.6% of participants had depressed mood. When the cut-off score was 23 points or higher, 65.9% had depressed mood. After multivariate analysis, covariates that had an independent association with depressed mood included injecting a drug in the past 4 weeks (OR 1.59; 95% CI 1.2 to 1.8), suffering the death or permanent separation from a parent before the age of 18 (OR 2.09; 95% CI 1.05 to 4.15), and physical assault or abuse by a partner in adult life (OR 2.79; 95% CI 1.38 to 5.64). Depressed mood was associated with lower self-efficacy scores for safe sexual behaviours. CONCLUSIONS: Our study suggests that high rates of depressed mood among people who have traded sex for money is associated with injection drug use and low self-efficacy for safe sexual health practices. These findings are important and may help explain the high rates of human immunodeficiency virus within the SHR.

Income and heart disease: Neglected risk factor.

OBJECTIVE: To determine the unadjusted and adjusted effects of income on heart disease; its main disease intermediary, high blood pressure; and its main behavioural risk factors, smoking and physical inactivity. DESIGN: Random-digit dialing telephone survey collected through the Canadian Community Health Survey by Statistics Canada. SETTING: Saskatchewan. PARTICIPANTS: A total of 27 090 residents aged 20 years and older; each health region in Saskatchewan was represented. MAIN OUTCOME MEASURES: Overall, 178 variables related to demographic characteristics, socioeconomic factors, behaviour, life stress, disease intermediaries, health outcomes, and access to health care were analyzed to determine their unadjusted and adjusted effects on heart disease. RESULTS: The mean age of the sample was 52.6 years. Women represented 55.9% of the sample. Most respondents were married (52.3%) and had some postsecondary or graduate education (52.5%). The mean personal income was $23 931 and the mean household income was $37 533. All models statistically controlled for age. Five covariates independently associated with heart disease included high blood pressure, household income of $29 999 or less per year, being a daily smoker, male sex, and being physically inactive. Five covariates independently associated with high blood pressure included being overweight or obese, being a daily smoker, household income of $29 999 or less per year, male sex, and being physically inactive. Five covariates independently associated with daily smoking included being a visible minority, household income of $29 999 or less per year, not being overweight or obese, education level of less than secondary school, and male sex. Six covariates independently associated with physical inactivity included being a visible minority, being overweight or obese, education level of less than secondary school, male sex, household income of $29 999 or less per year, and being a daily smoker. CONCLUSION: Household income was strongly and independently associated with heart disease; its main disease intermediary, high blood pressure; and its main behavioural risk factors, smoking and physical inactivity. Income inequality is a neglected risk factor worthy of appropriate public debate and policy intervention.

Prevalence and risk indicators of alcohol abuse and marijuana use among on-reserve First Nations youth.

The objectives of the present study were to identify the prevalence of alcohol abuse and marijuana use among First Nations youth living on-reserve, and to identify independent risk indicators associated with these behaviours. Two hundred four students from the Saskatoon Tribal Council (Saskatchewan) who were enrolled in grades 5 through 8 were asked to complete a school health survey. The prevalence of alcohol abuse and marijuana use among First Nations on-reserve youth was 23.5% and 14.7%, respectively. Surprisingly, female First Nations youth were more likely to abuse alcohol and use marijuana than male First Nations youth. The prevalence of alcohol abuse and marijuana use among Saskatoon urban youth of the same age were only 5.4% and 2.7%, respectively. After regression analysis, five independent risk indicators were associated with alcohol abuse and marijuana use among First Nations on-reserve youth. The prevalence of alcohol abuse among First Nations on-reserve youth is higher than that in neighbouring urban youth of the same age.

La présente étude visait à déterminer la prévalence de consommation excessive d'alcool et de consommation de marijuana chez les jeunes des Premières nations qui habitent dans les réserves, ainsi que les indicateurs de risque indépendants associés à ces comportements. Deux cent quatre élèves de cinquième à huitième année du Conseil de bande de Saskatoon, au Canada, ont été invités à répondre à un sondage sur la santé en milieu scolaire. La prévalence de consommation abusive d'alcool et de consommation de marijuana chez les jeunes des Premières nations dans les réserves s'élevait à 23,5 % et 14,7 %, respectivement. Fait surprenant, les jeunes filles de ce groupe étaient plus susceptibles de consommer trop d'alcool et de consommer de la marijuana que les jeunes garçons. La prévalence de consommation excessive d'alcool et de consommation de marijuana chez les jeunes en milieu urbain de Saskatoon ne s'élevait qu'à 5,4 % et 2,7 %, respectivement. Après l'analyse de régression, cinq indicateurs de risque indépendants s'associaient à la consommation excessive d'alcool et à la consommation de marijuana chez les jeunes des Premières nations dans les réserves, dont la prévalence de consommation excessive d'alcool est plus élevée que celle des jeunes du même âge d'un milieu urbain voisin.

