Chris Y. Lovato

Communicating Cancer Risk Information: The Challenges of Uncertainty.

Developments in predictive testing for inherited cancers have focused attention on the accurate and sensitive communication of risk information. Although sharing risk information is often equated with genetic testing, it is important to acknowledge that the need for risk information related to familial cancer is also relevant to those not eligible for, or interested in, testing. Communicating cancer risk information is germane to a number of health professions including physicians, geneticists, genetic counsellors, psychologists, nurses, health educators and social workers. Based on a literature review of 75 research reports, expert opinion papers and clinical protocols, we provide a synthesis of what is known about the communication of cancer risk information and make recommendations for the enhancement of knowledge and practice in the field.

Tobacco dependence: adolescents' perspectives on the need to smoke

To address the need for a better understanding of the perspective of Canadian youths on tobacco dependence, a qualitative study using ethnographic techniques was conducted to describe the patterns of language that they use to describe tobacco dependence and the meaning that it has for them. The study was comprised of three inter-related phases: (1) A secondary analysis of 47 individual unstructured interviews with adolescents was completed to identify the words and phrases they use to explain tobacco dependence; (2) contrast and structural questions focusing on tobacco dependence were developed and used in open-ended interviews with 13 adolescents. Data analysis of the transcribed interviews resulted in a set of 60 key phrases that represented the primary ways youths describe the need to smoke; and (3) interviews were conducted with 14 adolescents that involved an open card sort using the set of 60 key phrases. All card sorts and transcribed interview data were analyzed to identify domains representing types of tobacco dependence and sub-types within each domain. From their descriptions about the need to smoke, five aspects of tobacco dependence were identified: social, pleasurable, empowering, emotional, and full-fledged. This study provides a step in elucidating the construct of tobacco dependence among the young. Further research is required to extend this understanding and to develop appropriate measures.

School Smoking Policy Characteristics and Individual Perceptions of the School Tobacco Context: Are They Linked to Students' Smoking Status?

The purpose of this study was to explore individual- and school-level policy characteristics on student smoking behavior using an ecological perspective. Participants were 24,213 (51% female) Grade 10–11 students from 81 schools in five Canadian provinces. Data were collected using student self-report surveys, written policies collected from schools, interviews with school administrators, and school property observations to assess multiple dimensions of the school tobacco policy. The multi-level modeling results revealed that the school a student attended was associated with his/her smoking behavior. Individual-level variables that were associated with student smoking included lower school connectedness, a greater number of family and friends who smoked, higher perceptions of student smoking prevalence, lower perceptions of student smoking frequency, and stronger perceptions of the school tobacco context. School-level variables associated with student smoking included weaker policy intention indicating prohibition and assistance to overcome tobacco addiction, weaker policy implementation involving strategies for enforcement, and a higher number of students smoking on school property. These findings suggest that the school environment is important to tobacco control strategies, and that various policy dimensions have unique relationships to student smoking. School tobacco policies should be part of a comprehensive approach to adolescent tobacco use.

Smoking Decisions from a Teen Perspective: A Narrative Study

OBJECTIVE To explore the transitional phase between experimental and regular smoking from the perspective of teens. METHOD Narrative analysis of semistructured, individual interviews. RESULTS The need to belong and immediate social gain are major themes influencing teen smoking decisions. CONCLUSIONS Our findings have significance for public health workers planning and implementing tobacco-use prevention programs aimed at teens whose smoking behaviors are not yet determined by nicotine addiction. How such programs have been traditionally framed and the ways in which peer influence and risk behaviors have been addressed may be largely irrelevant to the rationale of the adolescents themselves.

