Tobacco wars: the bloody battle between good health and good politics

A battle to introduce new antitobacco legislation in Canada has caused political battles within the Liberal Party. While one side is worried about the need to protect people''s health, another is worried about the potential loss of jobs within the tobacco industry--many of which are located in politically volatile Quebec. Charlotte Gray writes about the machinations that led to the introduction of new smoking legislation in the House of Commons in November.     

Tobacco Knowledge among Adults in Zhejiang Province,China

Objective

The aims of current study were to assess the level of tobacco knowledge, anti-tobacco messages and major information channels in Zhejiang.

Methods

Face-to-face interviews were conducted with 2112 adults in Zhejiang. Data on demographic information, smoking status, tobacco knowledge, anti-tobacco messages and major information channels was collected.

Results

The findings revealed that only 31.87% of the population were aware that smoking could cause all three diseases (stoke, heart disease, and lung cancer), 86.09% were aware that smoking causes lung cancer, 46.43% and 42.40% were aware that smoking causes stroke and heart attack, respectively. Residence and education level had significant effects on awareness, while the effects of smoking status, gender, age, and household monthly income were not significant. There were five major information channels as follows: television (67.52%), newspapers or magazines (40.79%), billboards (30.02%), public walls (24.72), and radio (23.79%). Respondents got the following anti-tobacco messages from mass media: “No smoking in public” (66.34%), “No smoking in front of other people” (35.18%) and “Not offering cigarettes to one another” (22.82%).

Conclusions

The tobacco knowledge among residents in Zhejiang province is relatively poor. Improved information channels and content of anti-tobacco messages are necessary to increase the public’s tobacco knowledge, particularly among rural residents and people with less education.     

Reducing tobacco consumption: public policy alternatives for Canada.

The costs of smoking are extensive, not only in fiscal terms but also in terms of human suffering. A review of several major public policies reveals that concerted efforts by all levels of government and by the public can have an effect on the rate of consumption of tobacco. Specifically, increases in price through taxation, anti-smoking messages, restrictions on smoking behaviour and increased public pressure are effective in reducing smoking. Serious joint efforts in the area of public policy should be pursued to control the effects of this hazardous practice in Canada.     

Freedom of religion,women's agency and banning the face veil: the role of feminist beliefs in shaping women's opinion

Several countries have imposed bans on the wearing of face veils, a controversial option considered in Bill 94 by the province of Quebec in 2010. This paper examines non-Muslim women's support for the acceptability of the niqab in public spaces. Analysing the 2010 Quebec Women's Political Participation Survey, we find that key feminist arguments – that wearing the niqab is a woman's free choice, a matter of freedom of religion and a visible symbol of women's oppression – are important drivers of opinion. Their role in shaping opinion, however, is complex and mirrors divisions among feminist groups in the province. Additional attitudinal drivers include generation, exposure to the practice and openness to immigration. Equally important, our findings suggest that being a member of a racial minority, feelings of cultural insecurity and religiosity are of little consequence for thinking on the issue.     

Use of automobile seat restraints by children in two Canadian cities.

A telephone survey was conducted in Montreal and Calgary to determine the extent to which parents use safety restraints for their children in cars, the types of restraints used and the factors associated with such use. Of the combined sample 39% reported that their child regularly used a restraint, and 47% of the children in Montreal and 55% of those in Calgary wore an age-appropriate safety device. Birth order and the child''s and the respondent''s ages were significantly related to the use of restraints. However, the respondent''s use of seatbelts was the factor most likely to affect the rate of use of restraints for children. Although a large proportion of the parents with younger children owned a carseat, one in four did not use it regularly. Parents who did not use carseats believed they were useless or dangerous; many preferred to hold the child in their laps or arms. The seatbelt law in Quebec and the existence of a carseat rental program in Calgary appear to have had some influence on the rate of the use of restraints for children.     

Influence of passive smoking on admissions for respiratory illness in early childhood.

An association was sought between passive smoking and inpatient admissions for respiratory illness in 1058 children born between 1 June and 31 December 1981 and living in the neighborhoods of Nan-Jing Western Road and Yan-An Western Road in Jing-An District, Shanghai. The admission rate for first episodes of respiratory illness was positively correlated with the total daily cigarette consumption of family members during the children''s first 18 months of life. The relative risk of developing a first episode of respiratory illness was 1.80 for children living in families including people who smoked 10 or more cigarettes a day compared with those living in non-smoking families. Multiple logistic regression analysis showed that the effect of passive smoking on inpatient admission for respiratory illness was independent of the child''s birth weight, type of feeding, father''s education, size of the home, and chronic respiratory disease among adults in the family. The adjusted odds ratios compared with the non-smoking group were 1.17 in families smoking 1.9 cigarettes daily and 1.89 in families smoking 10 or more cigarettes daily. These data suggest that exposure to household cigarette smoke of children in early life increases the risk of severe respiratory illness.     

