Nazeem Muhajarine

Factors That Influence Physical Activity Participation Among High- and Low-SES Youth:

Researchers have rarely addressed the relationship between socioeconomic status (SES) and physical activity fromthe perspective of youth. To illuminate the factors that youth fromlowand high-SES areas consider important to increase physical activity participation among their peers, 160 youth (12-18 years) participated in small focus group interviews. Guiding questions centered on the general theme, “If you were the one in charge of increasing the physical activity levels of kids your age, what would you do?” Findings show that environmental factors (i.e., proximity, cost, facilities, and safety) are very important for youth living in low-SES areas to ensure participation in physical activity. Results also show that intrapersonal (i.e., perceived skill, competence, time) and social factors (i.e., friends, adult support) must be considered to help improve participation rates among both high- and low-SES youth.

Effectiveness of Home Visiting Programs on Child Outcomes: A Systematic Review

BackgroundThe effectiveness of paraprofessional home-visitations on improving the circumstances of disadvantaged families is unclear. The purpose of this paper is to systematically review the effectiveness of paraprofessional home-visiting programs on developmental and health outcomes of young children from disadvantaged families.MethodsA comprehensive search of electronic databases (e.g., CINAHL PLUS, Cochrane, EMBASE, MEDLINE) from 1990 through May 2012 was supplemented by reference lists to search for relevant studies. Through the use of reliable tools, studies were assessed in duplicate. English language studies of paraprofessional home-visiting programs assessing specific outcomes for children (0-6 years) from disadvantaged families were eligible for inclusion in the review. Data extraction included the characteristics of the participants, intervention, outcomes and quality of the studies.ResultsStudies that scored 13 or greater out of a total of 15 on the validity tool (n = 21) are the focus of this review. All studies are randomized controlled trials and most were conducted in the United States. Significant improvements to the development and health of young children as a result of a home-visiting program are noted for particular groups. These include: (a) prevention of child abuse in some cases, particularly when the intervention is initiated prenatally; (b) developmental benefits in relation to cognition and problem behaviours, and less consistently with language skills; and (c) reduced incidence of low birth weights and health problems in older children, and increased incidence of appropriate weight gain in early childhood. However, overall home-visiting programs are limited in improving the lives of socially high-risk children who live in disadvantaged families.ConclusionsHome visitation by paraprofessionals is an intervention that holds promise for socially high-risk families with young children. Initiating the intervention prenatally and increasing the number of visits improves development and health outcomes for particular groups of children. Future studies should consider what dose of the intervention is most beneficial and address retention issues.

Neighborhood characteristics in relation to diet, physical activity and overweight of Canadian children

BACKGROUND Neighborhood infrastructure may provide an important opportunity to prevent overweight among children. In the present study we investigated whether access to shops for modestly priced fresh produce, access to parks and playgrounds, access to recreational facilities and neighborhood safety are related to childrens diet, physical and sedentary activities, and body weights. METHODS Data were obtained from the Childrens Lifestyle and School-performance Study, a survey including 5,471 grade five students and their parents in the province of Nova Scotia, Canada. Students completed the Harvard Food Frequency Questionnaire and had their height and weight measured. Parents completed questions on socio-economic background and how they perceived their neighborhood. We applied multilevel regression methods to relate these neighborhood characteristics with childrens fruit and vegetable consumption, dietary fat intake, diet quality, frequency of engaging in sports with and without a coach, screen time, overweight and obesity. RESULTS Children in neighborhoods with greater perceived access to shops had healthier diets and were less likely to be overweight or obese. Children in neighborhoods with good access to playgrounds, parks and recreational facilities were reportedly more active and were less likely to be overweight or obese, whereas children in safe neighborhoods engaged more in unsupervised sports. CONCLUSIONS The study demonstrated associations between neighborhood characteristics, health behaviors and childhood overweight. This contributes to the knowledge base that is still too narrow to justify informed preventative public health policy. We advocate the evaluation of natural experiments created by new policy that affect neighborhood infrastructures as the optimal opportunity to enlarge this knowledge base.

