Cigarette brand preference as a function of price among smoking youths in Canada: are they smoking premium, discount or native brands?

INTRODUCTION: Given that little is known about the price-related cigarette brand preferences of youths, the current study seeks to characterise cigarette brand preferences and examine factors associated with smoking discount or native cigarette brands among Canadian youths who are current smokers. METHODS: This study used nationally representative data collected from 71,003 grade 5-12 students as part of the 2006-7 Canadian Youth Smoking Survey (YSS). Using data from current smokers, logistic regression models were used to examine factors associated with smoking discount or native cigarette brands relative to premium cigarette brands. RESULTS: In 2006, premium cigarettes were the most prevalent brand of cigarette youths report usually smoking (49.4%); a substantial number of youths do report usually smoking either discount (12.9%) or native (9.3%) cigarette brands. Occasional smokers were more likely to report usually smoking premium cigarettes whereas daily smokers were more likely to report smoking either discount or native cigarettes. In particular, discount and native brands appear to be appealing among smoking youths with less spending money or those who are heavier smokers compared to youths smoking premium brands. CONCLUSION: Discount and native cigarette brands are commonly used by a substantial number of smoking youths in Canada. Additional research is required to better understand the reasons behind different cigarette brand preferences and how youths are able to access premium, discount and illicit native cigarettes. Moreover, ongoing surveillance of the cigarette brand preferences of youths is required for guiding future tobacco control policy and programming activities.

School-based tobacco-control programming and student smoking behaviour.

The study examined the association of a school-based tobacco-control program with students' smoking behaviour over time using three cross-sectional, provincial census datasets (grade 10 students in 1999, grade 11 students in 2000, grade 12 students in 2001). Data were collected from all secondary schools in Prince Edward Island (Canada) using the Tobacco module of the School Health Action, Planning and Evaluation System (SHAPES). The proportion of regular smokers increased from grade 10 (22.3%) to grade 12 (27.8%, chi(2) = 10.35, df = 1, p < 0.001). Being exposed to different school-based tobacco programs and policies in grades 10 and 11 was not associated with the smoking behaviour of grade 12 students. The strongest predictors of smoking behaviour were having friends or close family members who smoke. This preliminary evidence suggests that programs and policies associated with banning smoking and enforcing smoking restrictions at school may be insufficient unless they also address the influence of smoking peers and family members and link to comprehensive programming within the broader context of other community and policy level interventions.

Addison disease in patients treated with glucocorticoid therapy.

Acute adrenal crisis in patients with unrecognized chronic adrenocortical failure is difficult to diagnose and potentially fatal. We describe 2 patients with acute adrenal crisis whose diagnoses were hindered because of concomitant glucocorticoid treatment. Acute adrenal insufficiency is primarily a state of mineralocorticoid deficiency. Prednisolone and prednisone, the most frequently prescribed anti-inflammatory corticosteroid agents, have minimal mineralocorticoid activity. Several conditions that may be treated with pharmacological glucocorticoids are associated with an increased risk of Addison disease. An acute adrenal crisis, against which concurrent glucocorticoid therapy does not confer adequate protection, may develop in such patients.

Evidence of increased parathyroid activity on discontinuation of high-aluminum dialysate in patients undergoing hemodialysis.

High-aluminum dialysate exposure has been incriminated in the pathogenesis of vitamin D-resistant osteomalacia in patients undergoing long-term hemodialysis. Parathyroid-mediated osteitis fibrosa is rare in these patients. Thirteen patients undergoing longterm hemodialysis were transferred from a center (Unit A) where water used to prepare dialysate was high in aluminum (100 to 450 micrograms/liter) to a new center (Unit B) where dialysate was highly purified (aluminum concentration less than 10 micrograms/liter), and changes in calcium metabolism were studied over a 12-month period. After transfer of patients to Unit B, serum aluminum levels fell (p less than 0.01), whereas serum immunoreactive parathyroid hormone levels rose (p less than 0.01) over 10 months. Over this time, predialysis serum calcium levels did not alter significantly, whereas postdialysis serum calcium levels declined slightly (p less than 0.05). Serum phosphate levels did not alter. Serum alkaline phosphatase levels rose progressively in Unit B (p less than 0.001). Discontinuation of dialysate high in aluminum in patients undergoing long-term hemodialysis may facilitate a rise in parathyroid activity.

Dexamethasone-suppressible hyperaldosteronism: a large new kindred.

