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We reviewed the authorship characteristics, editorial processing, and final fate of 126 papers dealing with data from countries other than the United States and Canada and submitted to the American Journal of Public Health in 1989. The acceptance rate of these international health papers was 22%, similar to that of all papers (25%). Authors from developed countries had higher acceptance rates than authors from developing countries, but the highest acceptance rate (36%) was for international health papers with joint authorship from both developed and developing countries. Of 83 rejected papers, 72% were published in other journals. Of these, 45% were published in journals covered by Index Medicus, a figure similar to that for all papers rejected by the Journal. [ABSTRACT FROM AUTHOR]

Objectives. To study the effects of several survey features on response rates in a general population health survey. Methods. In 2012 and 2013, 8000 households in British Columbia, Canada, were randomly allocated to 1 of 7 survey variants, each containing a different combination of survey features. Features compared included administration modes (paper vs online), prepaid incentive ($2 coin vs none), lottery incentive (instant vs end-of-study), questionnaire length (10minutes vs 30minutes), and sampling frame (InfoCanada vs Canada Post). Results. The overall response rate across the 7 groups was 27.9% (range = 17.1-43.4). All survey features except the sampling frame were associated with statistically significant differences in response rates. The survey mode elicited the largest effect on the odds of response (odds ratio [OR] = 2.04; 95% confidence interval [CI] = 1.61, 2.59), whereas the sampling frame showed the least effect (OR = 1.14; 95% CI = 0.98, 1.34).The highest response was achieved by mailing a short paper survey with a prepaid incentive. Conclusions. In a mailed general population health survey in Canada, a 40% to 50% response rate can be expected. Questionnaire administration mode, survey length, and type of incentive affect response rates. [ABSTRACT FROM AUTHOR]

This paper deals with the role of the health department and more specifically the public health nurse in the care of the aged based upon a study of the sociomedical needs of old people in Ontario. [ABSTRACT FROM AUTHOR]

Objectives. To model the relationship of unstable housing and evictions with physical and sexual violence perpetrated against women sex workers in intimate and workplace settings. Methods. We used bivariate and multivariable logistic regression with generalized estimating equations to model the association of unstable housing exposure and evictions with intimate partner violence (IPV) and workplace violence among a community-based longitudinal cohort of cisgender and transgender women sex workers in Vancouver, Canada, from 2010 through 2019. Results. Of 946 women, 85.9% experienced unstable housing, 11.1% eviction, 26.2% IPV, and 31.8% workplace violence. In multivariable generalized estimating equation models, recent exposure to unstable housing (adjusted odds ratio [AOR] = 2.04; 95% confidence interval [CI] = 1.45, 2.87) and evictions (AOR = 2.45; 95% CI = 0.99, 6.07) were associated with IPV, and exposure to unstable housing was associated with workplace violence (AOR = 1.46; 95% CI = 1.06, 2.00). Conclusions. Women sex workers face a high burden of unstable housing and evictions, which are linked to increased odds of intimate partner and workplace violence. Increased access to safe, women-centered, and nondiscriminatory housing is urgently needed. (Am J Public Health. 2023;113(4):442–452. https://doi.org/10.2105/AJPH.2022.307207) [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this paper is to describe the demographic and clinical characteristics of chiropractic patients and to document chiropractic visit rates in 6 sites in the Limited States and Canada. Methods. Random samples of chiropractors from S US sites and 1 Canadian site were selected. A record abstraction system was developed to obtain demographic and clinical data from office charts. Results. Of the 185 eligible chiropractors sampled, 131 (71 %) participated. Sixty-eight percent of the selected charts showed that care was sought for low back pain, while 32% recorded care for other reasons. Spinal manipulative therapy was recorded in 83% of all charts, There was a greater than 2-fold difference in the median number of visits related to low back pain per episode of care across sites. The chiropractic visit rates in the US sites and Ontario are estimated to be 101.2 and 140.9 visits per 100 person- years, respectively. Conclusions. The chiropractic use rate in these sites is twice that of estimates made 15 years ago. The great majority of patients receive care for musculoskeletal conditions of' the back and neck. The number of visits per episode varies appreciably by site. [ABSTRACT FROM AUTHOR]

Abstract: This paper uses claims data from a universal health care system to describe physicians' hospitalization styles after adjusting for case-mix characteristics of their primary patients. Patients were uniquely assigned to that physician (general or family practitioners, internist, general surgeon, or obstetrician/gynecologist) seen most frequently over each two two-year periods (1972-74 and 1974-76). Four indices were developed including: 1) percentage of primary patients hospitalized; 2) mean number of readmissions for such patients; 3) mean length of stay; and 4) total days of hospitalization per primary care patient (a summary measure combining the first three). Rates of admission, not length of stay, were shown to be strongly related to this summary measure. Marked variations in the hospitalization indices were observed across physicians; these variations cannot be explained by the health or sociodemographic characteristics of a physician's patients. Rural physicians practicing in areas with high bed-to-population ratios and low occupancy rates were particularly high users of hospitals. The economic implications of different practice styles are shown to be large; physicians who were high users of hospitals serve 27 per ¢ of the patients but their patients consume 42 per ¢ of the hospital days. [ABSTRACT FROM AUTHOR]

