"Hike up yer skirt, and quit." what motivates and supports smoking cessation in builders and renovators.

Construction-related occupations have very high smoking prevalence rates and are an identified priority population for efforts to promote cessation. This study sought to identify the smoking cessation supports and services which best suited this workforce group, and to identify gaps in reach of preventive health services. We performed qualitative text analysis on pre-existing conversations about smoking cessation among workers in this sector. The material appeared on a discussion forum about residential construction from 1998 and 2011. Roughly 250 unique user names appeared in these discussions. The qualitative analysis addressed knowledge, motivation, environmental influences, and positive and negative experiences with supports for cessation. Self-identified smokers tended to want to quit and described little social value in smoking. Actual quit attempts were attributed to aging and tangible changes in health and fitness. Peer-to-peer social support for cessation was evident. Advice given was to avoid cigarettes and smokers, to focus on personal skills, personal commitment, and the benefits of cessation (beyond the harms from smoking). Many discussants had received medical support for cessation, but behavioural counselling services appeared underutilized. Our findings support efforts toward more complete bans on workplace smoking and increased promotion of available behavioural support services among dispersed blue-collar workers.

Non-smoking worksites in the residential construction sector: using an online forum to study perspectives and practices.

OBJECTIVES: Blue-collar workers are a recognised priority for tobacco control. Construction workers have very high smoking rates and are difficult to study and reach with interventions promoting smoke-free workplaces and cessation. The objectives of this study were to explore the smoking-related social climate in the North American residential construction sector and to identify potential barriers and facilitators to creating smoke-free worksites. METHODS: The data source used was a popular internet forum on home building. Participants included a broad and unselected population of employers, employees and freelance tradespersons working in residential construction. The forum archive contained 10 years of discourse on the subjects of smoking, workplace secondhand smoke and smoking restrictions on construction sites. Qualitative data analysis methods were used to describe major and minor discussion themes relevant to workplace smoking culture and policies in this sector. RESULTS: Participants described considerable tension between smoking and non-smoking tradespersons, but there was also much interpersonal support for cessation and support for non-smokers' rights. Employers and employees described efforts to make construction sites smoke free, and a movement towards preferential hiring of non-smoking tradespersons was discussed. Board participants wanted detailed scientific evidence on secondhand smoke exposure levels and risk thresholds, particularly in open-air workplaces. CONCLUSIONS: Experience with success of smoking bans in other challenging workplaces can be applied to the construction sector. Potential movement of smokers out of the workforce represents a challenge for public health systems to ensure equitable access to cessation supports and services.

Identifying core competencies for public health epidemiologists.

BACKGROUND: Public health authorities have prioritized the identification of competencies, yet little empirical data exist to support decisions on competency selection among particular disciplines. We sought perspectives on important competencies among epidemiologists familiar with or practicing in public health settings (local to national). METHODS: Using a sequential, qualitative-quantitative mixed method design, we conducted key informant interviews with 12 public health practitioners familiar with front-line epidemiologists' practice, followed by a web-based survey of members of a provincial association of public health epidemiologists (90 respondents of 155 eligible) and a consensus workshop. Competency statements were drawn from existing core competency lists and those identified by key informants, and ranked by extent of agreement in importance for entry-level practitioners. RESULTS: Competencies in quantitative methods and analysis, critical appraisal of scientific evidence and knowledge transfer of scientific data to other members of the public health team were all regarded as very important for public health epidemiologists. Epidemiologist competencies focused on the provision, interpretation and 'translation' of evidence to inform decision-making by other public health professionals. Considerable tension existed around some potential competency items, particularly in the areas of more advanced database and data-analytic skills. INTERPRETATION: Empirical data can inform discussions of discipline-specific competencies as one input to decisions about competencies appropriate for epidemiologists in the public health workforce.

Differences in the correlates of physical activity between urban and rural Canadian youth.

BACKGROUND: Despite the benefits of physical activity (PA), a significant proportion of youth remains inactive. Studies assessing differences in the correlates of PA among urban and rural youth are scarce, and such investigations can help identify subgroups of the population that may need to be targeted for special intervention programs. The purpose of this study was to assess differences in the correlates of PA between Canadian urban and rural youth. METHODS: The sample consisted of 1398 adolescents from 4 urban schools and 1290 adolescents from 4 rural schools. Mean age of the participants was 15.6 +/- 1.3 years. Hierarchical regression analyses were used to examine the association between self-reported PA and a number of demographic, psychological, behavioral, and social correlates. RESULTS: Common correlates between the 2 locations included gender (with girls being less active than boys) perceptions of athletic/physical ability, self-efficacy, interest in organized group activities, use of recreation time, and friends' and siblings' frequency of participation in PA. Active commuting to school and taking a physical education class were unique correlates of PA at the multivariate level in urban and rural students, respectively. Variance explained in PA ranged from 43% for urban school students to 38% for rural school students. CONCLUSIONS: Although more similarities than discrepancies were found in the correlates of PA between the 2 geographical locations, findings from this study strengthen the policies that argue for a coordinated multisector approach to the promotion of PA in youth, which include the family, school, and community.

Testing a conceptual model related to weight perceptions, physical activity and smoking in adolescents.

