Volume 24
Number 1
2003

[Table of Contents]

Abstract

This study determined whether workplaces in northeastern Ontario currently collect and retain demographic information, medical history, work history, and information on occupational exposure. Surveys were mailed to 434 northeastern Ontario workplaces with 50 or more employees, and a telephone follow-up was conducted. The response rate was 42.6% (185/434). Over 97% of workplaces reported that they always collect surnames and first names of employees, 13.5% reported collecting maiden names (and 70.8% never collect maiden names), 85.4% collect date of birth, 55.7% next of kin, 97.8% current address, 21.6% medical history, and 31.9% collect the health insurance number. Job titles were routinely recorded by 79.5%. Start and end dates for each job were always recorded by 68.1%, and 70.3% reported that they always note the area of work. Overall, 64.9% of workplaces collected previous place of employment. For 72.1%, legislation influenced the amount of information collected on current records. Thirteen percent routinely recorded smoking history on occupational health records, and 25.9% undertook exposure surveillance. This type of information can assist in planning occupational epidemiological studies.

Key words: epidemiology; occupational health, surveillance

Introduction

According to the founding statement issued in February 2001 by the newly formed Canadian Association for Research on Work and Health, the majority of adult life is devoted to work-related issues, and disabilities and diseases associated with work activities can affect both individuals and Canadian society.¹ The founding statement also indicates that Health Canada estimates the annual cost of productive time from short- and long-term disability and premature mortality to exceed $44 billion² and suggests that about half of this amount is directly related to diseases and injuries that are work associated.¹

It is important for Canadian businesses to be aware of health and safety legislation; issues surrounding the collection and retention of information about employee demographic, health, and safety; and occupational exposures relevant to their particular workplaces. This type of information can prove valuable in the prevention and/or reduction of diseases and injuries, for compensation purposes, and to assist legislators and policy makers in establishing workplace exposure standards and guidelines. Although periodic retrospective review of health and safety statistics by a specific workplace for compliance purposes tends to be emphasized, prevention of occupational diseases and injuries, or at least reduction and minimization of their occurrence in workplaces, should be of paramount importance. Such shifts in focus can result in benefits at a personal and familial level as well as in terms of the available work force, benefits reduction, and compensation reduction.

Occupational epidemiological teams may be asked to undertake various types of workplace-related applied research studies, such as studies of a surveillance or etiological nature. Although the teams are capable of collecting original data, quite often their capabilities will depend largely on the quality of data collected previously by the workplace, particularly if the study includes historical information over a long period of time.

This study was modeled closely after studies conducted by Rushton and Betts in the United Kingdom and subsequently in the European Economic Community.^3-5 The objectives of this voluntary, cross-sectional study were to 1) determine what information on demographic factors, medical history, work history, and occupational health is collected by northeastern Ontario workplaces with 50 or more employees, 2) ascertain how long the information is retained, and 3) ultimately make recommendations and suggest guidelines governing the collection and retention of such information in northeastern Ontario.

Methods

The catchment area for this northeastern Ontario study consisted of the following nine census divisions: Algoma, Cochrane, Timiskaming, Nipissing, Parry Sound, Muskoka, Manitoulin, Sudbury District, and Sudbury Region. The study team decided to focus on businesses with 50 or more employees in order to avoid interaction with very small workplaces that are unlikely and unable to collect much more than very basic demographic information.

The questionnaire for the study was based on a copyrighted questionnaire developed by Rushton and Betts for use in a survey of industries in the European Economic Community; this was based on a similar survey that they had conducted in the United Kingdom.^3-5 Rushton provided copies of sections used in the European survey. Very slight modifications were made where terminology differed. The questionnaire contained three major sections: personnel records, occupational hygiene and exposure records, and occupational health and medical records, and took about 20 to 30 minutes to complete.

The short questionnaire, available in both English and French, was produced in booklet form. It was mailed to chief executive officers or directors of northeastern Ontario businesses for distribution to 434 workplaces with 50 or more employees. The names and addresses of the businesses were purchased from the Canadian Business Directory.⁶

In this study, workplaces with 50 or more employees were selected for study based on a desire to survey workplaces of reasonable size that would have joint health and safety committees. In Ontario, joint health and safety committees are required

• in workplaces that regularly employ 20 or more workers
• for construction projects, anticipated to last three or more months, that regularly employ 20 or more workers, or
• for workplaces, other than construction projects, for which a regulation about a designated substance applies, even if fewer than 20 workers are regularly employed
• any workplace where an order has been issued under section 33 of the Act (for “toxic substances)” even if fewer than 20 workers are regularly employed
• any workplace or construction project that has been ordered by the Minister of Labour to form a committee^7,8

Occasionally an alternative to a committee is permitted, if it provides comparable benefits for worker health and safety.^7,8 Under special conditions, The Minister of Labour may also permit a single committee to be established for more than one workplace.^7,8

Directions for completion by the most appropriate person(s) were included. Workplaces were free to select the most relevant person(s) to complete the three sections of the questionnaire, and job titles were ascertained for people completing each section. Stamped return envelopes were provided.

