OBJECTIVES: We examined the extent to which adolescents in Norway have been exposed to tobacco marketing despite an existing ban, and whether exposure is related to their current smoking or expectations they will smoke in the future. METHODS: Questionnaires were administered to nationally representative systematic samples of Norwegian youths aged 13 to 15 years in 1990 (n = 4282) and 1995 (n = 4065). RESULTS: About half in each cohort reported exposure to marketing. Youths reporting exposure were significantly more likely to be current smokers and to expect to be smokers at 20 years of age, after control for important social influence predictors. CONCLUSIONS: Adolescents' current smoking and future smoking expectations are linked to marketing exposure even in limited settings, suggesting the need for comprehensive controls to eliminate the function of marketing in promoting adolescent smoking.
Mortality rates for American Indians (including Alaska Natives) declined for much of the 20th century, but data published by the Indian Health Service indicate that since the mid-1980s, age-adjusted deaths for this population have increased both in absolute terms and compared with rates for the White American population. This increase appears to be primarily because of the direct and indirect effects of type 2 diabetes. Despite increasing appropriations for the Special Diabetes Program for Indians, per capita expenditures for Indian health, including third-party reimbursements, remain substantially lower than those for other Americans and, when adjusted for inflation, have been essentially unchanged since the early 1990s. I argue that inadequate funding for health services has contributed significantly to the increased death rate.
This paper discusses the urgency for change and improvements in health policy determined by the exploding demographics and inequities in the health status of First Nation people. A historical overview of health services for First Nation clients was conducted as set out through government legislation and health and social policies. Until WWII ended, the federal government provided assistance to First Nations through Indian Affairs branches of several departments. This responsibility was gradually transferred to National Health and Welfare. In 1962, the federal government established a Medical Services Branch, later renamed First Nations and Inuit Health Branch, and mandated to provide services to First Nation clients, which fell outside the provincial jurisdiction of health care. Initially centered on public health priorities, services have expanded to include primary health care, dental, mental health, environmental health, home and continuing care, and Non-Insured Health Benefits. The Romanow Report substantiated the urgency for health policy improvements voiced by many First Nations. However, it generalized Aboriginal issues in health care on a national front. Furthermore, its recommendations were specific to health care providers and delivery models and did not address the social and spiritual determinants of health, which are fundamental to a First Nations' holistic approach. Health planners must think holistically, considering traditional and westernized medicine, First Nations' values, priorities and government systems, and present and evolving health systems. Universities, health authorities, provinces and the federal government are continually developing new research and health models, which will also need consideration. Further, the imperative of involving community-level input must be recognized.
This article describes the process of the Vancouver Coastal Health's Aboriginal Health Practice Council (AHPC) who
provide policy direction to Vancouver Coastal Health
(VCH). The AHPC operates within unceded territories in what is now known as British Columbia, Canada. The council consists of Aboriginal Elders, knowledge keepers, community members, and VCH staff who work collaboratively to develop and implement best health care practices for Aboriginal people. Working within
local Indigenous protocols to create policy for service delivery this council operates under the assumption that to improve health outcomes it is incumbent for VCH to create appropriate methods of access to Aboriginal health practices. The council facilitates Aboriginal leadership in policy development informing health care practitioners on how they can support Aboriginal clients' right to
culturally appropriate Aboriginal health care services. The article describes the processes employed by the Aboriginal Health Practice Council. These processes offer a methodology for non-Indigenous organizations serving Aboriginal peoples to implement Indigenous community-based research principles, protocols, and practices central in the provision of effective, culturally appropriate health care.
Public health ideally concerns scales of the individual, groups of individuals, and functional populations. When only individual-level attributes are examined in public health research, results may be more misleading than when so-called poor-quality population-level data are analyzed.
Comment In: American Journal of Public Health. 1996 Feb;86(2):267-268