Who is using e-cigarettes in Canada? Nationally representative data on the prevalence of e-cigarette use among Canadians

The current study examined prevalence and correlates of electronic cigarette (e-cigarette) use in the Canadian population, using data from the nationally representative 2013 Canadian Tobacco, Alcohol and Drugs Survey (n = 14,565). Sociodemographic correlates of e-cigarette use (ever, and in the past 30 days) were examined using logistic regression models. Overall, 8.5% of Canadians aged 15 and older reported having ever tried an e-cigarette; 1.8% had used one in the past 30 days. E-cigarette use was particularly high among smokers and young people. Overall, prevalence did not differ between males and females, for ever (P = 0.24) or past 30-day use (P = 0.30). Smoking status was the strongest correlate of e-cigarette use (ever and in the past 30 days, P < 0.0001): 37.3% of current smokers had ever tried an e-cigarette (9.6% used in the past 30 days), compared to 3.0% of never-smokers (0.3% past 30-days), and 5.1% of former smokers (0.9% past 30-day). E-cigarette use also varied by age (P < 0.0001): prevalence was highest among youth aged 15–19 (19.8% ever; 2.6% past 30-day) and young adults aged 20–24 (20.1% ever; 3.9% past 30-day), and decreased with age. Among youth, the majority of e-cigarette users were never-smokers, while the majority of adult users were smokers. In Canada, e-cigarette use is particularly high among smokers and young people. Dual use with cigarettes was common, with most e-cigarette users also smoking conventional cigarettes. Continued monitoring of e-cigarette use and its relationship with smoking should be a priority, given the rapidly-evolving e-cigarette market and implementation of new policy measures.     

Can telepharmacy provide pharmacy services in the bush?

Rural and remote community pharmacies service large areas of rural Queensland, and because of the distances involved often do not meet the patients for whom they provide medication. Telepharmacy would improve the quality of pharmaceutical services provided in rural and remote areas, by allowing community pharmacists to have realtime contact with dispensing doctors, aboriginal health workers and patients via a video-phone. We used commercial (analogue) videophones to connect community pharmacists to dispensing doctors, patients in depot pharmacies (i.e. those with no pharmacist) and aboriginal health workers. However, various problems occurred and only 10 video-phone interactions were recorded during the six-month project. In all of the recorded interactions, the video-phone was actually used as a conventional telephone because a video-connection could not be established at the time of the call. (This may have been due to telephone network problems in the rural areas.) Despite these problems, all project participants showed great enthusiasm for the potential benefits of such a service.     

Can fear arousal in public health campaigns contribute to the decline of HIV prevalence?

Most American health professionals who work in HIV/AIDS do not support the use of fear arousal in AIDS preventive education, believing it to be counterproductive. Meanwhile, many Africans, whether laypersons, health professionals, or politicians, seem to believe there is a legitimate role for fear arousal in changing sexual behavior. This African view is the one more supported by the empirical evidence, which suggests that the use of fear arousal in public health campaigns often works in promoting behavior change, when combined with self-efficacy. The authors provide overviews of the prevailing American expert view, African national views, and the most recent findings on the use of fear arousal in behavior change campaigns. Their analysis suggests that American, post-sexual-revolution values and beliefs may underlie rejection of fear arousal strategies, whereas a pragmatic realism based on personal experience underlies Africans' acceptance of and use of the same strategies in AIDS prevention campaigns.     

Do patients' communication behaviors provide insight into their preferences for participation in decision making?

BACKGROUND: The Institute of Medicine report "Crossing the Quality Chasm' encourages physicians to tailor their approaches to care according to each patient's individual preferences for participation in decision making. How physicians should determine these preferences is unclear. OBJECTIVE: The objective of this study is to assess whether judgments of patient communication behaviors, either globally or individually, can yield insight into patient preferences for participation in decision making. METHODS: Using questionnaire responses to 3 items about the desired level of participation in decision making from a communication study involving 886 audiotaped visits between older patients and surgeons, the authors purposively selected 25 patients who preferred a large role and 25 who preferred a small role in decision making. Two independent raters listened to the audiotapes and coded them for the presence of 7 communication behaviors (question asking, information behavior, initiating, statements of preference, processing, resistance, deference). On the basis of their listening and coding, raters judged patient preferences for participation in decision making. RESULTS: Neither rater accurately judged preferences for participation in decision making beyond chance agreement (kappa statistics: rater 1 = 0.16, rater 2 = 0.20). Inter-rater reliability for the communication behaviors was also generally poor. Area-under-the-curve values for all communication behaviors hovered around 0.50, indicating that none of the behaviors had adequate power to discriminate between patients preferring large versus small roles. CONCLUSION: Patient preferences for participation in decision making cannot be reliably judged during routine visits based on judgments of patient communication behaviors. Engaging patients in a discussion of preferences for decision making may be the best way to determine the role each wants to play in any given decision.     

