Associations of gaseous air pollutants (including carbon monoxide, sulfur dioxide, nitrogen dioxi... more Associations of gaseous air pollutants (including carbon monoxide, sulfur dioxide, nitrogen dioxide, and ozone) with asthma hospitalization, stratified by sex and socioeconomic status, were examined among children 6-12 years of age in Vancouver, British Columbia, Canada, between 1987 and 1998. Relative risks for an exposure increment corresponding to the interquartile range for each gaseous air pollutant were estimated for asthma
This paper reviews the history of the development by governments, beginning in the 1980s in the U... more This paper reviews the history of the development by governments, beginning in the 1980s in the United States, of formal schemata intended to represent the necessary steps in arriving at a credible and robust risk management decision. The paper illustrates the challenge posed by the emergence of BSE, by summarizing the nature of prion disease risks, the experience of many
ABSTRACT Young children are more highly exposed and vulnerable to environmental health hazards th... more ABSTRACT Young children are more highly exposed and vulnerable to environmental health hazards than adults due to a variety of physiological and behavioural factors. Despite the significant responsibility mothers typically bear in managing their children’s health, little is known about how they perceive and negotiate these risks in their day-to-day lives. To better understand mothers’ environmental health risk perceptions and associated protective actions across socio-economic and geographic contexts, a telephone survey was conducted among new mothers (n = 606) recruited through two Public Health Units in Ontario, Canada. Analyses revealed that approximately half of the respondents were moderately or highly concerned about environmental health risks, ranging in nature from household products to outdoor air contaminants. Factors affecting the likelihood of experiencing concern included lower income and lower levels of perceived control. With regard to protective actions, 43% reported taking three or more actions to reduce environmental health risks to their children, with the likelihood of taking action being negatively affected by factors including low income and first language other than English or French, and positively affected by being a first-time parent (primiparous). This study contributes to our understanding of environmental health risk perceptions and associated protective behaviours among new mothers, and has implications for the development of more context-focused risk management and communication strategies.
ith the debates on health care in Canada and the creation of the Canadian Institutes of Health Re... more ith the debates on health care in Canada and the creation of the Canadian Institutes of Health Research (CIHR), a new field called "population health" has emerged. Multidimensional integration is required to reconceptualize health around "deter- minants of health" 1 and to reconfigure research conducted by the CIHR in terms of the biomedical, clinical, systems and ser vices, sociocultural, and
Background This article examines the relationship between lower income and the risk of experienci... more Background This article examines the relationship between lower income and the risk of experiencing high psychological distress over twelve years. Data and methods Data from the first 12 years of the longitudinal National Population Health Survey (1994/1995 through 2006/2007) were analysed. Proportional hazards modelling was conducted to determine whether lower household income was associated with a greater risk of experiencing
Canadian family physician Médecin de famille canadien, 2002
ABSTRACT ith the debates on health care in Canada and the creation of the Canadian Institutes of ... more ABSTRACT ith the debates on health care in Canada and the creation of the Canadian Institutes of Health Research (CIHR), a new field called "population health" has emerged. Multidimensional integration is required to reconceptualize health around "deter- minants of health" 1 and to reconfigure research conducted by the CIHR in terms of the biomedical, clinical, systems and ser vices, sociocultural, and environmental dimensions of health. Social ecology makes this integration possible. Family physicians can help increase awareness, communication, cooperation, and change to inte- grate population health into a social ecology para- digm. Consequently, family medicine researchers are uniquely positioned to investigate and report on population health. This article describes the major components of population health.
International Journal of Sport and Exercise Psychology, 2009
This two‐study research assessed intentions and actual physical activity behavior change in a com... more This two‐study research assessed intentions and actual physical activity behavior change in a community‐based sample of Canadian middle‐aged women by integrating concepts from two strong and complimentary psychological theories: the Theory of Planned Behavior (TPB) and Self‐Determination Theory (SDT). Specific objectives were 1) to examine associations among TPB variables, motivation, and intention to increase physical activity and 2) to examine
This article examines the relationship between lower income and the risk of experiencing high psy... more This article examines the relationship between lower income and the risk of experiencing high psychological distress over twelve years. Data from the first 12 years of the longitudinal National Population Health Survey (1994/1995 through 2006/2007) were analysed. Proportional hazards modelling was conducted to determine whether lower household income was associated with a greater risk of experiencing high distress, when adjusting for sociodemographic characteristics and baseline health status. It was also used to examine the relationship between reporting a stressor and experiencing a subsequent episode of distress. Overall, 11% of the initial sample experienced at least one episode of high distress during the 12 years of the study. Low-income respondents were at a significantly higher risk of becoming psychologically distressed, and many of the stressors were associated with a significantly higher risk of becoming distressed. Stressors accounted for 22% of the relationship between ...
