Community worry about heart disease: a needs survey in the Coalfields and Newcastle areas of the Hunter region

Abstract: A needs survey was administered by mail in the Coalfields area of the Hunter region (a lower socioeconomic area around Cessnock) and in a higher socioeconomic area of Newcastle. The purpose was to assist planning for Coalfields Healthy Heartbeat—a community-action heart disease prevention program. Response rates from random samples of residents were 435/897 (49 per cent) for the Coalfields and 565/875 (65 per cent) for Newcastle. In both study areas heart attack was ranked eleventh from a list of 17 potential community worries, well below drugs, crime, road safety, the environment, cancer and ‘loss of health’. Coalfields respondents were more worried about all issues on the list than were the residents in Newcastle and were less likely to have heard about recent health promotion campaigns. Coalfields respondents felt that heart disease prevention was the responsibility of the individual, the family, and the medical profession, in that order, and much less the responsibility of local community groups. Results suggest that health promotion strategies incorporating values, language and symbols that are meaningful to distinct subgroups may be more successful than disease-specific programs aimed at the general population.     

Analysis of nonresponse bias in a population-based case-control study on lung cancer

The objective of this study was to identify characteristics of nonrespondents and late respondents in a population-based case-control study on lung cancer conducted in the city of Turin (Italy). Information about demographic and socioeconomic variables of 634 cases and 859 controls who responded to an interview, as well as of 154 cases and 154 controls who did not respond were obtained from census and the public register of Turin. The socioeconomic level of nonrespondents was high in cases but low in controls. Late respondent controls (i.e., individuals who responded after contact through their general practitioner) had socioeconomic characteristics comparable with those of nonrespondents, while they were similar to respondents with respect to demographic variables. The interview of late respondents halved, from 14 to 7%, the magnitude of the bias introduced by nonresponse on the estimate of the association between educational level and lung cancer. Nonresponse, associated with socioeconomic status, is an important potential source of bias in population-based case-control studies, which should always be considered and discussed. The direction and magnitude of the bias can be quantified. General practitioners may contribute to decrease nonresponse bias. Caution should be used in inferring characteristics of nonrespondents on the basis of those of late respondents.     

Attitudes Toward Euthanasia: Implications for Social Work Practice

This article reports the findings of a randomized general household survey that examined the attitudes of 618 Chinese respondents toward different types of euthanasia. The general public is found to agree with active euthanasia and non-voluntary euthanasia, but is neutral about passive euthanasia. Support for euthanasia is predicted by decreasing importance of religious belief, higher family income, experiences in taking care of terminally ill family members, being non-Protestants, and increasing age. Patients were percieved as the chief decision makers in euthanasian decisions. Finally, suggestions on social work practice and professional training are made.     

African American Infant Mortality and the Genesee County, MI REACH 2010 Initiative: An Evaluation of the Undoing Racism Workshop

The authors examine African American African American and White socioeconomic and infant mortality outcomes in Genesee County, Michigan, assess the stated effects of the Undoing Racism Workshop (URW) on its participants and the greater-Genesee County community, and introduce the ecological approach to the cycle of socialization as a tool to help identify sources of racially linked tension and sites for ameliorative intervention. Findings show that African Americans in Flint are geographically and socioeconomically isolated, have fewer resources to sustain health, and experience higher rates of infant mortality when compared to Whites in Flint's surrounding suburbs. Between two thirds and three fourths of URW follow-up survey respondents endorse the belief that the URW can help reduce infant mortality, and results suggest the workshop helps elicit individual and institutional/policy-related changes intended to lessen the disparity. Authors assert the URW offers a common language and framework for discussing racism as a structural phenomenon rather than merely racial prejudice within individuals.     

An evaluation of demographic differences in the utilization of a cancer information service

A detailed empirical evaluation of the utilization of a cancer public telephone information program was conducted. This paper reports demographic differences between utilizers and the general population. It was found that utilization varied according to socioeconomic status, area of residence, age and sex. The greatest proportion of users were females, from the higher social classes, city residents and 20-39 years of age. Attempts to look at interrelationships among these variables did not produce any consistent findings.     