Objectives. This article describes Canadian civil servants' awareness of, attitudes toward, and self-reported use of ideas about the determinants of health. Methods. Federal and provincial civil servants in departments of finance, labor, social services, and health were surveyed. Results. With civil servants in finance departments a notable exception, most Canadian civil servants see the health of populations as a relevant outcome for their sectors. Many (65%) report that ideas about the determinants of health have already influenced policymaking in their sector, but most (83%) say they need more information about the health consequences of the policy alternatives their departments face. Conclusions. Civil servants should consider developing accountability structures for health and researchers should consider producing and transferring more policy-relevant research. (Am J Public Health. 2003;93:658-663) [ABSTRACT FROM AUTHOR]

Objectives. COMMIT (Community Intervention Trial for Smoking Cessation) investigated whether a community-level multichannel intervention would decrease the prevalence of adult cigarette smoking and increase quitting, with heavy smokers (>25 cigarettes per day) receiving the highest priority. Methods. One community within each of 11 matched community pairs (10 in the United States, 1 in Canada) was randomly assigned to intervention. Baseline (1988) and final (1993) telephone surveys sampled households to determine prevalence of smoking behavior. Results. Among the target population aged 25 to 64 years, there was no intervention effect on heavy smoking prevalence, which decreased by 2.9 percentage points in both intervention and comparison communities. Overall smoking prevalence decreased by 3.5 in intervention communities vs 3.2 in comparison communities, a difference not statistically significant, while the mean quit ratios were 0.198 versus 0.185, respectively, a difference of 0.013 (90% test-based confidence interval = -0.003,0.028). Conclusions. Results are consistent with the cohort analysis reported separately, although the more powerful cohort design showed a statistically significant intervention effect upon light-to-moderate smokers. This community-based intervention did not have a significant impact on smoking prevalence beyond the favorable secular trends. In future efforts, additional strategies should be incorporated and rigorously evaluated. [ABSTRACT FROM AUTHOR]

Abstract: Three nations carried out large surveys of their non-institutionalized populations during the period 1976-81, with essentially similar techniques for measuring height and weight. Using criteria previously published for the British survey, we analyzed the Canadian and Untied Stales data and compared the prevalence of excessive weight for ages 20-64 in the three countries. Overweight was defined as a Quetelet index value of 25.1-30 and obesity as a value exceeding 30. Compared to their Canadian and British counterparts, American men are more likely to be overweight or obese, especially at the lower age levels. The proportion of excessively heavy men reaches a plateau around age 50 in all three countries, possibly indicative of a survivor phenomenon. Among women, the LIS hits the highest proportion of excessively heavy individuals at all ages except 20-24: this difference is especially marked at ages 45-54. Unlike men, there is no evidence that the proportion of overweight or obese women reaches a plateau by age 64. [ABSTRACT FROM AUTHOR]

The incidence and mortality rates of malignant neoplasms in an isolated Indian population in northwestern Ontario, Canada during the period 1972-81 were determined and age-adjusted comparisons with the Canadian national population computed. Indian men were at half the risk of developing and dying from cancer compared to Canadian men, while among women the risks were similar. The most outstanding feature was the high mortality and incidence rates of kidney cancer in both sexes (relative risks for mortality and incidence 7 to 13 times that for Canadians,. Gallbladder cancer was of importance in females. similar to observations in other Amerindian groups. Low-risk sites among Indians included: lung in men, breast in women, and skin in both sexes. Other sites such as colon and prostate were common in both populations. Establishing baseline incidence and mortality data and continuing surveillance over a period of time in a well-defined, geographically isolated Native population undergoing rapid social change is of interest both epidemiologically and from the health service perspective. Further studies may elucidate risk factors, of which diet appears most responsible for the peculiar pattern observed. [ABSTRACT FROM AUTHOR]

Objectives. This study reports on Canadian mammography rates between 1990, when mass screening programs were launched, and 1994/95. Methods. Mammography rates from 2 national surveys were compared according to the presence of a provincial screening program. Results. Mammography rates among women aged 50 to 69 years (the targeted group) increased significantly, by 16%; increases were twice as high in provinces with screening programs. Among women in their 40s (nontargeted group), the changes were insignificant and independent of screening program status. Conclusions. Screening programs appear to have influenced the mammography rates of targeted women aged 50 to 69 years. [ABSTRACT FROM AUTHOR]

Canada is proposing a ban on asbestos, and the US Environmental Protection Agency has listed it among the first 10 materials it is investigating under the new Toxic Substances Control Act revisions. However, this effort is currently running up against enormous industry and political opposition. Here, we detail the activities in the early 1970s of the Friction Materials Standards Institute, an industry trade association, to stifle earlier attempts to regulate asbestos use in brake linings, one of the oldest and most obvious sources of asbestos exposure to mechanics, among others. [ABSTRACT FROM AUTHOR]

Objectives. To compare associations between socioeconomic status and low birth weight across the United States, the United Kingdom, Canada, and Australia, countries that share cultural features but differ in terms of public support and health care systems. Methods. Using nationally representative data from the United States (n = 8400), the United Kingdom (n = 12018), Canada (n = 5350), and Australia (n = 3452) from the early 2000s, we calculated weighted prevalence rates and adjusted odds of low birth weight by income quintile and maternal education. Results. Socioeconomic gradients in low birth weight were apparent in all 4 countries, but the magnitudes and patterns differed across countries. A clear graded association between income quintile and low birth weight was apparent in the United States. The relevant distinction in the United Kingdom appeared to be between low, middle, and high incomes, and the distinction in Canada and Australia appeared to be between mothers in the lowest income quintile and higher-income mothers. Conclusions. Socioeconomic inequalities in low birth weight were larger in the United States than the other countries, suggesting that the more generous social safety nets and health care systems in the United Kingdom, Canada, and Australia played buffering roles. [ABSTRACT FROM AUTHOR]

