Accessing support before or after a parent dies from cancer and young people's current wellbeing.

PURPOSE: To examine differences in distress and unmet needs between bereaved adolescent and young adult (AYA) offspring who accessed support before and after being bereaved by parental cancer, and to explore aspects of their cancer experience that influenced their help-seeking. METHODS: Phase 1: Surveys completed by AYAs (11-26 years) bereaved by parental cancer were subjected to analysis of covariance examining differences in distress and unmet needs between those who accessed support before (n = 159) and after (n = 212) parental bereavement. Phase 2: Semi-structured interviews explored the cancer experiences of bereaved offspring (n = 8) and factors that influenced their decision to seek support. RESULTS: Phase 1: There were no significant group differences in distress and unmet needs; however, older and female AYAs reported higher levels of distress and unmet needs. Interestingly, individuals who accessed support pre-bereavement were older on average (M = 17.35 years, SD = 3.26) than those who accessed support post-bereavement (M = 15.73 years, SD = 3.26). Phase 2: Three themes emerged centred on socio-emotional developmental changes during and after the cancer trajectory. These related to: participants' meaning-making and changes in understanding of the cancer experience, changing relationships and desires to fit in, and understanding of their own emotional needs. CONCLUSIONS: While no differences were found in unmet needs and distress between those who sought support pre- or post-bereavement, those seeking support pre-bereavement were older on average. Social and emotional development impacts how bereaved offspring access psychosocial support. Awareness of these issues can assist in improving support by ensuring services are age appropriate and families are sufficiently supported.

Challenges in assessing the implementation and effectiveness of physical activity and nutrition policy interventions as natural experiments.

The Ontario (Canada) government has instituted a policy requiring elementary schools to offer at least 20 min of daily physical activity for students in Grades 1-8 and replace non-nutritious vending machine foods with healthier choices. These policy interventions represent 'natural experiments' offering unique opportunities for conducting research and evaluation. The use of natural experiments to contribute evidence on the effectiveness of policy interventions is identified as an underused tool for public health [Tudor-Locke, C., Ainsworth, B. E. and Popkin, B. M. (2001) Active commuting to school: an overlooked source of children's physical activity? Sports Medicine, 31, 309-313; Petticrew, M., Cummins, S., Ferrell, C., Findlay, A., Higgins, C., Hoy, C. et al. (2005) Natural experiments: an underused tool for public health? Public Health, 119, 751-757]. To date, some Canadian school-based food and nutrition policies are being monitored, but their impact on child and youth obesity is unknown [Canadian Institute for Health Information. (2006) Improving the Health of Canadians: Promoting Healthy Weights, Ottawa, ON]. There are a number of challenges to the evaluation of policy interventions as natural experiments. Often, there are little or no baseline data available to use as the basis for assessing change. Government policies that result in the adoption of particular approaches across large jurisdictions, such as provinces, may result in wide variation in the design and implementation of interventions. Thus, in some cases, natural experiments may be at risk of having low potential to be adequately evaluated on key outcomes. In this paper, we discuss the context of these challenges in relation to the Ontario government school physical activity and nutrition policies.

Internal structure of a measure of self-efficacy in physical activity among high school students.