In order for the interviewers to prepare and cope with the number of questionnaires required for mailing, approximately 50 questionnaires were mailed out per week between November 23, 1999, and February 1, 2000. Telephone follow-up was conducted about every two weeks until early September 2000. Identification numbers were recorded on questionnaires for follow-up purposes, but potential study participants were assured that their individual responses were strictly confidential, reviewed only by study staff, and were ultimately shredded, and that the study results would be reported for group information only.

Returned questionnaires were coded, the data entered into the computer, and verified. After data quality assessment, simple frequencies, percentages, cross-tabulations, and t tests were performed in SPSS for Windows version 9.0.⁹

Results

The response rates for the study are shown in Table 1. The study response rate was 42.6%. The study refusal rate - the proportion of workplaces that indicated their refusal to take part in the study - was 34.1%. If refusals, unreturned questionnaires, questionnaires lost in the mail, and questionnaires returned blank are also considered refusals, the refusal rate was 57.1%.

The median number of employees reported by responding workplaces was 120, and the range was from 50 to 11,000.

The types of industry sectors represented in the study appear in Table 2. The majority (54.1%) considered themselves represented by the “other” or miscellaneous industry sector category. The remaining industrial sectors represented varied, and all sectors listed in the questionnaire were represented. Following the “other” category, transportation and communication was the next largest percentage of workplaces (8.6%), the distribution, hotels and catering, and repairs sector followed (8.1%), and other manufacturing industries were listed by 7.6% of the businesses.

A. Personnel or human resource information

The first section of the questionnaire inquired about personnel or human resources information collected and noted that records could be held in more than one location. Multiple response analysis revealed that 75.1% routinely hold current employee records in personnel or human resource areas, 34.6% reported that they hold them in salaries, wages, or finance areas, and 17.8% hold them in a wide variety of other areas.

Current employee records are held on paper and computer by 65.2%, on paper only by 36.4%, on computer only by 1.6%, and by means of other types of storage by 1.6%. The respondents were asked to check all methods that applied to their situation.

The demographic information routinely collected on recruitment of current employees is listed in Table 3. In the case of information always collected the highest percentages recorded were for first name(s), and surname(s), current address and postal code, followed by date of birth and sex. The categories for which demographic information was never collected were ethnicity and nationality, followed by place of birth and maiden name(s).

The demographic information in Table 3 is updated occasionally by 36.4% of workplaces, updated yearly by 19.6%, never updated by 4.3%, and updated monthly by 1.6%. Responses could include more than one category. The majority (42.4%) update this information on the basis of other criteria (e.g., as change requires, as provided by staff).

The distribution of some routinely collected occupational information for current staff is also provided in Table 3. The following occupational information was always collected by more than 75% of the responding workplaces (in order from highest to lowest): salary level(s) or grade(s), staff identity number, and job titles. Most workplaces (70.3%) always note section, work area, work department, or work group; 68.1% always record start and finish dates for each job; and 62.7% always collect location (i.e., site or plant) worked. Previous places of employment were noted by 64.9% of businesses.

Multiple response analysis of the various factors that may have influenced the amount of information collected on current employee records shows that storage costs are a factor for 75.4% of respondents, payroll administration for 73.2%, legislation for 72.1%, tax requirements for 65.0%, a variety of other reasons (e.g., collective agreements, benefits administration, and privacy concerns) for 6.0%, lack of space for 4.9%, administration costs for 4.4%, and company policy for 2.7% of respondents.

B. Retention and storage of ex-employee biographical and work history details

After an employee leaves, the average number of years that biographical and work history records are retained is 10.3 years (standard deviation [sd] 8.94 years), and the median time they are retained is 7.0 years, with a minimum of 0 and a maximum of 50 years. One hundred and forty-two workplaces provided a numerical answer, 39 indicated that they retain such information forever, and four did not answer. It was unfortunate that the number of years that workplaces had been operating was not determined.

