Louise Bouchard

Public Perception of Population Health Risks in Canada: Health Hazards and Sources of Information

ABSTRACT A national survey of health risk perception among 1,503 Canadians was conducted in 2004. The current survey follows-up a previous national survey conducted in 1992 and documents changes in risk perception since that time and investigates new risk issues not previously examined. This article presents a description of the ratings of perceived risk of thirty specific hazards to the Canadian population, sources of information about health issues and risk, and confidence in these information sources. Of the specific hazards considered, behavioral risks such as cigarette smoking, obesity, and unprotected sex were seen to present the greatest risk to the health of Canadians. Hazards related to the social environment (e.g., homelessness, street crime, unemployment) were seen as posing moderately high health risks. Medical devices or therapies (e.g., prescription drugs, vaccines, laser eye surgery) tended to rank the lowest in terms of health risk. Women, older respondents, and those with less education reported risks as being higher than men, younger respondents, and those with more education respectively. Large geographical differences in risk perception were also observed. Participants described receiving “a lot” of information from the news media, medical doctors, and the Internet but reported the greatest amount of confidence in medical doctors, university scientists/scientific journals, and health brochures/pamphlets.

Prevention and genetic testing for breast cancer: variations in medical decisions

The discovery linking the genes BRCA1&2 to familial breast cancer played an important role in the clinical practice of geneticists and physicians. The availability of genetic tests for BRCA gene mutations prompted cancer geneticists to give information about genetic risk and to assess many women with a personal or family history of breast or ovarian cancer to inform them of preventive measures. These consist mainly of breast self-examination, mammography screening, chemoprevention and prophylactic surgery (mastectomy, oophorectomy). This paper examines clinical practices related to hereditary breast cancer testing and introduces a number of results from a survey carried out, between 1996 and 1998, in three clinics located in Montreal (Quebec, Canada), Marseilles (France) and Manchester (Great Britain). Results show substantial differences in the way cancer geneticists deal with environmental risk factors, breast and ovarian cancer testing, and chemoprevention and prophylactic surgery. Differences across cities persist in the multivariate analysis, suggesting that attitudes towards preventive measures may be partially explained by cultural factors. Different dimensions of culture are discussed including the social representation of health and risk, the interpretation of scientific evidence and the role of innovation leadership.

The structure of Canadians' health risk perceptions: Environmental, therapeutic and social health risks

Abstract Numerous studies have examined health risk perception through public ratings of health hazards, comparing them across lists, across time or across subpopulations. Yet, few have unveiled peoples mental organization and representation of the factors affecting health risk. In order to better understand how the construct of health risk is conceptualized by the public, a principal components analysis was conducted on data from a previous national survey in which Canadians rated a series of hazards with respect to perceived level of health risk. Canadians conveyed their concerns as falling into three broad components: Environmental (e.g., nuclear waste, PCBs or Dioxins, etc.), Therapeutic (e.g., contact lenses, medical X-rays, etc.), and Social health risks (e.g., motor vehicle accidents, street crime, etc.). Generally, hazards perceived as posing the most health risk were those belonging to Social health risks. Perceptions of Environmental, Therapeutic and Social health risks were higher among women, respondents with lower education or income, and among residents of Québec. Results are discussed in relation to the population health approach (Evans et al. 1994), in which the physical environment, biology, lifestyle, social environment and health care represent major determinants of the health of populations and population subgroups.

Beyond the Hazard: The Role of Beliefs in Health Risk Perception

ABSTRACT This article addresses how beliefs about health risks cluster and how these relate to perceptions of risk among Canadians. A principal components analysis conducted on items reflecting various beliefs from the Canadian National Health Risk Perception Survey extracted four underlying dimensions: Cancer Dread, Trust in Regulators, Environmental Concern, and Personal Agency. Factor scores were then used to investigate relationships between belief factors and the perceived health risk of various hazards with gender, education, income, and province of residence as covariates. Environmental and Therapeutic health risk perceptions were significantly higher in respondents with high Cancer Dread and high Environmental Concern, but lower in respondents with high Trust in Regulators. Environmental health risk perceptions were lower in respondents with high Personal Agency, whereas Social health risk perceptions were higher in respondents with high Cancer Dread and Personal Agency. Results suggest that information about health risk–related beliefs can be useful in improving our understanding of the publics perceived risk of health hazards.

Research on health inequalities: A bibliometric analysis (1966–2014)

The objective of this study is to report on research production and publications on health inequalities through a bibliometric analysis covering publications from 1966 to 2014 and a content analysis of the 25 most-cited papers. A database of 49,294 references was compiled from the search engine Web of Science. The first article appears in 1966 and deals with equality and civil rights in the United States and the elimination of racial discrimination in access to medical care. By 2003, the term disparity has gained in prominence relative to the term inequality which was initially elected by the researchers. Marmots 1991 article is one of the five papers with the largest number of citations and contributes to the central perspective of social determinants of health and the British influence on the international status of research on social inequalities of health.

Public perception of population health risks in Canada: Health hazards and health outcomes

The focus of this article is a descriptive account of the perceptions of five health hazards (motor vehicles, climate change, recreational physical activity, cellular phones, and terrorism) and five health outcomes (cancer, long-term disabilities, asthma, heart disease, and depression) from a recent survey of 1503 Canadians. In an attempt to shed light on factors that influence risk perception in Canada, the extent to which these exemplars are perceived as high in risk and controllability, as well as the extent to which knowledge and uncertainty surrounding them is high, was examined. The degree to which these exemplars are deemed acceptable and generate worry among Canadians was also examined. Variation was observed in the extent to which different health hazards and outcomes are perceived on the various dimensions. Perceptions of health hazards and outcomes also vary significantly by gender, age, and education. Findings are compared to existing research on risk perception.

