How perceptions of community environment influence health behaviours: using the Analysis Grid for Environments Linked to Obesity Framework as a mechanism for exploration

INTRODUCTION

Overweight and obesity are influenced by a complex interplay of individual and environmental factors that affect physical activity and healthy eating. Nevertheless, little has been reported on people's perceptions of those factors. Addressing this critical gap and community partner needs, this study explored how people perceived the influence of micro- and macroenvironmental factors on physical activity and healthy eating.

METHODS

Community partners wanted the study results in a format that would be readily and easily used by local decision makers. We used photovoice to engage 35 community members across four municipalities in Alberta, Canada, and to share their narratives about their physical activity and healthy eating. A combination of inductive and deductive analysis categorized data by environmental level (micro vs. macro) and type (physical, political, economic, and sociocultural), guided by the Analysis Grid for Environments Linked to Obesity Framework.

RESULTS

Participants conceptualized health-influencing factors more broadly than physical activity and healthy eating to include "community social health." Participants spoke most often about the influence of the microenvironment (n = 792 ANGELO Framework coding tallies) on their physical activity, healthy eating and community social health in comparison to the macroenvironment (n = 93). Photovoice results provided a visual narrative to community partners and decision makers about how people's ability to make healthy choices can be limited by macroenvironmental forces beyond their control.

CONCLUSION

Focussing future research on macro- and microenvironmental influences and localized community social health can inform practice by providing strategies on how to implement healthy changes within communities, while ensuring that research and interventions echo diverse people's perceptions.

Retrospective and prospectively assessed childhood adversity in association with major depression, alcohol consumption and painful conditions

BACKGROUND

Considerable evidence now links childhood adversity to a variety of adult health problems. Unfortunately, almost all of these studies have relied upon retrospective assessment of childhood events, creating a vulnerability to bias. In this study, we sought to examine three associations using data sources that allowed for both prospective and retrospective assessment of childhood events.

METHODS

A 1994 national survey of children between the ages of 0 and 11 collected data from a 'person most knowledgeable' (usually the mother) about a child. It was possible to link data for n = 1977 of these respondents to data collected from the same people in a subsequent adult study. The latter survey included retrospective reports of childhood adversity. We examined three adult health outcomes in relation to prospectively and retrospectively assessed childhood adversity: major depressive episodes, excessive alcohol consumption and painful conditions.

RESULTS

A strong association between childhood adversities (as assessed by both retrospective and prospective methods) and major depression was identified although the association with retrospective assessment was stronger. Weaker associations were found for painful conditions, but these did not depend on the method of assessment. Associations were not found for excessive alcohol consumption irrespective of the method of assessment.

CONCLUSIONS

These findings help to allay concerns that associations between childhood adversities and health outcomes during adulthood are merely artefacts of recall bias. In this study, retrospective and prospective assessment strategies produced similar results.

Validity evidence for the back beliefs questionnaire in the general population

BACKGROUND

Despite common usage of the back beliefs questionnaire (BBQ) in a variety of studies, important validity evidence is missing. The objective of this study was to examine the validity of the BBQ in the general population.

METHODS

A population-based, cross-sectional study design was used. Adult residents in two Canadian provinces were randomly sampled. To examine structural validity, items from the BBQ were subjected to factor analysis. Construct validity was tested by examining two hypotheses: BBQ scores would be most pessimistic in those with a recent history of back pain and in those who utilized passive treatments for back pain. Multiple linear regression was used to analyse the two hypotheses.

RESULTS

Complete data were available for 6171 subjects. The best structure for the BBQ was to use eight or nine of the 14 items for scoring, which is consistent with the structure reported by the BBQ developers. BBQ scores varied based on participants' history of low back pain (LBP) and depended on pain severity. Those with severe pain and a recent history of LBP had the most pessimistic BBQ scores. In addition, participants who utilized passive management behaviours such as bed rest and activity avoidance had more pessimistic BBQ scores compared with those that did not.

CONCLUSIONS

This study provides strong validity evidence supporting the current structure and scoring of the BBQ. In addition, construct validity was evidenced by the behaviour of BBQ scores in a manner congruent with our hypotheses, further supporting use of the BBQ in the general population.

A new population-based measure of the economic burden of mental illness in Canada

This paper presents a comprehensive measure of the incremental economic burden of mental illness in Canada which incorporates the use of medical resources and productivity losses due to long-term and short-term disability, as well as reductions in health-related quality of life (HRQOL), for the diagnosed and undiagnosed population with mental illness. The analysis was based on the population-based Canadian Community Health Survey Cycle 2.1 (2003). For all persons, we measured all health services utilization, longterm and short-term work loss, and health-related quality of life and their dollar valuations, with the economic burden being the difference in dollar measures between the populations with and without mental health problems. In total, the economic burden was $51 billion in 2003. Over one-half was due to reductions in HRQOL. The current accepted practice in economic assessments is to include changes in medical resource use, work loss, and reductions in HRQOL.