We addressed the positive and negative factors that influence the health and wellness of urban Aboriginal youths in Canada and ways of restoring, promoting, and maintaining the health and wellness of this population. Fifty-three in-service professionals, care providers, and stakeholders participated in this study in which we employed the Glaserian grounded theory approach. We identified perceived positive and negative factors. Participants suggested 5 approaches--(1) youth based and youth driven, (2) community based and community driven, (3) culturally appropriate, (4) enabling and empowering, and (5) sustainable--as well as some practical strategies for the development and implementation of programs. We have provided empirical knowledge about barriers to and opportunities for improving health and wellness among urban Aboriginal youths in Canada. [ABSTRACT FROM AUTHOR]

Inaccuracies in the identification of Indigenous status and the collection of and access to vital statistics data impede the strategic implementation of evidence-based public health initiatives to reduce avoidable deaths. The impact of colonization and subsequent government initiatives has been commonly observed among the Indigenous peoples of Australia, Canada, New Zealand, and the United States. The quality of indigenous data that informs mortality statistics are similarly connected to these distal processes, which began with colonization. We discuss the methodological and technical challenges in measuring mortality for Indigenous populations within a historical and political context, and identify strategies for the accurate ascertainment and inclusion of Indigenous people in mortality statistics. [ABSTRACT FROM AUTHOR]

Objectives. We examined relationships between implementation of tobacco quitline practices, levels of evidence of practices, and quitline reach and spending. Methods. In June and July 2009, a total of 176 quitline funders and providers in the United States and Canada completed a survey on quitline practices, in particular quitline-level implementation for the reported practices. From these data, we selected and categorized evidence-based and emerging quitline practices by the strength of the evidence for each practice to increase quitline efficacy and reach. Results. The proportion of quitlines implementing each practice ranged from 3% (text messaging) to 92% (providing a multiple-call protocol). Implementation of practices showing higher levels of evidence for increasing either reach or efficacy showed moderate but significant positive correlations with both reach outcomes and spending levels. The strongest correlation was between reach outcomes and spending levels (r = 0.80; P < .01). Conclusions. The strong relationship between quitline spending and reach reinforces the need to increase quitline funding to levels commensurate with national cessation goals. [ABSTRACT FROM AUTHOR]

Objectives. We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010). Methods. We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls. Results. In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI] = 15.3, 26.4) and in hospital admissions (8.0%; 95% CI = 0.6, 14.9) and ambulance calls (7.2%; 95% CI = 1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI = 34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving. Conclusions. These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported. [ABSTRACT FROM AUTHOR]

Interorganizational networks that harness the priorities, capacities, and skills of various agencies and individuals have emerged as useful approaches for strengthening preventive services in public health systems. We use examples from the Canadian Heart Health Initiative and Alberta's Primary Care Networks to illustrate characteristics of networks, describe the limitations of existing frameworks for assessing the performance of prevention-oriented networks, and propose a research agenda for guiding future efforts to improve the performance of these initiatives. Prevention-specific assessment strategies that capture relevant aspects of network performance need to be identified, and feedback mechanisms are needed that make better use of these data to drive change in network activities. INSETS: SERVICES PROVIDED;IMPACT OF ALBERTA¿S PRIMARY CARE NETWORKS ON PATIENTS WITH...;OVERVIEW OF CANADIAN HEALTHY HEART INITIATIVE DEMONSTRATION.... [ABSTRACT FROM AUTHOR]

The United States faces a significant problem with access to oral health care, particularly for children. More than 50 countries have developed an alternative dental provider, a dental therapist, practicing in public, school-based programs, to address children's access to care. This delivery model has been demonstrated to improve access to care and oral health outcomes while providing quality care economically. We summarize elements of a recent major review of the global literature on the use of dental therapists, "A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States." We contrast the success of a school-based model of caring for children by dental therapists with that of the US model of dentists providing care for children in private practices. [ABSTRACT FROM AUTHOR]

Objectives. In this prospective cohort study, we examined the trajectory of general health during the first 4 years after new immigrants' arrival in Canada. We focused on the change in self-rated health trajectories and their gender and ethnic disparities. Methods. Data were derived from the Longitudinal Survey of Immigrants to Canada and were collected between April 2001 and November 2005 by Statistics Canada. We used weighted samples of 3309 men and 3351 women aged between 20 and 59 years. Results. At arrival, only 3.5% of new immigrants rated their general health as poor. Significant and steady increases in poor health were revealed during the following 4 years, especially among ethnic minorities and women. Specifically, we found a higher risk of poor health among West Asian and Chinese men and among South Asian and Chinese women than among their European counterparts. Conclusions. Newly arrived immigrants are extremely healthy, but the health advantage dissipates rapidly during the initial years of settlement in Canada. Women and minority ethnic groups may be more vulnerable to social changes and postmigration settlement. [ABSTRACT FROM AUTHOR]