The preliminary development of a measure of self-efficacy to participate in vigorous physical activity when confronted with specific perceived barriers to physical activity is described. Measures used in previous research ([Hofstetter, C.R., Hovell, M.F., Sallis, J.F., 1990a. Social learning correlates of exercise self-efficacy: Early experiences with physical activity, Social Science and Medicine, 31, 1169-1176.]; [Hofstetter, C.R., Sallis, J.F., Hovell, M.F., 1990b. Some health dimensions of self-efficacy: Analysis of theoretical specificity, Social Science and Medicine, 31, 1051-1056.]; [Reynolds, K.D., Killen, J.D., Bryson, M.S., Maron, D.J., Taylor, C.B., Maccoby, N., Farquhar, J.W., 1990. Psychosocial predictors of physical activity in adolescents, Preventive Medicine, 19, 541-551.]; [Sallis, J.F., Pinski, R.B., Grossman, R.M., Patterson, T.L., Nader, P.R., 1988. The development of self-efficacy scales for health-related diet and exercise behaviors, Health Education Research, 3, 283-292.]) were adapted and original items were developed. The 20-item measure has a 5-point Likert format ranging from not at all confident (1) to very confident (5). An earlier pilot study of 200 secondary school students showed that the measure was free of social desirability. The data were derived from a survey of 1041 secondary school students from a Metropolitan Toronto board of education. Principal component analysis (PCA) with oblique rotation of the data yielded two factors: self-efficacy to overcome external barriers and self-efficacy to overcome internal barriers. The 12-item external barriers subscale had a coefficient alpha of 0.88 and the 8-item internal barriers subscale had a coefficient alpha of 0.87. The subscales significantly correlated with the frequency of participation in vigorous physical activity. In summary, the results provide some support for the internal consistency reliability, construct validity, criterion validity, and discriminant validity of the measure. Though further psychometric research is warranted, the self-efficacy measure shows promise for physical activity research.

Self-efficacy and participation in vigorous physical activity by high school students.

The relationship between physical activity self-efficacy and participation in vigorous physical activity by high school students is examined in this article. Self-efficacy is hypothesized to be positively related to participation in three settings (physical education class, other school-related activities, and outside of school). The effects of age, gender, perceived barriers, and actual barriers are also examined. The sample consists of 1,041 grade 9 and 11 students from a large Metropolitan Toronto school board. Factors derived from a previous (factor) analysis were used to examine the effects of self-efficacy, perceived barriers, and life strain (an actual barrier). The results of multiple regression analysis indicate that physical activity self-efficacy, despite external barriers (but not internal barriers), is predictive of physical activity participation in the hypothesized direction. Other results show consistent age and gender effects on physical activity participation and some support for the hypothesized relationship between perceived barriers and participation.

Predictors of inactivity: an analysis of the Ontario Health Survey.

This paper develops a profile of the inactive population in Ontario. The findings were based on an analysis of data from the 1990 Ontario Health Survey. A Physical Activity Index, including frequency, duration, and an estimate of intensity, was used to classify individuals on the basis of their leisure time physical activity levels. Inactive comprised the group estimated to average less than 1.5 kcals/kg/day of energy expenditure. Multiple logistic regression was used to estimate the odds of inactivity for a number of predictor variables. Age, gender, friends' participation, perceived health status, and perceived future health problems were the strongest predictors of physical inactivity. The findings contribute to a further understanding of the factors influencing physical activity participation and promotion.

The effects of regular moderate to vigorous physical activity on student outcomes: a review.

Studies on the effects of regular (three to five times per week) periods of moderate to vigorous physical activity (MVPA) on the health, academic performance, attitudes and classroom behaviour of children at school are reviewed. Conclusions from the literature provide a basis for enhancement of school-based physical education programs that are currently considered to lack sufficient intensity, duration and frequency to benefit the children involved. The review not only confirms the value of and need for inclusion of MVPA in physical education programs but also shows the feasibility of doing so, to the advantage of both students and teachers.

Increasing response rates in community health surveys administered by telephone.

This paper reports the effects of two methods used to increase response rates in a community health survey administered by telephone. Converting refusals resulted in an increase of 3.7% in the final response rate, while the investigation and identification of indeterminate telephone numbers increased the response rate by an additional 6.1%. Together, these methods resulted in an increase of 9.8%, from an initial response rate of 70.1% to a final lower-bound response rate of 79.9%. The use of these methods helped to reduce non-response bias at a minimal cost.

Structured opportunities for student physical activity in Ontario elementary and secondary schools.

