Rates and social patterning of household smoking and breastfeeding in contrasting European settings

OBJECTIVE: To compare rates and social patterning of household smoking and breastfeeding in families with newborn infants in birth cohorts in Coventry, UK and Veria, North Greece. METHODS: Infants born in 1996 in Coventry, 1999 in Veria were recruited into birth cohort studies using similar methodologies. In Coventry recruitment was by family health visitor at the primary visit; in Veria, hospital-based paediatricians enrolled infants at the neonatal examination. Data were collected at the initial contact on household smoking, type of feeding, and household socio-demographic characteristics. Rates of initial breastfeeding and household smoking with 95% confidence intervals were estimated and breastfeeding and household smoking regressed on parental education and housing tenure in logistic regression models. RESULTS: Data were available on 2612 Coventry infants and 773 Veria infants. Rates of household smoking and breastfeeding were higher in Veria compared to Coventry. In Coventry, living in rented accommodation and lower maternal and paternal education were associated with household smoking and bottle feeding. Logistic regression models fitted on initiation of breastfeeding failed to show social patterning in Veria but more educated mothers showed a longer duration of breastfeeding. Only low paternal education was associated with household smoking after adjustment for maternal education and housing tenure. CONCLUSIONS: Smoking and breastfeeding are more prevalent among households with young infants in Veria compared with Coventry. The social patterning of health-related behaviours noted in Coventry is less marked in Veria. The relevance of these findings for public health interventions in the contrasting settings is discussed.     

Paediatricians' attitudes about discussing maternal depression during a paediatric primary care visit

OBJECTIVES: To assess paediatricians' beliefs about discussing maternal depressive symptoms during a paediatric visit, and methods paediatricians use to identify mothers with depressive symptoms. METHODS: In-depth telephone interviews were conducted with 23 primary care paediatricians from a practice-based research network. We asked a series of previously developed questions about discussing maternal depressive symptoms during a paediatric visit; methods used to identify mothers at risk; barriers encountered, and potential strategies to improve recognition and treatment of maternal depression. Interviews were audiotaped and transcribed. Data were codified and analysed using standard qualitative data techniques. RESULTS: All paediatricians agreed that it is appropriate to ask mothers about their own health during a well-child visit, because a mother's well-being affects her children. Paediatricians relied on observational cues to identify a mother with depressive symptoms, especially mother-child interactions. Few used direct questions or a checklist. Almost all paediatricians felt that lack of time was the barrier most often faced in addressing maternal depression. Lack of training, inadequate knowledge of resources and distractions encountered in the primary care setting were additional barriers cited. One-third of paediatricians acknowledged the fear of judgement and stigma that a mother may face when discussing maternal stresses. Paediatricians desired better ability to refer mothers to social workers for help. CONCLUSIONS: Observational cues are used more often than direct questions or screening tools to identify mothers at risk of depression. This may under-identify mothers at risk. Paediatricians prefer to rely on other professionals, particularly social services, to address maternal depression, yet mothers may be hesitant or ambivalent about such assistance because of fear of judgement. Paediatricians, in fact, may be the professional mothers most want to communicate with. Thus, appreciation of mothers' perspectives, empathetic communication skills and knowledge of community resources can enhance paediatricians' abilities to assist mothers at risk for depression.     

Parents’ decision-making strategies when selecting child care: Effects of parental awareness, experience, and education

The effects of level of parental awareness, parenting experience, and formal education on parents’ decision making about child care were examined in two experiments using “process-tracing” methodology. In Experiment 1, 60 mothers made decisions about child care for their child(ren). Mothers at higher levels of parental awareness used less information and demonstrated more variability in their information search patterns. Mothers at lower levels of parental awareness used more information and demonstrated less variable search patterns. These strategies imply the use of compensatory decision models and are less cognitively efficient. A similar result was obtained for education whereas parenting experience was not significant in influencing the decision strategies. Experiment 2 used pressure of time as a “stress” condition and the results replicated and extended the first experiment’s findings. This research was supported by a Post-Doctoral Fellowship from the Social Sciences and Humanities Research Council of Canada and a scholarship from the University of British Columbia. Experiment 1 was part of a larger study and was submitted to the Faculty of Graduate Studies of the University of British Columbia in partial fulfillment of the requirements for the doctoral degree under the direction of Professor P.K. Arlin.     

