Beth K. Potter

Does a relationship exist between body weight, concerns about weight, and smoking among adolescents? An integration of the literature with an emphasis on gender.

It has been speculated that body weight and concern about body weight are important factors in initiation of tobacco use among adolescents, particularly females. An examination of studies that have explored these relationships can provide important information on possible underlying mechanisms that could be used for prevention interventions. This review summarizes recent studies examining weight concerns and youth smoking, with a focus on gender differences. These studies were integrated with the few studies that have examined the relationship between actual body weight and smoking among adolescents. A total of 55 primary research articles met inclusion criteria for the review. Of these, 19 studies assessed the relationship between body weight and smoking, and 50 studies addressed weight concerns and smoking. Some evidence indicated a positive relationship between smoking and body weight among adolescents, although not all studies found a positive association. In terms of the relationship between weight concerns and adolescent smoking, the amount of evidence supporting a positive association differed depending on the dimension of weight concern considered, with the strongest evidence for dieting behaviors. For dieting behaviors, disordered eating symptoms, and some aspects of general weight concerns, the positive relationship with smoking was more consistent among female adolescents than among male adolescents. Possible explanations for these findings are discussed, and priorities for future research are identified.

Reporting Guidelines for Survey Research: An Analysis of Published Guidance and Reporting Practices

Carol Bennett and colleagues review the evidence and find that there is limited guidance and no consensus on the optimal reporting of survey research.

Exploring informed choice in the context of prenatal testing: findings from a qualitative study

Purpose  This study explored whether and how a sample of women made informed choices about prenatal testing for foetal anomalies; its aim was to provide insights for future health policy and service provision.

Women’s Experiences Breastfeeding in Public Places

This two-part field study compared researchers’ recorded observations to mothers’ perceptions of attention they received while publicly breastfeeding. In part 1, four breastfeeding and four bottle-feeding mothers each made eight restaurant visits. On average, there were more neutral looks from customers (P = .01) during breastfeeding visits, but no differences in the amount of overtly negative or positive attention given during breastfeeding versus bottle feeding. In part 2, four breastfeeding mothers made a total of 24 visits to shopping malls. There were more neutral looks given while mothers were breastfeeding and more smiles and comments while they were not feeding, but no difference in total amount of attention received. Breastfeeding mothers acknowledged they had anticipated some undesirable attention but instead received little attention. Nevertheless, they felt “vulnerable” nursing in public. Certain proactive behaviors and personal attributes as well as support from otherwomen enabled them to breastfeed successfully in public.

The effects of provincial bicycle helmet legislation on helmet use and bicycle ridership in Canada

Background Bicycle helmet legislation has been variably implemented in six of 10 Canadian provinces. The objectives of this study were to determine the association between the comprehensiveness of helmet legislation and both helmet use and bicycle ridership. Methods Analysis of helmet use was based on data from the 2005 Canadian Community Health Survey (CCHS) and included respondents from three Canadian provinces (Saskatchewan, Ontario, and Nova Scotia). Analysis of bicycle use was based on data from the 2000–01, 2003, 2005, and 2007 cycles of the CCHS and included respondents from all provinces. In the time between the 2000–01 and 2007 cycles, two provinces (Prince Edward Island (PEI) and Alberta) implemented helmet legislation. Results Helmets were reportedly worn by 73.2% (95% CI 69.3% to 77.0%) of respondents in Nova Scotia, where legislation applies to all ages, by 40.6% (95% CI 39.2% to 42.0%) of respondents in Ontario, where legislation applies to those less than 18 years of age, and by 26.9% (95% CI 23.9% to 29.9%) of respondents in Saskatchewan, where no legislation exists. Though legislation applied to youth in both Ontario and Nova Scotia, helmet use was lower among youth in Ontario than among youth in Nova Scotia (46.7% (95% CI 44.1% to 49.4%) vs 77.5% (95% CI 70.9% to 84.1%)). Following the implementation of legislation in PEI and Alberta, recreational and commuting bicycle use remained unchanged among youth and adults. Conclusions Canadian youth and adults are significantly more likely to wear helmets as the comprehensiveness of helmet legislation increases. Helmet legislation is not associated with changes in ridership.

Attitude and Knowledge about Genetics and Genetic Testing

Background: Increasing numbers of health care users may be confronted with new genetic knowledge and discoveries that offer new types of medical decision-making. How people use these new insights and make decisions about genetic risk depends, at least in part, on their knowledge and attitudes about human genetics. Methods: A postal survey administered to 560 women who had been offered prenatal screening in Ontario measured knowledge about, and attitudes toward, genetic testing and the uses of genetic information. Results: Respondents strongly supported the use of genetic information to improve disease diagnosis and to help understand disease causes; however, people also held a more critical attitude towards certain aspects of testing and genetic information. Relatively high levels of knowledge about genetics were also observed in this sample, although there were deficits in specific areas (e.g., transmission patterns). Conclusions: Despite overall positive attitudes towards genetics, participants held more critical attitudes towards certain aspects of testing and the uses of genetic information. It would be unwise for genetics policy-makers and stakeholders to assume that a better-informed public would automatically be more supportive of all genetics research and new genetic discoveries.

