The Commission on the Future of Health Care in Canada asked whether Medicare is sustainable in its present form. Well, Medicare is not sustainable for at least six reasons. Given a long list of factors, such as Canada's changing dependency ratio, the phenomenon of diminishing returns from increased taxation, competing provincial expenditure needs, low labour and technological productivity in government-funded healthcare, the expectations held by baby boomers, and the evolving value sets of Canadians--Medicare will impoverish Canada within the next couple of decades if not seriously recast. As distasteful as parallel private-pay, private-choice healthcare may be to some policy makers and providers who grew up in the 1960s, the reality of the 2020s will dictate its necessity as a pragmatic solution to a systemic problem.
To explore the cancer information preferences of immigrant women by their level of acculturation we conducted interviews with 34 Spanish-speaking English-as-a-second-language (ESL) women. Chi-square and Fisher's exact tests were used to look for differences by acculturation. Four themes were identified: What is prevention? What should I do; sources of my cancer information, strategies I use to better understand, and identifying and closing my health knowledge gaps. Acculturation did not differentiate immigrant women's cancer information sources, preferences, or strategies used to address language barriers. We suggest the effect of acculturation is neither direct nor simple and may reflect other factors including self-efficacy.
Child and Adolescent Health Research Unit (CAHRU), Department of PE, Sport and Leisure Studies, University of Edinburgh, St. Leonard's Land, Holyrood Road, EH8 8AQ, Edinburgh, UK. firstname.lastname@example.org
This paper examines the relationship between family structure and smoking among 15-year-old adolescents in seven European countries. It also investigates the association between family structure and a number of known smoking risk factors including family socio-economic status, the adolescent's disposable income, parental smoking and the presence of other smokers in the adolescent's home. Findings are based on 1998 survey data from a cross-national study of health behaviours among children and adolescents. Family structure was found to be significantly associated with smoking among 15-year-olds in all countries, with smoking prevalence lowest among adolescents in intact families and highest among adolescents in stepfamilies. Multivariate analysis showed that several risk factors were associated with higher smoking prevalences in all countries, but that even after these other factors were taken into account, there was an increased likelihood of smoking among adolescents in stepfamilies. Further research is needed to determine the possible reasons for this association.
Accounts of self-perceptions of oral health have hitherto been rare, although they are of great interest for strategies in health promotion. The objective of this study was to increase our knowledge of adolescents' perceptions of oral health and influencing factors. Semi-structured interviews of 17 Swedish adolescents were performed. Criteria for strategic sampling were age (15, 18 years), gender (male, female), and dental health (healthy, unhealthy). Data were analyzed according to the constant comparative method. Areas of focus were general oral health, personal oral health, dental care, and life-style issues. Oral health awareness was generally low among the informants. Two categories of oral health were identified: action (the physical things we do to effect the condition of our mouths) and condition (the physical status of the mouth). Conditional aspects were most frequent in evaluations of personal oral health. The informants considered their possibilities to influence oral health limited. Perceptions of influences on oral health were related to personal and professional care, social support and impact, and external factors. 'Concern for oral health' was derived as the core category in perceived influence on oral health. The study indicates that it is important to find factors that enhance adolescents' awareness of their own resources and to seek mechanisms that govern internalization. There is a need to find strategies to convey such knowledge to the intermediaries: dental personnel and parents.
The reinstatement of social activism as a central feature of nursing practice has been advocated by nursing scholars and is consistent with contemporary conceptualizations of primary health care and health promotion that are rooted in critical social theory's concept of empowerment. Advocacy oral history from a feminist postmodern perspective offers a method of research that has the potential and purpose to empower participants to transform their political and social realities and may, therefore, be considered social activism. A recent study of public health nurses who had experienced significant distress through the reduction and redirection of their practice is provided as an exemplar of advocacy oral history. Philosophies underpinning the research method and characteristics of feminist postmodern research are reviewed and implications for the use of this methodology for social activism in nursing are drawn.