青海省大学生吸烟现状及其影响因素分析

目的：探讨青海省大学生吸烟现状及其影响因素分析。方法：选择青海省综合性大学学生1106 例作为调查对象,采用分层 整群随机抽样的调查方法,对入选者使用自制问卷进行调查。结果：不同性别、不同专业、不同年级及父母是否抽烟的学生吸烟率 比较,差异具有统计学意义（P＜0.05）。对影响大学生吸烟行为的相关影响因素进行单因素分析发现,性别、周围朋友吸烟、父母不 反对以及抑郁或伤心是造成大学生吸烟的相关危险因素（P＜0.05）。对以上相关危险因素进行多因素回归分析发现,四者均是造 成大学生吸烟的独立危险因素（P＜0.05）。结论：性别、父母态度、周围朋友吸烟状况及自身抑郁心理是造成青海省大学生吸烟行 为的主要危险因素,高校应针对不同大学生的自身现状制定相应的控烟措施,减少大学生吸烟率。     

The knowledge used in vision and where it comes from.

Knowledge is often thought to be something brought from outside to act upon the visual messages received from the eye in a ''top-down'' fashion, but this is a misleadingly narrow view. First, the visual system is a multilevel heterarchy with connections acting in all directions so it has no ''top''; and second, knowledge is provided through innately determined structure and by analysis of the redundancy in sensory messages themselves, as well as from outside. This paper gives evidence about mechanisms analysing sensory redundancy in biological vision. Automatic gain controls for luminance and contrast depend upon feedback from the input, and there are strong indications that the autocorrelation function, and other associations between input variables, affect the contrast sensitivity function and our subjective experience of the world. The associative structure of sensory message can provide much knowledge about the world we live in, and neural mechanisms that discount established associative structure in the input messages by recoding them can improve survival by making new structure more easily detectable. These mechanisms may be responsible for illusions, such as those produced by a concave face-mask, that are classically attributed to top-down influences.     

Developing Content for a mHealth Intervention to Promote Postpartum Retention in Prevention of Mother-To-Child HIV Transmission Programs and Early Infant Diagnosis of HIV: A Qualitative Study

Background

Maternal attendance at postnatal clinic visits and timely diagnosis of infant HIV infection are important steps for prevention of mother-to-child transmission (PMTCT) of HIV. We aimed to use theory-informed methods to develop text messages targeted at facilitating these steps.

Methods

We conducted five focus group discussions with health workers and women attending antenatal, postnatal, and PMTCT clinics to explore aspects of women''s engagement in postnatal HIV care and infant testing. Discussion topics were informed by constructs of the Health Belief Model (HBM) and prior empirical research. Qualitative data were coded and analyzed according to the construct of the HBM to which they related. Themes were extracted and used to draft intervention messages. We carried out two stages of further messaging development: messages were presented in a follow-up focus group in order to develop optimal phrasing in local languages. We then further refined the messages, pretested them in individual cognitive interviews with selected health workers, and finalized the messages for the intervention.

Results

Findings indicated that brief, personalized, caring, polite, encouraging, and educational text messages would facilitate women bringing their children to clinic after delivery, suggesting that text messages may serve as an important “cue to action.” Participants emphasized that messages should not mention HIV due to fear of HIV testing and disclosure. Participants also noted that text messages could capitalize on women''s motivation to attend clinic for childhood immunizations.

Conclusions

Applying a multi-stage content development approach to crafting text messages – informed by behavioral theory – resulted in message content that was consistent across different focus groups. This approach could help answer “why” and “how” text messaging may be a useful tool to support maternal and child health. We are evaluating the effect of these messages on improving postpartum PMTCT retention and infant HIV testing in a randomized trial.     

Differences in Access to Services in Rural Emergency Departments of Quebec and Ontario

Introduction

Rural emergency departments (EDs) are important safety nets for the 20% of Canadians who live there. A serious problem in access to health care services in these regions has emerged. However, there are considerable geographic disparities in access to trauma center in Canada. The main objective of this project was to compare access to local 24/7 support services in rural EDs in Quebec and Ontario as well as distances to Levels 1 and 2 trauma centers.