Risk indicators of suicide ideation among on-reserve First Nations youth.

BACKGROUND: Despite the known disparity in suicide rates in Canada, there is limited information on the independent risk indicators of suicide ideation among First Nations youth living on reserve. OBJECTIVE: To determine the prevalence and adjusted risk indicators for suicide ideation among on-reserve First Nations youth. METHODS: Saskatoon Tribal Council (Saskatchewan) First Nations students enrolled in grades 5 through 8 who were living on reserve were asked to complete a health survey using validated questionnaires. In total, 75.3% of the students completed the survey. The study was led by the Saskatoon Tribal Council with assistance from three departments at the University of Saskatchewan (Saskatoon, Saskatchewan). RESULTS: Among on-reserve First Nations youth, 23% experienced suicide ideation within the past 12 months. In comparison, 8.5% of Saskatoon urban youth and 19% of Saskatoon urban Aboriginal youth within the same grades experienced suicide ideation. Wanting to leave home (OR 13.91 [95% CI 3.05 to 63.42]), having depressed mood (OR 2.98 [95% CI 1.16 to 7.67]) and not feeling loved (OR 3.85 [95% CI 1.49 to 9.93]) were independently associated with suicide ideation among on-reserve youth. None of the children with a father who was professionally employed reported suicide ideation. CONCLUSIONS: Understanding the independent risk indicators associated with suicide ideation among First Nations youth living on reserve will hopefully aid in appropriate interventions.

HISTORIQUE: Malgré la disparité connue des taux de suicide au Canada, l'information sur les indicateurs de risque indépendants d'idéation suicidaire chez les jeunes des Premières nations qui habitent dans les réserves est limitée. OBJECTIF: Déterminer la prévalence et les indicateurs de risque rajustés d'idéation suicidaire chez les jeunes des Premières nations dans les réserves. MÉTHODOLOGIE: Les élèves de cinquième à huitième année des Premières nations du Conseil de bande de Saskatoon qui habitaient dans les réserves ont été invités à remplir un sondage sur la santé au moyen de questionnaires validés. Au total, 75,3 % des élèves ont répondu au sondage mené par le Conseil de bande de Saskatoon avec l'aide de trois départements de l'université de Saskatchewan, à Saskatoon. RÉSULTATS: Chez les jeunes des Premières nations de la réserve, 23 % avaient eu des idéations suicidaires au cours des 12 mois précédents. En comparaison, en milieu urbain de Saskatoon, 8,5 % des jeunes et 19 % des jeunes autochtones des mêmes années scolaires avaient eu des idéations suicidaires. Vouloir quitter la maison (RR 13,91 [95 % IC 3,05 à 63,42]), une humeur dépressive (RR 2,98 [95 % IC 1,16 à 7,67]) et le sentiment de ne pas être aimé (RR 3,85 [95 % IC 1,49 à 9,93]) s'associaient de manière indépendante aux idéations suicidaires chez les jeunes dans les réserves. Aucun des enfants dont le père occupait un emploi professionnel ne faisait état d'idéations suicidaires. CONCLUSIONS: On espère que le fait de comprendre les indicateurs de risque indépendants associés aux idéations suicidaires chez les jeunes des Premières nations qui habitent dans les réserves contribuera à la mise en œuvre d'interventions pertinentes.

Risk indicators associated with injection drug use in the Aboriginal population.