The purpose of this study was to test a conceptual model based on theoretical and empirically supported relationships related to the influences of weight perceptions, weight concerns, desires to change weight, friends, age and location in relation to physical activity (PA) and smoking in adolescents. A total of 1242 males and 1446 females (mean age = 15.6 +/- 1.3) were recruited from rural and urban Canadian schools. Study respondents provided self-reports of PA, 'smoking', 'perceived body weight', 'desire to change weight', 'concern about weight gain' and 'friends' smoking and PA behaviors'. Results revealed an acceptable fitting model chi2 (40) = 155.63, P < 0.05, root mean square error of approximation = 0.047 and comparative fit index = 0.98. Large effect sizes for both genders were observed between friends' and adolescents' smoking behavior, and between perceived body weight and desire to change weight. Further, significant differences were identified between the male and female models [chi2 difference (24) = 65.28, P < 0.05]. Several findings of this study point to the need to design programs to motivate adolescent females to adopt healthy weight-control practices and to target young peoples' social networks to promote health behaviors, especially with regard to smoking.

Are physicians ready for patients with Internet-based health information?

BACKGROUND: An increasing number of patients bring Internet-based health information to medical consultations. However, little is known about how physicians experience, manage, and view these patients. OBJECTIVE: This study aimed to advance the understanding of the effects of incorporating Internet-based health information into routine medical consultations from physicians' perspectives, using a qualitative approach. METHODS: Six focus groups were conducted with 48 family physicians practising in Toronto. The data were analyzed using qualitative methods of content analysis and constant comparison, derived from grounded theory approach. RESULTS: Three overarching themes were identified: (1) perceived reactions of patients, (2) physician burden, and (3) physician interpretation and contextualization of information. Physicians in our study generally perceived Internet-based health information as problematic when introduced by patients during medical consultations. They believed that Internet information often generated patient misinformation, leading to confusion, distress, or an inclination towards detrimental self-diagnosis and/or self-treatment. Physicians felt these influences added a new interpretive role to their clinical responsibilities. Although most of the physicians felt obliged to carry out this new responsibility, the additional role was often unwelcome. Despite identifying various reactions of patients to Internet-based health information, physicians in our study were unprepared to handle these patients. CONCLUSION: Effective initiatives at the level of the health care system are needed. The potential of Internet-based health information to lead to better physician-patient communication and patient outcomes could be facilitated by promoting physician acknowledgment of increasing use of the Internet among patients and by developing patient management guidelines and incentives for physicians.

Physical activity, smoking, and obesity among Canadian school youth. Comparison between urban and rural schools.

BACKGROUND: More information is needed to document the prevalence of health risk factors in youth. The purpose of this study is to compare the prevalence of physical inactivity, smoking and overweight/obesity among youth in urban and rural schools. METHODS: Data were obtained from a Student Physical Activity and Smoking Survey of 2,697 high school students in four urban schools in Ontario and four rural schools in Alberta. Prevalence of physical inactivity was assessed by examining compliance with Canada's Physical Activity Guide to Healthy Active Living, and with daily energy expenditure classification values. Prevalence of smoking was assessed by examining current smoking status. Overweight and obesity prevalences were examined by comparing BMI values to the BMI index for age and sex percentiles set by the Centers for Disease Control and Prevention. RESULTS: Physical activity prevalence was found to be low in our study, with only 57.0% of youth achieving Canada's Physical Activity Guidelines, and with 26.0% classified as sedentary based on the daily energy expenditure classification values. A higher proportion of rural students reported "trying smoking" than urban school students (73.0% versus 64.4%, p<0.001). A significantly higher proportion of rural males were 'overweight' than urban males, and a significantly higher proportion of rural females were 'obese' in comparison to urban females. CONCLUSION: Our findings add further support for an urgent need to promote physical activity among Canadian youth. Additionally, our results suggest that it is especially important to target rural students, particularly girls, for smoking prevention programs. Future studies are required to examine such rural and urban differences within provinces.

Smoking, physical activity and breakfast consumption among secondary school students in a southwestern Ontario community.

OBJECTIVES: To determine the prevalence of smoking, low levels of physical activity, and missing breakfast among students (n=318) in grades 9 through 12 in three schools in southwestern Ontario; to see if these behaviours were associated; and, whether there were gender differences. METHODS: A self-administered survey was conducted in grade 10 English classes. RESULTS: The response rate was 87.1%. The prevalence of smoking was 36.2%; there was no gender difference. Only 42.8% of students ate breakfast daily; 48.8% of boys and 36.1% of girls (chi2 = 5.2; p<0.05). A higher proportion of boys (77.1%) were active for at least 30 minutes > or = 3 times/week compared to girls (66.0%) (chi2 = 4.8; p<0.05). Students who were active > or = 3 times/week were more likely to eat breakfast daily and, among boys, 60.4% of non-smokers ate breakfast daily compared to 31.9% of those currently smoking (chi2 = 13.3; p<0.001). There were no differences among girls. More girls (63.9%) were concerned about gaining weight compared to boys (36.1%) (chi2 = 37.7; p<0.001). Among girls, a higher proportion of those who were concerned about gaining weight were less likely to engage in physical activity or smoke, and more likely to skip breakfast compared to those who were not concerned. DISCUSSION: Weight concern was not associated with frequency of physical activity, smoking, or breakfast consumption among boys. The high prevalence rates for these behaviours suggests that interventions in high schools should include daily physical activity, promotion of breakfast eating (either at home or in the school), and encouragement to quit smoking.