Objectives. We examined the joint associations of marital status and duration of cohabitation on self-reported intimate partner violence, substance use, and postpartum depression among childbearing women. Methods. We analyzed data from the 2006-2007 Canadian Maternity Experiences Survey, a cross-sectional nationwide sample of 6421 childbearing women. Cohabiting women were married or nonmarried women living with a partner; noncohabiters were single, divorced, or separated women. We further categorized cohabiters by their duration of cohabitation (≤ 2, 3-5, or > 5 years). We used logistic regression to generate adjusted odds ratios and 95% confidence intervals. Results. About 92% of women were cohabiters. Compared with married women living with a husband more than 5 years, unmarried women cohabiting for 2 years or less were at higher odds of intimate partner violence (adjusted odds ratio [AOR] = 4.64; 95% confidence interval [CI] = 2.85, 7.56), substance use (AOR = 5.36; 95% CI = 3.06, 9.39), and postpartum depression (AOR = 1.87; 95% CI = 1.25, 2.80); these risk estimates declined with duration of cohabitation. Conclusions. Research on maternal and child health would benefit from distinguishing between married and unmarried cohabiting women, and their duration of cohabitation. [ABSTRACT FROM AUTHOR]

Objectives. We describe the prevalence of abuse before, during, and after pregnancy among a national population-based sample of Canadian new mothers. Methods. We estimated prevalence, frequency, and timing of physical and sexual abuse, identified category of perpetrator, and examined the distribution of abuse by social and demographic characteristics in a weighted sample of 76 500 (unweighted sample = 6421) Canadian mothers interviewed postpartum for the Maternity Experiences Survey (2006-2007). Results. Prevalence of any abuse in the 2 years before the interviews was 10.9% (6% before pregnancy only, 1.4% during pregnancy only, 1% postpartum only, and 2.5% in any combination of these times). The prevalence of any abuse was higher among low-income mothers (21.2%), lone mothers (35.3%), and Aboriginal mothers (30.6%). In 52% of the cases, abuse was perpetrated by an intimate partner. Receiving information on what to do was reported by 61% of the abused mothers. Conclusions. Large population-based studies on abuse around pregnancy can facilitate the identification of patterns of abuse and women at high risk for abuse. Before and after pregnancy may be particularly important times to monitor risk of abuse. [ABSTRACT FROM AUTHOR]

Leaded gasoline was officially removed from the Canadian market in December 1990. The removal of a major lead source and the subsequent decline in children's blood lead levels marked an important transition point and sparked the emergence of new discourse on lead in Canada. Today, childhood lead poisoning is viewed as a problem of the past or a problem of the United States. Sparse Canadian surveillance data supported this view. Moreover, tensions among federal agencies evolved into a power struggle, with Health Canada ultimately becoming the dominant authority, thereby relegating important research initiatives to obscurity and also shaping a vastly weaker regulatory response to lead than occurred in the United States. [ABSTRACT FROM AUTHOR]

Policy debates about immunization frequently focus on classic trade-offs between individual versus collective wellbeing. Publicly funded immunization programs are usually justified on the basis of widespread public benefit with minimal individual risk. We discuss the example of the policy process surrounding the adoption of the human papillomavirus (HPV) vaccine in Canada to consider whether public good arguments continue to dominate immunization policymaking. Specifically, we show how a range of stakeholders framed HPV vaccination as a personal- rather than a public-matter, despite the absence of a controversy over mandatory immunization as was the case in the United States. Our findings suggest an erosion of the persuasiveness of public good arguments around collective immunization programs in the policy discourse. [ABSTRACT FROM AUTHOR]

The right to health under the International Covenant on Economic, Social, and Cultural Rights, to which Canada is a signatory, entitles women to available, accessible, and acceptable abortion care, Abortion care in Canada currently fails this standard. Medication abortion (the use of drugs to terminate a pregnancy) could improve abortion care in Canada, but its potential remains unrealized. This is in part attributable to the unavailability of mifepristone, the safest and most effective pharmaceutical for medication abortion. Given that it could improve abortion care, we investigated why mifepristone remains unapproved in Canada, whether its unavailability is attributable to government inaction, and whether Canada is therefore failing to fulfill its obligations under the right to health. (Am J Public Health. 2008;98:1764-1769. doi: 10.2105/AJPH. 2008.134684) [ABSTRACT FROM AUTHOR]

The Canadian Cancer Society and the National Cancer Institute of Canada have charged their Centre for Behavioral Research and Program Evaluation with contributing to the development of the country's systemic capacity to link research, policy, and practice related to population-level interventions. Local data collection and feedback systems are integral to this capacity. Canada's School Health Action Planning and Evaluation System (SHAPES) allows data to be collected from all of a school's students, and these data are used to produce computer-generated school "health profiles." SHAPES is being used for intervention planning, evaluation, surveillance, and research across Canada. Strong demand and multipartner investment suggest that SHAPES is adding value in all of these domains. Such systems can contribute substantially to evidence-informed public health practice, public engagement, participatory action research, and relevant, timely population intervention research. (Am J Public Health. 2007;97:648-654.) [ABSTRACT FROM AUTHOR]

Objectives. We investigated the influence of neighborhood and metropolitan area characteristics on body mass index (BMI) in urban Canada in 2001. Methods. We conducted a multilevel analysis with data collected from a cross-sectional survey of men and women nested in neighborhoods and metropolitan areas in urban Canada during 2001. Results. After we controlled for individual sociodemographic characteristics and behaviors, the average BMIs of residents of neighborhoods in which a large proportion of individuals had less than a high school education were higher than those BMIs of residents in neighborhoods with small proportions of such individuals (P<.01). Living in a neighborhood with a high proportion of recent immigrants was associated with lower BMI for men (P<.01), but not for women. Neighborhood dwelling density was not associated with BMI for either gender. Metropolitan sprawl was associated with higher BMI for men (P=.02), but the effect was not significant for women (P=.09). Conclusions. BMI is strongly patterned by an individual's social position in urban Canada. A neighborhood's social condition has an incremental influence on the average BMI of its residents. However, BMI is not influenced by dwelling density. Metropolitan sprawl is associated with higher BMI for Canadian men, which supports recent evidence of this same association among American men. Individuals and their environments collectively influence BMI in urban Canada. [ABSTRACT FROM AUTHOR]