In 2009, the incidence of positive HIV tests in the Saskatoon Health Region, Canada, was 31.3 per 100,000 population when the national average was only 9.3 per 100,000 population. A majority of the positive HIV tests were of Aboriginal cultural status with a majority of those associated with injection drug use (IDU). The main objective of the study was to determine the risk indicators independently associated with higher rates of IDU in the Aboriginal population in comparison to other cultural groups. It appears that there is no another study with a similar analysis. From September 2009 to April 2010, 603 current IDUs were interviewed; which represents 76.6% of the known Saskatoon IDUs. In our study population, 88.1% of the current IDUs were of Aboriginal cultural status despite making up only 9.2% of the general population. Comparing Aboriginal IDUs to non-Aboriginal IDUs, our study found that Aboriginal injection users were more likely to be female and younger, less likely to receive paid income and were more likely to attend a Residential School or had a parent or grandparent attend a Residential School. If exposure to Residential Schools is ignored, Aboriginal IDUs were also more likely to use sex trading as a source of income and witness death or experience permanent separation from a parent during youth. Our study has identified a limited number of risk indicators independently associated with higher rates of IDU in the Aboriginal population. More specifically, Residential Schools are having a significant generational impact on current IDU, which might explain higher HIV incidence rates within the Aboriginal population.

Risk indicators and outcomes associated with bullying in youth aged 9-15 years.

OBJECTIVES: Bullying is a form of aggression in which children are intentionally intimidated, harassed or harmed. The main objective of our study was to determine the unadjusted and adjusted risk indicators associated with physical bullying. The second objective was to clarify the impact of repeated physical bullying on health outcomes - namely depressed mood. METHODS: Every student attending school in the city of Saskatoon, Canada, between grades 5-8 was asked to complete the Saskatoon School Health Survey. RESULTS: In total, 4,197 youth completed the questionnaire; of these, 23% reported being physically bullied at least once or twice in the previous four weeks. After multivariate adjustment, the covariates independently associated with being physically bullied included being male (OR=1.39), attending a school in a low-income neighbourhood (OR=1.41), not having a happy home life (OR=1.19), having a lot of arguments with parents (OR=1.16) and feeling like leaving home (OR=1.23). Children who were repeatedly physically bullied were more likely to have poor health outcomes. For example, 37.3% of children who were physically bullied many times per week had depressed mood in comparison to only 8.1% of children who were never bullied. After regression analysis, children who were ever physically bullied were 80% more likely to have depressed mood. CONCLUSION: Most of the independent risk indicators associated with physical bullying are preventable through appropriate social policy implementation and family support. It also appears that preventing repeated bullying should be the main focus of intervention in comparison to preventing more infrequent bullying.

Physical activity in youth: prevalence, risk indicators, and solutions.

OBJECTIVE: To determine the unadjusted and adjusted associations between developmental, environmental, psychological, social, or demographic factors and meeting the Health Canada physical activity standard. DESIGN: Survey. SETTING: Saskatoon, Sask. PARTICIPANTS: Every student in grades 5 to 8 in Saskatoon was asked to complete the Saskatoon School Health Survey; 4197 students did so. MAIN OUTCOME MEASURES: Whether students met the Health Canada standard for daily physical activity and associated risk factors for not meeting the standard. RESULTS: Among the 4197 youth who participated in the survey, only 7% met the Health Canada standard of daily physical activity longer than 1 hour of somewhat hard intensity or higher. Although there were 23 unadjusted factors associated with youth meeting the Health Canada standard, only 5 were significant after multivariate adjustment: 1) their fathers were employed (odds ratio [OR] 2.29, P = .027), 2) their parents watched them participate in physical activities or sports every day (OR 1.23, P < .001), 3) their friends encouraged them to do physical activities or sports every day (OR 1.19, P < .001), 4) their friends or classmates did not tease them for not doing well at physical activities or sports every day (OR 1.20, P = .001), and 5) they played sports or physical activities with coaches or instructors more than 4 times a week (OR 1.44, P < .001). CONCLUSION: Given the low rates of physical activity among youth, we believe that a reduced list of independent risk indicators is required to focus our limited human and financial resources for successful intervention in the community.

The short and long-term impact of the healthy kids initiative on depressed mood in youth living with obesity.

