Donald B. Langille

An emerging adolescent health risk: caffeinated energy drink consumption patterns among high school students.

OBJECTIVE To examine the prevalence, patterns, and correlates of energy drink use among adolescents, and determine whether more frequent use of energy drinks is associated with poorer health and behavioral outcomes. METHODS Data were from a 2012 cross-sectional survey of 8210 students in grades 7, 9, 10 and 12 attending public schools in Atlantic Canada. Multinomial logistic regression analysis was used to examine correlates of energy drink use patterns, including substance use, sensation seeking, risk of depression, and socioeconomic status. RESULTS Nearly two-thirds of survey respondents (62%) reported consuming energy drinks at least once in the previous year, with about 20% reporting use once or more per month. Sensation seeking, depression, and substance use were all higher among energy drink users relative to non-users, and in higher frequency users relative to lower frequency users. CONCLUSIONS The prevalence of energy drink consumption among high school students was high. The association of energy drinks with other potential negative health and behavioral outcomes suggests that use of these products may represent a marker for other activities that may negatively affect adolescent development, health and well-being.

Protective associations of importance of religion and frequency of service attendance with depression risk, suicidal behaviours and substance use in adolescents in Nova Scotia, Canada

PURPOSE We examined relationships of measures of personal importance of religion and frequency of attendance at religious services with risk of depression and risk behaviours in high school students in Cape Breton, Canada. We examined the impact of confounding and explanatory factors on these relationships. METHODS Data were drawn from self-report surveys of adolescents aged 15-19 (N=1615) at three high schools in May, 2006. We used logistic regression to assess associations of religious importance and religious service attendance with risk of depression, suicidal behaviour, binge drinking and frequent marijuana use, controlling in multivariate models for sociodemographic factors, family structure and social capital. RESULTS Among females, higher personal importance of religion was associated with decreased odds of depression, suicidal ideation, drinking and marijuana use, while more religious attendance was protective for substance use behaviours and suicidal ideation. In males, both measures of religiosity were associated with decreased substance use. In multivariate models, religious importance had weak protective effects for depression and suicidal thinking in females, which were respectively modified by social trust and substance use. Attendance was protective for suicidal thinking in females, and was modified by depression. These associations were not seen in males. Attendance was consistently associated with less substance use in females, while importance was not. Importance was consistently protective for marijuana use and attendance was protective for binge drinking in males. LIMITATIONS This was a cross-sectional self-report survey and causality cannot be inferred. CONCLUSION Protective associations of measures of religiosity are seen in Canadian adolescents, as they are elsewhere.

Implementing a communication skills programme in medical school: needs assessment and programme change

Communication skills training (CST) in medicine, once considered a minor subject, is now ranked a core clinical skill. To assess the state of formal and informal CST at Dalhousie Medical School a needs assessment was undertaken in 1997 with the goal of using these findings to plan and implement a new communication skills curriculum.

Responses of rural family physicians and their colleague and coworker raters to a multi-source feedback process: a pilot study.

Purpose. To describe responses of family physicians, their medical colleagues, and coworker raters to a multisource feedback assessment process. Method. Data collection tools included multisource feedback self-assessment and medical colleague, coworker, and patient rating forms; and program evaluation physician and rater questionnaires. Results. The pilot study included 142 physicians and their raters, with 113 (80%) physicians completing evaluations. Positive correlations were found between familiarity scores and medical colleague and coworker mean ratings. Peer medical colleagues were significantly more familiar with physicians than were consultants. Consultants were unable to rate items most frequently. Physicians disagreed with colleague feedback more frequently. Agreement was positively correlated with scores. Conclusions. Familiarity, ability to observe physicians appropriately to rate them, and physicians’ responses to feedback are factors to consider when multisource feedback is used.

Longitudinal associations of cannabis and illicit drug use with depression, suicidal ideation and suicidal attempts among Nova Scotia high school students

OBJECTIVE To examine associations of cannabis and other illicit drug use with depression, suicidal ideation and suicidal attempts over a two year period during adolescence. METHODS Nine hundred and seventy-six school students in four high schools in northern Nova Scotia, Canada, were surveyed in grade 10 and followed up in grade 12. Assessments of past 30 day cannabis and illicit drug use as well as mental health variables (risk of depression, suicidal ideation and suicide attempts) were obtained at baseline (2000 and 2001) and follow-up two years later (2002 and 2003). Generalized estimating equations modelled depression, suicidal ideation and attempts among illicit drug users and non-users. RESULTS Illicit drug use with or without cannabis use was significantly associated with higher odds of depression, suicidal ideation and suicide attempt. Heavy cannabis use alone predicted depression but not suicidal ideation or attempt. CONCLUSIONS Illicit drug use, with and without accompanying cannabis use, among high school students increases the risk of depression, suicidal ideation and suicidal attempts. Heavy cannabis use alone predicts depression but not suicidal ideation or attempts.

Faculty attitudes towards medical communication and their perceptions of students’ communication skills training at Dalhousie University

Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Physician perceptions of the effect of telemedicine on rural retention and recruitment.