Ex-employee records are stored on paper by 65.7% of those responding, on paper and computer by 33.7%, on microfiche by 2.2%, on computer by 1.1%, and in some other format by 1.1%. Responses could include more than one category.

The majority of respondents (63.5%) routinely store ex-employee records in human resources locations; 27.4% (50 workplaces) store them in a variety of other locations (e.g., occupational health, administration, archives), 26.5% of these 50 indicating that they store them in finance areas and 2.2% in areas responsible for pensions. Responses in more than one category were permitted.

Table 4 presents the information kept on file for previous employees. Interestingly, 75% or more reported that the following is always retained (in order from highest to lowest): first name, surname, postal code, last known address, date of birth, and salary level(s) or grade(s). On the other hand, 50% or more indicated that the following information is never retained (in order from largest to smallest): ethnicity, nationality, place of birth, maiden name(s), and health insurance number.

Of the factors that influence the length of time that employees' records are retained after they leave, company policy was responsible for the highest percentage (65.2%), followed by tax requirements (47.3%), health and safety legislation (36.5%), pension requirements (21.0%), space (16.6%), insurance requirements (15.5%), “other” (e.g., 15.5% for other legislation), storage costs (6.6%), and administration costs (1.1%). This question was in a multiple response format.

Similarly, of the various factors that influence the amount of information retained on previous employees, in the categories already described, company policy was responsible for the highest percentage (70.7%), followed by tax requirements (42.5%), health and safety legislation (33.1%), pension requirements (21.5%), insurance requirements (16.6%), space (14.4%), “other” (e.g., 13.8% for the Employment Standards Act), storage costs (5.0%), and administration costs (2.8%). Again, the respondents were asked to check all answers that applied.

In Table 5, the collection of demographic and occupational information for current and ex-employees is compared. With the exception of date of birth, information about current employees is collected significantly more frequently (at the 5% level or better) than information about ex-employees on next of kin, salary level, address, job titles held and address, work location, work area, sex, and number of children.

C. Workplace surveillance

Overall, 33.5 % (62) of the workplaces indicated that they provide in-house occupational health services for staff, and only 25.9% (48) undertake occupational hygiene or exposure surveillance in the workplace.

D. Occupational hygiene or exposure records

There are 48 workplaces (25.9%) that undertake occupational hygiene measurements of exposure; 72.9% of these measure exposure to noise, 62.5% to chemicals, 12.5% to biological agents, 12.5% to ionizing radiation, 6.3% to particulates, and 4.2% to “other” exposures (e.g., air quality, dust). Responses could include more than one category.

Multiple response analysis showed that the main reasons for undertaking occupational hygiene measurements are 1) to comply with legal requirements (81.3%), 2) as part of a company surveillance plan (75.0%), and 3) in response to problems as they arise (56.3%).

The predominant types of occupational hygiene measurements made are for individual workers (75.0%), particular locations (77.1%), particular job types (70.8%), and particular tasks (58.3%). This question was in a multiple response format.

The distribution of occupational hygiene or exposure information collected by workplaces is listed in Table 6. Of the 48 workplaces, 75% or more reported that the following information is always collected: location (i.e., site or plant), date of sample, agents measured, and personal protective equipment used; 45.8% never measure plant conditions and outputs.

Occupational hygiene record and plant history information are retained for an average of 16.6 years (sd 13.3), with a median of 10.0 years and range from 2 to 40 years (n=48) and 14 workplaces indicated that occupational hygiene and plant history information is retained forever. It was unfortunate that the length of time the workplaces had been operating was not determined. Multiples response analysis showed that the major factors influencing retention time of hygiene and plant history information are health and safety legislation (81.3%) and company policy (68.8%). Further, the predominant factors that influence the amount of hygiene information retained are also health and safety legislation (83.3%) and company policy (68.8%).

E. Occupational health or medical records

In-house medical or occupational health services were provided by 33.0% (62/185) of the workplaces. A listing of the health information collected by these workplaces is presented in Table 7. The following information is always collected by 50% or more of the workplaces: medical history (62.9%), employment history (58.1%), blood pressure (54.8%), weight, vision, and hearing (all at 53.2%), and height and hobbies (51.6%). Further, 72.6% of the workplaces never collect information about reproductive history, and 61.3% never collect information on biological monitoring.