PURPOSE: The purpose of this study is to determine the effect of a free, comprehensive program with social support on depressed mood in youth (aged 11-17 years) living with obesity in a prospective, longitudinal, community-based study. METHODS: Youth living with obesity (BMI > 30), residing in three cities in Saskatchewan, Canada, were eligible to participate in a 12-week program designed to facilitate behavioural change with five physical activity sessions a week, one dietary session a week, and one group cognitive behavioural session per week offered by health care professionals. Baseline data were collected on depressed mood (Centre for Epidemiological Studies-Depression 12 or CES-D 12), health-related quality of life (SF-12), and self-esteem (NLSCY) at baseline, 12-weeks, and at 52-weeks RESULTS: Overall, 2598 youth started and 2292 (88.2 %) completed the 12-week program with 1703 (74.3 %) of participants presenting for 52-week follow-up. Depressed mood improved significantly over the course of the program: 79.2 % of participants had depressed mood at the start of the program and this decreased to 64.7 % at the end of 12-weeks; which was an overall relative reduction of 18.4 % (Cohen's d = 0.94). The mean CES-D 12 score at one-year was significantly lower than the mean baseline score (17.90 compared to 21.11, p < .001). By depressed mood severity, 58.7 % of participants had severe depressed mood at baseline, which reduced to 31.6 % at 12 weeks, and 27.9 % at 52 weeks. Age and maternal occupation were initially significantly associated with depressed mood at 52-week follow-up (unadjusted). However, after binary logistic regression was used to determine the independent risk factors for having depressed mood at 52-week follow up, only older age (OR 1.88, 95 % CI 1.52-2.34, p < .001) was significant. CONCLUSION: The Healthy Kids Initiative lends more evidence that healthy behavioural interventions can have a positive impact on depressed mood among youth living with obesity.

Risk indicators of depressive symptomatology among injection drug users and increased HIV risk behaviour.

OBJECTIVES: In 2009, the annual incidence of positive human immunodeficiency virus (HIV) test reports for people in the Saskatoon Health Region (SHR) was 31.3 per 100,000, when the national average was only 9.3 per 100 000. The first objective was to determine the prevalence of depressive symptomatology among injection drug users (IDUs) in the SHR. The second objective was to determine the unadjusted and adjusted risk indicators associated with depressive symptomatology among IDUs. The third objective was to determine if depressive symptomatology was associated with HIV risk behaviours. METHODS: From September 2009 to April 2010, 603 current IDUs were surveyed with validated instruments; this sample represents 76.6% of known IDUs in the SHR. RESULTS: Among the respondents, 81.4% reported depressive symptomatology, whereas 57.7% reported more severe depressive symptomatology. After multivariate analysis, the 4 covariates that had an independent association with depressive symptomatology included sexual assault as an adult, sexual assault as a child, attending a residential school, and having an annual income of less than $10,000 Depressive symptomatology was initially associated with 7 HIV risk behaviours. After multivariate analysis, depressive symptomatology was associated with giving sex to get money, giving drugs to get sex, and with more frequently sharing injecting equipment. CONCLUSIONS: This study found that depressive symptomatology was strongly associated with injection drug use.

Prevalence, risk indicators and outcomes of bullying among on-reserve First Nations youth.

OBJECTIVE: Bullying is common and multifaceted. There is no published literature focusing on bullying in First Nations youth on-reserve in Canada. The purpose of this paper is to examine the prevalence, risk indicators and impact of bullying within a First Nations youth population currently living on-reserve. METHODS: Students in grades 5 through 8 (age 10 to 16 years) within the Saskatoon Tribal Council were asked to complete a youth health survey. Among the seven schools, 271 students were eligible to participate. RESULTS: 204 youth completed the eight-stage consent protocol and the school survey for a response rate of 75.3%. Overall, 35.8% of youth reported being physically bullied, 59.3% verbally bullied, 47.5% socially bullied and 30.3% electronically bullied at least once or twice in the previous four weeks. After regression analysis, having a father who works in a professional occupation, doing well in school, and having the perception that parents expect too much from them were found to be independent risk indicators of being bullied. Irrespective of the type of bullying, youth who were bullied were at least twice as likely to suffer from depressed mood. DISCUSSION: We have found that bullying is more common for First Nations youth living on-reserve, compared to other Canadian youth. Given that the independent risk indicators also appear to be different, we hope that this new information can aid in the design of effective bullying strategies.

Prevalence and risk indicators of depressed mood in on-reserve first nations youth.