The factors associated with the belief that vegetarian diets provide health benefits

The aim of this paper is to examine the factors associated with the belief that vegetarian diets provide health benefits. A random population mail survey about food choice was conducted among a sample of 1000 South Australians. An additional (non-random) survey of 106 vegetarians and semi-vegetarians was also conducted, giving a total of 707 participants from both samples. The main predictors of the belief that vegetarian diets provide health benefits for all respondents were found to be the belief that meat is neither healthy nor necessary and frequent searching for information on healthy eating. However, there were differences between vegetarians, non-vegetarians and semi-vegetarians. In particular, health issues were relatively more important for semi-vegetarians and vegetarians, while knowledge and convenience issues were most important for non-vegetarians. The results have important implications for public health. Many South Australians perceive that health benefits are associated with eating a vegetarian diet, which may also apply to plant-based diets in general. However, if non-vegetarians are to obtain some of the health benefits associated with the consumption of a plant-based diet, they require information on the preparation of quick and easy plant- based meals.     

Differences in health insurance and health service utilization among Asian Americans: method for using the NHIS to identify unique patterns between ethnic groups

The purpose of this study is to outline a method to identify the characteristics of socioeconomic variables in determining the differences in health insurance coverage and health services utilization patterns for different ethnic groups, using the behavioural model of health service utilization. A sample drawn from Asian American adult respondents to the 1992, 1993, and 1994 National Health Interview Surveys (NHIS) in the USA formed the data set. The results showed Asian Americans as not being homogeneous. There were distinctly different demographic and socioeconomic characteristics between six Asian American ethnic groups that affect health insurance coverage and health service utilization. The study method is useful for constructing health policy and services to address the general public need without adversely affecting smaller minority groups. Secondary analysis of well-constructed national data sets such as the specific Asian ethnic groups in NHIS, offers a rich method for predicting the differential impact of specific health policies on various ethnic groups.     

Weight loss practices among Malaysian adults

The practice of losing weight is gaining popularity globally with an increase in health consciousness among the general public. A survey was conducted in seven shopping centres in Kuala Lumpur and its neighbouring towns to assess the weight-loss practices of the general public. Out of the 1032 people approached by the researcher, 389 (37.7%) admitted that they had tried to lose weight before. Of these respondents, 50.4% had the wrong perceptions about their weight with 39.1% of the respondents having BMI lower than what they had perceived. The most common weight-loss method used was dieting (89.5%), followed by exercise (81%) and the use of slimming teas (24.9%). Exercise (79.0%) was perceived as the most effective method for losing weight, followed by dieting (71.6%). Most respondents (60.6%) obtained their weight-loss products from the pharmacies but only 34.9% of these respondents had consulted the pharmacists on these products. Therefore, pharmacists should play a more active role in assisting the general public to lose weight successfully and safely.     

Sex misinformation and misconceptions among Chinese medical students in Hong Kong

Sex knowledge and attitudes of 97 Chinese undergraduate medical students were assessed by ratings on a set of belief statements. The results of their responses indicated two salient dimensions of health concern and sex as unclean, reflecting areas of gaps in sex knowledge as well as misconceptions traceable to traditional Chinese beliefs on the association between health and semen. Respondents also reported relying more on the public media than health professionals as a source of sex information. Implications for sex education in general and for medical students in particular are discussed.     

Trends in acceptance of euthanasia among the general public in 12 European countries (1981-1999)

BACKGROUND: We wanted to examine how the acceptance of euthanasia among the general public in Western Europe has changed in the last decades, and we wanted to look for possible explanations. METHODS: We analysed data from the European Values Surveys, held in 1981, 1990, and 1999-2000 in 12 West European countries. In each country, representative samples of the general public were interviewed using the same structured questionnaire in all countries. Euthanasia was explained in the questionnaires as 'terminating the life of the incurably sick'. RESULTS: A total of 46 199 respondents participated in the surveys. A significant increase in acceptance of euthanasia could be observed in all countries except (West) Germany. While the average increase in euthanasia acceptance was 22%, the increase was particularly obvious in Belgium, Italy, Spain, and Sweden. Although changes in several characteristics of respondents, such as decrease in religious beliefs, rising belief in the right to self-determination, and (to a lesser extent) rise in levels of education, were associated with growing acceptance of euthanasia, they could only partly explain the increase of euthanasia acceptance over the years. CONCLUSIONS: An increase of euthanasia acceptance among the general public took place over the last two decades in almost all West European countries, possibly indicating a growing support for personal autonomy regarding medical end-of-life decisions. If this trend continues, it is likely to increase the public and political debate about the (legal) regulation of euthanasia under certain conditions of careful medical practice in several West European countries.     