Factors that influence the amount of information collected about the occupational health or medical records of ex-employees include health and safety legislation (80.3%), company policy (67.2%), insurance requirements (18.0%), and space (8.2%). After an employee has left a workplace, the predominant factors that influence the length of time their records are retained include health and safety legislation (75.0%) and company policy (63.3%). For both amount and retention of information, responses could include more than one category.

F. Some results by workforce size

In order to determine whether some results for current employees varied by workforce size, we examined some demographic and personnel information for companies with 50 to 99 employees (i.e., a small workplace), those with 100 to 199 employees (i.e., a medium-sized workplace), and those with 200 and more employees (i.e., a large workplace). These divisions were based on a desire for fairly even frequencies across categories as well as some perspective on small, medium, and larger workplaces in northeastern Ontario.

The results of these analyses are presented in Table 8, which shows that, of information always collected, surname, first name, and current address were almost universally present. However, for each size of company, substantial improvements in data collection could be made for maiden name(s) and ethnicity. Improvement is needed to enhance the collection of health insurance number, next of kin, marital status, location worked, section/work area/department worked, and job start and end date information. For staff identity number, job titles, and salary levels or grade - information always obtained by 75% to 98% of workplaces - improvement in data collection could be made to some extent.

When we considered the influence of workplace size on whether current employee records are held on paper and computer, there was no apparent trend (61.3% (n = 46), 57.1% (n = 32), and 79.2% (n = 42) for small, medium and large workplaces respectively). When we examined whether legislation influences the amount of information collected on current employees by workplace size, a slight increasing trend was detected (67.6%, n = 50; 67.9%, n = 38; and 83.0%, n = 44 respectively). A similar trend was observed for storage costs (68.9%, n = 51; 69.6%, n = 39; and 90.6%, n = 48). When payroll administration was considered, there was no apparent trend (74.3%, n = 55; 67.9%, n = 38; and 77.4%, n = 41), and similar results were observed for tax requirements (64.9%, n = 48; 58.9%, n = 33; and 71.7%, n = 38). All of these could have multiple responses.

When the median times of retention of ex-employee biographical and work history details were considered, there was no difference by workplace size (median = 7.00 years).

When asked to identify all factors that influence the length of retention of employee records, 19.2% (n = 14), 19.6% (n = 11), and 9.6% (n = 5) of respondents respectively listed space. Health and safety legislation was considered a factor by 24.7% (n = 18), 48.2% (n = 27), and 40.4% (n = 21) respectively, and company policy was a factor for 67.1% (n = 49), 57.1% (n = 32), and 71.2% (n = 37) respectively.

The percentage of small, medium, and large workplaces that undertake occupational hygiene or exposure measurements (n = 48) is 13.5%, 27.3%, and 44.2% respectively. In similar order, the percentage of workplaces that provide in-house medical or occupational health services for staff (n = 62), by company size, was 23.6%, 32.7%, and 52.9% respectively.

Discussion

The response rate in this study (42.6%) was lower than desirable and could compromise the generalizability of the results. The rate was not unexpected, given that the responses were voluntary, and it compares with the rate of 46% of Rushton and Betts in the European Economic Community.³ As suggested by Rushton and Betts,⁴ non-respondents may have more inferior record collection and retention practices than those who did participate in the study.

Northeastern Ontario workplaces that participated in this study appeared to routinely collect much of the very basic demographic information for current and ex-employees (e.g., surname, first name, date of birth, and current address) that is needed for occupational cohort, case-control, and cross-sectional studies. Given that such information is frequently used to link external records, such as various health events, in occupational epidemiological studies, it is reassuring that the recording practices of demographic or biographical data for current and past employees were quite similar throughout northeastern Ontario. However, improvements could be made in the collection of such information as ethnicity, nationality, place of birth, maiden name, and health insurance number, the latter particularly valuable for record linkage purposes and reduction of costs associated with linkages.³

For current staff, salary levels or grades, staff identity (or employee) number, and job titles were fairly well collected, but some improvements could be made in the collection of location, site, or plant; section, work area, department, or work group; and start and end dates for each job. In addition, despite the limitation of not determining the length of time that workplaces have been in operation, it may be problematic that ex-employee and work history information is not retained for longer periods and that the predominant type of storage of this information is on paper rather than computer. Much of this kind of information for current and ex-employees is essential for various types of occupational epidemiological studies and for studies of large numbers of subjects, and it can take a great deal of time to enter such data and verify its quality.

