Sophie Laforest

Staying connected: neighbourhood correlates of social participation among older adults living in an urban environment in Montréal, Québec

Alongside community involvement, promoting social participation has been identified as a key strategy of fostering empowerment, one of the central tenets of the health promotion movement. Engagement in social and productive activities appears to be particularly beneficial to older adults, as it has been found to be associated with positive outcomes on a variety of health indicators. It is therefore critical to identify factors that might lead to greater social participation within these age groups. The objective of this study was to investigate the relationship between perceptions of neighbourhood user-friendliness and social participation while controlling for personal characteristics in a sample of seniors living in an urban environment. A convenience sample of older adults (n = 282) was recruited through community organizations located in high- average- and low-income Montreal neighbourhoods. Data were collected via an interviewer-administered questionnaire assessing social participation and various variables at the neighbourhood level (e.g. housing and social environment, walking environment and transportation, and services and amenities) and at the individual-level (e.g. health status and socio-demographic characteristics). Five variables emerged as independent predictors of social participation. Positive predictors retained in the final regression model included frequent walking episodes (almost every day), higher Vitality and General Health SF-12v2 scores, and perceived accessibility to key resources for older adults. Also included was a negative predictor: age (R2 of the final model = 0.28). Implications of the findings for research and action pertaining to ecological, health promotion interventions for older adults are identified.

Surface characteristics, equipment height, and the occurrence and severity of playground injuries

Objectives—To evaluate whether surface characteristics (absorption level (g-max), material) and the height of play equipment are related to the occurrence and severity of injuries from falls. Setting and methods—During the summers of 1991 and 1995, conformity of play equipment to Canadian standards was assessed in a random sample (n=102) of Montreal public playgrounds. Surface absorption (g-max) was tested using a Max Hic instrument and the height of equipment was measured. Concurrently, all injuries presenting at the emergency department of Montreals two childrens hospitals were recorded and parents were interviewed. Inspected equipment was implicated in 185 injuries. The g-max measurements (1995 only) were available for 110 of these playground accidents. Results—One third of falls (35 %) occurred on a surface exceeding 200 g and the risk of injury was three times greater than for g level lower than 150 (95% confidence interval (CI) 1.45 to 6.35). On surfaces having absorption levels between 150 g and 200 g, injuries were 1.8 times more likely (95% CI 0.91 to 3.57). Injuries were 2.56 times more likely to occur on equipment higher than 2 m compared with equipment lower than 1.5 m. Analysis of risk factors by severity of injury failed to show any positive relationships between the g-max or height and severity, whereas surface material was a good predictor of severity. Conclusions—This study confirms the relationships between risk of injury, surface resilience, and height of equipment, as well as between type of material and severity of injury. Our data suggest that acceptable limits for surface resilience be set at less than 200 g, and perhaps even less than 150 g, and not exceed 2 m for equipment height. These findings reinforce the importance of installing recommended materials, such as sand, beneath play equipment.

Association between Neighborhood Active Living Potential and Walking

This paper examines the association between neighborhood active living potential and walking among middle-aged and older adults. A sample of 2,614 (61.1% women) persons aged 45 years or older and living in one of 112 census tracts in Montreal, Canada, were recruited between February and May of 2005 to participate in a 20-minute telephone survey. Data were linked to observational data on neighborhood active living potential in the 112 census tracts and analyzed through multilevel modeling. Greater density of destinations in the census tract was associated with greater likelihoods of walking for any reason at least 5 days per week for at least 30 minutes (odds ratio = 1.53, 95% confidence interval: 1.21, 1.94). Associations were attenuated but remained statistically significant after controlling for socioeconomic, health, lifestyle, and other physical activity characteristics. Sensitivity analyses showed that associations were robust across smaller and larger volumes of walking. No associations were found between dimensions of neighborhood active living potential and walking for recreational reasons. The authors conclude that a larger number and variety of neighborhood destinations in ones residential environment are associated with more walking and possibly more utilitarian walking among middle-aged or older adults.

