An ethnography of low-income mothers' safeguarding efforts.

PROBLEM: Children living in lower-income environments are at greater risk for unintentional injuries. However, little is known about the safety practices of mothers living in low-income situations. METHOD: This ethnographic study explored the child safeguarding experiences of low-income mothers using in-home interviews and observations. RESULTS: Mothers' safeguarding efforts included cognitive and emotional work, child directed work, and work directed at the physical and social environments. Factors that influenced the women's safeguarding included the quality of the indoor space, availability of safe play space, traffic hazards, sibling interactions, child care supports, relationships with neighbors, and trust in community services. DISCUSSION: These findings have implications for the conceptualization of safeguarding practices and provide insight about the experiences of mothers living on low-incomes. IMPACT ON INDUSTRY: When developing safety interventions, program planners should consider the views and practices of mothers as well as contextual factors in the physical and social environments.

Setting standards in the evaluation of community-based health promotion programmes--a unifying approach.

Community-based health promotion often emphasizes elements of empowerment, participation, multidisciplinary collaboration, capacity building, equity and sustainable development. Such an emphasis may be viewed as being in opposition to equally powerful notions of evidence-based decision making and accountability, and with funders' and government decision-makers' preoccupation with measuring outcomes. These tensions may be fuelled when community practitioners and lay participants feel evaluations are imposed upon them in a manner that fails to appreciate the uniqueness of their community, its programme, and practitioners' skills and experience. This paper attempts to provide an approach that depicts evaluation as being mutually beneficial to both funders/government and practitioners. First, a values stance for health promotion, termed a 'salutogenic' orientation, is proposed as a foundation for the evaluation of community-based health promotion. Secondly, we discuss possible objects of interest, the first component of an evaluation. We then discuss the spirit of the times and its implications for community-based health promotion. Finally, we address the key question of setting standards. A typology of standards is presented. Arbitrary, experiential and utility standards are based on perceived needs and priorities of practitioners, lay participants or professional decision-makers. Historical, scientific and normative standards are driven by empirical, objective data. Propriety and feasibility standards are those wherein the primary concern is for consideration of resources, policies, legislation and administrative factors. The 'model' standards approach is presented as an exemplar of a combined approach that incorporates elements of each of the other standards. We argue that the 'optimal' standard for community-based health promotion depends on the setting and the circumstances. There is no 'magic bullet', 'one-size-fits-all' or 'best' standard. Further, we argue that standards should be set from an inclusive, salutogenic orientation. This approach offers a means of creating a situation in which policy-makers and funders are more supportive of evaluation designs that fit with community realities, and community stakeholders are more capable and consistent in rigorously evaluating community-based health promotion programmes and policies.

Prescribing practices and attitudes toward giving children antibiotics.

OBJECTIVE: To investigate whether overprescribing is common in treatment of pediatric upper respiratory infections and to examine factors that influence prescribing antibiotics for children. DESIGN: A random, stratified sample of practising family physicians was surveyed with a mailed questionnaire. Initial nonresponders were mailed a second questionnaire. SETTING: British Columbia. PARTICIPANTS: A total of 608 general and family physicians. Response rate was 64%; 392/612 surveys were completed. MAIN OUTCOME MEASURES: Physicians' self-reported prescribing practices and knowledge of and attitudes toward using antibiotics for children's upper respiratory tract infections. RESULTS: Relative to treatment guidelines developed for the study, most physicians responded appropriately to the cough (94%) and lobar pneumonia (99.1%) vignettes. More than half the physicians (56.5%) reported they would immediately prescribe antibiotics for tympanic membrane dysfunction, and 79.4% indicated they would prescribe antibiotics for pharyngitis without obtaining a laboratory culture. Approximately 25% of physicians in the study did not believe that prior antibiotic use increased personal risk for acquiring drug-resistant infection, and 23.1% did not believe that antibiotic use was an important factor in promoting resistance in their communities. CONCLUSION: Education in current treatment of pediatric upper respiratory tract illnesses and antimicrobial drug resistance is required. The high response to the questionnaire (64%) and the many requests from physicians to receive the project's educational materials (45%) indicate a high level of interest in this subject.

The use of population health and health promotion research by health regions in Canada.

This study examined the use of population health and health promotion (PH&HP) research by health regions in Canada. An 11-item survey was faxed to 137 (of 140) health regions. Eighty-three completed questionnaires were returned (60.8%). Results indicate that while research, in general, plays more than a moderate role in the majority of participating health regions, PH&HP research is not used frequently. The most frequent uses of PH&HP research include the development of health goals and objectives, the development of programs and services, and resource allocation. Health regions most frequently obtain PH&HP research from their own staff and from government departments. University-based researchers are not a commonly used source. This study provides a descriptive overview of health regions' engagement in evidence-based decision making related to PH&HP issues, and points to a number of strategies that both health regions and researchers can employ to enhance the use of PH&HP research by health regions.

Factors that facilitated and challenged the development of health goals and targets: the British Columbia experience.

Health promotion research and practice reveal that goal setting and monitoring have gained increased acceptance at international, national, provincial/state, regional and local levels. The global adoption of health goals as a strategy for population health promotion has occurred even though few protocols or guidelines to support the health goals development process have been published. Limited study has occurred on the variation in approach to health goals planning, or on the complex, multiple forces that influence the development process. This paper describes conclusions drawn from an exploratory and descriptive case study that tracked the pathways to health goals in British Columbia (BC) and uncovered nearly 100 factors that influenced the final version of health goals adopted by the government of BC. Influencing factors included: (a) positive perceptions of the benefits of health goals, (b) the role of a trusted health goals champion, (c) positioning of the goals as government rather than health ministry goals, (d) the format and agenda of the health goals consulting process, and (e) political reluctance toward highly specific or measurable goals with targets.