Objectives. We compared health status, access to care, and utilization of medical services in the United States and Canada and compared disparities according to race, income, and immigrant status. Methods. We analyzed population-based data on 3505 Canadian and 5183 US adults from the Joint Canada/US Survey of Health. Controlling for gender, age, income, race, and immigrant status, we used logistic regression to analyze country as a predictor of access to care, quality of care, and satisfaction with care and as a predictor of disparities in these measures. Results. In multivariate analyses, US respondents (compared with Canadians) were less likely to have a regular doctor, more likely to have unmet health needs, and more likely to forgo needed medicines. Disparities on the basis of race, income, and immigrant status were present in both countries but were more extreme in the United States. Conclusions. United States residents are less able to access care than are Canadians. Universal coverage appears to reduce most disparities in access to care. (Am J Public Health. 2006;96:1300-1307.) [ABSTRACT FROM AUTHOR]

Objectives. This study investigated how media coverage has portrayed diabetes as newsworthy. Methods. The quantitative component involved tabulating diabetes coverage in 2 major Canadian newspapers, 1988-2001 and 1991-2001. The qualitative component focused on high-profile coverage in 2 major US magazines and 2 major Canadian newspapers, 1998-2000. Results. Although coverage did not consistently increase, the quantitative results suggest an emphasis on linking diabetes with heart disease and mortality to convey its seriousness. The qualitative component identified 3 main ways of portraying type 2 diabetes: as an insidious problem, as a problem associated with particular populations, and as a medical problem. Conclusions. Overall, the results suggest that when communicating with journalists, researchers and advocates have stressed that diabetes maims and kills. Yet even when media coverage acknowledged societal forces and circumstances as causes, the proposed remedies did not always include or stress modifications to social contexts. Neither the societal causes of public health problems nor possible societal remedies automatically received attention from researchers or from journalists. Skilled advocacy is needed to put societal causes and solutions on public agendas. (Am J Public Health. 2005;95:1832-1838.) [ABSTRACT FROM AUTHOR]

Objectives. We assessed the impact of graphic Canadian cigarette warning labels. Methods. We used a longitudinal telephone survey of 616 adult smokers. Results. Approximately one fifth of participants reported smoking less as a result of the labels; only 1% reported smoking more. Although participants reported negative emotional responses to the warnings including fear (44%) and disgust (58%), smokers who reported greater negative emotion were more likely to have quit, attempted to quit, or reduced their smoking 3 months later. Participants who attempted to avoid the warnings (30%) were no less likely to think about the warnings or engage in cessation behavior at follow-up. Conclusions. Policymakers should not be reluctant to introduce vivid or graphic warnings for fear of adverse outcomes. (Am J Public Health. 2004;94:1442-1445). [ABSTRACT FROM AUTHOR]

Objectives. This study sought to determine whether income inequality, household income, and their interaction are associated with health status. Methods. Income inequality and area income measures were linked to data on household income and individual characteristics from the 1994 Canadian National Population Health Survey and to data on self-reported health status from the 1994, 1996, and 1998 survey waves. Results. Income inequality was not associated with health status. Low household income was consistently associated with poor health. The combination of low household income and residence in a metropolitan area with less income inequality was associated with poorer health status than was residence in an area with more income inequality. Conclusions. Household income, but not income inequality, appears to explain some of the differences in health status among Canadians. (Am J Public Health. 2003;93: 1287-1293) [ABSTRACT FROM AUTHOR]

Objectives. This study compared trends in the incidence of work-related morbidity and disability across 3 sources of surveillance data in a Canadian province. Methods. Time series estimates of workplace injuries and work-related disability based on 2 panel surveys in the province of Ontario, Canada, for the period 1993-1998 were compared with rates of work-related injury and illness compensation claims during the same period. Results. Lost-time compensation claims declined by 28.8% over this 6-year period. The incidence of self-reported work-related injury declined by 28.2%, and the self-reported incidence of work absence for work-related causes declined by 32.2%. Conclusions. Parallel reductions in work-related morbidity were seen in 3 independent data sources. These results support an interpretation that there has been an important reduction in injury risk in Ontario workplaces over the past decade. (Am J Public Health. 2003;93:1283-1286) [ABSTRACT FROM AUTHOR]

The history of health determinants in Canada influenced both the direction of data gathering about population health and government policies designed to improve health. Two competing movements marked these changes. The idea of health promotion grew out of the 1974 Lalonde report, which recognized that determinants of health went beyond traditional public health and medical care. and argued for the importance of socioeconomic factors. Research on health inequalities was led by the Canadian Institute for Advanced Research in the 1980s, which produced evidence of health inequalities along socioeconomic lines and argued for policy efforts in early child development. Both movements have shaped current information gathering and the policies that have come to be labeled "population health." (Am J Public Health. 2003;93:388-392) [ABSTRACT FROM AUTHOR]