Moving Forward in Fall Prevention: An Intervention to Improve Balance Among Older Adults in Real-World Settings

OBJECTIVES We investigated the effectiveness of a group-based exercise intervention to improve balancing ability among older adults delivered in natural settings by staff in local community organizations. METHODS The main component of the intervention consisted of biweekly group-based exercise sessions conducted over 12 weeks by a professional, coupled with home-based exercises. In a quasiexperimental design, 10 community organizations working with older adults offered the intervention to groups of 5 to 15 persons concerned about falls, while 7 organizations recruited similar groups to participate in the control arm of the study. Participants (98 experimental and 102 control) underwent balance assessments by a physiotherapist at registration and 3 months later. RESULTS Eighty-nine percent of participants attended the 3-month measurement session (n=177). A linear regression analysis showed that after adjusting for baseline levels of balance and demographic and health characteristics, the intervention significantly improved static balance and mobility. CONCLUSION Structured, group-based exercise programs offered by community organizations in natural settings can successfully increase balancing ability among community-dwelling older adults concerned about falls.

Behavior change following a self-management intervention for housebound older adults with arthritis: an experimental study

BackgroundThis study examined the impact of a home-based self-management intervention for housebound older adults with arthritis on the adoption of health behaviors. The moderating role of socio-demographic, psychological, and physical characteristics in the process of behavior change was also investigated.MethodsParticipants were 113 older adult women (n = 102) and men (n = 11) with osteoarthritis (OA) or rheumatoid arthritis (RA) who were randomly assigned to experimental (n = 68) or wait list control (n = 45) groups. Participants were interviewed using standardized questionnaires at baseline, pre-intervention, and post-intervention.ResultsAdjusted multilevel modeling analyses indicated that from pre to post intervention, experimental participants significantly increased their weekly frequency of exercise and relaxation activities. Socioeconomic status and depression played a moderating role in this change for exercise with larger effects occurring among more privileged, non-depressed participants.ConclusionWe conclude that a self-management intervention can successfully improve involvement in exercise and relaxation among housebound older adults with arthritis.

Short-Term Effects of a Self-Management Intervention on Health Status of Housebound Older Adults With Arthritis

This study examines the impact of a self-management intervention for housebound adults with arthritis and presence of moderating variables. A total of 113 adults with a mean age of 77.7 years and diagnosed with osteoarthritis (62%) or rheumatoid arthritis (38%) were randomized to intervention (n = 65) and control groups (n = 48). Information on health, self-efficacy, outcome expectations, and health behaviors was collected (a) at baseline, (b) 2 months later, and (c) following the intervention. Multilevel analysis reveals that experimental group participants reported significantly fewer functional limitations and less helplessness than control participants postintervention. A trend for improved coping effectiveness was observed (p = .06). Greater improvements in outcome expectations and physical behaviors were associated with greater decreases in helplessness. Larger improvements in outcome expectations were associated with greater decreases in functional limitations. A structured self-management intervention can have a positive impact on the health status of housebound adults with arthritis.

Implementing a Community-Based Falls-Prevention Program: From Drawing Board to Reality

Plusieurs études ont démontré,à l’aide de devis randomisés, l’efficacité de programmes de prévention des chutes destinés aux aînés vivant dans la communauté. Cependant, on connaît peu de choses quant à la faisabilité d’implanter ces programmes dans des conditions naturelles et quant à l’efficacité de ces programmes lorsqu’ils sont offerts dans de telles conditions. Les objectifs de cet article sont de: (a) décrire un programme multifactoriel de prévention des chutes (pIED) destiné à des aînés autonomes vivant dans la communauté et (b) présenter les résultats d’une analyse de la faisabilité d’une implantation du programme dans les organismes communautaires. Le programme aété implanté dans 10 organismes du milieu communautaire situés dans la région métropolitaine de Montréal dans le contexte d’une étude d’efficacité. Les résultats concernant la population recrutée et la façon dont le programme a été offert, ainsi que le niveau de participation au programme montrent qu’un programme de prévention des chutes visant plusieurs facteurs de risque peut être implanté avec succès dans des milieux communautaires. Several studies have demonstrated the efficacy of falls-prevention programs designed for community-dwelling seniors using randomized designs. However, little is known about the feasibility of implementing these programs under natural conditions and about the success of these programs when delivered under such conditions. The objectives of this paper are to (a) describe a multifactorial falls-prevention program (called Stand Up!) designed for independent community-dwelling seniors and (b) present the results of an analysis of the practicability of implementing this program in community-based settings. The program was implemented in the context of an effectiveness study in 10 community-based organizations in the Montreal metropolitan area. Data pertaining to the reach and delivery of the program as well as participation level show that a falls-prevention program addressing multiple risk factors can be successfully implemented in community-based settings.