How hardwired is the brain? Technological advances provide new insight into brain malleability and neurotransmission

Any discussion of the impact of nutrition and environment on the brain is based on the premise that the brain is malleable, but just how malleable is this most complex of all organs? And to what extent does the term "malleability" extend beyond subtle functional changes into the realms of morphology and connectivity? Recent methodological advances have provided new insight into these issues and have revealed synapse populations that turn over at high rates and synaptic receptors that are continuously on the move. The unveiling of this unsuspected structural plasticity has prompted new research on a class of enzymes (matrix metalloproteinases) that regulate the physical constraints imposed by extracellular matrix molecules. The realization that the brain is more "softwired" than previously anticipated emphasizes the relevance of current endeavors to explore the impact of nutrition and exercise on brain function and structure.     

Dietary features and blood pressure among 18–88-year-old residents in an island population in China

Objectives

Dietary recommendations to reduce blood pressure (BP) have been widely disseminated and residents who live on islands have unique dietary characteristics. Here, we identified associations between dietary intake and BP levels among island residents in China.

Design

Cross-sectional study.

Setting

The Changhai islands, which is an important island county in China.

Participants

A total of 876 residents, 18–88 years old, of Changhai county.

Measurements

Dietary intake and BP measurements were assessed using standardized questionnaires and protocols, respectively. Dietary intake was compared across BP categories and linear regression analyses were performed between dietary intake and systolic blood pressure (SBP) and diastolic blood pressure (DBP).

Results

Participants previously diagnosed with hypertension consumed less salt than those with undiagnosed high BP (p < 0.01). After exclusion of participants previously diagnosed with hypertension, salt and meat consumption were positively and linearly associated with both SBP (p < 0.01 and < 0.001, respectively) and DBP (p = 0.03 and < 0.01, respectively), whereas consumption of marine products was inversely associated with SBP (p = 0.047). Mixed edible oil and edible oil consumption were associated with SBP (p < 0.01) and DBP (p = 0.021), respectively. In the multiple linear regression model, meat intake was positively associated with both SBP and DBP (ß = 0.139, p < 0.001; ß = 0.066, p = 0.047, respectively), whereas consumption of marine products was inversely associated with SBP (ß = -0.102, p < 0.001), while mixed edible oil was associated with SBP (ß = 0.062, p = 0.03).

Conclusion

Adherence to nutritional recommendations can be improved among hypertensive patients, even those aware of their conditions. In the general island population, eating habits regarding salt, meat, edible oil consumption, and use of mixed edible oil increased the risk of hypertension onset, whereas marine products were found to decrease this risk.

     

Can regional resource shares be based only on prevalence data? An empirical investigation of the proportionality assumption

The needs component of the current formulae for allocating resources for hospital services and prescribing in England is based on a utilisation approach. This assumes that expenditure on NHS activity in different geographical areas reflects relative needs and supply conditions, and that these can be disentangled by regression models to yield an estimate of relative need. These assumptions have been challenged on the grounds that the needs of some groups may be systematically ‘unmet’. Critics have suggested an alternative based on variations in the prevalence of health conditions, called the ‘epidemiological approach’.     

Can data from programs for the prevention of mother-to-child transmission of HIV be used for HIV surveillance in Kenya?

OBJECTIVE: In Africa, HIV surveillance is conducted among antenatal clinic (ANC) attendees using unlinked-anonymous testing (UAT). In Kenya, the utility of prevention of mother-to-child transmission (PMTCT) program data for HIV surveillance was evaluated. METHODS: UAT and PMTCT data were compared at the same clinics and for the same time (2003 UAT survey) period. The HIV testing uptake for PMTCT was defined as the number of ANC attendees tested for HIV out of those who had their first ANC visit during the ANC surveillance period. Odds ratios and 95% confidence intervals were calculated to determine associations between demographic characteristics and HIV testing acceptance. RESULTS: Of 39 ANC-UAT sites, six had PMTCT data. PMTCT data were recorded across several logbooks with varying quality. For PMTCT, 2,239 women were offered HIV testing and 1,258 (56%) accepted; for UAT, 1,852 women were sampled. Median UAT-based HIV prevalence was 12.8% (range, 8.1%-26.3%) compared with 14.4% (range, 7.0%-27.2%) in PMTCT. HIV testing acceptance for PMTCT ranged from 48% to 69% across clinics, and was more likely among primigravidae than multigravidae. CONCLUSION: Because of varying PMTCT data quality and varying HIV testing acceptance for PMTCT, PMTCT-based HIV prevalence estimates cannot currently replace UAT-based estimates in Kenya.     