A new population-based measure of the economic burden of mental illness in Canada

This paper presents a comprehensive measure of the incremental economic burden of mental illness in Canada which incorporates the use of medical resources and productivity losses due to long-term and short-term disability, as well as reductions in health-related quality of life (HRQOL), for the diagnosed and undiagnosed population with mental illness. The analysis was based on the population-based Canadian Community Health Survey Cycle 2.1 (2003). For all persons, we measured all health services utilization, longterm and short-term work loss, and health-related quality of life and their dollar valuations, with the economic burden being the difference in dollar measures between the populations with and without mental health problems. In total, the economic burden was $51 billion in 2003. Over one-half was due to reductions in HRQOL. The current accepted practice in economic assessments is to include changes in medical resource use, work loss, and reductions in HRQOL.

A multivariate study of predictors of repeat parasuicide

OBJECTIVE

To identify variables which differentiate future repeaters of parasuicide from non-repeaters in a multivariate analysis.

METHOD

Interviews were conducted with 507 parasuicide cases; data were collected on precipitating factors for the index parasuicide, psychiatric and medical history, stressful life events, prior history of parasuicide, hopelessness, anger, self-esteem and social adjustment. Individuals were followed for 1-2 years to determine if a repeat parasuicide occurred.

RESULTS

A logistic regression model identified four significant predictors of repeat parasuicide: prior history of parasuicide, a history of depression, a history of schizophrenia and poor physical health. A risk factor scale constructed from these four variables showed that the risk of repeat parasuicide increases as the number of risk factors increases.

CONCLUSION

This study identifies four key predictors of repeat parasuicide, and provides evidence that the risk of repeat parasuicide increases when multiple risk factors are present.

Characteristics of preterm delivery and low birthweight among 113,994 infants in Alberta: 1994-1996

This study examined the impact of infant and maternal factors on preterm delivery and low birthweight (LBW) in Alberta between January 1, 1994 and December 31, 1996. Data on 113,994 births were collected from vital statistics registration birth data. Logistic regression models for preterm and LBW delivery suggested the key risk factors were multiple and still birth (odds ratios > 22.0). Other characteristics included female gender, birth defects, nulliparous women, maternal age 35 and greater, unmarried, history of abortion, maternal smoking, maternal street drug use, and having less than 4 prenatal visits (odds ratios 0.86-2.54). Interactions between smoking and alcohol, and smoking and parity were noted. Efforts to improve the currently low rates (8.2%) of smoking cessation during pregnancy are required. Social, economic and medical factors associated with delayed childbearing and birth outcomes should be investigated.

Characteristics of PAHs, PCDD/Fs and PCBs in sediment following forest fires in northern Alberta

Extensive forest fires occurred in northern Alberta, Canada, in 1998. Polynuclear aromatic hydrocarbons (PAHs), polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) and polychlorinated biphenyls (PCBs) were studied following these forest fires in order to explore natural and anthropogenic influences on the affected forest fire area. Specifically, concentrations and profiles of these compounds were determined in sediment samples. A predominance of alkylated PAH derivatives over parent PAHs were observed at the burned and reference sites. Naturally dervied PAHs were abundant at all sites. A high proportion and concentration of retene was observed at the totally burned site and indicates some inputs from forest fires. Very low concentrations of PCDD/Fs and PCBs were observed at all sites, and the profiles were very similar. This likely reflects common atmospheric contributing sources to the study area.

Toward measuring the impact of ecological disintegrity on human health

Ecological integrity refers to the ability of environmental life-support systems to sustain themselves in the face of human-induced impacts. We used a correlational, aggregate-data study design to explore whether life expectancy, as a general measure of population health, is linked to large-scale declines in ecological integrity. Most of the data were obtained from World Resources Institute publications. Selected surrogate measures of ecological integrity and gross domestic product (GDP) per capita (as a socioeconomic confounder) were modeled, for the first time, using linear regression techniques with life expectancy as the health outcome. We found a modest relation between ecological integrity and life expectancy, but the direction of the association was inconsistent. When GDP per capita was controlled, the relation between ecological integrity and life expectancy was lost. GDP per capita was the overwhelming predictor of health. Any relation between ecological integrity and health may be mediated by socioeconomic factors. The effect of declines in ecological integrity may be cushioned by the exploitation of ecological capital, preventing a direct association between measures of exposure and outcome. In addition, life expectancy may be too insensitive a measure of health impacts related to ecological decline, and more sensitive measures may need to be developed.