OBJECTIVES: The first objective was to determine the prevalence of depressive mood in First Nations youth in school grades 5 through 8 in seven on-reserve communities. The second objective was to determine the unadjusted and adjusted risk indicators associated with depressed mood in these youth. METHODS: Students in grades 5 through 8 in the seven reserve communities of the Saskatoon Tribal Council were asked to complete a paper and pencil, comprehensive youth health survey in May 2010. An eight-stage consent protocol was followed prior to participation. RESULTS: Out of 271 students eligible to participate, 204 youth completed the survey for a response rate of 75.3%. Using the Center for Epidemiological Studies of Depression scale, 25% of the youth had moderate depressive symptoms. After cross-tabulation, 1 socioeconomic variable, 10 social variables, 3 social support variables, 1 self-esteem variable, 5 parental relationship variables and 3 bullying variables were associated with depressed mood. Logistic regression was used to determine four independent risk indicators associated with having depressed mood in First Nations youth, including: 1) not having worked through things that happened during childhood, 2) not having someone who shows love and affection, 3) having a lot of arguments with parents and 4) being physically bullied at least once per week. CONCLUSIONS: Our study found high rates of depressed mood in on-reserve First Nations youth. These youth are now at increased risk for problems later in life unless successful interventions can be implemented.

Mental health and socioeconomic status impact adherence to youth activity and dietary programs: a meta-analysis.

PURPOSE: Substantial efforts have gone into reducing the physiological and psychological harm of obesity in youth, but few studies have reviewed the factors contributing to adherence to pediatric weight management programs. The attrition rates to programs offering multiple components to address BMI improvement and healthy lifestyle change among youth are quite high. The purpose of this study is to review the literature for factors contributing to adherence to these programs among children and youth with obesity and determine pooled effect of these factors. METHODS: A systematic literature search and meta-analysis was conducted through the PubMed database on pediatric weight management interventions offering at least physical activity and dietary support for obese youth aged 10-17 years, where variables contributing to adherence were reported. Only those studies achieving a threshold of methodological rigour were included. RESULTS: Altogether, seven studies were included in the analysis. There was a pooled RR of lower socioeconomic status on non-adherence of 1.34 [95% confidence intervals 1.19-1.52] and poorer mental health on non-adherence of 1.12 [95% confidence intervals 1.08-1.17]. CONCLUSION: It is important to address barriers related to lower socioeconomic status in pediatric weight management programs to increase adherence. Further, addressing supports for those with poorer mental health can reduce the risk of non-adherence in multi-disciplinary programs targeting youth with obesity.

The Healthy Kids Initiative: Results from the First 2000 Participants.

PURPOSE: The comprehensive and free Healthy Kids Initiative (HKI) was developed with key features including social support, family support, and cognitive behavior education in order to promote program completion and improve health outcomes among youth. The first objective was to determine program completion rates and independent risk indicators for non-completion. The second objective was to determine the 12-week impact of the Healthy Kids Initiative on aerobic fitness, depressed mood and health-related quality of life. PATIENTS AND METHODS: Obese youth (ages 10-17) were referred to a community-based, multidisciplinary, free program by their doctor or pediatrician. Each participant was requested to attend the program with a "buddy" and complete three social support contracts with family and friends to support their behavioral modifications. The program duration was 12 weeks with physical activity, dietary, and cognitive behavior education sessions. Those who completed the program, and those who did not, were compared across socioeconomic variables, age, gender, depressed mood and aerobic fitness. RESULTS: Across five cohorts, 1789 of 1995 youth completed the program (89.7% completion rate). Five referred youth never started. Independent risk indicators associated with non-completion included older age (OR 3.07, 95% CI 2.26-4.17; p<0.001), mother with a non-professional occupation (OR 1.84, 95% CI 1.22-2.78; p=0.004), and living in a low-income neighborhood (OR 9.37, 95% CI 5.61-15.65; p<0.001). There were significant improvements from baseline for aerobic fitness (mCAFT score 35.84 to 55.72 mL × kg -1 × min-1; p<0.001), depressed mood (mean CES-D 12 score 21.47 to 17.40; p<0.001), and health-related quality of life (mean SF-12 score 23.4 to 33.8; p<0.001). CONCLUSION: The HKI program had high completion rates and early success in improving outcomes. Knowing the independent risk indicators for non-completion will allow for program revision to help at-risk participants complete the program.

The effects of household income distribution on stroke prevalence and its risk factors of high blood pressure and smoking: a cross-sectional study in Saskatchewan, Canada.