Are data on the uptake of disability benefits a useful addition to census data in describing population health care needs?

OBJECTIVE: To determine if administrative data relating to the uptake of disability benefits held by government departments in Northern Ireland are fair and unbiased indicators of relative need for health care and therefore a useful addition to census data. METHOD: This is an ecological study of the 566 electoral wards in Northern Ireland. The variation in uptake of a health-related benefit (Disability Living Allowance) was regressed against three other indicators of health (limiting long-term illness, mortality and the numbers of patients admitted to hospital). All the indicators had been indirectly standardised by age and sex. The unstandardised residuals from this model were regressed against the social and geographical factors, namely area deprivation score, religious denominational composition and urban/rural dwelling to see if they influenced benefit uptake above and beyond any association with ill health. RESULTS: The health factors alone explained 77.2% of the variation in benefit uptake, with limiting long-term illness being the major determinant; however, even after controlling for differences in health status, benefit uptake was shown to be higher in more urban areas and in areas that had a greater proportion of Catholics. Area deprivation was not associated with benefit uptake once health differences had been controlled for. CONCLUSION: Administrative data on disability benefits can undoubtedly provide useful additional information for describing the levels of relative disadvantage or ill health of areas. However, because they also reflect variations in uptake, which appears to be confounded by social and geographical factors, we would urge caution when they are used to identify priority areas or to allocate resources.     

Women performing repetitive work: Is there a difference in the prevalence of shoulder pain and pathology in supermarket cashiers compared to the general female population?

Objectives

Shoulder disorders in the occupational environment have been widely studied, but the quality of research and methodology applied vary. Little has been done to ascertain whether shoulder pain in female repetitive workers is due to any verifiable pathology, or to compare findings with the general population. Therefore, we decided to evaluate the prevalence of self-reported shoulder pain in a group of female supermarket cashiers and in the general female population using a standardized questionnaire. Shoulder pain prevalence was then compared to imaging findings in order to assess specific and non-specific pain prevalence.

Material and Methods

196 cashiers and 302 controls filled in a standardized shoulder questionnaire and underwent an imaging examination of a shoulder.

Results

The prevalence of shoulder pain was significantly higher in the group of cashiers (46.4%) than in the general population (25.5%) (OR = 1.821; 95% CI: 1.426–2.325). Specific pain prevalence was higher among the controls (19.5%) than among the cashiers (13.2%).

Conclusions

The more frequent reports of shoulder pain in the supermarket cashiers are not correlated with a higher prevalence of imaging abnormalities. The causes of these more frequent complaints should be probably sought in the psycho-social and occupational environment.     

Is a general women's health promotion program as effective as an HIV-intensive prevention program in reducing HIV risk among Hispanic women?

OBJECTIVE: This study aimed to assess whether participants in an HIV-intensive prevention program and participants in a general women's health promotion program reported greater HIV risk-reduction than participants in a wait-list control group immediately following program participation and at three-month follow-up. METHODS: The authors studied 162 Hispanic women ages 18 to 35 years, most of them immigrants. Three-fourths of the sample (74%) reported earning less than $800 a month, 29% did not have a high school degree, and 90% had children. Data were gathered through surveys at baseline, at intervention completion, and at three-month follow-up. Information was collected on sociodemographics, HIV risk factors, and risk behaviors. Crude and adjusted (for demographics and dose) logistic regression analyses were used to assess program effects on participants' risk reduction. RESULTS: Crude logistic regression analyses reveal that both programs resulted in increased condom use at post-test and follow-up. Only participants in the HIV-intensive prevention program reported increased safer sex negotiation at post-test and follow-up, however, and only participants in the women's health promotion program reported increased HIV testing at post-test. CONCLUSION: Both interventions increased condom use. The HIV-intensive prevention program appeared to be more effective in promoting safer sex negotiation, and the women's health promotion program appeared more effective in promoting HIV testing. The findings suggest that both approaches may be viable ways to package HIV prevention for short-term behavior change in this population.