Resilience has been described in many ways and is inherently complex. In essence, it refers to th... more Resilience has been described in many ways and is inherently complex. In essence, it refers to the capacity to face and do well when adversity is encountered. There is a need for empirical research on community level initiatives designed to enhance resilience for high-risk groups as part of an upstream approach to disaster management. In this study, we address this issue, presenting the EnRiCH Community Resilience Framework for High-Risk Populations. The framework presented in this paper is empirically-based, using qualitative data from focus groups conducted as part of an asset-mapping intervention in five communities in Canada, and builds on extant literature in the fields of disaster and emergency management, health promotion, and community development. Adaptive capacity is placed at the centre of the framework as a focal point, surrounded by four strategic areas for intervention (awareness/communication, asset/resource management, upstream-oriented leadership, and connectedness/engagement). Three drivers of adaptive capacity (empowerment, innovation, and collaboration) cross-cut the strategic areas and represent levers for action which can influence systems, people and institutions through expansion of asset literacy. Each component of the framework is embedded within the complexity and culture of a community. We present recommendations for how this framework can be used to guide the design of future resilience-oriented initiatives with particular emphasis on inclusive engagement across a range of functional capabilities.
Several trials have employed anxiety measures to assess decision aid effectiveness. This study em... more Several trials have employed anxiety measures to assess decision aid effectiveness. This study employed a systematic review method to integrate their findings. The affective impact of decision aids and the appropriateness of anxiety as a measure of decision aid effectiveness are explored. From 11,361 citations generated from searching electronic databases and journals, 26 randomised controlled trials evaluated patient decision aids;
In response to the 2003 global outbreak of severe acute respiratory syndrome (SARS), and the thre... more In response to the 2003 global outbreak of severe acute respiratory syndrome (SARS), and the threat of pandemic influenza, Canadian hospitals have been actively developing and revising their emergency plans. Healthcare workers are a particularly vulnerable group at risk of occupational exposure during infectious disease outbreaks, as seen during SARS and as documented/reported in the recent National Survey of the Work and Health of Nurses (Statistics Canada, 2006). Approximately one third of Canadian nurses identified job strain and poor health, related to their work environment. Three years after SARS, this article presents a critical analysis of the gaps of three hospital pandemic influenza plans in the context of established organizational supports for healthcare workers. Hospital pandemic influenza plans were obtained from institutional representatives in three Ontario cities. Qualitative gap analysis of these plans was conducted using a checklist of 11 support categories, devel...
Three years following the global outbreak of severe acute respiratory syndrome (SARS), a national... more Three years following the global outbreak of severe acute respiratory syndrome (SARS), a national, Web-based survey of Canadian nurses was conducted to assess perceptions of preparedness for disasters and access to support mechanisms, particularly for nurses in emergency and critical care units. The following hypotheses were tested: (1) nurses' sense of preparedness for infectious disease outbreaks and naturally occurring disasters will be higher than for chemical, biological, radiological, and nuclear (CBRN)-type disasters associated with terrorist attacks; (2) perceptions of preparedness will vary according to previous outbreak experience; and (3) perceptions of personal preparedness will be related to perceived institutional preparedness. Nurses from emergency departments and intensive care units across Canada were recruited via flyer mailouts and e-mail notices to complete a 30-minute online survey. A total of 1,543 nurses completed the survey (90% female; 10% male). The res...
The global impact of severe acute respiratory syndrome (SARS) brought attention to the role of he... more The global impact of severe acute respiratory syndrome (SARS) brought attention to the role of healthcare professionals as "first receivers" during infectious disease outbreaks, a collateral aspect to their role as responders. This article records and reports concerns expressed by Canadian emergency and critical care nurses in terms of organizational and social supports required during infectious disease outbreaks. The nature of work-family and family-work conflict perceived and experienced by nurses during infectious disease outbreaks, as well as the supports needed to enable them to balance their social roles during this type of heightened stress, are explored. Five focus groups consisting of 100 nurses were conducted using a Structured Interview Matrix facilitation technique. Four emergent themes included: (1) substantial personal/professional dilemmas; (2) assistance with child, elder, and/or pet care; (3) adequate resources and vaccinations to protect families; and (4...
