ABSTRACT
UNLABELLED: This population-based study of mid-aged Canadians assessed awareness of diagnosis by bone mineral density (BMD) following dual-energy X-ray absorptiometry (DXA) testing and compared the effects of feedback only to the physician with direct-to-participant feedback. Poor recall of osteoporosis results was observed irrespective of the feedback destination, but direct-to-participant feedback improved recall of borderline or normal results. INTRODUCTION: BMD testing provides information about fracture risk. This study assessed whether awareness of results, in a random population sample of mid-aged Canadians, differed if results were provided to physicians only or directly to participants. METHODS: Prospective cohort study of 2,678 women and men aged 40-60 years from the Canadian Multicentre Osteoporosis Study. Participants completed hip and spine DXA and interviewer-administered questionnaires regarding demographics and osteoporosis risk factors. Lateral spine X-rays were conducted on those > or =50 years of age. All test results were reported to the participant, the family physician or both. Associations between BMD results, feedback destination and correct self-report results, 3 years later, were assessed using logistic regression while adjusting for potential confounders. RESULTS: Only 25% of men and 33% of women correctly reported their osteoporosis diagnoses. Direct-to-participant vs. physician-only reports did not improve recall of osteoporosis diagnosis but improved recall of borderline or normal BMD. Older (vs. younger) men and men with prevalent vertebral fractures demonstrated better recall of their osteoporosis diagnosis. CONCLUSIONS: Recall of low BMD results was poor, despite direct-to-participant feedback and even in the presence of other osteoporosis risk factors. Direct-to-participant feedback may improve awareness of borderline or normal BMD results.
Subject(s)
Feedback, Psychological , Osteoporosis/diagnosis , Absorptiometry, Photon/methods , Adult , Age Factors , Bone Density , Canada , Disclosure , Female , Hip Joint/physiopathology , Humans , Lumbar Vertebrae/physiopathology , Male , Mental Recall , Middle Aged , Osteoporosis/physiopathology , Osteoporosis/psychology , Prospective StudiesABSTRACT
OBJECTIVE: To address observations that the smoking identities of youth are valid descriptors of their smoking behaviour, we examined the relationships between self-reported smoking identities, perceived levels of addiction, and established taxonomies of smoking behaviour of youth. METHOD: Cross-sectional data were collected on demographics, perceived extent of addiction to tobacco, smoking history, and self-reported smoking identity from questionnaires administered to 8225 students in British Columbia, Canada. A total of 7246 participants were categorised according to four smoking taxonomies established in the literature. Differences in perceived physical and mental addiction between smoking identity groups were calculated. The strength of the associations between the taxonomies of smoking and the smoking identity groups was also assessed. RESULTS: There were significant differences in perceived levels of physical (Kruskal-Wallis chi(2) = 3985.02, p<0.001) and mental (Kruskal-Wallis chi(2) = 4046.09, p<0.001) addiction to tobacco by the participants' self-reported smoking identity. Youth smoking identities were modestly associated with the established smoking taxonomies (Pearson C contingency coefficient = 0.64-0.72). CONCLUSION: Self-reported smoking identities appear to provide valid characterisation of the smoking behaviour of youths that complement and elaborate existing taxonomies of smoking behaviour. Questions about self-reported smoking identity should be used in conjunction with smoking behaviour taxonomies when investigating youth smoking behaviours.
Subject(s)
Psychology, Adolescent/classification , Smoking/psychology , Adolescent , British Columbia/epidemiology , Epidemiologic Methods , Female , Humans , Male , Tobacco Use Disorder/classification , Tobacco Use Disorder/epidemiology , Tobacco Use Disorder/psychologyABSTRACT
BACKGROUND: The number of elderly patients who do not have acute-care needs has increased in many North American hospitals. These alternate level care (ALC) patients are often cognitively impaired or physically dependent. The physical and psychosocial demands on caregivers may be growing with the increased presence of ALC patients leading to greater risk for injury among staff. METHODS: This prospective cohort study characterized several models for ALC care in four acute-care hospitals in British Columbia, Canada. A cohort of 2,854 patient care staff was identified and followed for 6 months. The association between ALC model of care and type and severity of injury was examined using multinomial and ordinal logistic regression. RESULTS: Regression models demonstrated that the workers on ALC/medical nursing units with "high" ALC patient loads and specialized geriatric assessment units had the greatest risk for injury and the greatest risk for incurring serious injury. Among staff caring for ALC patients, those on dedicated ALC units had the least risk for injury and the least risk for incurring serious injury. CONCLUSIONS: The way in which ALC care is organized in hospitals affects the risk and severity of injuries among patient care staff.