Advice to patients in Swedish primary care regarding alcohol and other lifestyle habits: how patients report the actions of GPs in relation to their own expectations and satisfaction with the consultation

BACKGROUND: Lifestyle advice given by general practitioners (GPs) may be a cost-effective means of health promotion; however, it is not fully put into routine practice. The aim of this study was to explore to what extent GPs' patients expect and receive advice concerning alcohol, tobacco, exercise and diet in relation to sociodemographic characteristics, type of visit and patient satisfaction. METHODS: A postal questionnaire was sent to a representative sample (n = 9750) of patients who had consulted GPs in a county in Sweden. The response rate was 69% (n = 6734). RESULTS: Exercise was the most (16%) and alcohol the least (5%) common type of advice. The patients received advice more often than they expected in all areas except alcohol. The patients reported the highest rate of unfulfilled advice expectation and the lowest rate of unexpected advice in the case of alcohol. Male gender, poorer self-rated health and scheduled appointment were independent predictors of all types of advice. Continuity of GP contact was only favourable for exercise and diet advice. The patients who received advice were more satisfied with their visit to the doctor. CONCLUSIONS: A tertiary preventive perspective guides GPs' practice of giving advice. Male patients with advanced illnesses are given priority. Women and patients with long-term risk habits are more neglected. The GPs tend to misjudge the expectations and needs of their patients and are too restrained in their counselling practice. Alcohol is the most disregarded area of advice in proportion to the patients' expectations and needs.     

When physicians and patients think alike: patient-centered beliefs and their impact on satisfaction and trust.

OBJECTIVE: Our goal was to identify physician and patient characteristics associated with patient-centered beliefs about the sharing of information and power, and to determine how these beliefs and the congruence of beliefs between patients and physicians affect patients' evaluations. STUDY DESIGN: Physicians completed a scale assessing their beliefs about sharing information and power, and provided demographic information. A sample of their patients filled out the same scale and made evaluations of their physicians before and after a target visit. POPULATION: Physicians and patients in a large multispecialty group practice and a group model health maintenance organization were included. Forty-five physicians in internal medicine, family practice, and cardiology participated, as well as 909 of their patients who had a significant concern. OUTCOMES MEASURED: Trust in the physician was measured previsit, and visit satisfaction and physician endorsement were measured immediately postvisit. RESULTS: Among patients, patient-centered beliefs (a preference for information and control) were associated with being women, white, younger, more educated, and having a higher income; among physicians these beliefs were unrelated to sex, ethnicity, or experience. The patients of patient-centered physicians were no more trusting or endorsing of their physicians, and they were not more satisfied with the target visit. However, patients whose beliefs were congruent with their physicians' beliefs were more likely to trust and endorse their physicians, even though they were not more satisfied with the target visit. CONCLUSIONS: The extent of congruence between physicians' and patients' beliefs plays an important role in determining how patients evaluate their physicians, although satisfaction with a specific visit and overall trust may be determined differently.     

Correlates of Prenatal Parenting Expectations in new Mothers: Is Better Self-Efficacy a Potential Target for Preventing Postnatal Adjustment Difficulties?

The extent to which a mother’s prenatal expectations are realistic or unrealistic has been associated with postnatal adjustment in first-time mothers. This cross-sectional study investigated the associations with prenatal parenting expectations to determine what makes them more or less realistic. A mediational model was developed to explain the relationships between family and social support, maternal adjustment (i.e., depression, anxiety, worry, stress, and happiness), parenting self-efficacy, and prenatal expectations. We recruited 255 first-time expectant mothers living in Brisbane, Australia. Using structural equation modeling, we found that higher levels of social and family support were associated with lower levels of maternal maladjustment, which in turn was related to higher parental self-efficacy. Finally, self-efficacy was a significant positive predictor of prenatal parenting expectations, implying that the more confident mothers are, the more realistic are their parenting expectations during pregnancy. This was a fully mediated effect. Our findings are of particular relevance for the educational and counseling services offered to pregnant mothers. Specifically, they could assist health professionals in identifying mothers who may be prone to having unrealistic expectations and prepare them for the demands and challenges of having a new baby, which may prevent poor adjustment in the postnatal period.     