European public acceptance of euthanasia: socio-demographic and cultural factors associated with the acceptance of euthanasia in 33 European countries

In many European countries, the last decade has been marked by an increasing debate about the acceptability and regulation of euthanasia and other end-of-life decisions in medical practice. Growing public sensibility to a 'right to die' for terminally ill patients has been one of the main constituents of these debates. Within this context, we sought to describe and compare acceptance of euthanasia among the general public in 33 European countries. We used the European Values Study data of 1999-2000 with a total of 41125 respondents (63% response rate) in 33 European countries. The main outcome measure concerned the acceptance of euthanasia (defined as 'terminating the life of the incurably sick', rated on a scale from 1 to 10). Results showed that the acceptance of euthanasia tended to be high in some countries (e.g. the Netherlands, Denmark, France, Sweden), while a markedly low acceptance was found in others (e.g. Romania, Malta and Turkey). A multivariate ordinal regression showed that weaker religious belief was the most important factor associated with a higher acceptance; however, there were also socio-demographic differences: younger cohorts, people from non-manual social classes, and people with a higher educational level tended to have a higher acceptance of euthanasia. While religious belief, socio-demographic factors, and also moral values (i.e. the belief in the right to self-determination) could largely explain the differences between countries, our findings suggest that perceptions regarding euthanasia are probably also influenced by national traditions and history (e.g. Germany). Thus, we demonstrated clear cross-national differences with regard to the acceptance of euthanasia, which can serve as an important basis for further debate and research in the specific countries.     

Antigen specific vaccine hesitancy in pregnancy

BackgroundVaccinations in pregnancy are recommended for the potential benefits of preventing severe pertussis disease in newborns and for preventing the impact of influenza on the pregnant woman, her foetus in utero and, the newborn in the first six months of life. Published data in Australia suggested that coverage rates were sub-optimal so the reasons for this were reviewed.MethodsA cross-sectional survey of 1014 postnatal women, aged 18 years and older, who had given birth in the previous six months was undertaken on the Gold Coast in Queensland, Australia. Participants completed a brief questionnaire on provided smart tablets at public vaccination clinics or with a researcher by phone or via an on-line link.ResultsJust over 85% of survey respondents received a pertussis booster with many of those not receiving vaccine having had it in a recent pregnancy. Only 36.7% of respondents had an influenza vaccine in pregnancy with key barriers being belief in influenza vaccine, seasonality of parturition and a lack of recommendation from the attending obstetric carers.DiscussionWhile maternal pertussis vaccine programs are a success, work needs to be done to improve the public perception of the risk benefit equation surrounding influenza vaccine in general, and particularly its use in pregnancy. Research is required into approaches to altering practitioner attitudes as well as how to alter public perceptions.     

General Practitioner Involvement in Non-Procedural Medicine in Public Hospitals in Melbourne, Australia

This study is a survey of general practitioners practising inan area in Melbourne, Australia, where there are two mediumsized public hospitals with limited general practitioner admittingrights. A questionnaire was mailed to the 207 general practitionerspractising in the study area; 167 (81%) responded. Seventy oneper cent of respondents had public hospital admitting rightsand 73% aimed to manage as many medical patients in hospitalas possible. The main reasons given for such involvement werepatient expectation, professional satisfaction and the benefitsto patients, beyond that of reassurance, which followed fromcontinuity of care. About half of respondents (52%) agreed thattheir role was a liaison or coordinating one alongside hospitalspecialists. Fifty-four per cent of respondents overall had in fact managedat least two medical patients in public hospitals in the past12 months. Lack of availability of general practitioner bedsand specialist dominance in public hospitals rather than inadequatetime or remuneration were perceived to be the main barriersto hospital practice. Almost three-quarters of respondents (72%) believed generalpractitioners would be excluded from public hospitals in theforeseeable future. They blamed specialist dominance and generalpractitioner apathy equally for this predicted state of affairs.A debate on the desirability or otherwise of such an exclusionis overdue within the medical community in order to considerwhat will otherwise be a fait accompli.     