We conducted a postal survey of 140 family and community specialist physicians in a predominantly rural area which had received clinical telemedicine services and videoconferenced continuing medical education (CME) for two years. The questionnaire contained 46 items. The response rate was 47%. Most respondents (83%) reported having attended videoconferenced CME sessions and 45% reported having referred patients for teleconsultation. Physicians in more rural areas used these services more frequently. Ratings of two statements assessing the value of telemedicine in community support were significantly and positively correlated with the number of videoconferenced CME sessions attended and the number of telemedicine services used. In relation to their decision to stay in their community for at least one year, respondents rated telemedicine lower in importance than all but one of 17 other factors expected to influence physician recruitment and retention in rural communities. The influences on physician rural recruitment and retention are complex. However, telemedicine was used more frequently by the more rural physicians, and there was a relationship between higher usage and higher ratings of its value as a community support.

Suicidal behaviours in adolescents in Nova Scotia, Canada: protective associations with measures of social capital.

PurposeFew studies of adolescent suicidality have examined its associations with social capital. We explored associations of measures of individual level social capital with self-reported suicide ideation and suicide attempt in adolescents in Cape Breton, Nova Scotia, Canada, controlling for other factors known to be associated with adolescent suicidality.MethodsWe surveyed 1,597 grade 10–12 students at three high schools in 2006 using self-completion questionnaires. Both sexes were combined for analysis. Outcome measures were suicidal ideation and attempt in the previous year. Measures of social capital included perceptions of trustworthiness and helpfulness of others at school, frequency of religious attendance and participation in extracurricular activities. Logistic regressions were carried out to determine associations of social capital with suicidality while controlling for other factors.ResultsPerceived trustworthiness and helpfulness were protective for suicidal ideation and suicide attempt in the previous year. In adjusted analyses, there were interactions of gender and social capital—females reporting more social capital were more protected from suicide attempt relative to males with similar levels of social capital.ConclusionsThis study provides initial evidence of protective associations of individual level social capital with adolescent suicidality. Our findings suggest that among adolescents low social capital as measured by perceptions of trust and helpfulness of others at school may be a warning sign for suicidality, particularly for females. It may be helpful to inquire of young people how they perceive the trustworthiness and helpfulness of their school environment as a measure of how supportive that environment might be to them when they are facing challenges to their mental health.

Rates and determinants of exclusive breastfeeding in first 6 months among women in Nova Scotia: a population-based cohort study

BACKGROUND Despite compelling evidence that exclusive breastfeeding for the first 6 months of life provides important health benefits to both mothers and their infants, most mothers do not follow this practice. We conducted a study to identify predictors of early cessation of exclusive breastfeeding (before 6 months after delivery). METHODS For this population-based longitudinal cohort study, we linked data from a perinatal database and a public health database for infants born between 2006 and 2009 in 2 regions in the province of Nova Scotia, Canada. The cohort was followed from the mothers first prenatal visit until her infant was 6 months old. Hazard ratios (HRs) for early cessation of exclusive breastfeeding were determined through Cox proportional hazards regression modelling. RESULTS Overall, 64.1% (2907/4533) of the mothers in the cohort initiated breastfeeding. Only 10.4% (413/3957) exclusively breastfed for the recommended 6 months. The largest drop in exclusive breastfeeding occurred within the first 6 weeks after birth. Among the mothers who initiated breastfeeding, significant predictors of early cessation of exclusive breastfeeding identified by multivariable modelling included less than high school education (HR 1.66, 95% confidence interval [CI] 1.35-2.04), lowest neighbourhood income quintile (HR 1.35, 95% CI 1.13-1.60), single motherhood (HR 1.24, 95% CI 1.10-1.41), prepregnancy obesity (HR 1.43, 95% CI 1.23-1.65), smoking throughout pregnancy (HR 1.39, 95% CI 1.21-1.60), no early breast contact by the infant (< 1 hour after birth) (HR 1.44, 95% CI 1.29-1.62) and no intention to breastfeed (HR 1.78, 95% CI 1.44-2.16). INTERPRETATION We found that most predictors of early cessation of breastfeeding were intertwined with social determinants of health. However, we identified potentially modifiable risk factors. Providing opportunities for early breast contact by the infant and continued efforts in smoking cessation and obesity reduction may contribute to a longer duration of exclusive breastfeeding.

Associations of sexual risk-taking with having intercourse before 15 years in adolescent females in Cape Breton, Nova Scotia, Canada

BACKGROUND This study was carried out to determine whether having first vaginal intercourse before 15 years of age is independently associated with sexual risk behaviours in Canadian female adolescents aged from 15 to 19 years. METHODS Self-completion surveys which included questions about sexual risk behaviours were carried out at three high schools in Cape Breton, Nova Scotia, Canada, in May 2006. The survey also contained questions asking about socioeconomic status, substance use and depression. Associations of early intercourse with risk behaviours were assessed using unadjusted and adjusted logistic regression. RESULTS The survey response rate was 92.5%. Of the 797 females aged 15-19 years responding, 475 had had vaginal intercourse in the previous year; 132 of these (27.8%) had intercourse before the age of 15 years. In adjusted analysis, early vaginal intercourse was associated with not using a condom at last intercourse (odds ratio (OR) 2.22; 95% confidence interval (CI) 1.40-3.54), unplanned intercourse in the previous year due to substance use (OR 2.45; 95% CI 1.49-4.04), having a casual partner at last intercourse (OR 2.10; 95% CI 1.23-3.56) and having three or more partners for vaginal intercourse in the previous year (OR 5.11; 95% CI 2.86-9.14). CONCLUSIONS A history of having first intercourse before 15 years is associated with subsequent sexual risk-taking behaviours in adolescent females. These associations have clinical importance because the occurrence of early intercourse can alert health care providers to the possible presence of these risk behaviours. They also underscore the need to develop and assess programs which can delay the onset of sexual debut.