Income disparities in life expectancy in the City of Toronto and Region of Peel, Ontario.

INTRODUCTION: To understand the lack of a gradient in mortality by neighbourhood income in a previous study, we used individual-level data from the 1991-2001 Canadian census mortality follow-up study to examine income-related disparities in life expectancy and probability of survival to age 75 years in the City of Toronto and Region of Peel. METHODS: We calculated period life tables for each sex and income adequacy quintile, overall and separately for immigrants and non-immigrants. RESULTS: For all cohort members of both sexes, including both immigrants and non-immigrants, there was a clear gradient across the income quintiles, with higher life expectancy in each successively richer quintile. However, the disparities by income were much greater when the analysis was restricted to non-immigrants. The lesser gradient for immigrants appeared to reflect the higher proportion of recent immigrants in the lower income quintiles. CONCLUSION: These findings highlight the importance of using individual-level ascertainment of income whenever possible, and of including immigrant status and period of immigration in assessments of health outcomes, especially for areas with a high proportion of immigrants.

A case-control study of risk factors for playground injuries among children in Kingston and area.

OBJECTIVE: To determine the risk for injury associated with environmental hazards in public playgrounds. SETTING: One hundred and seventeen playgrounds operated by municipalities or school boards in and around Kingston, Ontario, Canada. METHODS: A regional surveillance database was used to identify children presenting to emergency departments who were injured on public playgrounds; each case was individually matched (by sex, age, and month of occurrence) with two controls--one non-playground injury control, and one child seen for non-injury emergency medical care. Exposure data were obtained from an audit of playgrounds conducted using Canadian and US safety guidelines. Exposure variables included the nature of playground hazards, number of hazards, frequency of play, and total family income. No difference in odds ratios (ORs) were found using the two sets of controls, which were therefore combined for subsequent analysis. RESULTS: Multivariate analysis showed strong associations between injuries and the use of inappropriate surface materials under and around equipment (OR 21.0, 95% confidence interval (CI) 3.4 to 128.1), appropriate materials with insufficient depth (OR 18.2, 95% CI 3.3 to 99.9), and inadequate handrails or guardrails (OR 6.7, 95% CI 2.6 to 17.5). CONCLUSION: This study confirms the validity of guidelines for playground safety relating to the type and depth of surface materials and the provision of handrails and guardrails. Compliance with these guidelines is an important means of preventing injury in childhood.

Tobacco access to youth: beliefs and attitudes of retailers.

Results of a telephone survey provide insights into the knowledge, attitudes and beliefs of tobacco merchants from two local health units. More than 90% of the retailers said they should not be able to sell cigarettes to minors. They are aware of laws prohibiting such sales but are sceptical about the impact on young people. The majority report being motivated to help protect the health of youth, however, they advise that legislation provides the main reason for not selling cigarettes to minors. Other responses and behaviours of the merchants help provide a profile of an important group that is being asked to stop selling tobacco to young people. The authors classify the retailers into three groups according to the potential influence on their behaviour of messages about health and threats of enforcement. One of the health units had implemented a local intervention, therefore we also compare responses between the two health units. This type of information can be used when selecting strategies to strengthen health policies. Such policies and strategies should include input and feedback from retailers of tobacco.

Family physicians and smoking cessation. Survey of practices, opinions, and barriers.

OBJECTIVES: To assess what family physicians need to promote smoking cessation by looking at current knowledge, attitudes, and behaviours and to examine the barriers facing physicians in implementing an effective antismoking strategy. DESIGN: Cross-sectional study involving face-to-face interviews and mailed questionnaires. SETTING: Family practices in Kingston, Ont, and surrounding areas. PARTICIPANTS: All family physicians (n = 155) in the City of Kingston and the counties of Frontenac, Lennox, and Addington. MAIN OUTCOME MEASURES: Knowledge, attitudes, beliefs, and practices concerning smoking cessation; barriers and practices recommended in the literature. RESULTS: Response rate was 77%. Many physicians know about smoking cessation, and many actively counsel their patients to quit. Brief advice, nicotine replacement therapy, self-help materials, and follow-up appointments are the most common methods. Although many report that they are already knowledgeable, many are willing to learn more. Many physicians have unrealistically high estimates of the probability of success, and many find poor compliance among patients to be the greatest barrier. CONCLUSIONS: Family physicians in this are recognize the need to help their patients to quit and are identifying and counseling smokers in their practices. The main educational need could be to appreciate smoking as an addictive behaviour.

Changes among retailers selling cigarettes to minors.

This study analyzes changes over a three-year period among Ontario retailers selling cigarettes to minors. Under supervision, 13 and 14-year-old minors were sent into stores to attempt to buy cigarettes. These minor-purchase-events (MPEs) were carried out in a local health unit that had implemented a community-based intervention and in an adjoining comparison health unit. After the local program we observed a large reduction (from 46% to 6%) in merchants willing to sell tobacco to minors. In the neighbouring health unit, a high rate of selling continued until a federal program using a similar intervention was implemented, after which a large reduction (from 47% to 2%) was observed. This magnitude of change has been unprecedented, except when active enforcement was implemented by police officers. Thus, from a public health perspective, it is important to understand what is influencing the store operators.

Medical examination of school entrants: later school problems and absenteeism of attenders and non-attenders.

Children who were scheduled for medical examination before entering school were followed in school one or two years later. Non-attenders had a two-fold risk of repeating grades, special class placement, referral for speech/language problems, teacher-reported learning or behavior problems, failure of vision or hearing screening, and transfer between schools. Absenteeism was also significantly more common. Children not brought in for preventive health care are at greater risk than others for difficulties in school.