Effects of physician awareness of symptom-related expectations and mental disorders. A controlled trial

OBJECTIVE: To study whether physician awareness of symptom-related expectations and mental disorders reduces unmet expectations or improves patient satisfaction. DESIGN: Prospective, before-after trial, with control (n = 250) and intervention (n = 250) groups. Outcomes were assessed immediately after the index office visit, at 2 weeks, and at 3 months. SETTING: Ambulatory walk-in clinic. PARTICIPANTS: Five hundred adults with physical complaints. Exclusion criteria included upper respiratory tract infection and dementia. Follow-up was accomplished in 100% immediately after the visit, 92.6% at 2 weeks, and 82.6% at 3 months. INTERVENTIONS: Two-hour physician workshop followed by information provided before each visit on patient expectations, illness worry, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) disorders. MEASUREMENTS: Symptom-related expectations, satisfaction with care, symptom improvement, functional status, physician-perceived difficulty of the encounter, visit costs, and use of health care services. RESULTS: Serious illness worry (64%), 1 or more specific expectations (98%), or a DSM-IV disorder (29%) were commonly present in study patients. Intervention patients were less likely to report unmet expectations (odds ratio, 0.52; 95% confidence interval [CI], 0.43-0.97) immediately after the visit and at 2 weeks, less likely to be perceived as difficult by their physician (odds ratio, 0.49; 95% CI, 0.24-0.98), and more likely to be fully satisfied at 2 weeks (odds ratio, 1.63; 95% CI, 1.14-2.00). By 3 months, groups were similar in terms of satisfaction and residual expectations. Symptom improvement occurred in most patients by 2 weeks (70.5%) and 3 months (81.2%), regardless of study group. There was also no difference in patients' serious illness worry during the follow-up. The intervention did not increase visit costs or use of health care services. CONCLUSION: Identifying symptom-related expectations and mental disorders in patients presenting with physical complaints may improve satisfaction with care at 2-week follow-up and physician-perceived difficulty of the encounter.     

Spankers and Nonspankers: Where They Get Information on Spanking*

Because spanking is common, puts children at risk for harmful side effects, and is ineffective as a positive behavior management tool, it is important to identify the kind of advice families receive about the appropriateness of spanking. Using the health belief model, I examined spankers and nonspankers on the spanking messages they received from eight sources of discipline information and how important they perceived these messages to be. Data from telephone interviews with 998 mothers with children aged 2 to 14 years showed that 33% of mothers rated advice from workshops, pediatricians, newspapers and magazines, and books as “very important.” Less than 15% rated parents and relatives and friends as such. Spankers perceived sources as recommending spanking, whereas nonspankers perceived sources as opposing spanking. Mothers were more likely to spank when they perceived more intense messages to spank, less intense messages opposing spanking, had younger children, and were of lower socioeconomic status.     

The treatment of acute gastroenteritis in children in The Netherlands

A national survey on the treatment of acute gastroenteritis in children was conducted among 10% of the Dutch general practitioners and 10% of the paediatricians. Oral Rehydration Solution was used by less than 40% of the general practitioners, while 95% of the paediatricians used it (nearly) always. About a quarter of the general practitioners used antidiarrhoeal medication in contrast to the paediatricians who hardly or never used these drugs. The refeeding period after the acute rehydration therapy showed great difference. The need for a uniform dietary advice was felt by nearly half the general practitioners. It is concluded that the internationally accepted primary treatment with O.R.S. has insufficient impact on the Dutch general practitioners. Greater knowledge on the unique features of this method is needed. The dietary advice after the primary treatment needs more uniformity.     

Improving vaccination coverage in urban areas through a health communication campaign: the 1990 Philippine experience.

