What parenting practices do US and Canadian parents use to encourage or discourage healthy eating among their 5-12 year-old children?

This study explored the parenting practices that parents of 5-12 year-old children report using to encourage or discourage children's healthy eating and examined sex differences in parent's responses. A stratified sample of 135 parents in the US and Canada completed a semi-qualitative online survey (Jan-Feb 2014) (stratified by parents' sex, income, and ethnicity of each country). Parents provided short answers to questions regarding the strategies they or other parents used to encourage or discourage their children's healthy eating (5-12 year-old). The 2389 parent responses were coded by two coders with discrepancies triangulated. Data was qualitatively reviewed and log-linear analysis assessed whether responses varied by types of encouragement (encourage, discourage), sex of parent (male, female), and six dimensions of parenting practices (autonomy promotion, structure of the food environment, behavioral and educational, control, responsiveness, and consistency of the food environment). Parenting practices that were controlling or promoted structure were predominantly mentioned as a way to regulate children's eating behavior. Strategies that support children's self-regulatory processes, such as autonomy promotion and responsiveness, were infrequently mentioned. Sex differences in parenting practices emerged. Mothers mentioned autonomy promoting practices more often than fathers did. Fathers mentioned controlling practices more often than mothers did as a practice that discouraged healthy eating among children. The findings highlighted that parents need to gain a greater understanding of the practices that nurture healthy eating in children, such as autonomy supportive and responsive parenting practices, to better support children as they grow.

Patterns of health care utilization among people who overdosed from illegal drugs: a descriptive analysis using the BC Provincial Overdose Cohort. / Habitudes d'utilisation des soins de santé chez les personnes ayant fait une surdose de drogues illicites : analyse descriptive fondée sur la Cohorte provinciale des victimes de surdoses de la Colombie-Britannique.

INTRODUCTION: British Columbia (BC) declared a public health emergency in April 2016 in response to a rapid rise in overdose deaths. Further understanding of health care utilization is needed to inform prevention strategies for individuals who overdose from illegal drugs. METHODS: The Provincial Overdose Cohort includes linked administrative data on health care utilization by individuals who experienced an illegal drug overdose event in BC between 1 January 2015 and 30 November 2016. Overdose cases were identified using data from ambulance services, coroners' investigations, poison control centre calls and hospital, emergency department and physician administrative records. In total, 10 455 overdose cases were identified and compared with 52 275 controls matched on age, sex and area of residence for a descriptive analysis of health care utilization. RESULTS: Two-thirds (66%) of overdose cases were male and about half (49%) were 20-39 years old. Over half of the cases (54%) visited the emergency department and about one-quarter (26%) were admitted to hospital in the year before the overdose event, compared with 17% and 9% of controls, respectively. Nevertheless, nearly onefifth (19%) of cases were recorded leaving the emergency department without being seen or against medical advice. High proportions of both cases (75%) and controls (72%) visited community-based physicians. Substance use and mental health-related concerns were the most common diagnoses among people who went on to overdose. CONCLUSION: People who overdosed frequently accessed the health care system in the year before the overdose event. In light of the high rates of health care use, there may be opportunities to identify at-risk individuals before they overdose and connect them with targeted programs and evidence-based interventions. Further work using the BC Provincial Overdose Cohort will focus on identifying risk factors for overdose events and death by overdose.

