Chronic Diseases in Canada Volume 28, No. 1/2, 2007 Full PDF Version (784 KB) Downloadable in PDF format for complete issue or for each article separately. How to download PDF documents Table of Contents

Feature Articles
1. Personal factors influencing agreement between expert and self-reported assessments of an occupational exposure View Abstract Heather K Neilson, Andrea Sass-Kortsak, WY Wendy Lou and James T Purdham	PDF version 194 KB
2. Services for children and youth with chronic health conditions: Views of pediatricians in British Columbia View Abstract Anton R Miller, Magda Recsky, Mojgan Ghazirad, Michael Papsdorf and Robert W Armstrong	PDF version 192 KB
3. Pharmacists' attitudes, role perceptions and interventions regarding smoking cessation: Findings from four Canadian provinces View Abstract Mary Jane Ashley, J Charles Victor and Joan Brewster	PDF version 135 KB
4. Eliciting Canadian population preferences for health states using the Classification and Measurement System of Functional Health (CLAMES) View Abstract Cameron N McIntosh, Sarah Connor Gorber, Julie Bernier and Jean-Marie Berthelot	PDF version 411 KB
5. Population health impact of cancer in Canada, 2001 View Abstract Jane Boswell-Purdy, William M Flanagan, Hélène Roberge, Christel Le Petit, Kathleen J White and Jean-Marie Berthelot	PDF version 307 KB
6. Variations in injury among Canadian adolescents by urban-rural geographic status View Abstract Xuran Jiang, Dongguang Li, William Boyce and William Pickett	PDF version 139 KB
7. Determinants of high birth weight by geographic region in Canada View Abstract Lise Dubois, Manon Girard and Fabiola Tatone-Takuda	PDF version 187 KB

Chronic Diseases in Canada (CDIC) is a quarterly scientific journal focussing on current evidence relevant to the control and prevention of chronic (i.e. non-communicable) diseases and injuries in Canada. Since 1980 the journal has published a unique blend of peer-reviewed feature articles by authors from the public and private sectors and which may include research from such fields as epidemiology, public/community health, biostatistics, the behavioural sciences, and health services or economics. Only feature articles are peer reviewed. Authors retain responsibility for the content of their articles; the opinions expressed are not necessarily those of the CDIC editorial committee nor of the Public Health Agency of Canada.

Abstracts from Feature Articles in Chronic Diseases in Canada Volume 28, No 1/2, 2007

Abstract: This study aimed to identify personal factors associated with expert and respondent agreement on past occupational exposure. Epidemiologic data was collected from 1995 to 1998 in a community-based, case-control study of prostate cancer. Using longest jobs and excluding agreement on “never” exposure, self-reported and expert estimates of ever/ never exposure, by skin or ingestion, to polycyclic aromatic hydrocarbons were compared. Agreement between respondents and the expert was 53.9% (N=1,038), with overreporting being more common than underreporting relative to the expert (31.8% versus 14.4%). In multiple logistic regression models, white-collar occupational status was significantly associated with overreporting (odds ratio [OR] = 0.142; 95% confi dence interval [CI]: 0.095-0.211; blue-collar versus white-collar), while age was associated with underreporting (OR=1.077; 95% CI: 1.043-1.112; one-year increase). Neither job satisfaction nor risk perception appeared to confound other associations. In future studies, overreporting by white-collar workers might be avoided by providing clearer definitions of exposure, whereas elderly respondents may require aids to enhance exposure recall.

Abstract: Canadian research on health services for children and youth with chronic health conditions (CHC) is limited. In a postal survey, pediatricians in British Columbia rated the quality and safety of health care services for children with chronic medical conditions (Ch-Med) lower (mean rating ± SD on a seven-point scale: 4.86 ± 1.02 ) than services for children with acute conditions/injuries (5.97 ± 1.01), and lowest for children with chronic developmental, behavioural and mental health conditions (Ch-DBM; 3.06 ± 1.17). To improve health care services for CHC, respondents especially favoured improving access to community-based services and resources and to medical specialists and specialized facilities, and the implementation of alternative models of care. Respondents indicated that physician care of children with CHC could be enhanced by extending the physician's role, better integrating medical with other aspects of care and adopting more flexible payment mechanisms. Findings suggest the need for enhancement and innovation in medical services for children with CHC, especially Ch-DBM, but also that solutions need to take account of CHC subcategory, geographic factors and differences in practitioner readiness to embrace change.