From March to September 1990 the Philippine Department of Health, with the assistance of the HEALTHCOM Project, carried out a national mass-media communication campaign to support routine vaccination services. The essential elements of the campaign strategy were as follows: focusing on measles as a way to get mothers to bring their children to the health centre; emphasizing logistic knowledge in the mass-media messages, in particular popularizing a single day of the week as "vaccination day" and giving clear information about the age for measles vaccination; and focusing on urban areas, which had lower vaccination rates than rural areas. Evaluation of the effects of the campaign indicates an increase in vaccination coverage and a substantial increase in the timeliness of vaccination that can be attributed to improvement in carers'' knowledge about vaccination. Furthermore, most of the observed increase in knowledge was related to exposure to the mass-media campaign. There was no evidence of any programmatic change that could account for the increase in vaccination or evidence that increased health education efforts at health centres could account for the change in knowledge. These results indicate that when countries meet certain conditions--a high level of access to the media, sufficient expertise and funds available to develop and produce high-quality radio and television advertisements, and a routine system that is able to serve the increased demand--a mass communication campaign can significantly improve vaccination coverage.     

A cost-effectiveness analysis of self-help smoking cessation methods for pregnant women.

Estimates of the cost effectiveness and cost benefit of health promotion-health education methods for pregnant smokers designed to increase birth weight are not available. This paper presents the results of a cost-effectiveness analysis from a recently completed randomized trial to evaluate the effectiveness of self-help smoking cessation methods for pregnant women in public health maternity clinics. The study population--309 pregnant smokers from 3 prenatal clinics--were randomly assigned, during their first clinic visit, to 1 of 3 groups: (a) group 1 received the standard clinic information and advice to quit smoking, (b) group 2 received the standard clinic information and advice to quit plus the manual "Freedom From Smoking in 20 Days" by the American Lung Association, and (c) group 3 received the standard clinic information and advice to quit plus the pregnancy-specific manual "A Pregnant Woman''s Self-Help Guide to Quit Smoking." The quit rates by the end of pregnancy were 2 percent for group 1, 6 percent for group 2, and 14 percent for group 3. Analyses also indicated that the method used for group 3 was the most cost effective: group 3 achieved smoking cessation at less than half the cost experienced by the other two groups. Although additional studies are needed concerning the behavioral impact, cost effectiveness, and cost benefit of self-help health education methods for smoking cessation, the methods tested in this trial are promising as solutions to part of the problem of low birth weight among infants of smoking mothers in the United States.     

Enhancing Parenting Practices of At-risk Mothers

This study evaluated the effectiveness of an intervention designed to improve early parenting by increasing understanding of infant developmental needs and promoting maternal responsiveness as indicated by increased positive behavior support for infants and decreased psychological control. At-risk mothers were randomly assigned to control or treatment conditions, the latter consisting of training in parental responsiveness, developmental knowledge, and loving touch. Following the intervention, treatment mothers reduced their controlling tendencies; they were less rigid, less intrusive, and more flexible than control mothers. Treatment mothers provided more parental support indicated by higher quality verbalizations, more demonstrative teaching, and lower role-reversal tendencies. Editors' Strategic Implications: Further replication will be necessary, but the results for the "My Baby and Me" program are promising. The authors provide crucial information for parent educators about the pairing of basic knowledge transfer with the active engagement of parents with their infants in practicing new parenting skills.     

An office-based Internet patient education system: a pilot study

BACKGROUND: Patients' use of the Internet to find medical information is increasing, and physicians are exploring ways to incorporate the Internet into patient education programs and physician-patient encounters. We performed a pilot study of an Internet patient education system to obtain information on the usefulness of, feasibility of, and patient satisfaction with this type of information. METHODS: We developed a hypertext Web page directory to patient education sites on the Internet and made it available to patients in a community-based family practice residency clinic during their office visit. During a 1-month period, a medical student assisted patients with using the Internet, answered questions, interviewed patients, and collected data. Information was collected on sites visited, level of assistance required, amount of time spent "surfing" on-line versus intense reading on-line, quality of the experience, perceived usefulness of the educational materials, and patients' satisfaction with the materials. RESULTS: Fifty patients participated in the study. Forty-seven patients (94%) found the Internet information helpful. Most patients spent their time on-line intensely reading, and men spent significantly more time on-line (P = .007). Thirty-seven patients (77%) stated they would change a health behavior because of information they had read on the Internet; 45 (90%) were more satisfied with their visit than usual, and 46 (92%) would use the Internet center at the clinic again. CONCLUSIONS: Patients can obtain useful information from moderated Internet patient education systems and may plan to change health behaviors on the basis of that information. Internet patient information in the physician's office can improve patient satisfaction with clinic visits.     