SARS-related perceptions in Hong Kong

To understand different aspects of community responses related to severe acute respiratory syndrome (SARS), 2 population-based, random telephone surveys were conducted in June 2003 and January 2004 in Hong Kong. More than 70% of respondents would avoid visiting hospitals or mainland China to avoid contracting SARS. Most respondents believed that SARS could be transmitted through droplets, fomites, sewage, and animals. More than 90% believed that public health measures were efficacious means of prevention; 40.4% believed that SARS would resurge in Hong Kong; and approximately equals 70% would then wear masks in public places. High percentages of respondents felt helpless, horrified, and apprehensive because of SARS. Approximately 16% showed signs of posttraumatic symptoms, and approximately equals 40% perceived increased stress in family or work settings. The general public in Hong Kong has been very vigilant about SARS but needs to be more psychologically prepared to face a resurgence of the epidemic.     

Socioeconomic determinants of mortality in two Canadian provinces: multilevel modelling and neighborhood context

The influence of individual and contextual socioeconomic variables on mortality is compared in two Canadian provinces, Manitoba and Nova Scotia. Although differing substantially in size, ethnic mix, and history, both provinces provide greater access to health and social services as well as fewer income inequalities than the United States. A total of 8032 Manitoba respondents (followed from 1996-97 to 2002) and 2116 Nova Scotia respondents (followed from 1990 to 1999) were linked to the appropriate Canadian census as a source of neighborhood characteristics. Data were analyzed using individual- and multi-level logistic regression. Well-educated and higher income individuals were less likely to die during follow-up. No significant direct effect was found between neighborhood socioeconomic characteristics and mortality. However, both provinces showed an increased importance of individual income vis-à-vis mortality in advantaged neighborhoods relative to disadvantaged neighborhoods. Additional Manitoba analyses showed a "healthy mover" effect among respondents changing place of residence, regardless of whether they moved to more advantaged or more disadvantaged neighborhoods. The findings are discussed in the context of differences in health and health care among Canada, the United States, and other OECD countries.     

社区社会经济地位对老年居民日常生活自理能力的影响——以社区建成环境为中介

目的 探讨社区社会经济地位对老年人日常生活自理能力（activities of daily living, ADL）的影响，为维护老年人群健康提供相关参考。方法 基于CHARLS2011年基线数据，将280个社区4 269个调查对象纳入分析。采用因果逐步回归法，分析社区社会经济地位对老年ADL损失的影响，以及社区建成环境的中介作用。结果 调查对象ADL损失率为26.9%。因果逐步回归结果显示，在控制个人层面变量后，社区年人均纯收入越高，老年ADL无损失率越高（OR = 0.70，95%CI:0.51～0.96；P＜0.05）；社区安全资源（OR = 0.75，95%CI:0.59～0.96；P＜0.05）和社区运动资源(OR = 0.76，95%CI:0.60～0.96；P＜0.05)对老年ADL损失具有显著负向作用，两者可分别作为完全中介。 结论 社区社会经济地位可能通过社区安全资源和社区运动资源对老年ADL产生一定的影响。需要关注低社会经济地位社区老年居民的ADL，为社区老年居民创造安全良好的运动与安全环境。     

Does area-based social capital matter for the health of Australians? A multilevel analysis of self-rated health in Tasmania

BACKGROUND: Material circumstances and collective psychosocial processes have been invoked as potential explanations for socioeconomic inequalities in health; and, linking social capital has been proposed as a way of reconciling these apparently opposing explanations. METHODS: We conducted multilevel logistic regression of self-rated health (fair or poor vs excellent, very good, or good) on 14 495 individuals living within 41 statistical local areas who were respondents to the 1998 Tasmanian Healthy Communities Study. We modelled the effects of area-level socioeconomic disadvantage and social capital (neighbourhood integration, neighbourhood alienation, neighbourhood safety, social trust, trust in public/private institutions, and political participation), and adjusted for the effects of individual characteristics. RESULTS: Area-level socioeconomic disadvantage was associated with poor self-rated health (beta = 0.0937, P < 0.001) an effect that was attenuated, but remained significant, after adjusting for individual characteristics (beta = 0.0419, P < 0.001). Social trust was associated with a reduction in poor self-rated health (beta = -0.0501, p = 0.008) and remained significant when individual characteristics (beta = -0.0398, P = 0.005) were included. Political participation was non-significant in the unadjusted model but became significant when adjusted for individual characteristics (beta = -0.2557, P = 0.045). The effects of social trust and political participation were attenuated and became non-significant when area-level socioeconomic disadvantage was included. CONCLUSION: Area-based socioeconomic disadvantage is a determinant of self-rated health in Tasmania, but we did not find an independent effect of area-level social capital. These findings suggest that in Tasmania investments in improving the material circumstances in which people live are likely to lead to greater improvements in population health than attempts to increase area-level social capital.     