Translating rare-disease therapies into improved care for patients and families: what are the right outcomes, designs, and engagement approaches in health-systems research?

There is a need for research to understand and improve health systems for rare diseases in order to ensure that new, efficacious therapies developed through basic and early translational science lead to real benefits for patients. Such research must (i) focus on appropriate patient-oriented outcomes, (ii) include robust study designs that can accommodate real-world decision priorities, and (iii) involve effective stakeholder-engagement strategies. For transformative therapies, study outcomes will need to shift toward longer-term goals in recognition of success in preventing catastrophic outcomes. For incremental therapies, outcomes should be selected in recognition of the impact of care on quality of life for patients and families. To generate new evidence, we suggest that hybrid study designs integrating elements of practice-based observational research and pragmatic trials hold the most promise for addressing priorities such as minimizing bias, accounting for cointerventions, identifying long-term impacts, and considering clinical heterogeneity. To effectively engage with stakeholders, a knowledge exchange infrastructure is needed to foster collaboration among patients with rare diseases and their families, health-care providers, researchers, and policy decision makers. A key priority for these groups must be collaboration toward a shared understanding of the outcomes that are of most relevance to the facilitation of patient-centered care.Genet Med 18 2, 117–123.

Patterns of emergency room visits, admissions and death following recommended pediatric vaccinations - a population based study of 969,519 vaccination events.

BACKGROUND The risk of immediate adverse events due to the inflammation created by a vaccine is a potential concern for pediatric vaccine programs. METHODS We analyzed data on children born between March 2006 and March 2009 in the province of Ontario. Using the self-controlled case series design, we examined the risk of the combined endpoint of emergency room visit and hospital admission in the immediate 3 days post vaccination to a control period 9-18 days after vaccination. We examined the end points of emergency room visits, hospital admissions and death separately as secondary outcomes. RESULTS We examined 969,519 separate vaccination events. The relative incidence of our combined end point was 0.85 (0.80-0.90) for vaccination at age 2 months, 0.74 (0.69-0.79) at age 4 months and 0.68 (0.63-0.72) at age 6 months. The relative incidence was reduced for the individual endpoints of emergency room visits, admissions and death. There were 5 or fewer deaths in the risk interval of all 969,519 vaccination events. In a post hoc analysis we observed a large reduction in events in the immediate 3 days prior to vaccination suggesting a large healthy vaccinee effect. CONCLUSION There was no increased incidence of the combined end point of emergency room visits and hospitalizations in the 3-day period immediately following vaccination, nor for individual endpoints or death. The health vaccinee effect could create the perception of worsening health following vaccines in the absence of any vaccine adverse effect and could also mask an effect in the immediate post-vaccination period.

Adverse events following 12 and 18 month vaccinations: a population-based, self-controlled case series analysis.

Background Live vaccines have distinct safety profiles, potentially causing systemic reactions one to 2 weeks after administration. In the province of Ontario, Canada, live MMR vaccine is currently recommended at age 12 months and 18 months. Methods Using the self-controlled case series design we examined 271,495 12 month vaccinations and 184,312 18 month vaccinations to examine the relative incidence of the composite endpoint of emergency room visits or hospital admissions in consecutive one day intervals following vaccination. These were compared to a control period 20 to 28 days later. In a post-hoc analysis we examined the reasons for emergency room visits and the average acuity score at presentation for children during the at-risk period following the 12 month vaccine. Results Four to 12 days post 12 month vaccination, children had a 1.33 (1.29–1.38) increased relative incidence of the combined endpoint compared to the control period, or at least one event during the risk interval for every 168 children vaccinated. Ten to 12 days post 18 month vaccination, the relative incidence was 1.25 (95%, 1.17–1.33) which represented at least one excess event for every 730 children vaccinated. The primary reason for increased events was statistically significant elevations in emergency room visits following all vaccinations. There were non-significant increases in hospital admissions. There were an additional 20 febrile seizures for every 100,000 vaccinated at 12 months. Conclusions There are significantly elevated risks of primarily emergency room visits approximately one to two weeks following 12 and 18 month vaccination. Future studies should examine whether these events could be predicted or prevented.

Content Analysis of Infant Feeding Messages in a Canadian Women's Magazine, 1945 to 1995

Abstract This study describes trends in infant feeding messages in a Canadian womens magazine, from 1945 to 1995 (612 issues). Content analysis was used, with one researcher photocopying and coding all relevant items. The sample (n = 1082) included all messages related to infant feeding appearing in the magazine. Messages were coded according to sources (e.g., advertisement, article) and themes. Banduras Social Cognitive Theory was used to explore their relationship with infant feeding behavior. Data were analyzed using frequencies and averages and presented graphically.The majority (n = 666,62%) of messages were advertisements. There were only 32 infant feeding articles (3%); the remaining 384 items (35%) were portions of articles or editorial and health columns. The total number of messages declined over time. Trends in message themes (favoring breastfeeding, neutral, favoring bottle feeding) and in the number of advertisements were roughly comparable to breastfeeding initiation rates.These media messages may have been influencing behavior or merely reflecting societal values; further analyses of print media nutrition messages can provide insight into these relationships. Dietitians and nutritionists should consider using the popular media as a vehicle for nutrition education.