INTRODUCTION: La Colombie-Britannique (C.-B.) a déclaré un état d'urgence en santé publique en avril 2016 en réaction à une augmentation rapide du nombre de décès par surdose. Une meilleure compréhension de l'utilisation des soins de santé est nécessaire pour guider les stratégies de prévention pour les personnes qui font une surdose de drogues illicites. MÉTHODOLOGIE: La cohorte provinciale des victimes de surdoses comprend des données administratives couplées sur l'utilisation des soins de santé par les personnes qui ont été victimes d'une surdose de drogues illicites en Colombie-Britannique entre le 1er janvier 2015 et le 30 novembre 2016. Les cas de surdose ont été relevés à l'aide de données provenant des services ambulanciers, des enquêtes des coroners, des appels aux centres antipoison et des dossiers administratifs des hôpitaux, des services d'urgence et des médecins. Au total, 10 455 cas de surdose ont été recensés et comparés à 52 275 témoins appariés selon l'âge, le sexe et la zone de résidence en vue d'une analyse descriptive de l'utilisation des soins de santé. RÉSULTATS: Les deux tiers (66 %) des cas de surdose concernaient des hommes, et environ la moitié (49 %) les 20 à 39 ans. Plus de la moitié des cas (54 %) se sont rendus au service d'urgence, et environ le quart (26 %) ont été admis à l'hôpital au cours de l'année précédant la surdose, comparativement à respectivement 17 % et 9 % des témoins. Cependant, près d'un cinquième (19 %) des cas ont été enregistrés comme ayant quitté le service d'urgence sans avoir été vus par le médecin ou contre son avis. Des proportions élevées de cas (75 %) et de témoins (72 %) ont consulté un médecin en milieu communautaire. La consommation de substances et des problèmes en santé mentale ont été les diagnostics les plus courants chez les personnes qui ont fait une surdose. CONCLUSION: Les personnes qui ont fait une surdose ont souvent eu accès au système de soins de santé au cours de l'année précédant la surdose. Compte tenu de ces taux élevés d'utilisation des soins de santé, on pourrait peut-être repérer les personnes à risque avant qu'elles ne fassent de surdose et les aiguiller vers des programmes ciblés et des interventions fondées sur des données probantes. Il est prévu d'utiliser la cohorte provinciale des victimes de surdoses de la Colombie-Britannique pour déterminer les facteurs de risque relatifs aux surdoses et aux décès par surdose.

What do US and Canadian parents do to encourage or discourage physical activity among their 5-12 Year old children?

BACKGROUND: Parents have the potential to substantively influence their child's physical activity. This study identified the parenting practices of US and Canadian parents to encourage or discourage their 5-12 year-old child's physical activity and to examine differences in parenting practices by country, parental sex, age of child, and income. METHODS: The sample consisted of 134 US and Canadian parents (54.5% US; 60.4% female) recruited from a web-based panel by a polling firm. The parents answered open-ended questions about what they and other parents do to encourage or discourage their child to be active. Responses were coded using a scheme previously developed to code items used in the published literature. Coded responses were summarized by domain and dimension with differences in responses by country, parental sex, age of child, or household income assessed with a log-linear analysis. RESULTS: The 134 parents provided 649 and 397 responses to ways that parents encourage or discourage their child's physical activity, respectively. Over 70% of responses for practices that encourage physical activity were related to structure of the environment, parental encouragement, and co-participation. The most common response was co-participation in activity with the child. Of the practices that discourage physical activity, 67% were related to structure of the environment, lack of parental control, and modeling poor behaviors. The most common response was allowing screen time. There were no differences in response by country, parental sex, child age, or household income. CONCLUSIONS: Parents most often encouraged physical activity through structure and emotional support and discouraged physical activity through lack of structure and control. Understanding how parents influence their child's physical activity may help improve intervention strategies. The current results will inform the development of a physical activity parenting practices instrument.

Food parenting practices for 5 to 12 year old children: a concept map analysis of parenting and nutrition experts input.