The aims of the present study were to: (a) determine if self-reported coping is consistent with c... more The aims of the present study were to: (a) determine if self-reported coping is consistent with conceptually-equivalent investigator-rated coping indices; (b) establish which types of coping are associated with psychological stress; and (c) establish whether using investigator-rated in addition to self-report coping indices to predict stress outcomes is beneficial in a real life context of worker's stressors. To fulfil these aims, a longitudinal investigation was conducted among 40 Canadian workers from the public utility sector. Results from semi-structured interviews about their worst current stressors revealed main effects for some coping types as assessed with investigator-rated indices, whereas no main effects were observed with self-report coping indices. Still, self-report and investigator-rated coping indices together significantly predicted follow-up stress. Psychological stress was most strongly predicted by investigator-rated behavioural approach. While self-report co...
Associations of gaseous air pollutants (including carbon monoxide, sulfur dioxide, nitrogen dioxi... more Associations of gaseous air pollutants (including carbon monoxide, sulfur dioxide, nitrogen dioxide, and ozone) with asthma hospitalization, stratified by sex and socioeconomic status, were examined among children 6-12 years of age in Vancouver, British Columbia, Canada, between 1987 and 1998. Relative risks for an exposure increment corresponding to the interquartile range for each gaseous air pollutant were estimated for asthma
This paper reviews the history of the development by governments, beginning in the 1980s in the U... more This paper reviews the history of the development by governments, beginning in the 1980s in the United States, of formal schemata intended to represent the necessary steps in arriving at a credible and robust risk management decision. The paper illustrates the challenge posed by the emergence of BSE, by summarizing the nature of prion disease risks, the experience of many
ABSTRACT Young children are more highly exposed and vulnerable to environmental health hazards th... more ABSTRACT Young children are more highly exposed and vulnerable to environmental health hazards than adults due to a variety of physiological and behavioural factors. Despite the significant responsibility mothers typically bear in managing their children’s health, little is known about how they perceive and negotiate these risks in their day-to-day lives. To better understand mothers’ environmental health risk perceptions and associated protective actions across socio-economic and geographic contexts, a telephone survey was conducted among new mothers (n = 606) recruited through two Public Health Units in Ontario, Canada. Analyses revealed that approximately half of the respondents were moderately or highly concerned about environmental health risks, ranging in nature from household products to outdoor air contaminants. Factors affecting the likelihood of experiencing concern included lower income and lower levels of perceived control. With regard to protective actions, 43% reported taking three or more actions to reduce environmental health risks to their children, with the likelihood of taking action being negatively affected by factors including low income and first language other than English or French, and positively affected by being a first-time parent (primiparous). This study contributes to our understanding of environmental health risk perceptions and associated protective behaviours among new mothers, and has implications for the development of more context-focused risk management and communication strategies.
ith the debates on health care in Canada and the creation of the Canadian Institutes of Health Re... more ith the debates on health care in Canada and the creation of the Canadian Institutes of Health Research (CIHR), a new field called "population health" has emerged. Multidimensional integration is required to reconceptualize health around "deter- minants of health" 1 and to reconfigure research conducted by the CIHR in terms of the biomedical, clinical, systems and ser vices, sociocultural, and
Background This article examines the relationship between lower income and the risk of experienci... more Background This article examines the relationship between lower income and the risk of experiencing high psychological distress over twelve years. Data and methods Data from the first 12 years of the longitudinal National Population Health Survey (1994/1995 through 2006/2007) were analysed. Proportional hazards modelling was conducted to determine whether lower household income was associated with a greater risk of experiencing
Canadian family physician Médecin de famille canadien, 2002
ABSTRACT ith the debates on health care in Canada and the creation of the Canadian Institutes of ... more ABSTRACT ith the debates on health care in Canada and the creation of the Canadian Institutes of Health Research (CIHR), a new field called "population health" has emerged. Multidimensional integration is required to reconceptualize health around "deter- minants of health" 1 and to reconfigure research conducted by the CIHR in terms of the biomedical, clinical, systems and ser vices, sociocultural, and environmental dimensions of health. Social ecology makes this integration possible. Family physicians can help increase awareness, communication, cooperation, and change to inte- grate population health into a social ecology para- digm. Consequently, family medicine researchers are uniquely positioned to investigate and report on population health. This article describes the major components of population health.