Subject(s)
Accidents, Occupational/statistics & numerical data , Models, Statistical , Nursing Staff, Hospital/organization & administration , Nursing Staff, Hospital/statistics & numerical data , Occupational Diseases/epidemiology , Wounds and Injuries/epidemiology , Adult , British Columbia/epidemiology , Humans , Logistic Models , Models, Organizational , Occupational Diseases/classification , Progressive Patient Care/organization & administration , Progressive Patient Care/statistics & numerical data , Prospective Studies , Risk Assessment , Trauma Severity Indices , Wounds and Injuries/classificationABSTRACT
This study uses structural equation modeling to examine hypothesized relationships between sunburn and physical characteristics and potentially modifiable behavior. The analysis was based on self-reported data collected from a randomly selected national sample of Canadian adults. An initial model was tested with 50% of the cases (n = 1,408); the remaining cases (n = 1,298) were reserved for confirmatory testing. After the initial model failed, theoretically plausible effects were added incrementally to improve overall model fit. The initial model yielded: chi2(68 d.f.) = 3199.41 (P < .001) and the AGFI = .56. With 32 added effects, a fit model resulted in: chi2(36 d.f.) = 394.35 (P < .001), AGFI = 0.87, and IFI = 0.91 (the Critical-N was 210). Model fit was confirmed. Suntanning, failure to wear protective clothing, and sun exposure were associated with the frequency of severity-adjusted sunburns. Sunscreen use was not associated with sunburn frequency-severity.
Subject(s)
Sunburn/epidemiology , Adolescent , Adult , Aged , Canada/epidemiology , Data Collection , Female , Health Behavior , Humans , Male , Middle Aged , Models, Statistical , Protective Clothing , Psychophysiology , Risk Factors , Severity of Illness Index , Sex Distribution , Sunburn/prevention & control , Sunscreening Agents/administration & dosage , Surveys and QuestionnairesABSTRACT
The purpose of this study was to identify factors that influence the effectiveness of interventions in increasing women's use of mammography screening programs. To this end, we conducted a systematic literature review of studies published between 1966 and 1997. In this review, we recorded data about the year and country in which studies were completed, the study design, the methods for measuring screening rates, various sample characteristics, the nature of the intervention, and the resulting screening rates. The PRECEDE model was used as a framework to make distinctions between the various interventions. To synthesize evidence about the baseline screening rates and the effect of interventions on the incidence of mammography screening, we fit random-effects logistic regression models. These models revealed that more recent studies (those conducted from 1990 to 1996) were associated with higher screening rates (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.9). Conversely, those designed to target older women (minimum age, 50-65 years) and those set in clinics exhibited smaller screening rates (OR, 0.6, 95% CI, 0.3-1.0, and OR, 0.5; 95% CI, 0.3-0.8, respectively). The meta-analyses also suggested methodologic issues that must be considered before the relative strength of various interventions can be assessed rigorously.
Subject(s)
Breast Neoplasms/prevention & control , Diagnostic Tests, Routine/statistics & numerical data , Health Promotion/methods , Mammography/standards , Adult , Age Factors , Aged , Breast Neoplasms/mortality , Female , Health Behavior , Humans , Mammography/statistics & numerical data , Mass Screening/statistics & numerical data , Middle Aged , Randomized Controlled Trials as Topic , Risk , Treatment OutcomeSubject(s)
Infant Care , Mothers/psychology , Tobacco Smoke Pollution/prevention & control , Adolescent , Adult , Canada , Data Collection , Female , Humans , Infant , Infant, Newborn , RecurrenceABSTRACT
OBJECTIVE: To describe experiences of women seeking information about their risk of hereditary breast cancer who fail to meet strict eligibility criteria for genetic counseling and testing. DESIGN: Qualitative descriptive study. SETTING: Hereditary cancer program in western Canada. PARTICIPANTS: Women who had received notification of their ineligibility for referral for hereditary breast cancer risk assessment (n = 20) and some of their referring physicians (n = 10). Of 28 attempted contacts, five women had moved, one declined the invitation to participate, and two could not be interviewed because of scheduling conflicts. Ten of 20 physicians declined the invitation to participate. METHOD: In-depth, open-ended telephone interviews were conducted. Transcribed interviews were systematically analyzed to identify salient themes. MAIN FINDINGS: Three themes emerged. The first theme, "It's always on your mind," points to the profound concern about breast cancer that underlies women's experiences in seeking genetic testing. The second theme, "A test is a test," reflects women's beliefs that the test was relatively simple and similar to other medical tests in that it would provide a definitive answer. The third theme, "Falling through the cracks," captures the experience of ineligibility. Women reacted with a range of emotional responses and were left frustrated in their search for more specific information about their personal risk for breast cancer. Although women were encouraged to contact their physicians, few did. CONCLUSION: These findings point to the psychological consequences in women who seek genetic testing for risk of breast cancer when they are told they are ineligible and they are not given adequate information and support.
