HPV sampling options for cervical cancer screening: preferences of urban-dwelling Canadians in a changing paradigm.

Introduction: Of women in Canada diagnosed with invasive cervical cancer, 50% have not been screened according to guidelines. Interventions involving self-collected samples for human papillomavirus (hpv) screening could be an avenue to increase uptake. To guide the development of cervical cancer screening interventions, we assessed ■ preferred sample collection options,■ sampling preferences according to previous screening behaviours, and■ preference for self-sampling among women not screened according to guidelines, as a function of their reasons for not being screened. Methods: Data were collected in an online survey (Montreal, Quebec; 2016) and included information from female participants between the ages of 21 and 65 years who had not undergone hysterectomy and who had provided answers to survey questions about screening history, screening interval, and screening preferences (n = 526, weighted n = 574,392). Results: In weighted analyses, 68% of all women surveyed and 82% of women not recently screened preferred screening by self-sampling. Among women born outside of Canada, the United States, or Europe, preference ranged from 47% to 60%. Nearly all women (95%-100%) who reported fear or embarrassment, dislike of undergoing a Pap test, or lack of time or geography-related availability of screening as one of their reasons for not being screened stated a preference for undergoing screening by self-sampling. Conclusions: The results demonstrate a strong preference for self-sampling among never-screened and not-recently-screened women, and provides initial evidence for policymakers and researchers to address how best to integrate self-sampling hpv screening into both organized and opportunistic screening contexts.

Relationships between respiratory sinus arrhythmia and stress in college students.

The purpose of this study was to examine the relationships between university students' respiratory sinus arrhythmia (RSA) profiles and both retrospective and momentary ratings of stress. Participants were undergraduate students enrolled in an introductory health science course (N = 64). Participants provided RSA data at rest (tonic) and following an orthostatic challenge (phasic), completed the 10-item Perceived Stress Scale (PSS), and completed 6 daily ecological momentary assessments (EMA) of stress for 1 week. Higher tonic RSA was associated with lower perceived stress assessed via PSS and average EMA responses. Those with higher tonic RSA did not differ in their experience of stress across the week, whereas those with lower tonic RSA experienced increased stress across the week, and these trajectories varied as a function of phasic responses. These findings suggest a need for greater emphasis on behavioral strategies for maintaining and enhancing autonomic nervous system health among college students.

Area-level income disparities in colorectal screening in Canada: evidence to inform future surveillance.

Background: Participation in colorectal screening remains low even in countries with universal health coverage. Area-level determinants of low screening participation in Canada remain poorly understood. Methods: We assessed the association between area-level income and two indicators of colorectal screening (having never been screened, having not been screened recently) by linking census-derived local area-level income data with self-reported screening data from urban-dwelling respondents to the Canadian Community Health Survey (50-75 years of age, cycles 2005 and 2007, n = 18,362) who reported no known risk factors for colorectal cancer. Generalized estimating equation Poisson models estimated the prevalence ratios and differences for having never been screened and having not been screened recently, adjusting for individual-level income, education, marital status, having a regular physician, age, and sex. Results: About 53% of the study population had never been screened. Among individuals who had ever been screened, 35% had been screened recently. Adjusting for covariates, lower area-level income was associated with having never been screened [covariate-adjusted prevalence ratios: 1.24 for quartile 1; 95% confidence limits (cl): 1.16, 1.34; 1.25 for quartile 2; 95% cl: 1.15, 1.33; 1.15 for quartile 3; 95% cl: 1.08, 1.23]. Among individuals who had been screened in their lifetime, area-level income was not associated with having not been screened recently. Conclusions: Lower area-level income is associated with having never been screened for colorectal cancer even after adjusting for individual socioeconomic factors. Those findings highlight the potential importance of socioeconomic contexts for colorectal screening initiation and merit attention in both future research and surveillance efforts.

A theory of planned behaviour perspective on practitioners' beliefs toward the integration of the WIXX communication campaign messages and activities into daily practice.