It was not surprising that demographic and occupational information was generally collected better for current than ex-employees. Given the importance of such information in epidemiological studies, this is an area for additional education.

It is not surprising that only a small percentage of workplaces reported collection of occupational hygiene or exposure record information, given that collection of that type of information would not be relevant for some; unfortunately, relevance was not determined in this study. However, from the reporting workplaces it was clear that information on location, sample dates, agents measured, and personal protective equipment was fairly well collected, but improvements could be made for several other more detailed factors listed (e.g., plant conditions and outputs, plant processes involved, quality assurance, and sampling strategy, such as worst case or compliance), unique sample number, and workers' details. The great influence of health and safety legislation on the amount of this type of information collected and its retention time was evident. Obviously, it will be also be important to emphasize that inaccuracy and misclassification of exposures limit identification of risk factors.⁵ It would also be helpful for future studies to determine to what extent workplaces with exposures of concern are not collecting this type of information and the reasons related to this decision.

Rushton and Betts indicated that some industry-based bodies and professional societies are developing guidelines in response to concern surrounding the existence and quality of workplace records, and such guidelines may influence future practice in other workplaces. In addition, it will be important to determine how adequate available occupational hygiene information is in linking an individual worker with a health outcome to timing, duration, frequency, and magnitude of exposure. In northeastern Ontario, education is required regarding the value of good unique identification in occupational epidemiological studies. About a third of participating workplaces reported in-house collection of occupational health or medical record information, although this, too, may not be relevant for some workplaces (relevance was not evaluated). In their survey in the European Economic Union, Rushton and Betts indicated that 26% of companies reported in-house occupational health services.⁴ Similarly, this type of information was not well collected in the present study, such that current epidemiological studies would need to acquire the information by some other method and consider modification of this behaviour for the future.

Future studies of this nature could gear specific questions to their region of interest (e.g., questions about particular occupational exposures that are prevalent in the region) along with information about periods, duration, frequency, and magnitudes of exposure. Such studies could also ascertain whether particular workplaces plan to perform occupational epidemiological health studies and might require future assistance. As well as using quantitative instruments it could also be helpful to conduct qualitative research using focus groups with compliant and less compliant workplaces for information gathering and educational intervention purposes.

It is necessary to enhance the collection and retention of biographical, occupational exposure, and occupational health and medical information in northeastern Ontario and to establish clear objectives about the collection and retention of such data. In addition, it should be precisely determined what data should be collected and retained and whether the information will be able to provide reasonably good unique identification. The European Economic Commission held a workshop to discuss such issues as

• identification of a minimum dataset to be collected and retained for all employees
• appropriate methods for secure retention

• increasing industrial awareness of the importance of record keeping for health and safety reasons, and
• participation of governmental health and safety bodies and joint employer and employee organizations.^3,4

With funding, this approach could be adopted in northeastern Ontario and perhaps at provincial and national levels.

Rushton and Betts also recommended that

• records should uniquely identify an individual worker and facilitate linkage to occupational exposure and health effects information
• record format be accessible, suitable for record linkage, and secure, and
• data be retained by an identifiable organization with a secure chain of custody in case a company goes out of business³

Additionally, we recommend that personnel, occupational exposure, and medical information within workplaces be entered into databases that are compatible and easily linked. It is also important to establish the completeness and validity of data from such types of secondary sources⁴ and to ensure that records are secure and adequately stored when research may be conducted with such data.¹⁰

Furthermore, if collection of the information remains voluntary, the use of this type of information in occupational epidemiological studies could remain limited, since occupational epidemiological surveillance and etiological research are limited and, if done at all, take longer and cost more to undertake. Thus, it would appear timely to bring together governmental, occupational epidemiological, hygiene, and health researchers with policy makers in Canada, with national, provincial, and local representation, to discuss these issues further. They should consider the value of developing standards or guidelines for the collection, retention, and relevance of the basic biographical, occupational, and occupational exposure information, and medical records.