European patients' views on the responsiveness of health systems and healthcare providers

BACKGROUND: Responsiveness to patients is now seen as a key characteristic of effective health systems. This study aimed to learn more about European people's views on the responsiveness of their country's health systems and healthcare providers. METHODS: Telephone survey with random samples of the populations in Germany, Italy, Poland, Slovenia, Spain, Sweden, Switzerland and the UK using random digit dialling. RESULTS: Responses were obtained from 8119 people aged 16 and over. Just over half the respondents said that doctors always listened carefully to them, gave them time for questions and provided clear explanations. Respondents from Switzerland and the UK reported consistently high rates of satisfaction with doctors' communication skills, while respondents from Poland were significantly less satisfied. Younger people were more critical than older people. Expectations of patient involvement in treatment decisions were high, particularly among younger people, with 74% indicating a desire to be actively involved. Most respondents felt they should have a choice of primary care doctor, specialist doctor and hospital, but less than half felt they had sufficient information to make an informed choice. There were significant variations between the countries in reported levels of involvement and in satisfaction with opportunities for choice. CONCLUSIONS: The results suggest that many European patients want a more autonomous role in health care decision-making. Policy-makers and clinicians should consider how to narrow the gap between public expectations and patients' experience.     

Self-rated health, symptoms of depression and general symptoms at 3 and 12 months after a first-ever stroke: a municipality-based study in Sweden

Background

Patient satisfaction has become an important indicator of primary care and healthcare system performance. Ethnic disparities in patient satisfaction and compliance with physician care have been studied in several countries. However, this issue has not received significant attention in Canada. The unique characteristics of the Canadian healthcare system and ethnic population make it worthwhile to examine this issue in this population. Therefore, we conducted a survey among Chinese and Whites in a Canadian city to determine their reported satisfaction, and perceptions of physicians.

Methods

The survey was conducted in English, Mandarin and Cantonese in 2005 among Chinese and White Canadians, 18 years of age or older, who had visited at least one physician in Canada.

Results

We analyzed 746 Chinese and 711 Whites in the general practitioner (GP) visit group and 485 Chinese and 637 Whites in the specialist visit group. A lower proportion of Chinese compared to Whites reported that they were very satisfied or satisfied with GP (73.7% vs. 92.8%) and specialist care (75.5% vs. 85.6%) and the differences between the two groups remained after adjustment for demographic variables and chronic conditions (risk adjusted OR: 0.70, 95%CI: 0.42–1.18 for the GP visit group and OR: 0.77, 95%CI: 0.48–1.23 for the specialist visit group). A similar proportion of Chinese and Whites reported that they always followed a physician's advice (59.4% vs. 59.6% for the GP visit group and 67.2% vs. 62.8% for the specialist visit group). Non-English speaking Chinese and recent arrivals in Canada were less likely to be satisfied with GPs than Chinese born in Canada [risk adjusted OR: 0.5, 95%CI: 0.3–0.9, 0.2 and 0.1–0.7, respectively].

Conclusion

Chinese Canadians reported lower satisfaction with physicians and perceived physicians slightly more negatively than White Canadians. Particularly, Chinese with limited English and short length of stay in Canada were less satisfied than Canadian born Chinese.     