Abstract: Pharmacists in Ontario, Quebec, Saskatchewan and Prince Edward Island were surveyed in 2002 regarding their professional involvement in smoking cessation. In all provinces, at least 70% had positive attitudes toward smoking cessation. At least 50% thought that pharmacists have important roles in motivating patients to quit and in most aspects of motivating, assisting and referring patients. However, in all provinces, less than 40% had intervened in various ways in the past year with more than one half of their patients who smoked. Advising cutting down or quitting, attempting to increase motivation to quit and suggesting the use of nicotine replacement therapy were the most often performed interventions. Consistent inter-provincial patterns of differences in attitudes, role perceptions and interventions were not found. Some differences in attitudes and role perceptions were found between pharmacists practicing in provinces either banning or not banning tobacco sales in pharmacies, but there was no difference in overall interventions. The findings provide a baseline for provincial monitoring of pharmacists' professional smoking cessation attitudes, role perceptions and interventions. They also may inform tobacco control initiatives.

Abstract: A major objective of the Population Health Impact of Disease in Canada (PHI) research program was to obtain Canadian-specific preferences for health states associated with various diseases, in order to estimate the morbidity component of summary measures of population health embodying the Canadian experience of disease. In this study, preferences for health states were elicited from lay panels (N=146) in nine Canadian communities (Vancouver, Edmonton, Saskatoon, Toronto, Ottawa, Montréal, Québec, Moncton and Halifax); the study was conducted from January to June of 2003. Information on health states was presented to raters using the CLAssification and MEasurement System of Functional Health (CLAMES), which assesses functional capacity using 11 health status attributes, each with four to five levels ranging from normal to severely limited functioning. Preferences for 238 health states classified by CLAMES were elicited using the standard gamble (SG) technique in both individual and group exercises. Mean preferences for these health states were then used to estimate the parameters of a log-linear scoring function for CLAMES. The function provides a convenient method of computing preference scores for any health state classified by CLAMES, without the need for direct measurement in surveys. Further, the SG appears feasible in group settings.

Abstract: Summary measures of population health that incorporate morbidity provide a new perspective for health policy and priority setting. Health-adjusted life years (HALYs) lost to a disease combine the impact of years of life lost to premature mortality and morbidity, measured as year-equivalents lost to reduced functioning. HALYs for 25 cancers were estimated from mortality and incidence in 2001 in Canada; population-attributable fractions were estimated for major risk factors contributing to these cancers. Results from this analysis indicate that Canadians would lose an estimated 905,000 health-adjusted years of life to cancer for 2001, including 771,000 to premature mortality and 134,000 to morbidity from incident cases (years discounted at 3%). Most of the estimated premature mortality was due to lung cancer; morbidity was largely due to breast, prostate and colorectal cancers. An estimated one quarter of HALYs lost to cancer were attributable to smoking and almost one quarter were attributable to alcohol consumption, lack of fruit and vegetables, obesity and physical inactivity combined. These results are a significant advance in measuring the population health impact of cancer in Canada because they incorporate morbidity as well as mortality.

Abstract: Injuries are the leading cause of morbidity and mortality among Canadian adolescents. Rural adolescents may be disproportionally affected by these traumatic events. Differences in risk for injury between rural and urban adolescents remain understudied. We compared adolescent reports of medically attended injury by urban-rural geographic status using a representative national sample of Canadian adolescents. The study involved an analysis of a national sample of Canadian adolescents aged 11 to 15 years (N=7,235) from the 2001-2002 WHO/Health Behaviour in School-aged Children survey. Respondents were classified into five geographic categories according to school addresses. Several differences in risk for injury were documented by urban-rural geographic status. Adolescents from rural regions were more likely to report medically treated injury compared with the reference population from large metropolitan areas. These patterns of medically attended injury suggest that prevention and intervention programs could be better targeted to the needs of specific geographic populations of Canadian youth.

Abstract: This study aims to analyze the determinants of high birth weight (> 4000 grams) by various geographic regions of Canada. Analyses were performed using the data from cycles 1 to 4 (1994-2001; N=20,002 children) of the Canadian National Longitudinal Survey of Children and Youth (NLSCY). Children were grouped into five geographic residential area categories: the Atlantic provinces, Quebec, Ontario, the Prairie provinces and British Columbia. Determinants analyzed in the study include sex, gestational age and birth rank of children; maternal age and education; maternal smoking during pregnancy; family type; family socioeconomic status (SES) and maternal health (postpartum depression; hypertension and prescription drug use during pregnancy). In comparison to Quebec, the odds of giving birth to a high-birth-weight child were 25% higher in Ontario, 41% higher in the Atlantic provinces and 53% higher in British Columbia. In Quebec, non-smoking mothers of higher SES had increased odds of delivering a baby weighing more than 4000 grams, while in British Columbia, the odds of having a birth weight greater than 4000 grams doubled for children of non-smoking mothers from the lowest SES quintiles. The relationship between social disparities and macrosomia was found to vary by geographic region.