A comparative approach to identify unsafe older drivers

The identification of unsafe older drivers is a current and important challenge. In the present research, a comparative approach was used in which the on road driving errors and expert evaluations of older drivers with clinically significant declines in mental abilities (N = 155) were compared to the errors and evaluations of a normal elderly control group (N = 68) and a normal younger control group (N = 30). The results indicate that the conventional criteria used in North America for licensing new drivers is inappropriate for license removal in experienced drivers. The results also indicate that hazardous errors were the single best indicator of membership in the group of older drivers with clinical impairment. This group also differs from the two normal control groups on turn positioning errors, minor positioning errors and overcautiousness. All groups differ from each other on scanning errors. A regression analysis further indicated that the five driving errors listed above accounted for over 57% of the variance associated with global ratings provided by expert driving instructors.

Central executive function in working memory: event-related brain potential studies

Visual event-related brain potentials (ERPs) were recorded during a running memory task, in which subjects dynamically revised (updated) memory stores, and a control task not requiring maintenance of a changing memory set but utilising identical stimulus sequences and response patterns. In three experiments, ERPs associated with cognitive processes were isolated through subtraction of control potentials from ERPs acquired during updating. We provide evidence that resultant difference ERPs primarily reflected processing or processing control, as opposed to storage. These findings are consistent both with Baddeley's working memory model, which postulates separate storage and control modules, and Morris and Jones' behavioral evidence for specific involvement of Baddeley's central executive in memory updating. In addition, our ERP data indicate that updating requires processes not suggested by Morris and Jones' behavioural studies; possibly control processes engaged to reduce the effects of proactive interference. Overall the data are consistent with the discovery of an ERP correlate of central executive activity.

Speech Sounds Perception Test: nonrandom response locations form a logical fallacy in structure

The response format of the Speech Sounds Perception Test confounds speech perception with irrelevant method variance. To rectify this problem the response format was revised by randomizing the response locations. An empirical comparison of the revised and original forms was undertaken with forensic (n=59) and psychiatric (n=67) samples. The empirical results coupled with the logical problem in the original form indicates that a revision is necessary.

Neuropsychological test performance in depressed patients before and after drug therapy

Sixty psychiatrically depressed patients (female = 39, male = 21), classified as psychotic or neurotic, were neuropsychologically assessed on an expanded Halstead-Reitan battery before antidepressant medication. Extant normative data from a large control group (N = 142) were employed for comparative purposes. Statistical analysis of the pretreatment data revealed a selective impairment in the processing of visuospatial material and retention of both nonverbal and verbal information by both the Neurotic and Psychotic groups, with greater impairment shown by the latter group. Separation of the Psychotic group from the Neurotic and Control groups was possible using these data. Posttreatment data analysis, although tentative due to the high attrition rate (female = 19, male = 14), indicated significant improvement in those abilities most impaired initially and did not allow separation of the Neurotic and Psychotic groups from the Normal group. These results are consistent with previous research which suggest greater perturbation of the nondominant hemisphere in depressive disorders, attenuation of cognitive deficits with amelioration of symptomatology, and the presence of residual deficits after treatment in older subjects.

A neuropsychological study of the stable syndrome of hysteria

Ten patients with the stable syndrome of hysteria were matched for age, sex, handedness, and full-scale WAIS IQ with ten controls, ten psychotic depressives and ten schizophrenics. All were subjected to an extensive neuropsychological test battery. Compared to the controls, the hysteria group exhibited bifrontal impairment (R = L) and, globally, greater dysfunction of the nondominant hemisphere. A G analysis provided a complete separation between the hysteria and controls. However, a D-index analysis showed that the hysteria group was more impaired than normals and depressives because of greater dysfunction of the dominant hemisphere, whilst schizophrenia showed greater nondominant hemisphere dysfunction than hysteria. Further, a cluster analysis on the 40 subjects produced three clusters: normal controls, depressives, and a schizophrenia-hysteria grouping. These findings are interpreted as suggesting that dominant hemisphere dysfunction is fundamentally related to the syndrome of hysteria and that the dysfunction of the nondominant hemisphere is brought about by associated features: the female excess, the emotional instability and dysphoric mood, the presence of asymmetrical pain, and conversion symptomatology. It is further argued, in view of the familial associations, that hysteria in the female is a syndrome equivalent to psychopathy in the male (who also exhibits dominant hemisphere dysfunction) and might represent in the female a (relatively benign) variant of schizophrenia characterized by imprecise verbal communications, a subtle form of affective incongruity, together with the conversion parameter.