The pace of repeated childbearing among young American mothers

Women who first give birth at ages 16 and younger are more likely to bear a second child within the next two years (26 percent) than are women who have their first child at ages 17-18 (20 percent) or at ages 19-22 (22 percent). However, there are important racial and ethnic differences in the likelihood of rapid repeated childbearing: Among whites, age at first birth has little effect on the proportions who have a second birth quickly; but among blacks, it has a significant inverse effect, with younger women more likely than older women to have a second child quickly. At nearly all ages at first birth, Hispanic mothers are more likely than either whites or blacks to have a second birth soon after the first. While the youngest black mothers (those 16 and under) are more likely than the youngest whites to have a rapid second birth, the oldest white mothers (those 19-22) are more likely than the oldest blacks. Socioeconomic background (represented by level of parental education), marital status at first birth and wantedness of the first birth also affect the pace of repeated childbearing. Compared with young mothers whose own mothers are high school graduates, those whose mothers are dropouts are more likely to have a second child within two years. Teenage mothers who are married at their first birth appear somewhat more likely than their unmarried counterparts to bear another child quickly; and mothers who wanted their first child at the time of conception are generally more likely to do so than are mothers whose first births were unwanted.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effect of maternal smoking status,educational level and age on food and nutrient intakes in preschool children: results from the Avon Longitudinal Study of Parents and Children

OBJECTIVE: Studies in adults have demonstrated that smoking status is associated with dietary quality, with smokers tending to have diets that conform less closely to guidelines on healthy eating than nonsmokers. However, there is very little information on the relation between children's dietary quality and parental smoking status. The objective of this study was to investigate the relation between maternal smoking status and nutrient intake in preschool children, allowing for the possible confounding effects of maternal educational level and age at delivery. SUBJECTS: In total, 993 children aged 18 months participating in the Avon Longitudinal Study of Parents and Children. METHODS: Diet was assessed by a 3-day food record. Maternal smoking status and educational level and age at delivery were assessed by questionnaire. RESULTS: In multivariate analysis, the children of smokers had significantly higher intakes of monounsaturated fatty acids and starch, and lower intakes of nonstarch polysaccharides (NSP). They were also less likely to have eaten poultry, buns, cakes and puddings, wholemeal bread and fruit, and more likely to have drunk sugar-sweetened soft drinks. Intakes of NSP and most vitamins and minerals increased significantly with increasing maternal education. Children of more highly educated mothers were less likely to have eaten chocolate, crisps and white bread, and more likely to have consumed wholemeal bread, fruit and fruit juice. CONCLUSIONS: The children of nonsmokers and more highly educated mothers consumed a diet that conformed more closely to current guidelines on healthy eating. These dietary differences may contribute to the excess of ill-health observed in the children of smokers and of less-educated mothers.     

Physicians' advice to quit smoking. The glass remains half empty

BACKGROUND: We explored the relationships between advice from a physician to quit smoking and an array of respondents' characteristics, including sociodemographic factors, health status, health insurance status, physician continuity, and intensity of smoking. METHODS: We examined data from the nationally representative 1996-1997 Community Tracking Study Household Survey. We used multivariate logistic regression to model receipt of cessation advice in a sample of 8229 smokers aged 18 years and older who made at least one visit to a physician in the past year. RESULTS: Less than 50% of the subjects reported receiving cessation advice. Advice was less likely for patients who were younger, men, African American, uninsured, healthier, lower health care services users, or lighter smokers, and more likely for those with military health insurance, who attended hospital outpatient clinics, or who belonged to health maintenance organizations. CONCLUSIONS: Physicians continue to miss opportunities to provide smoking cessation advice, a potentially lifesaving intervention. Given the adverse health consequences of tobacco use and the demonstrated benefit of advice to quit, physicians need to improve their cessation counseling efforts.     

Preventing fetal alcohol effects; a trial of three methods of giving information in the antenatal clinic

We conducted two trials to compare three methods of impartingbasic advice designed to encourage a reduction of alcohol consumptionduring pregnancy. The information was given to mothers at theirfirst visit to the antenatal clinic. Written information alonewas compared with written information reinforced by personalizedadvice from the clinic doctor. Subsequently, written informationalone was compared with written information plus personalizedadvice reinforced by a specially produced video. There wereno significant differences within or between trials in termsof behavioural change. When the mothers were asked about safelevels of drinking during pregnancy, significantly more mothersin both arms of the second trial recommended one unit or lessa day. This suggests that external factors such as the massmedia, although influential in creating awareness, also failedto induce behavioural change. Our findings indicate that specialand expensive arrangements in the antenatal clinic are unnecessarybut that appropriate advice could be incorporated into all existingantenatal educational programmes. Counselling could be availablefor mothers who need further help.