BACKGROUND: Parents are an important influence on children's dietary intake and eating behaviors. However, the lack of a conceptual framework and inconsistent assessment of food parenting practices limits our understanding of which food parenting practices are most influential on children. The aim of this study was to develop a food parenting practice conceptual framework using systematic approaches of literature reviews and expert input. METHOD: A previously completed systematic review of food parenting practice instruments and a qualitative study of parents informed the development of a food parenting practice item bank consisting of 3632 food parenting practice items. The original item bank was further reduced to 110 key food parenting concepts using binning and winnowing techniques. A panel of 32 experts in parenting and nutrition were invited to sort the food parenting practice concepts into categories that reflected their perceptions of a food parenting practice conceptual framework. Multi-dimensional scaling produced a point map of the sorted concepts and hierarchical cluster analysis identified potential solutions. Subjective modifications were used to identify two potential solutions, with additional feedback from the expert panel requested. RESULTS: The experts came from 8 countries and 25 participated in the sorting and 23 provided additional feedback. A parsimonious and a comprehensive concept map were developed based on the clustering of the food parenting practice constructs. The parsimonious concept map contained 7 constructs, while the comprehensive concept map contained 17 constructs and was informed by a previously published content map for food parenting practices. Most of the experts (52%) preferred the comprehensive concept map, while 35% preferred to present both solutions. CONCLUSION: The comprehensive food parenting practice conceptual map will provide the basis for developing a calibrated Item Response Modeling (IRM) item bank that can be used with computerized adaptive testing. Such an item bank will allow for more consistency in measuring food parenting practices across studies to better assess the impact of food parenting practices on child outcomes and the effect of interventions that target parents as agents of change.

Longitudinal changes in visceral and subcutaneous adipose tissue and metabolic syndrome: Results from the Multicultural Community Health Assessment Trial (M-CHAT).

AIM: Few studies have examined whether longitudinal changes in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), independent of each other, are associated with the risk of developing metabolic syndrome (MetS). The objective of this study was to examine the longitudinal effects of VAT and SAT on MetS and metabolic risk factors in a multi-ethnic sample of Canadians followed for 5-years. MATERIALS AND METHODS: In total, 598 adults of the Multicultural Community Health Assessment Trial (M-CHAT) were included in this study. Assessments of body composition using computed tomography (CT) and metabolic risk factors were conducted at baseline, 3-, and 5-years. Mixed-effects logistic regression was used to model the longitudinal effects of VAT and SAT on MetS and metabolic risk factors. RESULTS: There were significant between-person (cross-sectional) effects such that for every 10cm2 higher VAT, the odds of MetS, high-risk fasting glucose levels and high-risk HDL-C levels significantly increased by 16% (95% CI: 9-24%), 11% (3-20%), and 7% (0-14%) respectively. Significant within-person (longitudinal) effects were also found such that for every 10cm2 increase in VAT the odds of MetS and high-risk triglyceride levels significantly increased by 23% (9-39%) and 30% (14-48%), respectively. Cross-sectional or longitudinal changes in SAT were not associated with MetS or metabolic risk factors. CONCLUSIONS: This study found a direct relationship between longitudinal change in VAT and MetS risk independent of changes in SAT. Clinical practice should focus on the reduction of VAT to improve cardiovascular health outcomes.

Conceptualizing physical activity parenting practices using expert informed concept mapping analysis.

BACKGROUND: Parents are widely recognized as playing a central role in the development of child behaviors such as physical activity. As there is little agreement as to the dimensions of physical activity-related parenting practices that should be measured or how they should be operationalized, this study engaged experts to develop an integrated conceptual framework for assessing parenting practices that influence multiple aspects of 5 to 12 year old children's participation in physical activity. The ultimate goal of this study is to inform the development of an item bank (repository of calibrated items) aimed at measuring physical activity parenting practices. METHODS: Twenty four experts from 6 countries (Australia, Canada, England, Scotland, the Netherlands, & United States (US)) sorted 77 physical activity parenting practice concepts identified from our previously published synthesis of the literature (74 measures) and survey of Canadian and US parents. Concept Mapping software was used to conduct the multi-dimensional scaling (MDS) analysis and a cluster analysis of the MDS solution of the Expert's sorting which was qualitatively reviewed and commented on by the Experts. RESULTS: The conceptual framework includes 12 constructs which are presented using three main domains of parenting practices (neglect/control, autonomy support, and structure). The neglect/control domain includes two constructs: permissive and pressuring parenting practices. The autonomy supportive domain includes four constructs: encouragement, guided choice, involvement in child physical activities, and praises/rewards for their child's physical activity. Finally, the structure domain includes six constructs: co-participation, expectations, facilitation, modeling, monitoring, and restricting physical activity for safety or academic concerns. CONCLUSION: The concept mapping analysis provided a useful process to engage experts in re-conceptualizing physical activity parenting practices and identified key constructs to include in measures of physical activity parenting. While the constructs identified ought to be included in measures of physical activity parenting practices, it will be important to collect data among parents to further validate the content of these constructs. In conclusion, the method provided a roadmap for developing an item bank that captures key facets of physical activity parenting and ultimately serves to standardize how we operationalize measures of physical activity parenting.

