Margaret J. Penning

Adolescent Marijuana Use: A Review

The adolescent marijuana literature is reviewed. Studies show that the prevalence of marijuana use is generally quite low in elementary schools. In junior and senior high samples, findings vary greatly from place to place. The prevalence of use increased dramatically during the 1970s although the use patterns may have peaked already in some areas. The use of marijuana increases with age, but some evidence suggests that a slight drop-off in use occurs near the end of high school. Female use seems to be increasing more than male use. Use seems to be somewhat more prevalent in middle- and upper-middle-class homes and in broken homes. Mixed support has been found for the hypothesis that marijuana users have parents that are more permissive. Parents of marijuana users are generally characterized as being less warm and supportive, and more inclined toward the use of drugs themselves. Peer and sibling use of marijuana seem to be particularly important predictors of adolescent marijuana use. Findings on personality characteristics of marijuana users are not extensive and are somewhat contradictory. There is some evidence that users tend to be somewhat alienated, external in their locus of control, and possibly higher on anxiety. Users are also characterized by a higher value on independence vs achievement and more positive attitudes toward marijuana use. Behavioral correlates of marijuana use include greater use of alcohol and other drugs, and poorer school performance.

“In Sickness and in Health” Does Cohabitation Count?

Using data from the 1994-95 (Canadian) National Population Health Survey (6,494 women, 5,368 men), we investigated the impact of cohabitation on a range of physical and mental health indicators, controlling for self-selection into cohabitation and other relevant factors. Uncontrolled results indicate that the physical and mental health of cohabitors tends to fall between that of the married and the divorced/separated, widowed, and single/never married. However, when other factors are controlled, health differences between cohabitors and the currently married become nonsignificant. Self-selection, into cohabitation and into marriage, initially appears to play a significant role in accounting for variations in health, but with controls added to the models, selection mostly becomes nonsignificant. We concluded that self-selection at most may explain a small proportion of the variation in health but that protection effects are more likely to explain the positive health advantages of marriage and cohabitation.

Examining Distance Effects on Hospitalizations Using GIS: A Study of Three Health Regions in British Columbia, Canada

We examine travel distance and its effect on total and on avoidable hospitalizations, using data from three health regions in British Columbia, Canada. We conceptualize distance to hospital in geographic and socioeconomic contexts from the care seekers perspective, and develop a GIS procedure to generate variables for these contexts. The procedure includes geocoding hospital locations and patient locations to determine travel distance for each hospitalization, generating several geographic barriers such as mountain crossings, and linking patient-neighborhood locations to socioeconomic variables. The findings reveal that overall, hospitalization rates are inversely related to distance to hospital. Even though low-income patients are more likely to be hospitalized for avoidable conditions, the income effect influences different dimensions from those affected by the distance effect. A balanced approach may be needed to address issues appropriately at both the low and the high ends of physical accessibility.

Behavioural Problems and Distress among Caregivers of People with Dementia

This paper seeks to identify specific problem behaviours related to the distress experienced by informal caregivers of dementia victims. Analyses are conducted using a random sample of caregivers rather than a restricted clinical sample. Distress is measured in terms of both depression and caregiver burden. The findings reveal that specific behaviours on the part of the care receiver are strong correlates of the distress experienced by caregivers. In particular, aimlessness, aggressive behaviours, forgetfulness, and restlessness are correlated with heightened feelings of burden. Apathy or a lack of interest in daily activities is strongly correlated with both feelings of burden and depression. The identification of specific problem behaviours suggests where efforts should be placed in order to alleviate the distress experienced by informal caregivers.

Cognitive impairment, caregiver burden, and the utilization of home health services.

This study addresses the relationship between caregiver burden and the use of home health services among older adults with cognitive impairment. Analyses draw on data from personal interviews conducted with 327 older adults with cognitive impairment and living in the community of their primary caregivers. Using the Andersen-Newman framework, the results of ordinary least squares and logistic regression analyses reveal that caregiver burden and formal home health service use are only weakly related. Possible explanations for the findings are discussed.