OBJECTIVES: To favour the dissemination and the implementation of the WIXX multimedia communication campaign, the aim of this study was to examine practitioners' beliefs towards the integration of the WIXX campaign activities into daily practice. STUDY DESIGN: An exploratory qualitative study. METHODS: Overall, 58 community-based practitioners completed an online questionnaire based on the theory of planned behaviour guidelines pertaining to perceived advantages/disadvantages and perceived barriers/facilitators toward the campaign. A content analysis was performed by two independent coders to extract modal beliefs. Results were validated by a third coder. RESULTS: Local partners had a positive attitude toward the WIXX campaign, but significant barriers remained and needed to be addressed to ensure full implementation of this campaign (e.g. lack of time or resources, additional workload, complexity of the registration process and so forth). Beliefs were fragmented and diversified, indicating that they were highly context dependent. CONCLUSIONS: To conclude, some remaining challenges regarding the full implementation of the WIXX communication campaign were identified, suggesting that additional efforts might be needed to ensure the full adoption of the campaign by local practitioners.

Correlates and moderators of physical activity in parent-tween dyads: a socio-ecological perspective.

OBJECTIVES: The identification of correlates and moderators of physical activity (PA) among parents and their children can support the development of more effective interventions. The aims of this study were to identify individual- and family-level predictors of PA among parent-tween dyads and to examine the moderating role of socio-economic status (SES) on these associations. STUDY DESIGN: As part of a larger investigation, a cross-sectional telephone survey was conducted in 2012 among 1000 parent-child dyads. METHODS: Children were aged between nine and 13 years (tweens). Frequency of participation in PA was self-reported by means of questionnaires. Multilevel modelling was used. Individual predictors included body mass index and sedentary lifestyles whereas family-level predictors included parents' cognitions, family co-participation in PA, and socio-economic characteristics. RESULTS: Significant between-dyad variability in PA was observed among parent-daughter dyads (n = 470, ICC = 0.17, P < 0.001) but not parent-son dyads (n = 520, ICC = 0.01, P = 0.37). Sedentary activity (ps < 0.001) and co-participation in PA (ps < 0.001) were associated with greater PA. Positive parental perceptions of facilitating factors and greater self-efficacy were associated with PA among parent-daughter dyads (ps < 0.04) while parents' outcomes expectancies were associated with PA among parent-son dyads (P = 0.04). The relationship between facilitating factors and PA was moderated by SES (education) among parent-daughter dyads (P = 0.009). CONCLUSIONS: Promoting co-participation in PA and less sedentary activities appear as useful targets for increasing PA among parents and tweens. Additional strategies might be considered according to the sex of the children and family SES. Future research addressing socio-economic inequalities in the correlates of PA among families with tween girls is required.

What is the association between quality of treatment for depression and patient outcomes? A cohort study of adults consulting in primary care.

BACKGROUND: The association between adequate treatment for a Major Depressive Episode (MDE) and improvements in depressive symptoms is not well established in naturalistic practice conditions. The main objective of this study was to examine the association between receiving at least one minimally adequate treatment for MDE (i.e. according to clinical guidelines) in the previous 12 months and evolution of depressive symptoms at 6- and 12-months. Associations with receiving pharmacotherapy and/or psychotherapy and the role of severity of depression were examined. METHODS: This cohort study included 908 adults meeting criteria for previous-year MDE and consulting at one of 65 primary care clinics in Quebec, Canada. Multilevel analyses were performed. RESULTS: Results show that (i) receiving at least one minimally adequate treatment for depression was associated with greater improvements in depression symptoms at 6 and at 12 months; (ii) adequate pharmacotherapy and adequate psychotherapy were both associated with greater improvements in depression symptoms, and (iii) the association between adequate treatment and improvement in depression symptoms varied as a function of severity of symptoms at the time of inclusion in the cohort with worse symptoms at the time of inclusion being associated with greater reductions at 6 and 12 months. LIMITATIONS: Measures are self-reported. Participants were recruited at different stages over the course of their MDE. CONCLUSIONS: This study shows that adequate treatment for depression is associated with improvements in depressive symptoms in naturalistic primary care practice conditions, but that those with more severe depressive symptoms are more likely to receive adequate treatment and improve across time.