Does parental and adolescent participation in an e-health lifestyle modification intervention improves weight outcomes?

BACKGROUND: Few studies have evaluated the effect of adherence to a lifestyle intervention on adolescent health outcomes. The objective of this study was to determine whether adolescent and parental adherence to components of an e-health intervention resulted in change in adolescent body mass index (BMI) and waist circumference (WC) z-scores in a sample of overweight/obese adolescents. METHODS: In total, 159 overweight/obese adolescents and their parents participated in an 8-month e-health lifestyle intervention. Each week, adolescents and their parents were asked to login to their respective website and to monitor their dietary, physical activity, and sedentary behaviours. We examined participation (percentage of webpages viewed [adolescents]; number of weeks logged in [parents]) and self-monitoring (number of weeks behaviors were tracked) rates. Linear mixed models and multiple regressions were used to examine change in adolescent BMI and WC z-scores and predictors of adolescent participation and self-monitoring, respectively. RESULTS: Adolescents and parents completed 28% and 23%, respectively, of the online component of the intervention. Higher adolescent participation rate was associated with a decrease in the slope of BMI z-score but not with change in WC z-score. No association was found between self-monitoring rate and change in adolescent BMI or WC z-scores. Parent participation was not found to moderate the relationship between adolescent participation and weight outcomes. CONCLUSIONS: Developing strategies for engaging and promoting supportive interactions between adolescents and parents are needed in the e-health context. Findings demonstrate that improving adolescents' adherence to e-health lifestyle intervention can effectively alter the weight trajectory of overweight/obese adolescents.

Exploring the mediating roles of physical activity and television time on the relationship between the neighbourhood environment and childhood obesity.

OBJECTIVE: Understanding the mechanisms by which neighbourhood environments influence childhood obesity is needed to facilitate the development of prevention strategies. The objective of this cross-sectional study was to identify the distinct types of neighbourhoods in which Canadian children reside and examine the extent to which physical activity and sedentary behaviour mediate the relationship between neighbourhood type and childhood obesity. METHODS: Baseline data from the National Longitudinal Survey of Children and Youth (1994/1995) were used for this study. Latent class analysis was used to group children (age 0-11; N = 22,831) into neighbourhood types based on perceived and census-derived measures of neighbourhood attributes. A path analysis was used to determine the extent to which levels of physical activity and sedentary behaviour mediated the relationship between the resulting neighbourhood types and obesity. RESULTS: Five neighbourhood types were identified. Children living in the high safety-low deprivation neighbourhood type, which had the most supportive attributes with regard to physical activity, were significanlty less likely to be obese than children living in the other neighbourhood types. Relative to the high safety-low deprivation neighbourhood, the relationship between neighbourhood type and obesity was partially mediated by physical activity and sedentary behaviour (7%-12% of total effect) among the other urban neighbourhoods, and no mediating effect was found in the rural neighbourhood. CONCLUSIONS: Intervention strategies attempting to address the increased risk of obesity associated with neighbourhood environments should be tailored according to urban and rural setting and should consider taking a comprehensive approach aimed at improving a range of obesity-related behaviours.

Are the Physical Activity Parenting Practices Reported by US and Canadian Parents Captured in Currently Published Instruments?

