Small-area contextual effects on children's dental caries in Alberta: a multilevel analysis.

OBJECTIVES: The objective of this study was to examine the presence of small-area-level effects on children's dental caries in Alberta, Canada, where dental public health programming is targeted in nature, based on an area-level measure of socio-economic circumstances. METHODS: This cross-sectional study included data on tooth decay (from an intra-oral examination conducted by dental hygienists at school) and socio-demographic and behavioural information (from a parent questionnaire) from 5677 grade 1 and 2 schoolchildren attending schools in public or Catholic school systems in Calgary and Edmonton in 2013/2014. Area-level socio-economic circumstances were quantified using the Pampalon Material Deprivation Index derived from census data, applied to the dissemination area (DA) of the child's school. The outcome variable was presence (vs. absence) of tooth decay (cavitation). Data were analyzed using multilevel modeling with two levels: individual level (level 1) and school dissemination area (DA) (level 2). RESULTS: We observed a small but statistically significant area-level effect on children's caries experience, above and beyond individual-level characteristics. CONCLUSION: Study findings are relevant to dental public health programming in Alberta and other jurisdictions that use targeted strategies. Multilevel interventions, including universal approaches, are necessary to reduce inequities in children's dental caries.

RéSUMé: OBJECTIFS: Examiner la présence d'effets de petite région sur les caries dentaires des enfants en Alberta, au Canada, où les programmes publics de santé dentaire sont ciblés de nature, d'après un indicateur régional de la situation socioéconomique. MéTHODE: Cette étude transversale a inclus des données sur la carie dentaire (venant d'un examen intra-buccal mené par des hygiénistes dentaires dans les écoles) et des informations sociodémographiques et comportementales (venant d'un questionnaire auprès des parents) concernant 5 677 enfants d'âge scolaire de 1e et de 2e année fréquentant les écoles du système public ou du système catholique de Calgary et d'Edmonton en 2013-2014. La situation socioéconomique régionale a été chiffrée à l'aide de l'indice de défavorisation matérielle de Pampalon dérivé des données du Recensement, lesquelles ont été appliquées à l'aire de diffusion (AD) des écoles des enfants. Le résultat a été la présence (c. l'absence) de carie dentaire (cavitation). Les données ont été analysées par modélisation multiniveaux selon deux niveaux : la personne (niveau 1) et l'AD de l'école (niveau 2). RéSULTATS: Nous avons observé un effet régional léger mais significatif sur l'expérience de caries des enfants, au-delà des caractéristiques individuelles. CONCLUSION: Les constatations de l'étude sont pertinentes pour les programmes de santé dentaire en Alberta et dans d'autres administrations qui utilisent des stratégies ciblées. Des interventions multiniveaux, y compris des approches universelles, sont nécessaires pour réduire les iniquités dans les caries dentaires des enfants.

Predictors of physical activity at 12 month follow-up after a supervised exercise intervention in postmenopausal women.

BACKGROUND: Few studies have examined recreational physical activity (RPA) after participating in a structured exercise intervention. More specifically, little is known about the long-term effects of exercise interventions in post-menopausal women. This study had two objectives: 1) To compare RPA in postmenopausal women in the exercise group and the control group 12 months after the end of the Alberta Physical Activity and Breast Cancer Prevention (ALPHA) Trial; and 2) To apply the Theory of Planned Behaviour (TPB) to identify predictors of RPA 12 months post-intervention among women in the exercise group. METHODS: Self-reported RPA 12-months post-intervention from a validated questionnaire was used to estimate RPA levels for control group (118/160, 74% response) and exercise group participants (126/160, 79% response). Bivariate analysis was used to compare RPA between exercise and control group participants and to identify TPB variables for multivariate analysis. Logistic regression was applied to TPB data collected from self- administered questionnaires at end of trial by exercise group participants (126/160, 79% response) to identify predictors of long-term RPA. RESULTS: At 12 months post-intervention, 62% of women in the exercise group were active compared to 58% of controls (p = 0.52). Of the TPB constructs examined, self-efficacy (OR =2.98 (1.08-8.20)) and behavioural beliefs (OR = 1.46 (1.03-2.06)) were identified as predictors of RPA for exercise group participants. CONCLUSIONS: Levels of RPA in the exercise and control groups were comparable 12 months post intervention, indicating that participation in the ALPHA trial was associated with increased physical activity in previously inactive women, regardless of randomization into either the exercise group or in the control group. Exercise interventions that promote self-efficacy and positive behavioural beliefs have the potential to have long-term impacts on physical activity behaviour, although further research is needed to examine additional psychological, social and environmental predictors of long-term RPA in post-menopausal women. TRIAL REGISTRATION: ClinicalTrials.gov NCT00522262.