Comparison of Survey and Physician Claims Data for Detecting Hypertension

Using linked data from the Manitoba (Canada) Heart Health Survey (MHHS) and physician service claims files we assessed the degree to which self-reported hypertension and clinically measured hypetension agreed with physician claims hypertension, and examined the likely sources of disagreement. The overall agreement between survey and claims data for hypertension detection was moderate to high: 82% (kappa = 0.56) for self-reported and physician claims hypertension, and 85% (kappa = 0.60) for clinically measured and physician claims hypertension. In the comparison between self-report and physician claims, those who were classified as obese, diabetic, or a homemaker were significantly more likely to have a hypertension measure not confirmed by the other. Disagreement between clinically measured and physician claims was also more common among the obese and homemakers, as well as those on medication for heart diseases, elevated cholesterol levels (LDL), and 35 years of age and older. The high overall level of agreement among these three measures suggest that each may be used with confidence as an indication of hypertension; however, the agreement appears lower among individuals presenting a more complicated clinical profile.

Beyond the divides: Towards critical population health research

The term ‘population health’ has supplanted that of public health and health promotion in many Anglophone countries. The ideas underlying the term are not new and owe much to the legacies of nineteenth-century public health radicalism, Latin American social medicine and, more recently, social epidemiology. Its influential modeling by the Canadian Institute for Advanced Research in the early 1990s, however, was criticized for a lack of theory, reliance on large data sets, a simplistic modeling of the healthcare/economy relationship, little attention to the physical environment and an absence of human agency. While researchers working under the rubric of population health have addressed many of these early limitations, there has yet to be an articulation of what comprises a critical population health research practice. This article, based on the discussions and work of an interdisciplinary group of researchers in the Saskatchewan Population Health and Evaluation Research Unit (SPHERU) in Canada, argues that such a practice proceeds from a theoretical engagement (theories of knowledge, society and social change), community engagement (a politicization of research knowledge) and policy engagement (which must extend beyond the simplistic notions of ‘knowledge translation’ that now permeate the research communities). A critical population health research practice, it concludes, is a moral praxis built upon explicit social values and analyses.

Patterns of depression and treatment in pregnant and postpartum women.

Objective: To determine the course of depression and the effects of treatment during pregnancy and into the postpartum period. Method: This is a longitudinal study of a community sample of 649 pregnant women who were assessed in early pregnancy (17.4 ± 4.9 weeks), late pregnancy (30.6 ± 2.7 weeks), and postpartum (4.2 ± 2.1 weeks) with the Edinburgh Postnatal Depression Scale (EPDS). Women who scored 12 or more on the EPDS were encouraged to seek assessment and treatment. We used generalized estimating equation modelling to determine the predicted mean depression scores, taking age, ethnicity, history of depression, and previous and present treatment status into account. Results: The unadjusted prevalence of depression (EPDS ≥ 12) was 14.1% (n = 91) in early pregnancy, 10.4% (n = 62) in late pregnancy, and 8.1% (n = 48) postpartum. Twelve per cent of women were engaged in treatment. The predicted mean EPDS score decreased over the course of the pregnancy into the postpartum period, most significantly when women were engaged in counselling or taking psychotropic medication. Counselling was the more common method of treatment during pregnancy and medication in the postpartum period. Women who were depressed and untreated were more likely to be younger, more stressed, have less support, have a history of depression, and use alcohol. Conclusions: We confirm that depressive symptoms improve over the course of the pregnancy into the postpartum period, particularly for women who receive treatment. Our study is unique as it takes the history of depression, present and past treatment status, and the longitudinal nature of the data into account.

The community and consumer food environment and children’s diet: a systematic review