BACKGROUND: The purpose of this study was to compare the physical activity parenting practices (PAPPs) parents report using with the PAPPs incorporated in the published literature. METHODS: PAPPs in the literature were identified by reviewing the content of 74 published PAPP measures obtained from current systematic reviews supplemented with a literature search. The types of PAPPs used by parents were identified by surveying a stratified sample of 134 Canadian and US parents of 5- to 12 year-old children. Items from the literature and parent responses were coded using the same coding scheme. Differences between the PAPPs emphasized by the parents and the literature were examined. RESULTS: Parents significantly emphasized different issues than what is measured in the literature (P < .001). Parents emphasized more control (13.6% vs. 6.9%), modeling and teaching (13.2% vs. 9.2%), and structural strategies (32.2% vs. 28.6%) and less autonomy support (11.8% vs. 14.0%), logistical support (9.9% vs. 12.8%), and responsiveness strategies (19.3% vs. 28.5%). CONCLUSIONS: Physical activity practices most often employed by parents are not the ones emphasized in current measures. The extent to which putting more emphasis on the areas identified by parents will increase the predictive validity of the measures warrants further examination.

Development of an item bank for food parenting practices based on published instruments and reports from Canadian and US parents.

Research to understand how parents influence their children's dietary intake and eating behaviors has expanded in the past decades and a growing number of instruments are available to assess food parenting practices. Unfortunately, there is no consensus on how constructs should be defined or operationalized, making comparison of results across studies difficult. The aim of this study was to develop a food parenting practice item bank with items from published scales and supplement with parenting practices that parents report using. Items from published scales were identified from two published systematic reviews along with an additional systematic review conducted for this study. Parents (n = 135) with children 5-12 years old from the US and Canada, stratified to represent the demographic distribution of each country, were recruited to participate in an online semi-qualitative survey on food parenting. Published items and parent responses were coded using the same framework to reduce the number of items into representative concepts using a binning and winnowing process. The literature contributed 1392 items and parents contributed 1985 items, which were reduced to 262 different food parenting concepts (26% exclusive from literature, 12% exclusive from parents, and 62% represented in both). Food parenting practices related to 'Structure of Food Environment' and 'Behavioral and Educational' were emphasized more by parent responses, while practices related to 'Consistency of Feeding Environment' and 'Emotional Regulation' were more represented among published items. The resulting food parenting item bank should next be calibrated with item response modeling for scientists to use in the future.

Body mass index trajectories from ages 1 to 20: Results from two nationally representative canadian longitudinal cohorts.

OBJECTIVE: In this study, unique body mass index (BMI) trajectories from ages 1 to 20 years were identified; each trajectory according to socio demographic and family characteristics was described. METHODS: Participants came from two national population surveys (n = 7,253; n = 901) and were aged 1-6 years at baseline. Children were surveyed biennially over eight waves up to 14-20 years of age. BMI trajectories by sex and survey cohort were identified by group-based trajectory modeling. After crossvalidating trajectories between survey cohorts, the characteristics of trajectory membership were assessed by multinomial regression. RESULTS: Four BMI trajectories were found: low, decreasing, medium, and high. The decreasing trajectory was characterized by an overweight or obese childhood followed by a normal-weight adolescence. The low, medium, and high trajectories were characterized by growth curves culminating, by age 20, to BMI 22.6, 29.3, and 34.9 kg/m(2) , respectively, for males and 20.6, 24.5, and 32.0 kg/m(2) , respectively, for females. Factors associated with the high trajectory included ethnicity and paternal education (female only), large for gestational age, rural area residence, and maternal smoking. CONCLUSIONS: The identification and validation of four major trajectories reflect the heterogeneity in patterns of BMI development from 1 to 20 years.

Parent-Adolescent Patterns of Physical Activity, Sedentary Behaviors and Sleep Among a Sample of Overweight and Obese Adolescents.