Understanding suicide among indigenous adolescents: a review using the PRECEDE model.

AIM: To use the available literature to identify the causes of suicide among indigenous adolescents. METHOD: The PRECEDE model provided a framework to organize the material and identify the areas where relatively little research had been reported. RESULTS: The epidemiological diagnosis showed that suicide was greater in indigenous than non-indigenous populations and particularly high among adolescent males. Environments of native persons are characterized by remoteness, poverty, cultural displacement, and family disintegration. The educational and organizational diagnosis identified predisposing factors reflecting the social environments previously identified, the enabling factors of televised suicides, and firearm and alcohol availability, in conjunction with an absence of positive expectations. Finally the administrative and policy diagnosis identified a piecemeal, short term perspective, often lacking cultural sensitivity. Although there was more literature from the United States than from Canada, Australia or New Zealand, the pictures emerging were consistent, with problems being identified across continents. Literature was more abundant in relation to the epidemiological, environmental, and educational/ organizational diagnoses than in relation to policy and administration. CONCLUSION: The increased suicide rates among indigenous adolescents were not a product of their native origins, but of the social milieu in which these people generally found themselves.

Relationship of organizational characteristics of Canadian workplaces to anti-smoking initiatives.

BACKGROUND: In Canada, with universal single-payer health care insurance and a lower proportion of the gross domestic product going to health care costs, employers may be less motivated than their U.S. counterparts to develop health promotion programs for their employees. This study determined the extent to which nongovernmental workplaces in Canada have made smoking-related information, policies, and programs available to their employees. Several characteristics of those workplaces most likely to have engaged in such activities were identified. METHODS: A secondary analysis of data collected in the 1992 National Workplace Survey was conducted. All Canadian provinces, except Saskatchewan, were included. Dunn and Bradstreet's register of companies was used to select companies randomly from those with 20 or more employees. Questionnaires were distributed to 10000 workplaces. The response rate was 35.5% (N = 3,549). There were no significant differences found between responders and nonresponders in a phone survey. RESULTS: One-half of workplaces reported some kind of smoking-related initiative. Most of the initiatives were smoking policies; only 11.7% of workplaces provided smoking cessation programs. The number of employees and the number of other lifestyle and occupational health and safety programs available are most predictive of smoking-related programs. CONCLUSIONS: If Canadians are going to achieve a smoke-free society, greater efforts to assist smokers to quit will be necessary. The workplace provides an excellent opportunity for such efforts. Health promotion advocates must communicate the cost savings and other benefits to employers garnered from workplace smoking reduction efforts.

Setting the stage for health impact assessment.

Defining health impact assessment as any combination of procedures or methods by which a proposed policy or program may be judged as to the effect(s) it may have on the health of a population, we make recommendations about how to evaluate the health impact of all government-initiated policies. Such health impact cannot be assessed in the absence of a conceptual or organizing framework that provides the requisite guideposts--population health goals and targets. Health impact assessment offers an approach to ensuring that governments' program and policy initiatives align, or are congruent with, the agreed-upon health goals. It suggests that proposed national policies should be supported or resisted on the basis of their probable influence on the health of populations. In the current Canadian national policy framework, however, there are no underpinnings on which to situate such a process. The specification of consensus goals and objectives with measurable targets can provide the requisite guideposts and benchmarks for health impact assessment. Such an undertaking can set the stage and provide the necessary foundation for an effective health impact assessment process.

A dissemination research agenda to strengthen health promotion and disease prevention.

The question of how to enhance the dissemination of knowledge and the use of innovations related to disease prevention and health promotion was posed to an international group of experts at an invitational research conference held in Vancouver, British Columbia in March 1995. The Canadian Conference on Dissemination Research Strengthening Health Promotion and Disease Prevention was co-sponsored by 15 voluntary organizations, government agencies and industries. It examined advances and gaps in the study of diffusion and adoption of preventive knowledge and practices among health professionals and the public. It was the first national conference of its kind devoted to dissemination research and dissemination of research specifically in health promotion and disease prevention. This paper summarizes the major issues raised in the papers presented at this conference. Policies and strategies for strengthening dissemination research and the dissemination of health promotion knowledge and practices are suggested.

Spouse-pair risk factors and cardiovascular reactivity.

Epidemiological research has identified increased risk for coronary heart disease in Type A men married to well-educated women. The present study examined mechanisms that may explain the increased risk associated with this specific spouse-pair combination. Cardiovascular and self-report responses to an individual, standardized laboratory stress task and a dyadic, interactive affect provocation task were assessed in Type A or B men married to women of either low ( < or = 13 years) or high ( > 13 years) educational levels. Type A men with highly educated spouses (i.e., the highest risk group) also reported the greatest anger-out tendency, high trait anger, and low anger control scores. These men further exhibited elevated diastolic blood pressure at baseline and greater diastolic reactivity specific to the dyadic task than did the men in the lower risk groups. These findings, based on a laboratory study of spousal interactions, support the epidemiological high-risk designation of the Type A man with a highly educated spouse and confirm earlier conceptions that Type A research benefits more from a social interaction approach rather than from an individual trait perspective.

Crisis centers and their role in treatment: suicide prevention versus health promotion.

Suicide is a major health problem. In the industrialized nations, it remains among the 10 leading causes of death. There has been a massive effort to reduce suicide mortality through establishment of prevention centers. These centers have proliferated despite a lack of evidence concerning their efficacy. The development and evaluation of suicide prevention centers, primarily community-based, telephone interventions, are discussed. The evidence regarding the effectiveness of suicide prevention centers and the presence of a causal relationship between exposure to crisis counseling and a reduction in suicide rates is reviewed. Some cautions and recommendations are made. Finally, a model of health promotion program planning and evaluation is examined in the context of suicide prevention.