Materials and Methods

Rural EDs were identified through the Canadian Healthcare Association''s Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities. There were 26 rural EDs in Quebec and 62 in Ontario meeting these criteria. Data were collected from ministries of health, local health authorities, and ED statistics. Fisher’s exact test, the t-test or Wilcoxon-Mann-Whitney test, were performed to compare rural EDs of Quebec and Ontario.

Results

All selected EDs of Quebec and Ontario agreed to participate in the study. The number of EDs visits was higher in Quebec than in Ontario (19 322 ± 6 275 vs 13 446 ± 8 056, p = 0.0013). There were no significant differences between Quebec and Ontario’s local population and small town population density. Quebec’s EDs have better access to advance imaging services such as CT scanner (77% vs 15%, p < .0001) and most the consultant support and ICU (92% vs 31%, p < .0001). Finally, more than 40% of rural EDs in Quebec and Ontario are more than 300 km away from Levels 1 and 2 trauma centers.

Conclusions

Considering that Canada has a Universal health care system, the discrepancies between Quebec and Ontario in access to support services are intriguing. A nationwide study is justified to address this issue.     

Passive exposure to tobacco smoke: saliva cotinine concentrations in a representative population sample of non-smoking schoolchildren.

Saliva cotinine concentrations in 569 non-smoking schoolchildren were strongly related to the smoking habits of their parents. When neither parent smoked the mean concentration was 0.44 ng/ml, rising to 3.38 ng/ml when both parents were cigarette smokers. Mothers'' smoking had a stronger influence than did fathers'' (p less than 0.01). In addition, there was a small independent effect of number of siblings who smoked (p less than 0.01). The dose of nicotine received from fathers'' smoking was estimated as equivalent to the active smoking of 30 cigarettes a year, that from mothers'' smoking as equivalent to smoking 50 cigarettes a year, and that from both parents smoking as equivalent to smoking 80 cigarettes a year. This unsolicited burden may be prolonged throughout childhood and poses a definite risk to health.     

Internet marketing directed at children on food and restaurant websites in two policy environments

Objective:

Food and beverage marketing has been associated with childhood obesity yet little research has examined the influence of advertising policy on children's exposure to food/beverage marketing on the Internet. The purpose of this study was to assess the influence of Quebec's Consumer Protection Act and the self‐regulatory Canadian Children's Food and Beverage Advertising Initiative (CAI) on food manufacturer and restaurant websites in Canada.

Design and Methods:

A content analysis of 147 French and English language food and restaurant websites was undertaken. The presence of child‐directed content was assessed and an analysis of marketing features, games and activities, child protection features, and the promotion of healthy lifestyle messages was then examined on those sites with child‐directed content.

Results:

There were statistically no fewer French language websites (n = 22) with child‐directed content compared to English language websites (n = 27). There were no statistically significant differences in the number of the various marketing features, or in the average number of marketing features between the English and French websites. There were no fewer CAI websites (n = 14) with child‐directed content compared to non‐CAI websites (n = 13). The CAI sites had more healthy lifestyle messages and child protection features compared to the non‐CAI sites.

Conclusion:

Systematic surveillance of the Consumer Protection Act in Quebec is recommended. In the rest of Canada, the CAI needs to be significantly expanded or replaced by regulatory measures to adequately protect children from the marketing of foods/beverages high in fat, sugar, and sodium on the Internet.     

Smoking and Crohn's disease.

In a case-control study 82 patients with Crohn''s disease and matched controls drawn from general practice lists were questioned about their smoking habits. Patients with Crohn''s disease were significantly more likely to be smokers than the controls, and the association was stronger for smoking habit before the onset of the disease than for current smoking habit, the relative risks for smokers compared with non-smokers being 4.8 and 3.5 respectively. Taken in conjunction with earlier data showing an association between non-smoking and ulcerative colitis, these results suggest that smoking habit may be an important determinant of the type of inflammatory bowel disease that develops in predisposed subjects.     

Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study.