Neighborhood built and social environment characteristics: a multilevel analysis of associations with obesity among children and their parents.

OBJECTIVE: To examine associations between characteristics of neighborhood built and social environments and likelihood of obesity among family triads living at the same residential address and to explore whether these associations differ between family members. METHODS: Data were from the baseline wave of QUALITY (Quebec Adipose and Lifestyle Investigation in Youth), an ongoing study on the natural history of obesity in 630 Quebec youth aged 8-10 years with a parental history of obesity. Weight and height were measured in children and both biological parents and body mass index was computed. Residential neighborhood environments were characterized using a Geographic Information System and in-person neighborhood audits. Principal components analysis allowed for identification of overarching neighborhood indicators including poverty, prestige, level of urbanicity, traffic, physical disorder and deterioration, and pedestrian friendliness. Multilevel logistic regressions were used to examine associations between neighborhood indicators and obesity within multiple family members residing at the same address while controlling for household-level sociodemographic variables. RESULTS: A total of 417 families were included in the analysis. Families residing in lower and average prestige neighborhoods were more likely to be obese (odds ratio (OR)=1.69, 95% confidence interval (CI): 1.16, 2.44, and OR=1.51, 95% CI: 1.09, 2.11, respectively) than those residing in higher prestige neighborhoods. Residing in lower traffic neighborhoods was associated with less obesity (OR=0.69, 95% CI: 0.50, 0.95). Other neighborhood indicators may have differential effects across family members. For example, as neighborhood poverty increased, obesity was more likely among children but less likely among fathers and no different for mothers. CONCLUSION: Findings indicate that some shared neighborhood exposures are associated with greater risk of obesity for entire families whereas other exposures may heighten obesity risk in some but not all family members. Patterns may reflect differences in the way in which family members use residential neighborhood environments.

Baseline determinants of global diet quality in older men and women from the NuAge cohort.

UNLABELLED: Judicious food choices are of prime importance during aging. OBJECTIVES: This study was conducted to identify individual and collective attributes determining global diet quality (DQ). METHODOLOGY: Participants were 1,793 adults (52% women) from the NuAge study on nutrition and successful aging. Subjects aged 67 to 84 years in relatively good health were recruited from the Québec Medicare Database. Sociodemographic, affective, and cognitive data, health conditions, perceived physical health and functional status, dietary habits and dietary attributes and community resources were obtained using questionnaires. Body weight and height were measured and body mass index (BMI) was calculated. Three non-consecutive 24-hour diet recalls were collected at recruitment. DQ, assessed using the Canadian Healthy Eating Index (C-HEI, /100), was computed on the mean intakes from the diet recalls. Analyses were stratified by gender. Variables significantly related to DQ in bivariate analyses (p<.05) were entered into backward stepwise multiple regression analyses. RESULTS: Among men, the final model showed higher education (ß=0.23, p=.01), diet knowledge (ß=0.96, p<.0001), number of daily meals (ß=1.91, p=.02) and perceived physical health (ß=0.06, p=.01) to be positive determinants of DQ, whereas alcohol consumption (ß=-2.25, p=.05), wearing dentures (ß=-2.31, p=.01) and eating regularly in restaurants (ß=-1.65, p=.03) were negative determinants of DQ (adjusted R2 = 13.7%). Among women, higher education (ß=0.29, p=.002), diet knowledge (ß=0.54, p=.002), number of daily meals (ß=3.61, p<.0001), and hunger (ß=0.61, p<.0001) were positive determinants of global DQ; greater BMI (ß=-0.16, p=.03) and chewing problems (ß=-0.48, p=.03) were negative determinants of DQ (adjusted R2 = 7.8%). DISCUSSION: These results point to several key factors influencing global DQ in older adults and also show gender-based differences. More research must be done to better understand how these factors change with aging and exert their impact on diet, particularly since variance in DQ was largely unexplained. As diet knowledge was an independent predictor for both genders, targeted, sustainable interventions are needed to ensure good diet quality as people age.