BACKGROUND: Stroke is a major chronic disease and a common cause of adult disability and mortality. Although there are many known risk factors for stroke, lower income is not one that is often discussed. AIMS: To determine the unadjusted and adjusted association of income distribution on the prevalence of stroke in Saskatchewan, Canada. METHODS: Information was collected from the Canadian Community Health Survey conducted by Statistics Canada for 2000-2008. In total, 178 variables were analysed for their association with stroke. RESULTS: Prior to statistical adjustment, stroke was seven times more common for lower income residents than higher income residents. After statistical adjustment, only four covariates were independently associated with stroke prevalence, including having high blood pressure (odds ratio (OR) = 2.62; 95% confidence interval (CI) = 2.12-3.24), having a household income below CAD$30,000 per year (OR = 2.49; 95% CI = 1.88-3.29), being a daily smoker (OR = 1.36; 95% CI = 1.16-1.58) and being physically inactive (OR = 1.27; 95% CI = 1.13-1.43). After statistical adjustment, there were five covariates independently associated with high blood pressure prevalence, including having a household income below CAD$30,000 per year (OR = 1.52; 95% CI = 1.41-1.63). After statistical adjustment, there were five covariates independently associated with daily smoking prevalence, including having a household income below CAD$30,000 per year (OR = 1.29; 95% CI = 1.25-1.33). CONCLUSIONS: Knowledge of disparities in the prevalence, severity, disability and mortality of stroke is critically important to medical and public health professionals. Our study found that income distribution was strongly associated with stroke, its main disease intermediary - high blood pressure - and its main risk factor - smoking. As such, income is an important variable worthy of public debate as a modifiable risk factor for stroke.

Shifting the balance: conceptualising empowerment in individuals with spinal cord injury.

Empowerment is believed to be an essential element in self-management of disease and the promotion of self-efficacy, and can be defined as the ability of individuals to increase control over aspects of their lives. In contrast, powerlessness in individuals with chronic illness can occur when they perceive that they lack the capacity, authority or resources to affect an outcome. Individuals with spinal cord injuries (SCIs) are at risk for powerlessness and have the potential to become empowered, but these concepts have not been explored within their context. The purpose of this study was to explore how individuals with SCI enact the empowerment process using Lord's (1991) process of empowerment framework. This study used a secondary analysis of a data set obtained from a mixed methods study exploring access to health and social care for 23 persons with SCI in Saskatchewan, Canada. The primary study data were collected from September 2012 to January 2013. The secondary analysis of data utilised a deductive thematic analysis approach and findings were conceptualised and applied to a model that represents the shift in balance between powerlessness and empowerment in individuals with SCI.

The Healthy Weights Initiative: a community-based obesity reduction program with positive impact on depressed mood scores.

OBJECTIVES: The risk for many chronic diseases increases with obesity. In addition to these, the risk for depression also increases. Exercise interventions for weight loss among those who are not overweight or obese have shown a moderate effect on depression, but few studies have looked at those with obesity. The objectives of this study were to determine 1) the prevalence of depressed mood in obese participants as determined by the Beck Depression Inventory II at baseline and follow-up; 2) the change in depressed mood between those who completed the program and those who did not; and 3) the differences between those whose depressed mood was alleviated after the program and those who continued to have depressed mood. METHODS: Depressed mood scores were calculated at baseline and follow-up for those who completed the program and for those who quit. Among those who completed the program, chi-squares were used to determine the differences between those who no longer had depressed mood and those who still had depressed mood at the end of the program, and regression analysis was used to determine the independent risk factors for still having depressed mood at program completion. RESULTS: Depressed mood prevalence decreased from 45.7% to 11.7% (P<0.000) from baseline to follow-up among those who completed the program and increased from 44.8% to 55.6% (P<0.000) among those who quit. After logistic regression, a score of <40 in general health increased the risk of still having depressed mood upon program completion (odds ratio [OR] 3.39; 95% CI 1.18-9.72; P=0.023). CONCLUSION: Treating depressed mood among obese adults through a community-based, weight-loss program based on evidence may be an adjunct to medical treatment. More research is needed.

Improving health-related quality of life through an evidence-based obesity reduction program: the Healthy Weights Initiative.