In addition, these groups could consider the possibility of national surveillance databases of demographic and occupational exposure factors, and occupational medical records for current and ex-employees, particularly the value of and challenges to achieving consistency.^11,12 Kauppinen and Toikkanen recommended development of a uniform, comprehensive, and continuously developing occupational surveillance system that is valid, current and easy to use.¹³ It is encouraging that both European and American groups have been discussing essential elements for occupational databases and how to promote their adoption by public and private sectors.^4,14,15 It would be helpful to have their participation at the proposed Canadian discussions. The American-based NIOSH (the National Institute for Occupational Safety and Health) Hazard Surveillance Team is currently recommending that a new national, on-site survey be conducted to update information on the distribution of health and safety hazards and exposures in regulated industries.¹⁶

It is essential that the importance of collecting and retaining biographical, occupational exposure, and health record data, as well as the confidentiality of such data, should receive additional attention from workplaces, researchers, government, and policy makers in northeastern Ontario, provincially and nationally. Without such information, health and exposure surveillance in occupational epidemiological studies and workplace disease etiology studies will be extremely limited, and much more time-consuming and costly from a human health and workplace perspective. Kauppinen and Toikkanen emphasize that regular analyses of occupational surveillance information by competent individuals with appropriate follow-up and action may be one of the most effective preventive and health promotion measures in the workplace.¹³

Although some workplaces may be suspicious of such external involvement and knowledge about their workplaces, the savings generated from prevention, reduction, and/or early detection of diseases and injuries, as well as from associated compensation, should be convincing.

Acknowledgements

We gratefully acknowledge the research support for this study provided by the Northern Cancer Research Foundation. We would like to thank Hasan Merali for editorial assistance.

References

1. Canadian Association for Research on Work and Health. Founding Statement. Unpublished document. 2001 Feb 12. (www.workhealth.ca).

2. Moore R, Mao Y, Zhang J, Clarke K. Economic burden of illness in Canada, 1993. Ottawa: Health Canada, 1993.

3. Betts D, Rushton L. The feasibility of conducting occupational epidemiology in the UK. Occup Med 1998;48:433-39.

4. Rushton L, Betts D. Collection of data for occupational epidemiologic-research - results from a survey of European industry. Scand J Work Environ Health 2000;26: 317-21.

5. Rushton L, Betts DS. Exposure information in European industry: implications for future occupational research. Appl Occup Environ Hyg 2001;16:178-81.

6. Canadian business directory. Montreal: Infotel Canada, 1999.

7. Occupational Health and Safety Act. Toronto: Ministry of Labour, Operation Division: Queen's Printer for Ontario, 2002.

8. Ontario Ministry of Labour. A guide to the Occupational Health and Safety Act. Toronto: Queen's Printer for Ontario, 2002.

9. SPSS 9.0 users manual. Chicago: SPSS Incorporated, 1998.

10. Embree VC, Enarson DA, Hertzman C. Historical employment records as data bases for occupational disease research - a case study. Can J Public Health 1989;80:50-3.

11. Teschke K, Barroetavena MC. Occupational cancer in Canada: what do we know? Can Med Assoc J 1992;147:1501-07.

12. Stamm R. MEGA-database: one million data since 1972. Appl Occup Environ Hyg 2001;16:159-63.

13. Kauppinen T, Toikkanen J. Health and hazard surveillance - needs and perspectives. Scand J Work Environ Health 1999; 25(suppl. 4):61-7.

14. Rajan R, Aylesburg R, Cason B, et al and the Working Group on Exposure Registers in Europe. European Foundation for the Improvement of Living and Working Conditions: Occupational Databases. A proposal for core information for workplace exposure measurements on chemical agents. Luxembourg: Office for Official Publications of the European Communities, 1996.

15. Lippmann M, Gomez MR, Rawle GM. Data elements for occupational exposure databases: guidelines and recommendations for airborne hazards and noise. Appl Occup Environ Hyg 1996; 11:1294-1311.

16. Boiano JM, Hull RD. Development of a national occupational exposure survey and database associated with NIOSH hazard surveillance initiatives. Appl Occup Environ Hyg 2001;16:128-34.

Author References

Nancy Lightfoot, Northeastern Ontario Regional Cancer Centre, Sudbury, Ontario, Canada and Department of Sociology and Anthropology and School of Nursing, Laurentian University, Sudbury, Ontario, Canada and Department of Public Health Sciences, University of Toronto, Ontario, Canada

Jennifer Dumont, Michael Conlon, Rachelle Arbour-Gagnon, Tim Rico, Sharon Duhamel, and Randy Bissett, Northeastern Ontario Regional Cancer Centre, Sudbury, Ontario, Canada

Correspondence: Dr. Nancy Lightfoot, Epidemiology Research Unit, Northeastern Ontario Regional Cancer Centre, 41 Ramsey Lake Road, Sudbury, Ontario, Canada P3E 5J1; Fax: (705) 675-8067; E-mail: nlightfoot@neorcc.on.ca

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