BACKGROUND: The purpose of this study was to examine the association between parent and adolescent levels of physical activity, sedentary behaviors, and sleep among a group of overweight and obese adolescents. METHODS: Baseline data of parent-adolescent pairs who enrolled in a lifestyle modification intervention were analyzed for this study (n = 176). Participants completed questionnaires about their screen time (TV, video game, and computer time), wore an accelerometer for 8 days, and completed a sleep diary for 1 week. In total, 98 parent-adolescent dyads provided valid data for the analyses. Multivariable regression analyses were conducted to assess the relationship between parent and adolescent's moderate-to-vigorous activity (MVPA), step counts, sedentary behaviors, and sleep duration. Analyses were split by weekday, weekday evening and weekend. RESULTS: Parent-adolescent MVPA was significantly associated on weekdays (b = 0.18; SE = 0.08; ß = 0.26), weekday evenings (b = 0.21; SE = 0.08; ß = 0.28), and weekends (b = 0.29; SE = 0.12; ß = 0.27). This study found associations between parent-child video game time on weekends (b = 1.10; SE = 0.49; ß = 0.24) and computer time on weekdays (b = 0.42; SE = 0.19; ß = 0.23). Adolescent sleep was associated with parental sleep on weekdays only (b = 0.38; SE = 0.09; ß = 0.46). CONCLUSION: The findings warrant further investigation into the direction and mechanism of the relationship between parent and adolescent weight related behaviors.

Individual and household predictors of adolescents' adherence to a web-based intervention.

BACKGROUND: Adherence to e-health obesity interventions is a significant challenge. PURPOSE: We examined the individual and household predictors of adolescents' adherence to a Web-based lifestyle intervention. METHODS: One hundred sixty overweight/obese adolescents and one of their parents enrolled in the 8-month e-health intervention. Structural equation modeling was used to examine individual factors from the theory of planned behavior and self-determination theory and household factors (food/soda availability, parenting, environment) that predict adolescents' adherence to components of the intervention. RESULTS: We explained 10.8 to 36.9% of the total variance in adherence to components of the intervention. Intrinsic motivation and parenting practices and styles directly predicted adherence. Relatedness and autonomy support indirectly predicted adherence via intrinsic motivation. Finally, household income modulated these effects. CONCLUSION: Taking a self-regulatory perspective (i.e., accounting for intrinsic motivation) contributes to our understanding of intervention adherence, but the household environment may play a greater role in facilitating adolescent behavior change.

Who knows more about immunization?: Survey of public health nurses and physicians.

OBJECTIVE: To report the findings of a knowledge survey of nurse and physician immunization providers. DESIGN: Cross-sectional postal survey assessing demographic characteristics and vaccine knowledge. SETTING: British Columbia (BC). PARTICIPANTS: Nurse and physician immunization providers in BC. MAIN OUTCOME MEASURES: Knowledge of vaccine-preventable diseases, vaccines in general, and vaccine administration and handling practices. RESULTS: Survey responses were received from 256 nurses and 292 physicians (response rates of 48.6% and 18.3%, respectively). Most nurses (98.4%) reported receiving immunization training outside of the academic setting compared with 55.6% of physicians. Overall, nurse immunizers scored significantly higher than physician immunizers on all 3 domains of immunization knowledge (83.7% vs 72.8%, respectively; P < .001). Physicians scored highest on the vaccine-preventable disease domain and least well on the general vaccine domain. Nurses with more experience as health care providers scored higher. Physicians scored higher if they were female, served patient populations predominantly younger than 5 years, or received immunization training outside of academic settings. CONCLUSION: In BC, nurse immunizers appear to have higher overall immunization knowledge than physicians and are more likely to receive immunization training when in practice. Physician immunizers might benefit most from further training on vaccines and vaccine administration and handling.

Estimates of smoking-attributable mortality and hospitalization in BC, 2002-2007.

OBJECTIVE: The objective of this paper was to estimate the number and rate of deaths and hospitalizations attributable to smoking in British Columbia (BC) from 2002 to 2007. METHODS: Using attributable fractions adjusted to BC smoking prevalence and mortality and hospital administrative data, estimates of smoking-attributable mortality (SAM) and smoking-attributable hospitalization (SAH) were calculated by year, disease category, sex, and geographic region. RESULTS: Among active smoking adults 15 years of age and older, there were an estimated 4,851 deaths and 25,314 hospitalizations attributed to smoking in BC in 2007. SAM and SAH rates in 2007 were estimated as 119 and 633 per 100,000, respectively. Rates increased from 2002 to 2005 but have declined in subsequent years. Lung cancer and chronic obstructive pulmonary disease were responsible for the largest proportion of SAM and SAH, respectively. There were regional differences, with the Northern Health authority having the highest rate of SAM and SAH and Vancouver Coastal Health authority having the lowest. CONCLUSION: Smoking still presents a substantial human and economic burden in BC. Estimates of annual SAM and SAH provide researchers with the ability to detect emerging trends, target intervention and cessation programs, and evaluate current smoking reduction programs. The methodology can be adapted to other provinces to allow for cross-province comparisons.