When evaluating any health intervention, it is critical to include the impact of the intervention on health-related quality of life (HRQL). Among those who are obese, HRQL is often lower than the general population and even more when considering obesity-related comorbidities and bodily pain. The objectives of this paper were to determine the impact of a multidisciplinary, community-based obesity reduction program on HRQL and to determine the independent risk factors for lack of improvement from baseline to follow-up. HRQL was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at baseline and follow-up (24 weeks). To date, 84.5% of those who completed the program had improvements in their overall SF-36 score. Significant increases in the mean scores on eight dimensions of health were also observed. Lack of improvement was independently affected by smoking status (odds ratio 3.75; 95% confidence interval 1.44-9.78; P=0.007) and not having a buddy to attend the program (odds ratio 3.70; 95% confidence interval 1.28-10.68; P=0.015). Obesity reduction programs that target increasing exercise, improving diet, and cognitive behavioral therapy can positively impact HRQL in obese adults. Social support has a strong role to play in improving outcomes.

Third-world realities in a first-world setting: A study of the HIV/AIDS-related conditions and risk behaviors of sex trade workers in Saskatoon, Saskatchewan, Canada.

The transmission and prevalence of Human Immunodeficiency Virus (HIV) among those employed as sex trade workers (STW) is a major public health concern. The present study describes the self-reported responses of 340 STW, at-risk for contracting HIV. The participants were recruited by selective targeting between 2009 and 2010 from within the Saskatoon Health Region (SHR), Saskatchewan, Canada. As of 2012, the SHR has the highest incidence rate of positive test reports for HIV in Canada, at more than three times the national average (17.0 vs. 5.9 per 100,000 people). Additionally, the epidemiology of HIV/AIDS in the SHR is different from that seen elsewhere in Canada (still mostly men having sex with men and Caucasians), with its new HIV cases predominantly associated with injection drug use and Aboriginal cultural status. The purpose of this study was to (a) describe the demographic and socio-economic characteristics of the STW in the SHR, (b) identify their significant life events, self-reported problems, knowledge, attitudes, behaviors, self-efficacy, and barriers regarding HIV, and (c) determine the significant independent risk indicators for STW self-reporting a chance of greater than 50% of becoming infected with HIV/AIDS. The majority of the study participants were females, who were never married, of Aboriginal descent, without a high school diploma, and had an annual income of less than $10,000. Using multivariate regression analysis, four significant independent risk indicators were associated with STW reporting a greater that 50% chance of acquiring HIV/AIDS, including experiencing sexual assault as a child, injecting drugs in the past four weeks, being homeless, and a previous Chlamydia diagnosis. These findings provide important evidence of the essential sexual and drug-related vulnerabilities associated with the risk of HIV infection among STW and offer insight into the design and implementation of effective and culturally sensitive public health intervention and prevention efforts. To be most effective, it is recommended that such intervention and prevention initiatives: (1) use specifically tailored community-based outreach to high risk STW who are drug users and link them with appropriate drug treatment and HIV/AIDS prevention and treatment services, (2) provide free and confidential, routine HIV counseling and testing in substance abuse programs, and (3) build capacity among the local, Aboriginal NGOs so as to address with cultural sensitivity both the drug and HIV-related risk factors prevalent among this vulnerable population.

Weight loss intervention adherence and factors promoting adherence: a meta-analysis.

BACKGROUND: Adhering to weight loss interventions is difficult for many people. The majority of those who are overweight or obese and attempt to lose weight are simply not successful. The objectives of this study were 1) to quantify overall adherence rates for various weight loss interventions and 2) to provide pooled estimates for factors associated with improved adherence to weight loss interventions. METHODS: We performed a systematic literature review and meta-analysis of all studies published between January 2004 and August 2015 that reviewed weight loss intervention adherence. RESULTS: After applying inclusion and exclusion criteria and checking the methodological quality, 27 studies were included in the meta-analysis. The overall adherence rate was 60.5% (95% confidence interval [CI] 53.6-67.2). The following three main variables were found to impact adherence: 1) supervised attendance programs had higher adherence rates than those with no supervision (rate ratio [RR] 1.65; 95% CI 1.54-1.77); 2) interventions that offered social support had higher adherence than those without social support (RR 1.29; 95% CI 1.24-1.34); and 3) dietary intervention alone had higher adherence than exercise programs alone (RR 1.27; 95% CI 1.19-1.35). CONCLUSION: A substantial proportion of people do not adhere to weight loss interventions. Programs supervising attendance, offering social support, and focusing on dietary modification have better adherence than interventions not supervising attendance, not offering social support, and focusing exclusively on exercise.