OBJECTIVE--To evaluate the ability of doctors in primary care to assess risk patients'' risk of coronary heart disease. DESIGN--Questionnaire survey. SETTING--Continuing medical education meetings, Ontario and Quebec, Canada. SUBJECTS--Community based doctors who agreed to enroll in the coronary health assessment study. MAIN OUTCOME MEASURE--Ratings of coronary risk factors and estimates by doctors of relative and absolute coronary risk of two hypothetical patients and the "average" 40 year old Canadian man and 70 year old Canadian woman. RESULTS--253 doctors answered the questionnaire. For 30 year olds the doctors rated cigarette smoking as the most important risk factor and raised serum triglyceride concentrations as the least important; for 70 year old patients they rated diabetes as the most important risk factor and raised serum triglyceride concentrations as the least important. They rated each individual risk factor as significantly less important for 70 year olds than for 30 year olds (all risk factors, P < 0.001). They showed a strong understanding of the relative importance of specific risk factors, and most were confident in their ability to estimate coronary risk. While doctors accurately estimated the relative risk of a specific patient (compared with the average adult) they systematically overestimated the absolute baseline risk of developing coronary disease and the risk reductions associated with specific interventions. CONCLUSIONS--Despite guidelines on targeting patients at high risk of coronary disease accurate assessment of coronary risk remains difficult for many doctors. Additional strategies must be developed to help doctors to assess better their patients'' coronary risk.     

Decrypting Financial Markets through E-Joint Attention Efforts: On-Line Adaptive Networks of Investors in Periods of Market Uncertainty

This paper looks at 800,000 messages on the Unicredit stock, exchanged by 7,500 investors in the Finanzaonline.com forum, between 2005 and 2012 and measured collective interpretations of stock market trends. We examined the correlation patterns between market uncertainty, bad news and investors'' network structure by measuring the investors'' communication patterns. Our results showed that the investors'' network reacted to market trends in different ways: While less turbulent market phases implied less communication, higher market volatility generated more complex communication patterns. While the information content of messages was less technical in situations of uncertainty, bad news caused more informative messages only when market volatility was lower. This meant that bad news had a different impact on network behaviour, depending on market uncertainty. By measuring the investors'' expertise, we found that their behaviour could help predict changes in daily stock returns. We also found that expert investors were more influential in communication processes during high volatility market phases, whereas they had less influence on the real-time forum''s reaction after bad news. Our findings confirm the crucial role of e-communication platforms. However, they also show the need to reconsider the fragility of these collective intelligence systems when under external shocks.     

Quebec's Ice Storm '98: "all cards wild,all rules broken" in Quebec's shell-shocked hospitals

The remarkable ice storm that brought life to a standstill in most of Eastern Ontario and Quebec in January had a huge impact on medical services. Hospitals that lost power found themselves serving as shelters not only for patients but also for staff members and nearby residents. Doctors'' offices were forced to close and a large number of operations were cancelled. The 2 articles that follow detail the huge impact the "ice storm of the century" had on health care.     

Relation between nicotine intake and Alzheimer's disease.

OBJECTIVE--To study the association between Alzheimer''s disease and nicotine intake through smoking. DESIGN--Population based case-control study. SETTING--City of Rotterdam and four northern provinces of The Netherlands. SUBJECTS--198 patients with early onset Alzheimer''s disease, 198 controls matched for age and sex, and families of 17 patients in whom Alzheimer''s disease was apparently inherited as an autosomal dominant disorder. MAIN OUTCOME MEASURES--Age of onset of dementia, relative risk of Alzheimer''s disease. RESULTS--89 of 193 patients with Alzheimer''s disease had a history of smoking compared with 102 of 195 controls. Among the patients and controls with a family history of dementia, smoking was significantly less common in those with dementia (40/95 with dementia v 55/96 controls; relative risk 0.35; 95% confidence interval 0.16 to 0.78). The risk of Alzheimer''s disease decreased with increasing daily number of cigarettes smoked before onset of disease (relative risk 0.3 in those smoking greater than 21/day v 1 in non-smokers). In six families in which the disease was apparently inherited as an autosomal dominant disorder, the mean age of onset was 4.17 years later in smoking patients than in non-smoking patients from the same family (p = 0.03). CONCLUSIONS--These findings suggest an inverse association between smoking and Alzheimer''s disease, although smoking cannot be advocated for other health reasons. We speculate that nicotine may have a role in the aetiology of both Alzheimer''s disease and Parkinson''s disease.     

Reducing aluminum: an occupation possibly associated with bladder cancer.

A case-control study, undertaken to identify reasons for the exceptionally high incidence of bladder cancer among men in the Chicoutimi census division of the province of Quebec, revealed an increased risk associated with employment in the electrolysis department of an aluminum reduction plant. The estimated relative risk was 2.83 (95% confidence interval; 1.06 to 7.54). An interaction was found between such employment and cigarette smoking, resulting in a combined relative risk of 5.70 (95% confidence interval: 2.00 to 12.30). These findings suggest that employment in an aluminum reduction plant accounts for part of the excess of bladder cancer in the region studied.