Objectives. Comparisons of cancer survival in Canadian and US metropolitan areas have shown consistent Canadian advantages. This study tests a health insurance hypothesis by comparing cancer survival in Toronto, Ontario, and Honolulu, Hawaii. Methods. Ontario and Hawaii registries provided a total of 9190 and 2895 cancer cases (breast and prostate, 19861990, followed until 1996). Socioeconomic data for each person's residence at the time of diagnosis were taken from population censuses. Results. Socioeconomic status and cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Honolulu, residents of low-income areas in Toronto experienced 5-year survival advantages for breast and prostate cancer. In support of the health insurance hypothesis, between-country differences were smaller than those observed with other state samples and the Canadian advantage was larger among younger women. Conclusions. Hawaii seems to provide better cancer care than many other states, but patients in Toronto still enjoy a significant survival advantage. Although Hawaii's employer-mandated health insurance coverage seems an effective step toward providing equitable health care, even better care could be expected with a universally accessible, single-payer system. (Am d Public Health. 2000;90:1866-1872) [ABSTRACT FROM AUTHOR]

Objectives. This study compared rates of annual mammography screening across socioeconomic status between the United States and Canada in 1994. Methods. Population-based cross-sectional surveys were used to compare the rates. Results. Screening rates were higher in the United States than in Canada for women aged 50 to 69 years (47.3% vs 38.8%; P<.01). Women with higher education and with higher incomes were more likely to receive screening in both countries, with no significant differences between countries. Conclusions. For women aged 50 to 69 years, screening rates in Canada have substantially increased relative to those in the United States. However, disparities in screening across levels of socioeconomic status persist in both countries. (Am d Public Health. 2000; 90:799-803) [ABSTRACT FROM AUTHOR]

Objectives. This study developed prevalence estimates of gambling-related disorders in the United States and Canada, identified differences in prevalence among population segments, and identified changes in prevalence over the past 20 years. Methods, A meta-analytic strategy was employed to synthesize estimates from 119 prevalence studies. This method produced more reliable prevalence rates than were available from any single study. Results. Prevalence estimates among samples of adolescents were significantly higher than estimates among samples of adults for both clinical (level 3) and subclinical (level 2) measures of disordered gambling within both lifetime and past-year time frames (e.g., 3.9% vs 1.6% for lifetime estimates of level 3 gambling). Among adults, prevalence estimates of disordered gambling have increased significantly during the past 20 years. Conclusions. Membership in youth, treatment, or prison population segments is significantly associated with experiencing gambling-related disorders. Understanding subclinical gamblers provides a meaningful opportunity to lower the public health burden associated with gambling disorders. Further research is necessary to determine whether the prevalence of disordered gambling will continue to increase among the general adult population and how prevalence among adolescents will change as this cohort ages. (Am d Public Health. 1999;89:1369-1376) [ABSTRACT FROM AUTHOR]

Objectives. This study investigated dentists' refusal to treat patients who have HIV. Methods. A survey was mailed to a random sample of all licensed dentists in Canada, with 3 follow-up attempts (n=6444). Data were weighted to allow for probability of selection and nonrespense and analyzed with Pearson's x2 and multiple logistic regression. Results. The response rate was 66%. Of the respondents, 32% had knowingly treated HIV-infected patients in the last year; 16% would refuse to treat HIV-infected patients. Respondents reported willingness to treat HIV-infected patients (81%), injection drug users (86%), hepatitis B virus-infected patients (87%), homosexual and bisexual persons (94%), individuals with sexually transmitted disease(s) (94%), and recipients of blood and blood products (97%). The best predictors of refusal to treat patients with HIV were lack of ethical responsibility (odds ratio = 9.0) and items related to fear of cross-infection or lack of knowledge of HIV. Conclusions. One in 6 dentists reported refusal to treat HIV-infected patients, which was associated primarily with respondents' lack of belief in an ethical responsibility to treat patients with HIV and fears related to cross-infection. These results have implications for undergraduate, postgraduate, and continuing education. [ABSTRACT FROM AUTHOR]

Objectives. This study estimated morbidity and mortality attributable to substance abuse in Canada. Methods. Pooled estimates of relative risk were used to calculate etiologic fractions by age, gender, and province for 91 causes of disease or death attributable to alcohol, tobacco, or illicit drugs. Results. There were 33498 deaths and 208 095 hospitalizations attributed to tobacco, 6701 deaths and 86076 hospitalizations due to alcohol, and 732 deaths and 7095 hospitalizations due to illicit drugs in 1992. Conclusions. Substance abuse exacts a considerable toll on Canadian society in terms of morbidity and mortality, accounting for 21% of deaths) 23% of years of potential life lost, and 8% of hospitalizations. [ABSTRACT FROM AUTHOR]

Examines the transmission dynamics of chlamydia and gonorrhea in Winnipeg, Manitoba, Canada. Response to control programs; Approaches used to identify sexually transmitted disease core groups; Evolution of the epidemiology of chlamydia and gonorrhea; Winnipeg risk areas; Descriptive epidemiology.

