Small group estimation for public health.

We used synthetic estimation and linear regression to estimate the prevalence of selected risk factors and health status indicators in small populations. The derivation was based on the sociodemographic characteristics of the populations and the relationships between these variables and the health variables, as measured by the Ontario Health Survey (OHS). The estimates were validated by a comparison with the direct results of the OHS (gold standards). Synthetic estimates were much less dispersed than the regression estimates or the direct OHS estimates. Regression estimates performed better than synthetic estimates on most validation indicators, and combined approaches performed marginally better yet, although there were few clear patterns. Although correlation coefficients with gold standards in excess of 0.8 were obtained for some variables, the estimates rarely met pre-determined criteria for accuracy. At present these techniques have limited value for public health workers, but further work is justified, especially on approaches combining synthetic and regression estimation.

Attitudes and practices of primary care physicians in the management of elevated serum cholesterol levels.

We conducted a telephone survey of 102 randomly selected Ottawa family physicians to determine their attitudes and practices regarding the treatment of hypercholesterolemia. Of the 102, 56% routinely measured serum cholesterol levels in all their patients over the age of 30 years, and 24% did so for patients in more restricted age ranges. The level at which they started dietary therapy averaged 6.95 mmol/L (270 mg/dl); for 25% it was less than 6.22 mmol/L (240 mg/dl). The level at which they started drug therapy averaged 8.9 mmol/L (345 mg/dl); for only 15% was it 7.23 mmol/L (280 mg/dl) or less. Two-thirds were unable to give numerical values to the serum cholesterol levels at which they started diet therapy, and 38% used the upper limits of laboratory normal values as an indication to start therapy. Our findings contrast markedly with results reported for US family physicians, who treat hypercholesterolemia much more aggressively. The variability in practices must be addressed if public campaigns to lower serum cholesterol levels are to be undertaken.

Weight control in the workplace: a needs assessment for men.

This investigation was designed to assess the needs and interests of overweight men in a worksite weight control program. Employees of 2 high-tech companies were surveyed; 373 men and 238 women responded. 56% of respondents were interested in a worksite program. 44% of male respondents had a Body Mass Index (BMI) of 25 or greater and of those, 75% indicated an interest in participating. Among women, 21% had a BMI of 25 or greater and 92% were interested in the program. Also 68% of women who were not overweight would participate in a weight control program. There was a strong preference for a self-help teaching format over group activities, and particular interest in an evaluation of their present food habits, behaviour modification techniques for weight control and the health consequences of overweight. These findings give clear direction for the development of an effective worksite intervention.

Smoking and health care patterns among pregnant women.

A population-based hospital survey of 3628 women in the postpartum period was conducted in the Ottawa-Carleton region in 1983 to determine the prevalence of smoking before and during pregnancy, the demographic and socioeconomic characteristics of women who smoke during pregnancy and the use of health care services by these women. Of the 3628 women 91% completed a full-length questionnaire and 4% completed a shorter questionnaire. Before pregnancy 37.4% of the women smoked cigarettes. Overall, 61.1% of the smokers changed their smoking habit: 31.1% stopped, 28.1% decreased the amount smoked and 2.0% increased the amount smoked. Two thirds of the women who stopped smoking did so as soon as they realized they were pregnant. Over 50% of teenagers, single women, women living common-law and women with less than a grade 11 education smoked after the 3rd month of pregnancy. The physician is in an ideal position to identify as soon as possible pregnant women who smoke and to initiate a health education program. Only a few women who smoked during pregnancy attended early prenatal classes. Physicians and class organizers must work to improve this situation if such classes are to have an impact on smoking during pregnancy.