This paper examines structured opportunities for student physical activity in Ontario elementary and secondary schools. Random samples of elementary and secondary schools were selected, and telephone surveys of 353 elementary and 360 secondary school personnel were conducted in 1998. The findings indicate that elementary schools offered physical education, on average, just under three days per week. The duration of physical education class and, in some cases, the duration of vigorous physical activity in class and the weekly amount of vigorous activity in class, were significantly higher at successive grade levels. The physical education enrollment rate in secondary schools was significantly lower at successive grade levels. Student participation in secondary school intramurals and interschool sports was 22.8% and 28.7% respectively. These findings suggest increasing the weekly frequency of physical education in elementary schools and increasing participation in physical education classes in secondary schools. Also, intramural opportunities and participation should be promoted.

Age and sex differences in physical inactivity among Ontario teenagers.

Research on physical activity and fitness indicates their importance in the prevention of disease and promotion of health. However, levels of physical activity have been shown to vary significantly by age, sex and a wide range of additional factors. This paper examines age and sex differences in physical inactivity among 13 to 19 year olds participating in the 1990 Ontario Health Survey. Findings from the bivariate analysis suggest a major increase in physical inactivity between ages 15 and 16. When logistic regression is used to examine the adjusted effects of predictor variables on physical inactivity, the effects of age remain significant. However, the odds of inactivity at one year increments are not significant. There are significant increased odds of inactivity associated with such factors as sex, friends' (activity) participation, perceived future health problems, and perceived health status. The public health implications of the findings suggest that those responsible for developing programs and policies to increase physical activity among teenagers should consider the critical years of decreased activity and the factors that might explain why this decline occurs.

Social and school factors in predicting cannabis use among Ontario high school students.

This paper explores the influence of social factors and school factors on cannabis use among Ontario high school students. The data are derived from a survey of students conducted by the Addiction Research Foundation in 1987. Multiple classification analysis was used to examine the relationship between the two groups of factors and cannabis use. Results of the analysis indicate that social factors are more highly predictive of cannabis use than are school factors. A theoretical framework specifying the influence of social and school factors on cannabis use needs to be developed and tested in order to understand this relationship more clearly.

General social support and physical activity: an analysis of the Ontario Health Survey.

In spite of the many benefits of regular physical activity, the majority of Canadians are sedentary. This paper examines the relationship between general social support and physical activity levels. An analysis of data on 29,135 individuals from the 1990 Ontario Health Survey was conducted. Hierarchical multiple regression was used to determine the relationship between measures of general social support, derived from factor analysis, and physical activity levels. Sociodemographic and perceived health status measures were included as control variables. The results showed that general social support, in the form of Social Quantity and Social Frequency (number of friends/family members and frequency of contact), was significantly associated with higher levels of physical activity. Conversely, support in the form of Familial Structure (marital/cohabitation and parental status) was significantly associated with lower levels of physical activity. The findings indicate the types of general social support that facilitate or hinder participation in physical activity.

The career paths of MHSc graduates in health promotion.

There is much support for health promotion in Canada, but not much is known about the various academic programs in this field or of their impact on the practice of community health. A census survey was conducted in 1991 to determine the career paths of graduates of the MHSc program in Health Promotion at the University of Toronto. Findings from the study indicate that the career paths of graduates change following completion of their degree. They are more likely to work in health organizations other than hospital or treatment settings, to have more responsibility and authority in their positions as reflected by changes in job titles and to utilize a wider range of health promotion strategies and methods in their work following graduation. The findings indicate that graduate training in health promotion has a positive effect on the planning, implementation and evaluation of community health programs.

Predictors of health risk behaviours among young adults: analysis of the National Population Health Survey.

This paper examines the individual and social determinants of physical inactivity, daily smoking, heavy drinking, and overall risk behaviour among 1,395 Canadians aged 20-24 in the 1994 National Population Health Survey. Logistic regression was used to estimate models of risk behaviour using the following variables: sex, mastery, self-esteem, sense of coherence, chronic stress, psychological distress, social support, income adequacy, education, and main activity (working, looking for work, attending school, other). Results of the analysis indicate that the most consistent predictors were chronic stress and main activity. Thus, social context appears to be an important influence on risk-related behaviour, and should be taken into account in approaches designed to promote health behaviours.