Trajectories of endurance activity following pulmonary rehabilitation in COPD patients.

Maintenance of physical activity following pulmonary rehabilitation remains a challenge for patients with chronic obstructive pulmonary disease (COPD). The objectives of this study were to identify patterns of endurance activity after completion of pulmonary rehabilitation and to characterise people who succeed and those who have difficulty maintaining endurance activity. In a longitudinal study embedded within a randomised clinical trial, 206 individuals with COPD underwent a 3-month pulmonary rehabilitation programme. Weekly duration of endurance activity was assessed at 4, 6, 8 and 12 months after the start of rehabilitation. Trajectory modelling was used to determine the most common patterns of activity during the post-rehabilitation phase from 4-12 months. Three distinct patterns were identified, two of which indicated difficulty in maintaining endurance activity: 61 individuals reported a high activity level at 4 months (2.7 h·week(-1)) and stayed high; 114 individuals started at a low activity level (mean 1.0 h·week(-1)) and stayed low; and 31 individuals started high (3.0 h·week(-1)) and declined. The low activity group was characterised by more severe disease and greater respiratory impairment. The high and declined group had less severe disease and respiratory impairment, but reported greater barriers to exercise. Pulmonary rehabilitation should include interventions aimed at minimising barriers, in order to induce long-term behaviour change.

Duration of lack of money for basic needs and growth delay in the Quebec Longitudinal Study of Child Development birth cohort.

OBJECTIVE: To examine the relationship between duration of lack of money for basic needs and growth delay in a birth cohort. METHODOLOGY: Mothers of children (n = 1929) from the Quebec Longitudinal Study of Child Development (QLSCD) participating when the children were ages 2(1/2) and 4 years were interviewed at home and data were extracted from birth records. Children's height at 4 years old was transformed into an age- and sex-adjusted z-score. A z-score under the 10th percentile of the Centers for Disease Control and Prevention population growth curve was equated with growth delay. Lack of money for basic needs (paying for rent, electricity and/or heating, clothing, medications or other needs) when the children were ages 2(1/2) and 4 years was reported by the mother. RESULTS: Only 2.5% of children experienced two episodes of lack of money for basic needs. Logistic regression analyses showed that, after adjusting for confounding variables, the probability of growth delay at 4 years among children whose families experienced two episodes of lack of money was higher than for their peers who had not lacked money (OR 3.43; 95% CI 1.54 to 7.66). Experiencing lack of money only at 2(1/2) years showed higher but not significant odds of growth delay at 4 years (OR 1.51; 95% CI 0.84 to 2.72), whereas the likelihood of growth delay was similar for children who experienced lack of money only at 4 years and for their counterparts who never lacked money (OR 0.74; 95% CI 0.26 to 2.11). CONCLUSION: In an industrialised country toddlers whose families experienced persistent lack of money for basic needs are more likely to have growth delay even after controlling for neonatal conditions and their mothers' characteristics.

Validation of a measure of maternal perception of the child's health status.

BACKGROUND: The main objective of this population-based and cross-sectional study was to determine the validity of maternal perception as an indicator of the 17-month-old child's health status. METHODS: Data from this study came from the Quebec Longitudinal Study of Child Development (QLSCD, Round 1999) which was based on a representative sample of babies born in Québec in 1997 and 1998. The analyses were based on the 2045 children aged 17 months who participated in the survey in 1999. Maternal perception of the child's health status was examined as a function of a series of children's health indicators, namely the presence of acute health problems (last 3 months), asthma attacks since birth, presence of chronic problem and hospitalizations during the previous 12 months. Confounding influences of both maternal and child-related characteristics were controlled in the analyses. RESULTS: Sequential logistic regressions indicated that maternal perception was strongly associated with the different health indicators even after controlling for confounding variables. However, a significant interaction between the child's gender and the presence of chronic health problems was observed. The association between maternal perception of the child's health and the presence of chronic health problems was stronger for boys than for girls. CONCLUSIONS: The analyses confirm that the mother's perception of the health status of her 17-month-old child corresponds with the actual health status of the child as reflected by the presence or absence of selected health problems.