BackgroundWhile there is a growing body of research on food environments for children, there has not been a published comprehensive review to date evaluating food environments outside the home and school and their relationship with diet in children. The purpose of this paper is to review evidence on the influence of the community and consumer nutrition environments on the diet of children under the age of 18 years.MethodsOur search strategy included a combination of both subject heading searching as well as natural language, free-text searching. We searched nine databases (MEDLINE, Web of Science, CINAHL, Embase, Scopus, ProQuest Public Health, PsycINFO, Sociological Abstracts, and GEOBASE) for papers published between 1995 and July 2013. Study designs were included if they were empirically-based, published scholarly research articles, were focused on children as the population of interest, fit within the previously mentioned date range, included at least one diet outcome, and exposures within the community nutrition environment (e.g., location and accessibility of food outlets), and consumer nutrition environment (e.g., price, promotion, and placement of food choices).ResultsAfter applying exclusion and inclusion criteria, a total of 26 articles were included in our review. The vast majority of the studies were cross-sectional in design, except for two articles reporting on longitudinal studies. The food environment exposure(s) included aspects of the community nutrition environments, except for three that focused on the consumer nutrition environment. The community nutrition environment characterization most often used Geographic Information Systems to geolocate participants’ homes (and/or schools) and then one or more types of food outlets in relation to these. The children included were all of school age. Twenty-two out of 26 studies showed at least one positive association between the food environment exposure and diet outcome. Four studies reported only null associations.ConclusionsThis review found moderate evidence of the relationship between the community and consumer nutrition environments and dietary intake in children up to 18 years of age. There is wide variation in measures used to characterize both the community and consumer nutrition environments and diet, and future research should work to decrease this heterogeneity.

Social role occupancy, gender, income adequacy, life stage and health: a longitudinal study of employed Canadian men and women.

Social role researchers are increasingly going beyond simply asking whether role occupancy is associated with health status to clarifying the context in which particular social role-health relationships emerge. Building on this perspective, the present study investigates the relationship between social role occupancy and health status over time in a sample of employed Canadian men and women who vary by family role occupancy, life stage, and income adequacy. Results indicated that compared to triple role women (defined as those who are married, have children living at home and are in the workforce), single and double role occupants in 1994/95 were significantly more likely to report poorer self-rated health and the presence of a chronic health condition in 1996/97. This relationship held true for women in varying life stage and economic circumstances. While family role occupancies were not as strongly related to the health status of men as women, one exception emerged: for older men, single and double role occupants reported significantly poorer self-rated health status than triple role men. Methodological limitations of the study are discussed, and the need for added specificity in the study of social roles and health status emphasized.

Nausea and vomiting of pregnancy: prevalence, severity and relation to psychosocial health.

Purpose:Symptoms of nausea and vomiting are commonly experienced during early pregnancy (nausea and vomiting of pregnancy or NVP) and have been associated with stress, anxiety, and depression in pregnancy. However, nausea and vomiting in late pregnancy is a little-studied phenomenon. The purpose of our study was to examine the prevalence, severity, and psychosocial determinants of NVP during early and late pregnancy. Study Design and Methods:Data were originally from a longitudinal and epidemiological study of depression in pregnancy and postpartum in a cohort of 648 Canadian women conducted from 2005 to 2008. Measures included the Nausea and Vomiting in Pregnancy Instrument (NVPI), the Cambridge Worry Scale (CWS), and the Edinburgh Postnatal Depression Scale (EPDS). Demographic, maternal/obstetrical, psychological, and behavioral variables related to NVP were also examined. Odds ratios and 95% confidence intervals were calculated for all risk factors investigated using multiple logistic regression, controlling for potential confounders. Results:The prevalence of NVP was 63.3% (n = 551) at Time 1 (early pregnancy) and 45.4% (n = 575) at Time 2 (late pregnancy). Severity of symptoms was associated with earlier gestation, antiemetic medication use, employment status, and symptoms of major depression. Maternal smoking and having the support of three or more persons were protective for NVP. Clinical Implications:This study suggests that screening for NVP should be ongoing throughout pregnancy and measures that address NVP, poor social support, and depression are warranted. Further research is needed in regard to effective management of this very common and distressing condition.

Youth and Adolescent Physical Activity Lapsers: Examining Self-efficacy as a Mediator of the Relationship between Family Social Influence and Physical Activity

The present study examined whether self-efficacy mediates the relationship between family social influence and physical activity among youth who have experienced a recent lapse in their physical activity participation. Using a prospective, longitudinal design, participants completed measures of social influence, self-regulatory efficacy and physical activity. Only those participants whose physical activity declined were retained for further analysis. Self-regulatory efficacy partially mediated the relationship between family social influence and physical activity, with self-efficacy mediating 36 percent of the total effect. The results provide support for self-regulatory efficacy as a mediator and provide preliminary insight into the potential mechanisms for preventing lapses in activity from developing into prolonged periods of inactivity within this population.