Dexamethasone-suppressible hyperaldosteronism (DSH) is a rare familial variety of primary aldosteronism in which the biochemical features of mineralocorticoid excess are corrected by treatment with glucocorticoids. We report a large new kindred with this syndrome, the second such family described in the British Isles and the first in Ireland. The family has a dramatic history of premature cardiovascular death. We have documented DSH in four members and found evidence of aldosterone excess in two others. The kindred is unique in that we have documented DSH in distant relatives (fourth cousins). All patients described are well controlled on potassium-sparing diuretics. Our report underlines the importance of a detailed family history in the assessment of hypertension due to primary aldosteronism.

Actinomyces pyogenes septic arthritis in a diabetic farmer.

We report a case of septic arthritis and osteomyelitis of the left ankle due to Actinomyces pyogenes in a diabetic farmer. Few confirmed human cases of A. pyogenes infection have been reported, partly because of inadequate identification of this bacterium. Bacteriological characteristics of the organism, which resembles Arcanobacterium haemolyticum, are described with a review of previous case reports.

The Prince Edward Island Conceptual Model for Nursing: a nursing perspective of primary health care.

The philosophy of primary health care (PHC) recognizes that health is a product of individual, social, economic, and political factors and that people have a right and a duty, individually and collectively, to participate in the course of their own health. The majority of nursing models cast the client in a dependent role and do not conceptualize health in a social, economic, and political context. The Prince Edward Island Conceptual Model for Nursing is congruent with the international move towards PHC. It guides the nurse in practising in the social and political environment in which nursing and health care take place. This model features a nurse/client partnership, the goal being to encourage clients to act on their own behalf. The conceptualization of the environment as the collective influence of the determinants of health gives both nurse and client a prominent position in the sociopolitical arena of health and health care.

Primary hyperoxaluria--a case report.

A case of primary hyperoxaluria which presented with progressive renal failure in a 34 year old woman is reported. The patient died six years following the initial diagnosis and post mortem examination revealed widespread deposition of oxalate crystals in her tissues.

Renal failure and thyroid function tests: the effects of commencing haemodialysis.

Thyroid function tests are often noted to be abnormal in patients with chronic renal failure. We investigated thyroid and pituitary function in six patients with renal failure. In order to study the effects of improvement in the uraemic state on these tests, they were repeated after regular haemodialysis was commenced. Serum thyroxine and free thyroxine levels were at the lower limit of the normal range prior to dialysis and both showed a non-significant increase after regular haemodialysis was started. The TSH response to TRH (TRH test) decreased in five of the six patients after dialysis but this did not achieve statistical significance. The abnormalities in thyroid function tests often observed in clinically euthyroid patients with renal failure do not appear to change significantly after the institution of regular dialysis.

Are experimental smokers different from their never-smoking classmates? A multilevel analysis of Canadian youth in grades 9 to 12.

INTRODUCTION: Understanding the characteristics of experimental smoking among youth is critical for designing prevention programs. This study examined which student- and school-level factors differentiated experimental smokers from never smokers in a nationally representative sample of Canadian students in grades 9 to 12. METHODS: School-level data from the 2006 Canadian Census and one built environment characteristic (tobacco retailer density) were linked with data from secondary school students from the 2008-2009 Canadian Youth Smoking Survey and examined using multilevel logistic regression analyses. RESULTS: Experimental smoking rates varied across schools (p < .001). The location (adjusted odds ratio [AOR] = 0.66, 95% CI: 0.49-0.89) of the school (urban vs. rural) was associated with the odds of a student being an experimental smoker versus a never smoker when adjusting for student characteristics. Students were more likely to be experimental smokers if they were in a lower grade, reported low school connectedness, used alcohol or marijuana, believed that smoking can help people relax, received pocket money each week and had a family member or close friend who smoked cigarettes. CONCLUSION: School-based tobacco prevention programs need to be grade-sensitive and comprehensive in scope; include strategies that can increase students' attachment to their school; and address multi-substance use, tobacco-related beliefs and the use of pocket money. These programs should also reach out to students who have smoking friends and family members. Schools located in rural settings may require additional resources.