Adiposity, physical fitness and incident diabetes: the physical activity longitudinal study.

AIMS/HYPOTHESIS: The purpose of this study was to investigate the relationships among adiposity, physical activity, physical fitness and the development of diabetes in a diverse sample of Canadians. METHODS: The sample included 1,543 adults (709 men and 834 women) from the Canadian Physical Activity Longitudinal Study who were free of diabetes at baseline (1988). Several indicators of adiposity (BMI, waist circumference, WHR, sum of skinfold thicknesses), musculoskeletal fitness (sit-ups, push-ups, grip strength, trunk flexibility), cardiorespiratory fitness (maximal metabolic equivalents [METs]) and leisure-time physical activity levels were measured at baseline. Participants were followed until 2002-2004 for the ascertainment of new cases of diabetes. RESULTS: The 15.5-year cumulative incidence of diabetes was 5.0% (5.2% in men, 4.9% in women). Adiposity and physical fitness, but not physical activity, were significant predictors of diabetes after adjustment for age, sex and several covariates. For each standard deviation of the indicators of adiposity, the risk of diabetes was 99-194% higher. Conversely, the risk was 70 and 61% lower for each standard deviation of maximal METs and composite musculoskeletal fitness score, respectively. Receiver operating characteristic curve analyses confirmed that neither adiposity nor physical fitness provided a superior prediction of incident diabetes. CONCLUSIONS/INTERPRETATION: Adiposity and physical fitness were both important predictors of the development of diabetes in this cohort of Canadians.

Neighbourhood level versus individual level correlates of women's body dissatisfaction: toward a multilevel understanding of the role of affluence.

STUDY OBJECTIVE: This study examined the prevalence of body dissatisfaction as a function of individual level and neighbourhood level indicators of affluence. PARTICIPANTS AND SETTING: A subset of data from a larger random digit dialling telephone survey was used to obtain individual level data on body dissatisfaction, body weight and height, and income from a group of 895 adult women (age 24-56, 61% English speaking) living in 52 neighbourhoods (census tract areas) within the provinces of Alberta, Ontario, and Quebec, Canada who were selected for their heterogeneity in social class. DESIGN: Aggregated census tract data from 1996 were used to develop neighbourhood indicators of affluence. Using hierarchical linear modelling, body dissatisfaction (dichotomous) was examined as a function of individual body mass index, individual level affluence and neighbourhood level affluence. MAIN RESULTS: The impact of body mass index on body dissatisfaction depended on the level of neighbourhood affluence: an average body mass index was associated with higher likelihood of reporting body dissatisfaction in a neighbourhood of above average affluence (71% probability) than in a neighbourhood of average affluence (58% probability), independent of a woman's individual affluence (whether she was low income or not). CONCLUSION: It is concluded that a clearer understanding of the role of affluence on body dissatisfaction can be achieved by a joint examination of individual and neighbourhood level influences.

The cumulative impact of being overweight on women's body esteem: a preliminary study.

As much research indicates that a woman's current weight status is an important predictor of her body esteem, we examined the relationship between weight status history (retrospective self-report since the age of 5 years) and current body esteem among 266 female college students, who completed a measure of body esteem and reported whether they had been "underweight", "normal weight", or "overweight" during 3 age ranges. Analysis of variance (ANOVA) was used to examine differences in current body esteem between groups characterised by the following weight history trajectories: "always overweight", "always normal/underweight", "increase in weight over time" and "decrease in weight over time". Although the women in the groups "always overweight" and "increase in weight over time" were currently overweight [according to self-reported body mass index (BMI)], the current body esteem of the former was significantly lower (worse) than that of the latter. We introduce the idea that being overweight for a long period of time has a cumulatve negative impact on adult body esteem.