陕西省宝鸡市公众结核病防治知信行调查分析

目的了解宝鸡市公众对结核病防治知识的掌握程度和信念行为现状。方法采用多级系统抽样方法随机抽取调查对象进行问卷调查。结果共调查公众2400人,其中2212人（92.2%）知道结核病。防治知识的知晓率平均为60.3%,其中医务人员知晓率最高为92.6%,农民和学生较低分别为54.9%、51.9%,对结核病的主要症状、结核病防治机构及治疗管理政策知晓率分别为56.8%、45.0%、43.9%;对结核病人的态度有54.7%的人是“尽量保持距离”;获得结核病防治知识信息来源,“听别人说的”占64.0%,来自电视、传单、报纸、宣传栏、广播的分别占58.0%、36.8%、33.8%、29.5%、22.8%;公众对结核病防治知识、信念、行为状况与职业、城乡、文化程度等因素有关。结论宝鸡市结核病健康促进工作的重点应放在农村,把学生、农民、商业/服务业、工人作为宣传的重点对象。宣传的内容应以防治的基本知识、治疗管理政策等为重点,充分发挥人际传播和电视宣传等在结核病相关防治知识的传播中的主渠道作用。     

Public response to cost-quality tradeoffs in clinical decisions.

PURPOSE: To explore public attitudes toward the incorporation of cost-effectiveness analysis into clinical decisions. METHODS: The authors presented 781 jurors with a survey describing 1 of 6 clinical encounters in which a physician has to choose between cancer screening tests. They provided cost-effectiveness data for all tests, and in each scenario, the most effective test was more expensive. They instructed respondents to imagine that he or she was the physician in the scenario and asked them to choose which test to recommend and then explain their choice in an open-ended manner. The authors then qualitatively analyzed the responses by identifying themes and developed a coding scheme. Two authors separately coded the statements with high overall agreement (kappa = 0.76). Categories were not mutually exclusive. RESULTS: Overall, 410 respondents (55%) chose the most expensive option, and 332 respondents (45%) choose a less expensive option. Explanatory comments were given by 82% respondents. Respondents who chose the most expensive test focused on the increased benefit (without directly acknowledging the additional cost) (39%), a general belief that life is more important than money (22%), the significance of cancer risk for the patient in the scenario (20%), the belief that the benefit of the test was worth the additional cost (8%), and personal anecdotes/preferences (6%). Of the respondents who chose the less expensive test, 40% indicated that they did not believe that the patient in the scenario was at significant risk for cancer, 13% indicated that they thought the less expensive test was adequate or not meaningfully different from the more expensive test, 12% thought the cost of the test was not worth the additional benefit, 9% indicated that the test was too expensive (without mention of additional benefit), and 7% responded that resources were limited. CONCLUSIONS: Public response to cost-quality tradeoffs is mixed. Although some respondents justified their decision based on the cost-effectiveness information provided, many focused instead on specific features of the scenario or on general beliefs about whether cost should be incorporated into clinical decisions.     

An examination of the stages of change construct for health promotion within organizations.

PURPOSE: The purpose of this research is to examine the organizational stages of change construct of the transtheoretical model of behavior change. DESIGN/METHODOLOGY/APPROACH: Data on organizational and individual stages of change for tobacco reduction, physical activity promotion, and heart healthy eating promotion were collected from service provider, senior management, and board level members of provincial health authorities across three data collection periods. FINDINGS: Results revealed significant correlations between individual and organizational stages of change for management level respondents, but inconsistent relationships for service providers and no significant correlations for board level respondents. There were no significant differences between respondent levels for organizational stage of change for any of the promotion behaviors. In general, changes in stage failed to predict whether there was a belief in an organization's capability of addressing any of the health promotion activities. There was also a large amount of variance between individual respondents for most health authorities in their reported organizational stages of change for physical activity and healthy eating. PRACTICAL IMPLICATIONS: Based on the results of the present study it is concluded that there is little evidence that the organizational stages of change construct is valid. The evidence indicates that assessing individual readiness within an organization may be as effective as asking individuals to report on organizational stages of readiness. ORIGINALITY/VALUE: This paper reports on the validity of the organizational stages of change construct in a health promotion context and provides information for those who are considering using it.