The devil is in the details: trends in avoidable hospitalization rates by geography in British Columbia, 1990–2000

BackgroundResearchers and policy makers have focussed on the development of indicators to help monitor the success of regionalization, primary care reform and other health sector restructuring initiatives. Certain indicators are useful in examining issues of equity in service provision, especially among older populations, regardless of where they live. AHRs are used as an indicator of primary care system efficiency and thus reveal information about access to general practitioners. The purpose of this paper is to examine trends in avoidable hospitalization rates (AHRs) during a period of time characterized by several waves of health sector restructuring and regionalization in British Columbia. AHRs are examined in relation to non-avoidable and total hospitalization rates as well as by urban and rural geography across the province.MethodsAnalyses draw on linked administrative health data from the province of British Columbia for 1990 through 2000 for the population aged 50 and over. Joinpoint regression analyses and t-tests are used to detect and describe trends in the data.ResultsGenerally speaking, non-avoidable hospitalizations constitute the vast majority of hospitalizations in a given year (i.e. around 95%) with AHRs constituting the remaining 5% of hospitalizations. Comparing rural areas and urban areas reveals that standardized rates of avoidable, non-avoidable and total hospitalizations are consistently higher in rural areas. Joinpoint regression results show significantly decreasing trends overall; lines are parallel in the case of avoidable hospitalizations, and lines are diverging for non-avoidable and total hospitalizations, with the gap between rural and urban areas being wider at the end of the time interval than at the beginning.ConclusionThese data suggest that access to effective primary care in rural communities remains problematic in BC given that rural areas did not make any gains in AHRs relative to urban areas under recent health sector restructuring initiatives. It remains important to continue to monitor the discrepancy between them as a reflection of inequity in service provision. In addition, it is important to consider alternative explanations for the observed trends paying particular attention to the needs of rural and urban populations and the factors influencing local service provision.

Self-, Informal and Formal Care: Partnerships in Community-Based and Residential Long-Term Care Settings

Increasing emphasis is being placed on the need to have older adults, their families and formal service providers work together collaboratively or “in partnerships” to provide long-term care, both in community and residential care settings. There is therefore a need to determine how such relationships are currently structured. This paper systematically reviews the results of studies published from 1985 through 1998 on relationships involving self-, informal and formal care within these settings. The findings suggest that formal services are not used to displace or substitute for informal care but rather, that formal services tend to be used to supplement and complement the care provided by the informal network. This is true both in community and residential care settings. Exactly how these partnerships are structured and the relationships between self-care and both informal and formal systems of care are less clear. The findings point to a need to refocus attention away from the creation of partnerships and protecting against unnecessary substitution, towards broader concerns with supporting the partnerships that already exist.

Marital Instability After Midlife

Divorce in later life has been shown to produce dramatic declines in the economic, psychological, and physical well-being of marital partners. This study examines the prevalence and determinants of marital disruption after midlife using Beckers theory of marital instability. Using recent Canadian national data, the marital outcomes of women and men who were married as of age 40 are tracked across the remaining years of the marriage. Cox proportional hazard regression models indicate stabilizing effects of the duration of the marriage, the age at first marriage, the presence of young children, as well as of remarriage for middle-aged and older persons. Other significant risk factors include education, heterogamous marital status, premarital cohabitation, number of siblings, and region.

Bridging Policy and Research in Eldercare

A new paradigm for continuing care policy has emerged that is based on assumptions about the benefits of caring partnerships and client-centred care delivery. Such assumptions place the interface between formal and informal care squarely on the policy agenda. The authors describe how existing research can contribute to the debate stimulated by the new policy paradigm and suggest future research that is informed by the paradigm. They argue that theory is an important tool to make policy agendas more explicit and they use human ecology theory to illustrate how theory can frame the development of research to address policy. Finally, they describe barriers to be overcome in order for policy and research to inform one another. Coauthors are Janet E. Fast, Ingrid A. Connidis, Margaret Penning, and Janice Keefe.

Self-Care in Relation to Informal and Formal Care

This paper examines the prevalence, inter-relationships and correlates of various forms of self, informal and formal care. Analyses of data drawn from a random sample of 743 non-institutionalised elderly individuals living in Winnipeg, Manitoba reveal similarities as well as differences among the three types of care. Self- and formal care are somewhat similar, being positively related and having similar correlates. Nevertheless, substitutability as a consequence of medical scepticism is also evident. Both are unrelated to informal care. It is poor health in the form of functional disability and the availability of support through the marital relationship which are the strongest correlates of informal care. In contrast, health (chronic conditions and perceived health status) as well as beliefs in the efficacy of both preventative health behaviours and medical services are among the strongest correlates of self- and formal care.