Severity of fall injuries on sand or grass in playgrounds

Playground injuries are a major public health problem.1-3 Laboratory studies have recommended sand, pearock, synthetic materials, or wood chips as protective surfaces beneath equipment,2 and epidemiological studies have confirmed that hard surfaces are dangerous. However, some questions remain about grass.1-3 To compare the protection offered by grass and sand, public and residential playgrounds need to be considered. Most sand surfaces are in public playgrounds, while grass is used mostly at home where up to 25% of accidents occur.2 4 This study aimed at comparing the risk of severe injuries after a fall on sand or on grass. During the summers of 1991 and 1995, children aged 1 to 14, who attended the emergency department of Montreals two childrens hospitals for a fall related injury involving playground equipment, were identified (n=930). The following information was gathered during a telephone interview with the parents: age, sex, mother tongue, mothers educational level, family size, location (Island of Montreal or not), mechanism of the accident and of the injury, type of playground (home, public, other), supervision (presence of an adult), mean number of playground visits weekly, type of equipment, surface material, nature of injury and body part injured, and number of medical consultations for injuries in the past year. A 91% response rate was achieved. The nature of the injury reported was validated using information from the doctor.5 This variable represents one of our two main outcomes, and it was divided into two categories. The “fracture and head injury” category includes concussions, skull fractures, or head contusions (n=110), fractures and dislocations (n=508). All others types of injuries were grouped into the “other” category. This classification by nature of injury was added to the Abbreviated Injury Scale (AIS) where 1 corresponds to a minor injury and 6 to death,6 …

Skateparks as a health‐resource: are they as dangerous as they look?

Skateboarding raises an interesting dilemma in the field of health promotion. While public health institutions are engaged in unprecedented efforts to counter the sedentary lifestyles of youth, the promotion of lifestyle sports and active leisure practices, such as skateboarding, is tempered by the potential risks of injuries. The health‐risks associated with skateboarding have generally been viewed through the lens of epidemiology. Sociology, on the other hand, has yet to provide research on injuries that meshes with this literature. This paper addresses this absence by drawing on the works of Pierre Bourdieu to present a different perspective on the health benefits and injuries associated with skateparks. Using his concepts of ‘physical capital’ and ‘social capital’, the analysis consists of 388 days of observation (mean of 35 days in 11 skateparks) and 23 in‐depth interviews with male and female skaters in Montreal, Canada. Its findings indicate that few serious injuries occurred in these skateparks and that these spaces do not correspond to the image depicted of skateboarding in previous research. From this, we suggest that skateparks should be conceived as a valuable health‐resource for youth because they provide various social, psychological and physical resources that encourage a safe and active lifestyle.

Physical Activity Promotion Among Underserved Adolescents: “Make It Fun, Easy, and Popular”

There is a paucity of studies regarding noncurricular physical activity promotion interventions among adolescents, and even less such research pertaining to underserved youth. This article describes the development and implementation of a noncurricular, school-based physical activity promotion program designed for a multiethnic, underserved population of adolescents. The program’s impact on leisure-time physical activity (LTPA) and on physical activity enjoyment (PAE) is also presented. The 16-week program, named FunAction, utilizes social marketing principles. Control (n = 90) and intervention (n = 131) students are assessed pre- and postintervention for levels of LTPA and PAE. Results indicate that although the program did not contribute to an increase in LTPA or PAE among intervention group students, participation in the program was elevated. This study offers preliminary evidence that noncurricular physical activity promotion programs that apply social marketing principles can be effective in engaging multiethnic, underserved adolescents in physical activity.