Objectives. This study examined whether socioeconomic status has a differential effect on the survival of adults diagnosed with cancer in Canada and the United States. Methods. The Ontario Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program provided a total of 58 202 and 76 055 population-based primary malignant cancer cases for Toronto, Ontario, and Detroit, Mich, respectively. Socioeconomic data for each person's residence at time of diagnosis were taken from population censuses. Results. In the US cohort, there was a significant association between socioeconomic status and survival for 12 of the 15 most common cancer sites; in the Canadian cohort, there was no such association for 12 of the 15 sites. Among residents of low-income areas, persons in Toronto experienced a survival advantage for 13 of 15 cancer sites at 1- and 5-year follow-up. No such between-country differentials were observed in the middle- or high-income groups. Conclusions. The consistent pattern of a survival advantage in Canada observed across various cancer sites and follow-up periods suggests that Canada's more equitable access to preventive and therapeutic health care services is responsible for the difference. [ABSTRACT FROM AUTHOR]

Objectives. This study examined the association between exposure to chlorophenates and the risk of soft tissue sarcoma; non-Hodgkin's lymphoma; Hodgkin's disease; and cancers of the lung, and nasopharynx. Methods. A retrospective cohort study was conducted of 26 487 workers employed for at least 1 year between 1950 and 1985 in 11 chlorophenate-using and 3 non-using sawmills in British Columbia, Canada. Exposures by job were ascertained with interviews of senior employees. Results. Probabilistice record linkage to the Canadian Mortality Data Base and the British Columbia Cancer Registry found 4710 deaths between 1950 and 1990, and 1547 incident cases of cancer between 1969 and 1989. None of the cancers of interest had elevated mortality related to chlorophenate exposure. Non-Hodgkin's lymphoma incidence (n = 65) increased with increasing chlorophenate exposure hours, yielding the following standardized incidence ratios: les than 120 hours 0.68; 120 to 1999 hours, 0.59; 2000 to 3999 hours, 1.04; 4000 to 9999 hours, 1.02; and 10 000 or more hours, 1.30. Conclusions. These results are consistent with the borderline positive associations seen in other recently reported studies of chlorophenate-exposed workforces. [ABSTRACT FROM AUTHOR]

Objectives. We compared US and Canadian health administration costs using national medical care employment data for both countries. Methods. Data from census surveys on hospital, nursing home, and outpatient employment in the United States (1968 to 1993) and Canada (1971 and 1986) were analyzed. Results. Between 1968 and 1993, US medical care employment grew from 3.976 to 10.308 million full-time equivalents. Administration grew from 0.719 to 2.792 million full-time equivalents, or from 18.1% to 27.1% of the total employment. In 1986, the United States deployed 33 666 health care full-time equivalent personnel per million population, and Canada deployed 31 529. The US excess was all administrative; Canada employed more clinical personnel, especially registered nurses. Between 1971 and 1986, hospital employment per capita grew 29% in the United States (mostly because of administrative growth) and fell 14% in Canada. In 1986, Canadian hospitals still employed more clinical staff per million. Outpatient employment was larger and grew faster in the United States. Per capita nursing home employment was substantially higher in Canada. Conclusions. If US hospitals and outpatient facilities adopted Canada's staffing patterns, 1 407 000 fewer managers and clerks would be necessary. Despite lower medical spending, Canadians receive slightly more nursing and other clinical care than Americans, as measured by labor inputs. [ABSTRACT FROM AUTHOR]

Since 1971 pediatric mortality rates have decreased markedly but differently in Canada and the United States. These trends were examined in light of changes in hospital use and health care financing. Annual mortality and hospital use rates for children aged 14 years and younger were calculated. Between 1971 and 1987, all-cause mortality in Canada fell from 165 to 74 per 100 000; the American rate fell from 172 to 96 per 100 000. American hospitalization rates remained essentially constant until 1983 and then fell by 27.5%, while Canadian hospitalization rates declined throughout. In 1987 Canadian children had higher hospitalization rates, while American children had higher mortality rates. These differences may be associated with differences in health financing; the adoption of US prospective payment systems was temporally coincident with sharp declines in hospitalization rates for American children. [ABSTRACT FROM AUTHOR]

Objectives. This study describes the costs and outcomes of community-based tuberculin screening programs conducted between 1987 and 1991 in Montreal, Quebec, Canada. Methods. Follow-up information was abstracted from hospital records of all reactors detected in tuberculin screening of students in grades 6 and 10, of first-year health professional students, and of workers aged 18 to 25 in a number of Workforces. Screening costs were estimated directly from survey records, and follow-up costs were estimated from the annual financial report of the Montreal Chest Hospital for 1989/90. Results. Of 7669 persons tested, 782 (10.2%) had positive results and 757 (9.9%) were referred to a clinic. Of those, 525 (6.8% of the original 7669) reported, 293 (3.8%) were prescribed therapy, and 154 (2.0%) were compliant. In Canadian dollars, screening cost $5.70 per person tested and $56 per tuberculin reactor detected, but follow-up of the total program cost of $13 455 to $18 753 per case of tuberculosis prevented. Conclusions. Because of high rates of patient and provider noncompliance, a tuberculin screening program was much less cost-effective than anticipated. Screening costs must be targeted to the highest risk populations, and compliance with recommendations for preventive therapy must be maximized. [ABSTRACT FROM AUTHOR]