Subject(s)
Breast Neoplasms/genetics , Breast Neoplasms/prevention & control , Genetic Testing/psychology , Adult , Eligibility Determination , Female , Humans , Middle AgedABSTRACT
Many women who stop smoking during pregnancy relapse soon after the birth of their infants. Using narrative research, experiences of smoking relapse were explored using interviews with 27 postpartum women. The stories of relapse were analyzed to identify important components, paying attention to commonalities, differences, and areas of emphasis. Five general story lines were identified: (1) controlling one's smoking (starting with a "puff" and consciously restricting the amount smoked); (2) being vulnerable to smoking(relapsing because of an inability to resist cigarettes); (3) nostalgia for one's former self(relapsing to recapture feelings of freedom and happier times); (4) smoking for relief(relapsing to manage emotions and stress); and (5) never really having quit (relapsing because they did not quit for themselves). The findings of this study provide support for the claim that the experiences of smoking cessation and relapse among postpartum women may be unique and, consequently, may require specialized intervention.
Subject(s)
Attitude to Health , Mothers/psychology , Puerperal Disorders/psychology , Smoking Cessation/psychology , Smoking/psychology , Adaptation, Psychological , Adolescent , Adult , Cognitive Dissonance , Conflict, Psychological , Female , Guilt , Health Knowledge, Attitudes, Practice , Humans , Internal-External Control , Nursing Methodology Research , Recurrence , Self Concept , Stress, Psychological/prevention & control , Stress, Psychological/psychology , Surveys and QuestionnairesABSTRACT
This study examined the long-term effectiveness of a postpartum smoking relapse prevention intervention by evaluating the smoking status and smoking cessation self-efficacy of original study participants at 12 months following delivery. Two hundred and thirty-eight women who had participated in a randomized clinical trial, a nurse-delivered relapse prevention intervention, were visited in their homes. Data were collected on smoking status, self-efficacy, mental health, alcohol use, breast feeding, social support, smoking in the social environment, and sociodemographics. Smoking status was verified with measures of carbon monoxide in expired air. The 12-month continuous smoking abstinence rate was 21.0% in the treatment group and 18.5% in the control group; odds ratio (OR) = 1.17, 95% confidence interval (CI) = 0.62-2.22. One half (50.4%) of the control group and 41.2% of the treatment group reported smoking daily at 12 months; OR = 1.45, 95% CI = 0.87-2.43. The treatment group attained higher self-efficacy. Four variables were associated with relapse to daily smoking; breast feeding and mental health had protective effects, while partners who smoked and greater amount smoked prior to pregnancy had adverse effects.
Subject(s)
Postpartum Period/psychology , Smoking Cessation/psychology , Smoking Prevention , Adolescent , Adult , Female , Follow-Up Studies , Health Knowledge, Attitudes, Practice , Humans , Pregnancy , Recurrence , Treatment OutcomeABSTRACT
BACKGROUND: Although many women quit smoking during pregnancy, the majority resume smoking shortly after giving birth. OBJECTIVES: To test a program to prevent smoking relapse in the postpartum period by comparing the rates of continuous smoking abstinence, daily smoking, and smoking cessation self-efficacy in treatment and control groups. METHODS: In a randomized clinical trial, nurses provided face-to-face, in-hospital counseling sessions at birth, followed by telephone counseling. The target population included women who quit smoking during pregnancy and who gave birth at one of five hospitals. The 254 participating women were interviewed 6 months after delivery and assessed biochemically to determine smoking status. RESULTS: The 6-month continuous smoking abstinence rate was 38% in the treatment group and 27% in the control group (odds ratio [OR] = 1.63, 95% confidence interval [CI] .96 - 2.78). Significantly more control (48%) than treatment (34%) group participants reported smoking daily (OR = 1.80, 95% CI = 1.08 - 2.99). Smoking cessation self-efficacy did not vary significantly between the groups. CONCLUSIONS: Smoking cessation interventions focusing on the prenatal period have failed to achieve long-term abstinence. Interventions can be strengthened if they are extended into the postpartum period.