TITRE: Les fumeurs à titre expérimental sont-ils différents de leurs camarades de classe n'ayant jamais fumé? Une analyse multiniveaux des jeunes Canadiens de la 9e à la 12e année. INTRODUCTION: Il est essentiel de comprendre les caractéristiques du tabagisme expérimental chez les jeunes pour élaborer des programmes de prévention. Dans cette étude, nous avons analysé, à partir d'un échantillon représentatif des élèves canadiens de la 9e à la 12e année, les facteurs relatifs aux élèves et les facteurs relatifs aux écoles qui différenciaient les fumeurs à titre expérimental des élèves n'ayant jamais fumé. MÉTHODOLOGIE: Des données relatives aux écoles recueillies dans le cadre du Recensement de 2006 ainsi qu'une caractéristique relative au milieu bâti (densité des détaillants de produits du tabac) ont été reliées à des données relatives aux élèves du secondaire tirées de l'Enquête sur le tabagisme chez les jeunes de 2008-2009 et ont été soumises à une série d'analyses par régression logistique multiniveaux. RÉSULTATS: Le taux de tabagisme expérimental variait d'une école à l'autre (p < 0,001). Après ajustement en fonction des caractéristiques des élèves, on a observé une association entre l'emplacement (rapport de cotes ajusté = 0,66, intervalle de confiance à 95 % : 0,49 à 0,89) de l'école (milieu urbain ou rural) et le risque qu'un élève soit fumeur à titre expérimental plutôt qu'élève n'ayant jamais fumé. Les élèves étaient plus susceptibles d'être fumeurs à titre expérimental s'ils étaient d'un niveau scolaire inférieur, s'ils avaient un faible sentiment d'appartenance à leur école, s'ils consommaient de l'alcool ou de la marijuana, s'ils croyaient que le tabagisme avait un effet apaisant, s'ils recevaient de l'argent de poche chaque semaine et si un membre de leur famille ou un de leurs amis intimes fumait des cigarettes. CONCLUSION: Les programmes de prévention du tabagisme en milieu scolaire doivent à la fois être adaptés au niveau scolaire et exhaustifs, comprendre des stratégies visant à accroître le sentiment d'appartenance des élèves à leur école et tenir compte du phénomène de polyconsommation, des croyances relatives au tabagisme et de l'utilisation qui est faite de l'argent de poche. Ces programmes devraient également cibler les élèves dont un ami ou un membre de la famille fume. Par ailleurs, les écoles situées en milieu rural pourraient avoir besoin de ressources supplémentaires.

Knowledge exchange systems for youth health and chronic disease prevention: a tri-provincial case study.

INTRODUCTION: The research teams undertook a case study design using a common analytical framework to investigate three provincial (Prince Edward Island, New Brunswick and Manitoba) knowledge exchange systems. These three knowledge exchange systems seek to generate and enhance the use of evidence in policy development, program planning and evaluation to improve youth health and chronic disease prevention. METHODS: We applied a case study design to explore the lessons learned, that is, key conditions or processes contributing to the development of knowledge exchange capacity, using a multi-data collection method to gain an in-depth understanding. Data management, synthesis and analysis activities were concurrent, iterative and ongoing. The lessons learned were organized into seven "clusters." RESULTS: Key findings demonstrated that knowledge exchange is a complex process requiring champions, collaborative partnerships, regional readiness and the adaptation of knowledge exchange to diverse stakeholders. DISCUSSION: Overall, knowledge exchange systems can increase the capacity to exchange and use evidence by moving beyond collecting and reporting data. Areas of influence included development of new partnerships, expanded knowledge-sharing activities, and refinement of policy and practice approaches related to youth health and chronic disease prevention.

TITRE: Étude sur les systèmes d'échange des connaissances pour la santé des jeunes et la prévention des maladies chroniques : étude de cas menée dans trois provinces. INTRODUCTION: Les équipes de recherche ont adopté un modèle d'étude de cas utilisant un cadre d'analyse commun dans le but d'étudier trois systèmes provinciaux (Île-du-Prince-Édouard, Nouveau-Brunswick et Manitoba) d'échange des connaissances. Ces trois systèmes visent à générer et utiliser des données probantes lors de l'élaboration des politiques, de la planification des programmes et des évaluations afin d'améliorer la santé des jeunes et de prévenir les maladies chroniques. MÉTHODOLOGIE: Nous avons appliqué un modèle d'étude de cas pour examiner en profondeur les leçons apprises (c.-à-d. les principales conditions ou les principaux processus contribuant au développement de la capacité d'échange des connaissances) à l'aide d'une méthode de collecte de données multiples. Les activités de gestion, de synthèse et d'analyse des données ont été simultanées, itératives et continues. Les leçons apprises ont été classées en sept catégories. RÉSULTATS: L'échange des connaissances est un processus complexe, qui exige des champions et des partenariats de collaboration, une adaptation aux divers intervenants et qui exige aussi que les régions soient préparées. ANALYSE: Dans l'ensemble, les systèmes d'échange des connaissances peuvent accroître la capacité d'échange et d'utilisation des données probantes en allant au-delà de la collecte et de la transmission de données. Leurs aires d'influence sont l'établissement de nouveaux partenariats, des activités élargies d'échange des connaissances et le perfectionnement des approches axées sur les politiques et les pratiques liées à la santé des jeunes et à la prévention des maladies chroniques.