Objectives. The primary hypothesis of COMMIT (Community Intervention Trial for Smoking Cessation) was that a community-level, multichannel, 4-year intervention would increase quit rates among cigarette smokers, with heavy smokers (≥25 cigarettes per day) of priority. Methods. One community within each of 11 matched community pairs (10 in the United States, 1 in Canada) was randomly assigned to intervention, Endpoint cohorts totaling 10 019 heavy smokers and 10 328 light-to-moderate smokers were followed by telephone. Results. The mean heavy smoker quit rate (i.e., the fraction of cohort members who had achieved and maintained cessation at the end of the trial) was 0.180 for intervention communities versus 0.187 for comparison communities, a nonsignificant difference (one-sided P = .68 by permutation test; 90% test-based confidence interval (CI) for the difference = -0.031, 0.019). For light-to-moderate smokers, corresponding quit rates were 0.306 and 0.275; this difference was significant (P = .004; 90% CI = 0.014, 0.047). Smokers in intervention communities had greater perceived exposure to smoking control activities, which correlated with outcome only for light-to-moderate smokers. Conclusions. The impact of this community-based intervention on light-to-moderate smokers, although modest, has public health importance. This intervention did not increase quit rates of heavy smokers; reaching them may require new clinical programs and policy changes. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this study was to examine the US and Canadian systems from the unique perspective of physicians who have practiced in both Canada and the United States. Methods. Questionnaires were sent to 355 Canadian physicians who graduated from US medical schools and 347 US physicians who graduated from Canadian medical schools. Results. The overall response rate was 59% (65% of US-graduated Canadian physicians and 54% of Canadian-graduated US physicians). Thirty-six percent of the respondents were "dual experience" physicians; that is, they had practiced medicine in both countries after completing their medical training. Physicians who left Canada were more likely than those who left the United States to indicate dissatisfaction with the health care system as a reason for leaving. Respondents expressed greater professional satisfaction with their current country of practice, but overall, dual-experience physicians in the United States favored that system only slightly more than the Canadian system, whereas those in Canada rated the Canadian system significantly better than the US system. Conclusions. The comparatively weak rating of the US system by dual-experience physicians underlines the need for health care reform. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this study was to review cardiovascular mortality, morbility, and risk factors in the multiethnic population of the Northwest Territories, Canada. Methods. We analysed death certificates and hospital records, and used a community health and examination survey. Results. The age-standardized mortality rate for ischemic heart disease (but not for other heart diseases or stroke) among the Northwest Territories population was lower than among the Canadian population. Among the indigenous Inuit/Eskimos and Indians, the age-standardized mortality rate for all circulatory diseases was lower than Canadians. Among Indian women, the rate approached the Canadian rate and exceeded that of Inuit and non-Natives. Compared with residents of Manitoba, Northwest Territories Inuit adults had a higher prevalence of smoking in all age-sex groups. Obesity was prevalent among older Inuit women and hypertension among young Inuit men. Except for women aged 25 to 44, the total cholesterol and triglyceride levels among Inuit were lower than or not different from Manitoba residents. Relatively high levels of high-density lipoprotein were found in older Inuits. Conclusions. The epidemiologic pattern of cardiovascular diseases in Arctic Canada differs from that among non-Native, southern Canadians. Rapid sociocultural changes may alter the situation, and health agencies must anticipate such transitions and intensify culturally appropriate control programs. [ABSTRACT FROM AUTHOR]

OBJECTIVES. The purpose of this study was to compare hip fracture hospitalization rates between a fluoridated and a non-fluoridated community in Alberta, Canada: Edmonton, which has had fluoridated drinking water since 1967, and Calgary, which considered fluoridation in 1991 but is currently revising this decision. METHODS. Case subjects were all individuals aged 45 years or older residing in Edmonton or Calgary who were admitted to hospitals in Alberta between January 1, 1981, and December 31, 1987, and who had a discharge diagnosis of hip fracture. Edmonton rates were compared with Calgary rates, with adjustment for age and sex using the Edmonton population as a standard. RESULTS. The hip fracture hospitalization rate for Edmonton from 1981 through 1987 was 2.77 per 1000 person-years. The age-sex standardized rate for Calgary was 2.78 per 1000 person-years. No statistically significant difference was observed in the overall rate, and only minor differences were observed within age and sex subgroups, with the Edmonton rates being higher in males. CONCLUSIONS. These findings suggest that fluoridation of drinking water has no impact, neither beneficial nor deleterious, on the risk of hip fracture. [ABSTRACT FROM AUTHOR]

We evaluated the benzo[a]pyrene (BaP) content in the smoke from 35 brands of Canadian cigarettes and 5 brands of Canadian tobaccos for roll-your-own cigarettes. For the cigarettes, mean values of BaP ranged from 3.36 ng to 28.39 ng per cigarette, roughly in proportion with declared tar values. The relationship between declared tar and yields of BaP, however, does not allow accurate prediction of one from the other. For the tobaccos, mean BaP values ranged from 22.92 ng to 26.27 ng (average, 24.7 ng) per cigarette. The implications of these findings are discussed with respect to overall exposure. [ABSTRACT FROM AUTHOR]

In Manitoba, Canada, a representative cohort of elderly individuals ages 65 to 84 (n = 3,573) were interviewed in 1971 and the survivors of this cohort were reinterviewed in 1983. This analysis assesses the determinants of successful aging--whether or not an individual will live to an advanced age, continue to function well at home, and remain mentally alert. Over 100 separate indicators of demographic and socio-economic status, social supports, health and mental status in 1971 were available as potential predictors of successful aging. Indicators of access to health care over the period 1970-82 and indicators of diseases over this period were also available as predictors. Those who aged successfully were shown to have greater satisfaction with life in 1983 and to have made fewer demands on the health care system than those who aged less well. Despite the large number of potential predictors of successful aging which were examined, only age, four measures of health status, two measures of mental status, and not having one's spouse die or enter a nursing home were shown to be predictive of successful aging. [ABSTRACT FROM AUTHOR]