The relationship between income and weight control strategies among Canadian adults.

OBJECTIVE: The goal of this study was to examine use of weight control strategies in Canadian adults and the role of income as a barrier to using these strategies. METHODS: Data from the Canadian Community Health Survey cycle 4.1 on health behaviour change was used for this study. Analysis was restricted to adults (18+ years) residing in the 10 provinces of Canada. Respondents were categorized as having used weight control strategies in their lifestyle if they responded that they increased exercise, improved/modified their eating habits, or lost weight in the previous 12 months, as the primary means of health improvement. An adjusted household income ratio divided into deciles was used as a measure of income. Multivariable logistic regression was used to examine the relationship between income and weight control strategies adjusting for known confounders. RESULTS: Of the 103,990 respondents analyzed, 60% were overweight or obese and 45% reported using weight control strategies in the previous 12 months. Age, sex, ethnicity, having a regular doctor, education, and income were all significantly associated with using weight control strategies in the multivariable model. Results that included all two- and three-way interactions between sex, weight category, and income found that lower income was significantly associated with using fewer weight control strategies--more so for obese men and normal weight women. CONCLUSION: Efforts must be made to create equal access to services and food products that promote weight reduction or control strategies given the rising prevalence of adult obesity in Canada.

Identifying attitudes, beliefs and reported practices of nurses and doctors as immunization providers.

AIM: This paper is a report of a study conducted to examine the attitudes, beliefs, behavioural intentions and self-reported behaviour of nurses and physicians relating to key immunization behaviours and compare the findings for nurses and physicians. BACKGROUND: Immunization is an important and effective public health intervention. Understanding immunization providers' attitudes and beliefs toward immunization has the potential to improve educational efforts and lead to behavioural change. METHOD: A postal survey was conducted with all immunization providers in British Columbia, Canada, in 2005. The survey elicited data on demographics, practice characteristics, attitudes, perceived social norms and perceived behavioural control related to key immunization behaviours. RESULTS: Responses were received from 344 nurses and 349 physicians. The response rate was 67% for nurses and 22% for physicians. More nurses than physicians thought that administering all recommended vaccines at one visit was important (89.2% vs. 63.2%P < 0.001); nurses felt more pressure from parents to administer all recommended vaccines (82.4% vs. 48.7%P < 0.001), and nurses were also more likely to intend to give all recommended vaccines at one visit (98.8% vs. 73.8%P < 0.001). Both nurses and physicians thought that their own receipt of influenza vaccine each year was important (88.9%, 87.1% respectively P = 0.65). CONCLUSION: The foundational work done to develop the survey tool can be used to modify it so that survey findings can be validated according to the Theory of Planned Behaviour. The results could inform the development of behavioural change interventions targeting the identified determinants of immunization provider behaviour.

The context of illicit drug overdose deaths in British Columbia, 2006.

