Donna Murnaghan

A multilevel analysis examining the association between school-based smoking policies, prevention programs and youth smoking behavior: evaluating a provincial tobacco control strategy

This paper examined how smoking policies and programs are associated with smoking behavior among Grade 10 students (n = 4709) between 1999 and 2001. Data from the Tobacco Module from the School Health Action Planning and Evaluation System were examined using multilevel logistic regression analyses. We identified that (i) attending a school with smoking prevention programs only was associated with a substantial risk of occasional smoking among students with two or more close smoking friends and (ii) attending a school with both smoking prevention programs and policies was associated with substantial risk of occasional smoking among students who did not believe there were clear smoking rules present. Students attending schools where year of enrollment in high school starts in Grade 9 were more likely to be regular and occasional smokers. Each 1% increase in Grade 12 smoking rates increased the odds that a Grade 10 student was an occasional smoker. It appears that grade of enrollment, senior student smoking behavior, close friends smoking behavior and clear rules about smoking at school can impact school-based tobacco control programming. These preliminary study findings suggest the need for further research targeting occasional smoking behavior and the transition stage into high school.

Predictors of physical activity, healthy eating and being smoke-free in teens: a theory of planned behaviour approach.

This paper elicited context specific underlying beliefs for physical activity, fruit and vegetable consumption and smoke-free behaviour from the Theory of Planned Behaviour (TPB), and then determined whether the TPB explained significant variation in intentions and behaviour over a 1 month period in a sample of grade 7–9 (age 12–16 years) adolescents. Eighteen individual interviews and one focus group were used to elicit student beliefs. Analyses of this data produced behavioural, normative and control beliefs which were put into a TPB questionnaire completed by 183 students at time 1 and time 2. The Path analyses from the main study showed that the attitude/intention relationship was moderately large for fruit and vegetable consumption and small to moderate for being smoke free. Perceived behavioural control had a large effect on being smoke free and a moderately large effect for fruit and vegetable consumption and physical activity. Intention had a large direct effect on all three behaviours. Common (e.g. feel better, more energy) and behaviour-specific (e.g., prevent yellow fingers, control my weight) beliefs emerged across the three health behaviours. These novel findings, to the adolescent population, support the importance of specific attention being given to each of the behaviours in future multi-behavioural interventions.

Use of contraband cigarettes among adolescent daily smokers in Canada

Current tobacco-control strategies seek to inhibit and reduce smoking among adolescents. However, such strategies are probably undermined by the contraband tobacco market. Using data from Canada’s 2006/2007 Youth Smoking Survey, we found that 13.1% of respondents who were daily smokers reported that contraband cigarettes were their usual brand. They consumed significantly more cigarettes than respondents who smoked other brands. Contraband cigarettes accounted for about 17.5% of all cigarettes smoked by adolescent daily smokers in Canada overall, and for more than 25% in the provinces of Ontario and Quebec.

The influence of student-level normative, control and behavioral beliefs on staying smoke-free: An application of Ajzen's theory of planned behavior

This study, the first to examine the utility of the Theory of Planned Behavior (TPB) in explaining intentions and behavior to remain smoke-free, generated smoke-free related beliefs in adolescents and examined their association to the TPB global constructs (i.e., attitudes, subjective norm, perceived behavioral control (PBC), intention, and behavior) 1 month later in a population of intermediate students (N = 214) in Prince Edward Island, Canada. The results showed that intentions to remain smoke-free were significantly predicted by attitudes and PBC, whereas smoke-free behavior was determined by PBC. From a global TPB perspective, PBC appears to be the dominant variable within the TPB framework on which to guide a smoke-free adolescent intervention. These results have the potential to inform new interventions that address remaining smoke-free that are relevant to adolescents. However, the preliminary nature of these findings warrant further study before any firm conclusions can be drawn.

The prevalence of eating behaviors among Canadian youth using cross-sectional school-based surveys

BackgroundObesity is a growing public health concern in Canada. Excess weight is particularly a concern among youth given that obesity in youth predicts obesity in adulthood. Eating behaviors, both inside and outside the home have been associated with increased risk of obesity; however, there is little data among Canadian youth to monitor trends.MethodsThe School Health Action, Planning and Evaluation Surveys (SHAPES) were administered in schools. Our study examined 20, 923 students (grades 5-12) from four regions in Canada. The regions were Hamilton and Thunder Bay (both in Ontario), the Province of Prince Edward Island, and the Province of Quebec.ResultsConsuming breakfast daily was reported by 70% of grade 5-8 students, and 51% of grade 9-12’s. Among students in grade 9-12, 52% reported eating with family members daily, compared with 68% in grade 5-8. Just over half of students in grade 5-8, and 70% in grade 9-12 reported eating at a fast-food place once a week or more. Among grade 5-8 students 68% reported eating in front of the television at least once per week, compared to 76% in grade 9-12. Obese students were more likely to watch TV while eating, and less likely to eat with a family member and eat breakfast.ConclusionsThe findings suggest that only a modest proportion of youth report dietary patterns that have previously been associated with healthy eating and reduced risk of obesity. Later adolescence may be a critical time for intervention in health-related behaviors.