Public perception of population health risks in Canada: Risk perception beliefs

A national survey of health risk perception among 1,503 adult Canadians was conducted in 2004 as a follow-up to a previous survey in 1992. Respondents were asked to indicate their personal opinion regarding a range of risk perception belief statements reflecting environmental concern, social concern, genetic concern, dependence on regulators, locus of health risk control (internal, powerful others, chance), risk acceptability and technological enthusiasm. The results indicated considerable concern over the state of the environment in general, however, less concern existed for the environment nearest to the individual. A high degree of concern was expressed over stress in the workplace, and poverty was perceived to represent an important health risk for Canadians. A strong sense of the importance of personal lifestyle factors and personal control over ones health was also observed as were notable increases in trust and dependence on the ability of government and experts to make decisions and regulate health risks in Canada as compared to the previous survey. Belief statements reflecting environmental and social concern correlated with the level of risk perceived for a variety of health hazards and outcomes.

Watching the Race to Find the Breast Cancer Genes

This article focuses on a crucial development in genetic research that occurred in the 1990s: the identification of the first two of the genes responsible for hereditary breast and ovarian cancer (BRCA1 and BRCA2). Issues addressed touch on the evolution of the subfield, its potential impact on cancer treatment, and industry involvement. The article follows the activities of the various research groups competing in the race to identify the genes and depicts the frequent conflicts between them. Data are derived chiefly from a bibliometric database. The results show a diversity of research practices. Industrial researchers interacted within far more tightly knit networks than their counterparts working in public organizations. The patenting and commercial exploitation of results led to fierce battles, with one group capturing most of the benefits.

Methodological Issues in Analyzing Small Populations Using CCHS Cycles Based on the Official Language Minority Studies

Statistical analyses for small populations or small domains of interest can be challenging. To obtain reliable estimates, only very large surveys such as the Canadian Community Health Survey can be considered. However, despite its good geographical and temporal coverage, the analysis of small populations in smaller regions (e.g., health regions) and in regards to specific health issues remains challenging. We will look at the methodological issues in analysis of small populations in relation to sampling and non-sampling survey errors that affect the precision and accuracy of the estimates. Francophone minorities in Canada will be used to illustrate the issues throughout the paper.RésuméLes analyses statistiques pour les petites populations ou petits domaines d’intérêt peuvent constituer un défi. Pour obtenir des estimations fiables, seules les très grandes enquêtes telles que l’Enquête sur la santé dans les collectivités canadiennes peuvent être considérées. Toutefois, en dépit de sa couverture géographique et temporelle, l’analyse de petites populations au niveau des régions (régions sociosanitaires par exemple) et en ce qui concerne les questions de santé spécifiques, reste difficile. Nous nous pencherons sur les questions méthodologiques de l’analyse de petites populations en ce qui concerne les erreurs d’enquête (échantillonnage et non dues à l’échantillonnage) qui influent sur la précision et l’exactitude des estimations. La population francophone en situation minoritaire au Canada sera utilisée pour illustrer ces problèmes.

Le surplus de poids chez les francophones et les anglophones

RésuméObjectifsDes études récentes rapportent une prévalence d’embonpoint et d’obésité plus élevée chez les francophones en situation linguistique minoritaire en comparaison à la majorité anglophone du Canada. L’objectif de l’étude est de vérifier si l’appartenance au groupe linguistique minoritaire s’ajoute aux déterminants sociaux du surplus de poids.MéthodeLes statistiques descriptives (n=128 986), provenant de cinq cycles de l’Enquête sur la santé dans les collectivités canadiennes, ont été croisées en fonction de la langue et du sexe des individus. Deux modèles de régression logistique multivariée, pour les hommes et pour les femmes, ont permis de tester l’association entre le surplus de poids et la langue en contrôlant pour les déterminants socioéconomiques et comportementaux.RésultatsLa prévalence du surplus de poids est plus élevée chez les francophones que chez les anglophones de l’Ontario, bien que cette différence ne soit plus significative lorsque le modèle est ajusté pour les caractéristiques socioéconomiques et comportementales. Néanmoins, les francophones sont plus âgés, moins éduqués et vivent davantage en milieu rural que leurs homologues anglophones, un contexte qui les rend plus vulnérables.ConclusionL’étude vient réaffirmer le rôle des déterminants sociaux et comportementaux dans la prévalence du surplus de poids. Bien que la langue n’influence pas directement le surplus de poids, compte tenu de la réalité socioéconomique de la minorité francophone, représentée en plus grande proportion dans les strates de la population plus vulnérable au surplus de poids, l’appartenance à un groupe minoritaire devrait interpeller les planificateurs de la santé.AbstractObjectivesRecent studies show a higher prevalence of being obese or overweight in Francophones living in minority settings compared to Canada’s Anglophone majority. The objective of our study was to determine whether belonging to the linguistic minority constituted a social determinant of having a weight problem.MethodsDescriptive variables (n=128,986) from five cycles of the Canadian Community Health Survey were stratified by respondents’ language and sex. Two logistic regression models tested the association between being overweight/obese (as defined by the measure of body mass index) and language, for men and women, while adjusting for social and behavioural determinants.ResultsPrevalence of excess weight was higher among Francophones compared to Anglophones of Ontario, although the difference was not significant after adjustment for socio-economic and behavioural determinants. However, Francophones were older, less educated and more likely to live in rural areas than their Anglophone counterparts, a situation which makes them more vulnerable.ConclusionThe study confirms the role of social and behavioural determinants of being obese/overweight. Although language does not have a direct influence on having a weight problem, the socio-economic reality of the Francophone minority makes them more likely than the Anglophone majority to fall in vulnerable strata of the population with regards to being overweight/obese. This situation should be considered when planning health services.