Association of serotonin and cortisol indices with childhood abuse in bulimia nervosa.

BACKGROUND: Bulimia nervosa (BN) is reported to co-occur with childhood abuse and alterations in central serotonin (5-hydroxytryptamine [5-HT]) and cortisol mechanisms. However, findings also link childhood abuse to anomalous 5-HT and cortisol function, and this motivated us to explore relationships between childhood abuse and neurobiological variations in BN. METHODS: Thirty-five bulimic and 25 nonbulimic women were assessed for childhood physical and sexual abuse, eating symptoms, and comorbid psychopathological tendencies. These women provided blood samples for measurement of platelet hydrogen-3-paroxetine binding and serial prolactin and cortisol responses following oral administration of the partial 5-HT agonist meta-chlorophenylpiperazine (m-CPP). RESULTS: Bulimic women showed markedly lower mean +/- SD density (B(max)) of paroxetine-binding sites (631.12 +/- 341.58) than did normal eaters (1213.00 +/- 628.74) (t(54) = -4.47; P =.001). Paroxetine binding did not vary with childhood abuse. In contrast, measures of peak change on prolactin levels after m-CPP administration (Delta-peak prolactin) indicated blunted response in abused bulimic women (7.26 +/- 7.06), nonabused bulimic women (5.62 +/- 3.95), and abused women who were normal eaters (5.73 +/- 5.19) compared with nonabused women who were normal eaters (13.57 +/- 9.94) (F(3,51) = 3.04, P =.04). Furthermore, individuals reporting childhood abuse showed decreased plasma cortisol levels relative to nonabused women who were normal eaters. CONCLUSION: Findings imply that BN and childhood abuse are both generally associated with reduced 5-HT tone but that childhood abuse may be somewhat more specifically linked to reduced cortisol levels (ie, hypothalamic-pituitary-adrenal axis) activity.

The role of perfectionism and excessive commitment to exercise in explaining dietary restraint: replication and extension.

UNLABELLED: The etiological complexity of the eating disorders has incited researchers to examine how personality characteristics and other variables operate jointly in the development of deviant eating patterns. OBJECTIVE: This study investigated the independent, interactive, and indirect prediction of dietary restraint by perfectionism and excessive commitment to exercise. METHOD: Multiple regression analyses designed to test moderating and mediating models were conducted on a sample of female university students (n = 269). RESULTS: Several dimensions of perfectionism, as well as excessive commitment to exercise, significantly and independently predicted dietary restraint in these women. There was no evidence for an interaction effect. Mediation analyses suggested that for selected dimensions of perfectionism, the direct relationship between perfectionism and dietary restraint is partially explained by excessive commitment to exercise. DISCUSSION: Interventions aimed at challenging perfectionistic standards in the context of dieting need to address not only one's self-standards, but one's perceptions of standards held by others. The mediating role of excessive exercise commitment pinpoints this variable as an alternative intervention target in the prevention of excessive dieting.

Interpersonal influence and disordered eating behaviors in adolescent girls: the role of peer modeling, social reinforcement, and body-related teasing.

This study investigated the association between interpersonal relationships, eating behaviors, and body esteem in a sample of adolescent girls. Participants included 876 girls who completed questionnaires regarding body esteem, eating behavior, peer pressure, and interpersonal relationships. Peer pressure was a strong predictor of eating behavior and body esteem after controlling for interpersonal variables. High externalized self-perceptions, self-reported teasing, and attributions about the importance of weight and shape for popularity and dating were important predictors of both body esteem and eating behavior. Also, girls who were nominated as popular by peers were more likely to engage in disordered eating and have lower body esteem. Results highlight the need for eating disorder prevention at the level of the peer group. Programs should focus on decreasing pressure to be thin, acceptance by peers for attributes other than appearance, and combating weight- and shape-related teasing within the school system.

A two-factor model of disordered eating.