Evaluating the Impact of a North American Nursing Exchange Program on Student Cultural Awareness

As the demand for cultural awareness in the provision of nursing care continues to increase, nursing programs must develop creative and effective teaching strategies and curricula to address this need. The evaluation of a five year, funded, North American nursing exchange project developed and implemented by six partner universities in Canada, Mexico and the United States of America is described in this article. The project was designed to enable nursing students to increase cultural awareness, redefine their role relationships with nurses from the partner countries, and increase knowledge regarding the health care systems and role of the nurse in those countries. Findings provide evidence that teaching nursing through a prism of cultural awareness, using both a jointly taught online course and student and faculty exchanges across the three countries is an effective strategy to increase the level of cultural awareness in nursing students.

Cigarette brand preference as a function of price among smoking youths in Canada: are they smoking premium, discount or native brands?

Introduction: Given that little is known about the price-related cigarette brand preferences of youths, the current study seeks to characterise cigarette brand preferences and examine factors associated with smoking discount or native cigarette brands among Canadian youths who are current smokers. Methods: This study used nationally representative data collected from 71 003 grade 5–12 students as part of the 2006–7 Canadian Youth Smoking Survey (YSS). Using data from current smokers, logistic regression models were used to examine factors associated with smoking discount or native cigarette brands relative to premium cigarette brands. Results: In 2006, premium cigarettes were the most prevalent brand of cigarette youths report usually smoking (49.4%); a substantial number of youths do report usually smoking either discount (12.9%) or native (9.3%) cigarette brands. Occasional smokers were more likely to report usually smoking premium cigarettes whereas daily smokers were more likely to report smoking either discount or native cigarettes. In particular, discount and native brands appear to be appealing among smoking youths with less spending money or those who are heavier smokers compared to youths smoking premium brands. Conclusion: Discount and native cigarette brands are commonly used by a substantial number of smoking youths in Canada. Additional research is required to better understand the reasons behind different cigarette brand preferences and how youths are able to access premium, discount and illicit native cigarettes. Moreover, ongoing surveillance of the cigarette brand preferences of youths is required for guiding future tobacco control policy and programming activities.

Sugar-Sweetened Beverage Consumption among a Subset of Canadian Youth.

BACKGROUND Sugar-sweetened beverages (SSBs) may play a role in increased rates of obesity. This study examined patterns and frequencies of beverage consumption among youth in 3 distinct regions in Canada, and examined associations between beverage consumption and age, sex, body mass index (BMI), physical activity and dieting behavior, as well as beverage displacement. METHODS The study included data from 10,188 youth (ages 13-18) from Hamilton and Thunder Bay, Ontario, and Prince Edward Island (PEI) in 2009 to 2010. The study used in-school self-reported surveys with 12 questions regarding beverage consumption during the previous day, along with self-reported height, weight, physical activity levels, and demographic information. Logistic regression analyses were conducted to examine variables associated with SSB intake. RESULTS Overall, 80% of youth consumed at least 1 SSB in the previous day, with 44% consuming 3 or more SSBs. Youth in Thunder Bay consumed significantly more SSBs than Hamilton and PEI, and youth in Hamilton consumed more SSBs than PEI. Boys consumed significantly more SSBs than girls. Older and more physically active youth consumed significantly fewer SSBs. No significant association between BMI and SSB consumption was observed in any model. A modest positive correlation was identified between SSB consumption and milk (r = .06, p < .001) and 100% fruit juice (r = .10, p < .001). CONCLUSIONS A large proportion of youth consumed SSBs, many at high levels. Research evaluating SSB policy and interventions should be considered a priority.

Exploring nursing roles across North American borders

Professional nurses are challenged by the increasing complexity of their own healthcare delivery systems and by the growing interconnectivity of healthcare systems worldwide. There are increasing calls for practice across boundaries; however, the role and scope of nursing practice within individual countries are often unclear, ill-defined, and misunderstood by nurses from other countries. In this collaborative educational project among six schools of nursing located in Canada, México, and the United States, nursing students and faculty are exploring the role of the nurse within each countrys healthcare system while striving to develop their multicultural awareness. Participating faculty describe the process, challenges, and keys to success found in creating and living this international project. They share strategies for addressing challenges, which included meeting deadlines, time differences, differing academic schedules, writing joint documents in two languages, designing and presenting a shared course, and creating an exchange process between the six partner schools. They describe the evolution of their working relationships, the language challenges, and the joy of coming together as newfound colleagues and friends.

Distinct trajectories of light and moderate to vigorous physical activity in heart disease patients: Results from the Activity Correlates afTer cardIac hospitalizatiON (ACTION) trial

OBJECTIVES Research suggests that light and moderate to vigorous physical activity (MVPA) has beneficial effects concerning longevity in heart disease patients. Yet, very little is known about the physical activity trajectories of patients who do not attend cardiac rehabilitation programs and whether the demographic/clinical predictors of these trajectories are similar for light and MVPA. DESIGN Longitudinal. METHODS Patients (N=269) completed a questionnaire assessing demographic, clinical, and physical activity variables at baseline, three, six, nine, and 12 months after hospitalization for heart disease. Charts were reviewed for height, weight and clinical diagnosis. RESULTS Latent class growth analyses showed two classes of patients emerged for light physical activity (i.e., patients who remained inactive and patients whose physical activity levels significantly declined) and MVPA (i.e., patients whose physical activity significantly increased and patients whose activity levels significantly decreased). Light intensity class membership was predicted by diagnosis (OR=2.22), whereas MVPA class membership was predicted by gender (OR=.15). Finally, dual trajectory analyses showed that patients whose activity levels declined for one intensity had a high probability of transitioning into the declining group for the other intensity. CONCLUSIONS Physical activity trajectories for heart disease patients vary as a function of intensity as do the demographic/clinical predictors of these trajectories.