International Journal of Sport and Exercise Psychology, 2009
This two‐study research assessed intentions and actual physical activity behavior change in a com... more This two‐study research assessed intentions and actual physical activity behavior change in a community‐based sample of Canadian middle‐aged women by integrating concepts from two strong and complimentary psychological theories: the Theory of Planned Behavior (TPB) and Self‐Determination Theory (SDT). Specific objectives were 1) to examine associations among TPB variables, motivation, and intention to increase physical activity and 2) to examine
This article examines the relationship between lower income and the risk of experiencing high psy... more This article examines the relationship between lower income and the risk of experiencing high psychological distress over twelve years. Data from the first 12 years of the longitudinal National Population Health Survey (1994/1995 through 2006/2007) were analysed. Proportional hazards modelling was conducted to determine whether lower household income was associated with a greater risk of experiencing high distress, when adjusting for sociodemographic characteristics and baseline health status. It was also used to examine the relationship between reporting a stressor and experiencing a subsequent episode of distress. Overall, 11% of the initial sample experienced at least one episode of high distress during the 12 years of the study. Low-income respondents were at a significantly higher risk of becoming psychologically distressed, and many of the stressors were associated with a significantly higher risk of becoming distressed. Stressors accounted for 22% of the relationship between ...
Resilience has been described in many ways and is inherently complex. In essence, it refers to th... more Resilience has been described in many ways and is inherently complex. In essence, it refers to the capacity to face and do well when adversity is encountered. There is a need for empirical research on community level initiatives designed to enhance resilience for high-risk groups as part of an upstream approach to disaster management. In this study, we address this issue, presenting the EnRiCH Community Resilience Framework for High-Risk Populations. The framework presented in this paper is empirically-based, using qualitative data from focus groups conducted as part of an asset-mapping intervention in five communities in Canada, and builds on extant literature in the fields of disaster and emergency management, health promotion, and community development. Adaptive capacity is placed at the centre of the framework as a focal point, surrounded by four strategic areas for intervention (awareness/communication, asset/resource management, upstream-oriented leadership, and connectedness/engagement). Three drivers of adaptive capacity (empowerment, innovation, and collaboration) cross-cut the strategic areas and represent levers for action which can influence systems, people and institutions through expansion of asset literacy. Each component of the framework is embedded within the complexity and culture of a community. We present recommendations for how this framework can be used to guide the design of future resilience-oriented initiatives with particular emphasis on inclusive engagement across a range of functional capabilities.
Several trials have employed anxiety measures to assess decision aid effectiveness. This study em... more Several trials have employed anxiety measures to assess decision aid effectiveness. This study employed a systematic review method to integrate their findings. The affective impact of decision aids and the appropriateness of anxiety as a measure of decision aid effectiveness are explored. From 11,361 citations generated from searching electronic databases and journals, 26 randomised controlled trials evaluated patient decision aids;
In response to the 2003 global outbreak of severe acute respiratory syndrome (SARS), and the thre... more In response to the 2003 global outbreak of severe acute respiratory syndrome (SARS), and the threat of pandemic influenza, Canadian hospitals have been actively developing and revising their emergency plans. Healthcare workers are a particularly vulnerable group at risk of occupational exposure during infectious disease outbreaks, as seen during SARS and as documented/reported in the recent National Survey of the Work and Health of Nurses (Statistics Canada, 2006). Approximately one third of Canadian nurses identified job strain and poor health, related to their work environment. Three years after SARS, this article presents a critical analysis of the gaps of three hospital pandemic influenza plans in the context of established organizational supports for healthcare workers. Hospital pandemic influenza plans were obtained from institutional representatives in three Ontario cities. Qualitative gap analysis of these plans was conducted using a checklist of 11 support categories, devel...
Three years following the global outbreak of severe acute respiratory syndrome (SARS), a national... more Three years following the global outbreak of severe acute respiratory syndrome (SARS), a national, Web-based survey of Canadian nurses was conducted to assess perceptions of preparedness for disasters and access to support mechanisms, particularly for nurses in emergency and critical care units. The following hypotheses were tested: (1) nurses' sense of preparedness for infectious disease outbreaks and naturally occurring disasters will be higher than for chemical, biological, radiological, and nuclear (CBRN)-type disasters associated with terrorist attacks; (2) perceptions of preparedness will vary according to previous outbreak experience; and (3) perceptions of personal preparedness will be related to perceived institutional preparedness. Nurses from emergency departments and intensive care units across Canada were recruited via flyer mailouts and e-mail notices to complete a 30-minute online survey. A total of 1,543 nurses completed the survey (90% female; 10% male). The res...