Intrapersonal and social environment correlates of leisure-time physical activity for cancer prevention: a cross-sectional study among Canadian adults.

BACKGROUND: Little is known about the intrapersonal and social factors associated with sufficient physical activity (PA) for cancer prevention, which is greater than for cardiovascular health. METHODS: 1087 and 1684 randomly selected men and women, age 35-64, completed self-administered questionnaires on PA behavior and psycho-social characteristics. Using gender-stratified logistic regression, we investigated correlates of compliance with Canadian Society for Exercise Physiology PA guidelines for general health (150 min/wk), and the American Cancer Society (ACS; 225 min/wk) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AIRC; 420 min/wk) guidelines for cancer prevention. RESULTS: Only 39% and 19% of men and women met ACS and WCRF/AICR guidelines, respectively. Self-efficacy, scheduling PA and friend social support were positively correlated with recommended PA for cancer prevention. In men, poor self-rated health and perceived negative outcomes were negatively correlated and hypertension was positively correlated with meeting cancer prevention guidelines. For women, not being married and having a companion for PA were positively correlated with meeting cancer prevention guidelines. CONCLUSIONS: Few adults participate in sufficient PA for cancer risk reduction. Multidimensional public health strategies that incorporate intrapersonal and social factors and are tailored for each gender are needed to promote PA for cancer prevention.

Interest, awareness, and perceptions of genetic testing among Hispanic family members of breast cancer survivors.

OBJECTIVE: To provide a preliminary description of the interest, awareness, and perceptions of genetic testing among Hispanics with a family history of breast cancer DESIGN: This cross-sectional pilot study used interpersonal structured interviews for data collection. PARTICIPANTS: We interviewed 48 Hispanics without breast cancer but who had a family member with breast cancer; participants lived in San Antonio and the surrounding area. MAIN OUTCOME: The outcomes were interest in breast cancer genetic testing, awareness about genetic testing, perceived risk of carrying a breast cancer susceptibility gene, and the perceived benefits and risks associated with a genetic test. MEASURES: Items previously used in research regarding interest and perceived genetic risk and a previously validated benefits and risks-limitations scale for genetic testing commonly used by other researchers were used to measure the outcomes. RESULTS: Awareness of genetic testing for breast cancer susceptibility was very low, yet most (82%) participants were interested in a genetic test for breast cancer susceptibility. Participants were more likely to identify with the benefits than the potential risks of genetic testing. The most highly endorsed benefits were to know to take better care of one's self and to undergo more frequent screening. CONCLUSIONS: Hispanics seem to have positive perceptions about genetic testing for breast cancer susceptibility. However, the high level of interest in genetic testing may be driven by a lack of knowledge about genetic testing. Culturally sensitive and appropriate educational programs about breast cancer genetic testing and the surrounding issues are needed for the Hispanic population.

Breast and cervical cancer knowledge, attitudes, and screening practices of Hispanic women diagnosed with cancer.

BACKGROUND: Cancer survivors' screening participation is important to prevent cancer recurrence and to maintain health for the growing number of Hispanic cancer survivors. METHODS: Using a case comparison study design, data from a survey of Hispanic breast (n = 54) and cervical cancer (n = 58) survivors were analyzed by bivariate analysis. RESULTS: Knowledge of screening guidelines was low for all participants, especially regarding cervical cancer screening. Breast cancer survivors were most knowledgeable. Although survivors held positive cancer attitudes, participation in preventive cancer screening was low indicating the need for more effective cancer prevention communication processes. CONCLUSIONS: Hispanic cancer survivors need culturally sensitive cancer prevention education and the associated communication processes that acknowledges differences among the varying Hispanic subgroups.