Factors predictive of adolescents' intentions to use birth control pills, condoms, and birth control pills in combination with condoms.

Using the Theory of Planned Behaviour (Ajzen, 1988) as a conceptual framework, 705 secondary school students were surveyed to identify their intentions to use birth control pills, condoms, and birth control pills in combination with condoms. Hierarchical multiple regression revealed that the theory explained between 23.5% and 45.8% of the variance in intentions. Variables external to the model such as past use, age, and ethnicity exhibited some independent effects. Attitudes were consistently predictive of intentions to use condoms, pills, and condoms in combination with pills for both male and female students. However, there were differences by gender in the degree to which subjective norms and perceived behavioural control predicted intentions. The findings suggest that programs should focus on: creation of positive attitudes regarding birth control pills and condoms; targeting important social influences, particularly regarding males' use of condoms; and developing strategies to increase students' control over the use of condoms.

Sources of stress and coping responses of high school students.

A series of focus group interviews was used to identify major sources of stress and coping responses of Grade 10 students. Relationships with parents and family, work, and lack of money were found to be important sources of stress. Major coping responses included substance use and diversionary activities. Differences between academic streams (tracks) in sources of stress and coping responses were examined.

Academic stream and tobacco, alcohol, and cannabis use among Ontario high school students.

This paper examines the relationship between academic stream and cigarette, alcohol, and cannabis use among 2,543 high school students as part of the Ontario Student Drug Survey (1987). Students in basic and general academic streams were found to have significantly higher levels of cigarette, alcohol, and cannabis use compared to advanced level students. The effects of academic stream remain significant (except for alcohol use) when gender, grade average, drug education lessons, and pressure to use these substances are included in multiple regression analysis. The findings indicate that the process of academic streaming needs to be further examined as a possible precipitating factor in drug use.

Perceived barriers to physical activity among high school students.

BACKGROUND: Perceived barriers to physical activity, the factor structure of perceived barriers, and the relationship between perceived barriers and participation in vigorous physical activity were examined. METHODS: A two-stage cluster sample of high school students (N = 1,041) in a large Metropolitan Toronto school district was used. Students completed a questionnaire (response rate 81.4%) dealing with participation in physical activity in three settings. Factor analysis was used to examine the dimensionality of perceived barriers. Multiple regression analysis was then used to examine the relationship between perceived barriers and participation. RESULTS: Time constraints due to school work, other interests, and family activities were three of the four barriers considered most important. Females cited consistently higher levels of perceived barriers than males. Two empirically distinct and theoretically meaningful factors emerged from the analysis--perceived internal barriers and perceived external barriers. Perceived internal barriers were predictive of physical activity in overall activity and outside of school activity. Perceived external barriers were predictive of overall physical activity and other school activity, but in the direction opposite to that hypothesized. CONCLUSIONS: It was concluded that perceived barriers may be predictive of physical activity participation among high school students only under specific conditions.

Effects on students of teacher training in use of a drug education curriculum.

The study reported here examines the effects of differential teacher training in use of a drug education curriculum on students' knowledge levels, problem-solving and coping skills, attitudes towards planned decision making, behavioral intentions and tobacco and alcohol use. An experimental design was used to compare the effects of exposure to teachers who had either intensive staff development, in-service training or no training. The findings indicate a statistically significant difference between groups of students on the intention to drink alcohol. Students whose teachers had intensive staff development were less likely to intend to take a drink if offered than students whose teachers had in-service or no training. Possible reasons for a lack of significant results on other variables are the confounding influences of school, classroom and teacher effects.

Future research needs in policy, prevention, and treatment for drug abuse problems.

This paper outlines major research issues for the areas of illicit drug use. Research questions are posed for the following areas: (1) epidemiology and etiology; (2) social policy development; (3) prevention; and (4) treatment.