Subject(s)
Patient Education as Topic , Postpartum Period , Self Efficacy , Smoking Cessation , Smoking Prevention , Adolescent , Adult , Female , Humans , Odds Ratio , Pregnancy , Recurrence , TelephoneABSTRACT
In the Salutogenic Model, Aaron Antonovsky suggested that a sense of coherence (SOC) is the key determinant in the maintenance of health. He theorized that individuals with a strong SOC have the ability to (a) define life events as less stressful (comprehensibility), (b) mobilize resources to deal with encountered stressors (manageability), and (c) possess the motivation, desire, and commitment to cope (meaningfulness). To determine the effects of SOC on health outcomes, a greater understanding of the development and maintenance of SOC is necessary. Data from the 1994 Canadian National Population Health Survey were analyzed to investigate the effects of stress, social support, and recent traumatic life events on SOC. As predicted, stress and recent traumatic events were found to be inversely related to SOC, and social support was positively related. Traumatic events encountered in childhood were stronger predictors of SOC than traumatic life events experienced in adulthood.
Subject(s)
Attitude to Health , Internal-External Control , Life Change Events , Models, Psychological , Social Support , Stress, Psychological/prevention & control , Stress, Psychological/psychology , Adaptation, Psychological , Adult , Age Factors , Canada , Child , Female , Health Status , Health Surveys , Humans , Male , Middle Aged , Motivation , Predictive Value of Tests , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
BACKGROUND: Smoking in the postpartum period may contribute to early weaning, although the nature and temporal aspect of the relationship are poorly understood. The objective of this study was to examine the association between early weaning and smoking relapse among women who stopped smoking during pregnancy. METHODS: A secondary analysis of data from a randomized controlled trial was conducted. The participants were 228 women who had stopped smoking for pregnancy, who participated in a smoking relapse prevention trial, and who breastfed. Women who relapsed to daily smoking postpartum were compared with those who remained abstinent or smoked occasionally. The dependent variable was breastfeeding for less than 26 weeks (early weaning). Potential covariates included intended duration of breastfeeding, parity, partner's smoking, nicotine dependence, emotional health, return to paid employment, and various sociodemographic variables. RESULTS: Approximately two-thirds (65.1%) of the women who relapsed to daily smoking weaned before 26 weeks compared with 33.8 percent of the women who remained abstinent or smoked occasionally. Controlling for intended duration of breastfeeding, education, and return to paid employment, women who resumed daily smoking were almost four times more likely to wean early than those who abstained or smoked occasionally. CONCLUSIONS: Early weaning may result from psychological or physiological changes associated with tobacco use. Smoking relapse prevention in the postpartum period may be one of the most effective interventions in ensuring that women who stop smoking for pregnancy remain stopped and breastfeed their babies for the recommended duration.
Subject(s)
Breast Feeding/statistics & numerical data , Puerperal Disorders/epidemiology , Smoking Cessation/statistics & numerical data , Smoking/epidemiology , Weaning , Adolescent , Adult , Confounding Factors, Epidemiologic , Female , Humans , Infant , Infant, Newborn , Recurrence , Risk Factors , Socioeconomic Factors , Time FactorsABSTRACT
Developments in predictive testing for inherited cancers have focused attention on the accurate and sensitive communication of risk information. Although sharing risk information is often equated with genetic testing, it is important to acknowledge that the need for risk information related to familial cancer is also relevant to those not eligible for, or interested in, testing. Communicating cancer risk information is germane to a number of health professions including physicians, geneticists, genetic counsellors, psychologists, nurses, health educators and social workers. Based on a literature review of 75 research reports, expert opinion papers and clinical protocols, we provide a synthesis of what is known about the communication of cancer risk information and make recommendations for the enhancement of knowledge and practice in the field.
Subject(s)
Communication , Neoplasms/genetics , Risk Assessment , Female , Genetic Counseling , Humans , Male , Patient Education as Topic , Truth DisclosureABSTRACT
PURPOSE: To determine whether individuals' perceptions of their emotional, physical, social, and spiritual health constitute elements of their self-rated health status operationalized with a commonly employed single indicator. DESIGN: Secondary analysis of cross-sectional survey data. Structural equation modeling with LISREL was used. SETTING: The Yukon Health Promotion Survey, Yukon Territory, Canada, 1993. SUBJECTS: The population-based sample was made up of 742 women and 713 men between 15 and 90 years of age; 80.3% responded. MEASURES: Self-rated health status was operationalized with the "excellent, good, fair, poor" indicator derived from the question: "In general, compared to other people your age, would you say your health is...." Social, spiritual, emotional, and physical health status were also self-rated from excellent to poor. RESULTS: The model's fit of the data was acceptable. Only physical health status significantly contributed to the variance in self-rated health status (55.1% of the variance was explained). Emotional, social, and spiritual health were found to have no effect on individuals' ratings of their health status. CONCLUSIONS: Although recent conceptualizations have broadened in much of the theoretical and political discourse about health, especially in health promotion, the self-rated health status indicator measures only physical health status.