Evaluation of a violence risk assessment system (the Alert System) for reducing violence in an acute hospital: A before and after study

OBJECTIVES To investigate the effectiveness of a risk assessment system in reducing the risk of violence in an acute care hospital in the Canadian province of British Columbia. METHODS Hospital violence incident rates (number of incidents/100,000 work hours) were calculated and compared pre, during and post implementation of the Alert System, a violence risk assessment system, at one acute care hospital. Poisson regression models were used to examine the effect of the Alert System on hospital-level violent incident rates. Multivariable, conditional logistic regression was used to examine the effect of the Alert System on the individual-level risk of violent incidence using a case-control study. RESULTS The violent incident rate decreased during the Alert System implementation period only, but subsequently returned to pre-implementation levels. In the case-control analyses, the Alert flag was associated with an increased risk for a patient violent incident (odds ratio=7.74, 95% CI=4.81-12.47). CONCLUSIONS Although useful at identifying violent patients, the Alert System even though offered in conjunction with violence prevention training, does not appear to provide the resources or procedures needed by healthcare workers to prevent a patient from progressing to a violent incident once flagged. Violence in healthcare should be studied and prevented using a multifaceted approach.

Characterizing violence in health care in British Columbia.

BACKGROUND The high rate of violence in the healthcare sector supports the need for greater surveillance efforts. AIM The purpose of this study was to use a province-wide workplace incident reporting system to calculate rates and identify risk factors for violence in the British Columbia healthcare industry by occupational groups, including nursing. METHODS Data were extracted for a 1-year period (2004-2005) from the Workplace Health Indicator Tracking and Evaluation database for all employee reports of violence incidents for four of the six British Columbia health authorities. Risk factors for violence were identified through comparisons of incident rates (number of incidents/100,000 worked hours) by work characteristics, including nursing occupations and work units, and by regression models adjusted for demographic factors. RESULTS Across health authorities, three groups at particularly high risk for violence were identified: very small healthcare facilities [rate ratios (RR) = 6.58, 95% CI =3.49, 12.41], the care aide occupation (RR = 10.05, 95% CI = 6.72, 15.05), and paediatric departments in acute care hospitals (RR = 2.22, 95% CI = 1.05, 4.67). CONCLUSIONS The three high-risk groups warrant targeted prevention or intervention efforts be implemented. The identification of high-risk groups supports the importance of a province-wide surveillance system for public health planning.

Crossing the Line: Adolescents’ Experiences of Controlling Their Tobacco Use

Although adolescents are often curious about cigarettes and anxious to “try” smoking, they are unsure about what engaging in the act of smoking will mean. Most adolescents who experiment with smoking do not set out to become addicted to tobacco. Using a grounded theory approach, the authors examined the process youth undergo to regain control over their smoking. Accounts of early smoking experiences suggest that youth undergo a process to control tobacco use that includes (a) determining if smoking is a problem, (b) “crossing the line” of acceptable tobacco use, and (c) implementing strategies to regain control of smoking. The findings of this study lay the basis for the development of harm reduction approaches that facilitate youth’s propensity to control their tobacco use.

Evaluating distributed medical education : what are the community's expectations?

Objectives  This study aimed to explore community members’ perceptions of present and future impacts of the implementation of an undergraduate medical education programme in an underserved community.

The pit and the pendulum: the impact on teen smokers of including a designated smoking area in school tobacco control policy

Thirty per cent of school districts in British Columbia do not ban smoking outright on school grounds, and in several instances, smoking is permitted in smoking pits, regardless of school district policy. While there is evidence to suggest that enforcing a tobacco-free environment for students does reduce adolescent smoking rates, the concomitant safety and discipline problems it creates for school staff and administration are demanding and complex, and may override concerns regarding student smoking. This study uses a qualitative approach to explore the meanings that students place on tobacco control policy and the impact that these meanings have on their own smoking behaviours. We found that students were surprised and concerned that smoking was permitted on school property and that it negatively impacted their own tobacco prevention/control/cessation attempts.

Sun Protection as a Family Health Project in Families with Adolescents

This study examined sun protection in families with adolescents from an action-theoretical perspective. Interview data were collected from 20 families about their attitudes and behaviors around sunbathing and sun protection. The data support the understanding of project as joint goal-directed action over time as the basis on which these behaviors are organized in families. Families used the language of goal-directed action to discuss family sun protection. Differences between families with focused and diffuse sun-protection projects are identified. Sun protection in families as one part of an array of family goal-directed actions and projects has implications for health promotion.