General psychopathology (i.e., personality disturbance, mood/affect dysregulation) has been identified as common and perhaps etiologically important in eating disorder (ED) patients. In this context, we examined a two-factor model of disordered eating which implicated the independent and interactive contribution of (a) general psychopathology (personality) and (b) eating-related psychopathology (body esteem) in explaining deviant eating patterns. A sample of 266 female college/university students (M age=22.1) and 76 women with a clinically diagnosed ED (M age=28.09) completed paper and pencil questionnaires of deviant eating patterns, body esteem, and personality pathology. First, a K-means cluster procedure revealed a compelling three-cluster solution among the nonclinical women based on deviant eating variables: <>(n=61), <> (n=92), and <> (n=103). The ED women were classified as Cluster 4; <> (n=76). Second, to evaluate our two-factor model, multinomial logistic regression (MLR) was used with cluster membership as the outcome variable and the following variables as predictors: body esteem, personality pathology, and all two-way interactions. In addition to several significant main effects, three interaction terms were marginally significant: Body esteem appearance x Narcissism (P=.047), Body esteem weight x Narcissism (P=.044), and Body esteem attribution x Stimulus seeking(P=.051). The overall extent of correct cluster classification was 63%. These results indicate that the presence of both low body esteem and maladaptive personality, and the interactive operation of these two factors, seems to contribute to the likelihood of having an eating disorder, beyond the independent contribution of either factor alone. Results are considered in the context of etiological models in which general psychopathology presents a vulnerability factor in ED development.

Age and mortality among white male problem drinkers.

AIMS: This study is designed to determine the relative risk of mortality for white male problem drinkers compared to white males in the general population, and to identify any variation in relative risk of problem drinking in three age groups (18-29, 30-49 and 50-79 years). DESIGN: The research design is prospective, using historical administrative datasets from treatment programs in conjunction with vital records datasets. PARTICIPANTS: Participants include all white men aged 18-79 treated for alcohol-related problems in community mental health substance abuse programs in Vermont during 1991. The treatment group includes 1853 service recipients; the comparison group includes 196,443 adult white male residents of Vermont. MEASUREMENT: Measurement of mortality rates for problem drinkers was based on probabilistic determination of overlap between treatment and vital record datasets. FINDINGS: Mortality for problem drinkers is greater than the general population in all three age groups. The estimated relative risk of mortality in the oldest age group was lower than the other groups, but substantially higher than found in recently published research. The estimated relative risk of mortality in the youngest age group, which has rarely been addressed in previous research, was higher than the relative risk in the middle age group. CONCLUSION: The application of a public health research model in which problem drinkers are compared to the general population has potential to inform public policy. In this case, the public health approach identified an elevated risk of mortality associated with problem drinking among older adults that had not been evident in the previous research.

Effects of leadership style and group dynamics on enjoyment of physical activity.

PURPOSE: The primary purpose of this study was to examine the independent and combined effects of leadership style and group dynamics on the enjoyment of physical activity. DESIGN: A completely randomized 2 x 2 factorial design was used in which the manipulation of "leadership style" (socially enriched vs. bland) was crossed with a manipulation of "group dynamics" (socially enriched vs. bland). SETTING: The study was conducted in an aerobics studio on a university campus. SUBJECTS: The sample included 48 male and 42 female undergraduate students who were moderately active. INTERVENTION: Each participant was involved in a single session of step aerobics. A female graduate student provided either an enriched or bland series of interactions to manipulate leadership style, and a trained group of planted undergraduates was used to promote either an enriched or bland group environment. MEASURES: The outcome measures of interest were enjoyment and the probability of engaging in a similar activity in the future. RESULTS: Participants in the enriched leadership style plus enriched group dynamics condition reported higher enjoyment than did participants in the other three conditions. On average, the level of enjoyment was 22.07% higher in this condition than in the other three conditions (p < .001). The probability of future involvement was 13.93% higher for participants in the enriched group environment, irrespective of leadership style (p < .03). CONCLUSIONS: Enjoyment during physical activity is optimized when a positive and supportive leadership style is coupled with an enriched and supportive group environment. Future research is required to extend these findings to other activities and populations.