The global impact of severe acute respiratory syndrome (SARS) brought attention to the role of he... more The global impact of severe acute respiratory syndrome (SARS) brought attention to the role of healthcare professionals as "first receivers" during infectious disease outbreaks, a collateral aspect to their role as responders. This article records and reports concerns expressed by Canadian emergency and critical care nurses in terms of organizational and social supports required during infectious disease outbreaks. The nature of work-family and family-work conflict perceived and experienced by nurses during infectious disease outbreaks, as well as the supports needed to enable them to balance their social roles during this type of heightened stress, are explored. Five focus groups consisting of 100 nurses were conducted using a Structured Interview Matrix facilitation technique. Four emergent themes included: (1) substantial personal/professional dilemmas; (2) assistance with child, elder, and/or pet care; (3) adequate resources and vaccinations to protect families; and (4...
The aims of the present study were to: (a) determine if self-reported coping is consistent with c... more The aims of the present study were to: (a) determine if self-reported coping is consistent with conceptually-equivalent investigator-rated coping indices; (b) establish which types of coping are associated with psychological stress; and (c) establish whether using investigator-rated in addition to self-report coping indices to predict stress outcomes is beneficial in a real life context of worker's stressors. To fulfil these aims, a longitudinal investigation was conducted among 40 Canadian workers from the public utility sector. Results from semi-structured interviews about their worst current stressors revealed main effects for some coping types as assessed with investigator-rated indices, whereas no main effects were observed with self-report coping indices. Still, self-report and investigator-rated coping indices together significantly predicted follow-up stress. Psychological stress was most strongly predicted by investigator-rated behavioural approach. While self-report co...
Background: The potential inclusion of genomic risk profiling into population-based screening pro... more Background: The potential inclusion of genomic risk profiling into population-based screening programs may enable more targeted use of different types and intensities of screening and follow-up. However, the use of genomic profiling within screening will depend in part on public attitudes. It is, therefore, important to engage in a scientific understanding of public attitudes and respond to their concerns to ensure the effective and appropriate implementation of these applications. Objectives: To identify (i) general reactions to the idea of incorporating genomic risk profiling into routine screening activities, and (ii) responses to specific issues that may require consideration before implementing genomic risk profiling into routine screening using colorectal cancer (CRC) and newborn bloodspot screening (NBS) as examples. Methods: Eight workshops (5 CRC, 3 NBS) were conducted in Ontario and Newfoundland and Labrador, Canada. Participants were provided information regarding the possible personal, health system and societal implications of the technology. Discussions were recorded using field notes and written responses. Participants also completed a structured survey and indicated, from a list, words that best described their attitudes toward the technology.
Results: Participants (N=170; 120 CRC and 50 NBS) varied in attitude; more participants in the CRC groups indicated that they were “enthusiastic” or “optimistic”, while participants in the NBS workshops were more “worried” or had “mixed feelings”. More NBS participants were concerned that a result indicating increased
risk would cause extra worry compared to those in the CRC workshops (91% vs 49% respectively; p<0.01). Other differences included the relevance of results for their family (89% CRC vs 61% NBS; p<0.01 ). In both contexts concern was expressed regarding who had access to test results and implications for insurance. Conclusion: Consistent with previous studies in genetic testing, public attitudes appeared to be contingent on the context in which the genomic risk profiling technology was applied. Public attitudes to genomic technologies must, therefore, be considered in a nuanced, context-specific manner and broad brush assessments avoided. A one-size generic policy is unlikely to be satisfactory. That being said, concerns over access to test results and implications on for insurance were common to both contexts.
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Results: Participants (N=170; 120 CRC and 50 NBS) varied in attitude; more participants in the CRC groups indicated that they were “enthusiastic” or “optimistic”, while participants in the NBS workshops were more “worried” or had “mixed feelings”. More NBS participants were concerned that a result indicating increased
risk would cause extra worry compared to those in the CRC workshops (91% vs 49% respectively; p<0.01). Other differences included the relevance of results for their family (89% CRC vs 61% NBS; p<0.01 ). In both contexts concern was expressed regarding who had access to test results and implications for insurance. Conclusion: Consistent with previous studies in genetic testing, public attitudes appeared to be contingent on the context in which the genomic risk profiling technology was applied. Public attitudes to genomic technologies must, therefore, be considered in a nuanced, context-specific manner and broad brush assessments avoided. A one-size generic policy is unlikely to be satisfactory. That being said, concerns over access to test results and implications on for insurance were common to both contexts.