Subject(s)
Health Status Indicators , Adaptation, Psychological , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Health Status , Humans , Male , Middle Aged , Models, Psychological , Religion , Social Adjustment , Yukon TerritoryABSTRACT
BACKGROUND: In Canada, with universal single-payer health care insurance and a lower proportion of the gross domestic product going to health care costs, employers may be less motivated than their U.S. counterparts to develop health promotion programs for their employees. This study determined the extent to which nongovernmental workplaces in Canada have made smoking-related information, policies, and programs available to their employees. Several characteristics of those workplaces most likely to have engaged in such activities were identified. METHODS: A secondary analysis of data collected in the 1992 National Workplace Survey was conducted. All Canadian provinces, except Saskatchewan, were included. Dunn and Bradstreet's register of companies was used to select companies randomly from those with 20 or more employees. Questionnaires were distributed to 10000 workplaces. The response rate was 35.5% (N = 3,549). There were no significant differences found between responders and nonresponders in a phone survey. RESULTS: One-half of workplaces reported some kind of smoking-related initiative. Most of the initiatives were smoking policies; only 11.7% of workplaces provided smoking cessation programs. The number of employees and the number of other lifestyle and occupational health and safety programs available are most predictive of smoking-related programs. CONCLUSIONS: If Canadians are going to achieve a smoke-free society, greater efforts to assist smokers to quit will be necessary. The workplace provides an excellent opportunity for such efforts. Health promotion advocates must communicate the cost savings and other benefits to employers garnered from workplace smoking reduction efforts.
Subject(s)
Commerce/organization & administration , Health Promotion/statistics & numerical data , Occupational Health Services/statistics & numerical data , Smoking Prevention , Adult , Canada , Chi-Square Distribution , Confidence Intervals , Female , Health Promotion/economics , Health Promotion/methods , Health Surveys , Humans , Logistic Models , Male , Odds Ratio , Public Policy , Workplace/organization & administrationABSTRACT
Defining health impact assessment as any combination of procedures or methods by which a proposed policy or program may be judged as to the effect(s) it may have on the health of a population, we make recommendations about how to evaluate the health impact of all government-initiated policies. Such health impact cannot be assessed in the absence of a conceptual or organizing framework that provides the requisite guideposts--population health goals and targets. Health impact assessment offers an approach to ensuring that governments' program and policy initiatives align, or are congruent with, the agreed-upon health goals. It suggests that proposed national policies should be supported or resisted on the basis of their probable influence on the health of populations. In the current Canadian national policy framework, however, there are no underpinnings on which to situate such a process. The specification of consensus goals and objectives with measurable targets can provide the requisite guideposts and benchmarks for health impact assessment. Such an undertaking can set the stage and provide the necessary foundation for an effective health impact assessment process.
Subject(s)
Health Policy , Health Promotion , Health Status Indicators , Public Health Administration , Canada , Health Planning Guidelines , Health Services Research , Humans , Population , Program EvaluationABSTRACT
The purpose of this study was to test a theoretical model of the following variables, decentralization, professional autonomy, job satisfaction, and organizational commitment. Data were collected through a comprehensive survey of first-line nurse managers (N = 200) in acute care hospitals with more than 100 beds in British Columbia, Canada. The final model excluded all explored personal characteristics of the nurse manager-gender, health or vitality status, marital status, age, education, and years of supervisory or management experience. Job satisfaction was found to be an important predictor of organizational commitment. However, decentralization was most important because it affected organizational commitment directly, as well as indirectly, through professional autonomy and job satisfaction.
Subject(s)
Job Satisfaction , Nursing Service, Hospital/organization & administration , Professional Autonomy , Adult , Female , Humans , Male , Middle Aged , Models, Nursing , Surveys and QuestionnairesABSTRACT
Data from 197 randomly selected male adults were analyzed in order to examine the dimensionality of two of the concepts in the Health Promotion Model-perceived control of health and definition of health. The model, tested with LISREL, examines the impact of age on exercise with the key concepts modeled as intervening variables. The addition of multiple indicators resulted in a model that failed to meet the data constraints, thereby calling into question the putative dimensionality of perceived control of health and definition of health. The proportionality constraints within multiple-indicator structural equation models seem to provide a more stringent test of whether several indicators measure the same concept than the test provided by the internal consistency constraints implicit in factor analysis.