BACKGROUND: Illicit drug overdose deaths (IDD) relate to individual drug dose and context of use, including use with other drugs and alcohol. IDD peaked in British Columbia (BC) in 1998 with 417 deaths, and continues to be a public health problem. The objective of this study was to examine IDD in 2006 in BC by place of residence, injury and death, decedents' age and sex and substances identified. METHODS: IDD data was obtained through the BC Coroners Office and entered into SPSS (version 14). Fisher's exact and Pearson's chi2 were used for categorical data; Mann-Whitney U-test for continuous variables. Rates were calculated using 2006 population estimates. RESULTS: We identified 223 IDD in BC; 54 (24%) occurred in Vancouver. Vancouver decedents (compared to those occurring outside Vancouver) were older (mean age 43.9 vs. 39.2 years; p < 0.01) and more likely to be male (90.7% vs. 77.5%; p = 0.03). Provincially Aboriginal ethnicity was reported for 19 deaths; 13 (30.2%) of 43 females and 6 (3.3%) of 180 males (p = < 0.001).Cocaine was identified in 80.3%, opiates 59.6%, methadone 13.9%, methamphetamine/amphetamine 6.3%, and alcohol in 22.9% of deaths. Poly-substance use was common, 2 substances were identified in 43.8% and 3 or more in 34.5% of deaths. Opiates were more frequently identified in Vancouver compared to outside Vancouver (74.1% vs. 55.0%) p = 0.015. CONCLUSION: Collaboration with the Coroner's office allowed us to analyze IDD in detail including place of death; cocaine, opiates and poly-substance use were commonly identified. Poly-substance use should be explored further to inform public health interventions.

Prevalence and incidence of hepatitis C virus in hemodialysis patients in British Columbia: Follow-up after a possible breach in hemodialysis machines.

BACKGROUND: A possible breach of the transducer protector in specific dialysis machines was reported in June 2004 in British Columbia (BC), which led to testing of hemodialysis patients for hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV. This testing provided an opportunity to examine HCV incidence, prevalence and coinfection with HBV and HIV, and to compare anti-HCV and HCV polymerase chain reaction (PCR). METHODS: The results of hemodialysis patients who were dialyzed on the implicated machines (65% of BC dialysis patients), and tested for HCV, HBV and HIV, between June 1, 2004, and December 31, 2004, were reviewed and compared with available previous results. RESULTS: Of 1286 hemodialysis patients with anti-HCV and/or HCV-PCR testing, 69 (5.4%) tested positive. Two HCV genotype 4 seroconversions were identified. HCV incidence rate on dialysis was 78.8 cases per 100,000 person-years. Younger age, history of renal transplant and past HBV infection were associated with HCV infection. No occult infection was identified using HCV-PCR. INTERPRETATION: Hemodialysis patients had three times the HCV prevalence rate of the general BC population, and more than 20 times the incident rate of the general Canadian population. One of the two seroconversions occurred before the testing campaign; the patient was likely infected during hemodialysis in South Asia. The other was plausibly a late seroconversion following renal transplant in South Asia. Nosocomial transmission cannot be ruled out because both patients were dialyzed in the same centre. Baseline and annual anti-HCV testing is recommended. HCV-PCR should be considered at baseline for persons with HCV risk factors, and for returning travellers who received dialysis in HCV-endemic countries to identify HCV infection occurring outside the hemodialysis unit.

Gender differences in the correlates of adolescents' cannabis use.

Adolescents' gender-specific cannabis use rates and their correlates were examined. Data were obtained via a cross-sectional survey conducted in 2004 in British Columbia, Canada, funded by the Canadian Institutes of Health Research. School districts were invited to participate, and schools within consenting districts were recruited. In total, 8,225 students (50% male) from Grades 7 to 12 participated. About 73% were "White," and 47% had used cannabis in their lifetime. Cannabis users were grouped according to their frequency of use: "never users," "frequent users," or "heavy users." Male heavy cannabis users (14.3% of boys) were more likely to be in Grade 9 or higher; be Aboriginal; report poorer economic status; never feel like an outsider; frequently use alcohol and tobacco; and have lower satisfaction with family, friends, and school compared with boys that never used. Female heavy users (8.7% of girls) were more likely to be in a higher grade; report poorer economic status, mental health, and academic performance; frequently use alcohol and tobacco; and have lower satisfaction with their school compared with female never users. Three important gender differences in the multivariate analysis of the correlates of cannabis use were noted: school grade (for boys only), Aboriginal status (for boys only), and mental health (for girls only). Despite the limitations of relying on self-reports, a subset of youth appears to be at risk for excessive cannabis use that may impair life opportunities and health. The gender differences may be important in the design and implementation of prevention or treatment programs for adolescents.