Indirect standardization was used to produce estimates of the prevalence of selected risk factors and health status indicators for all health units in Ontario, based on their socio-demographic characteristics and on the relationships between these socio-demographic variables and the health variables of interest, as measured by the Ontario Health Survey (OHS). Socio-demographic variables were drawn from both the OHS and the 1986 Census of Canada. In addition, the validity of the estimates was assessed. A total of 13 combinations of predictor variables were used to estimate 18 selected health status indicators and risk factors. Results showed that the choice of predictor variables used for estimation can have a substantial impact on the error associated with a set of estimates. As well, it was found that the dispersion of the estimates was reduced in comparison to the true values. The ranking of the estimates was found to vary from poor to good. In addition, estimates were shown to be better than using the provincial value as the estimate for each health unit value. Comparison by region showed that estimates for northern regions had somewhat more error than estimates for other regions and that addition of a geographic identifier reduced the amount of error among the estimates. Given all these results, it was concluded that this type of methodology does not appear to be adequate to meet the information needs for health units but that other methods such as regression might produce better results.

Plusieurs explications ont ete avancees afin d'expliquer la surconsommation d'alcool chez les Peuples Autochtones mais tres peu ont des fondements bien etablis. Bref, il n'y a pas de consensus parmi les auteurs. Par contre, il y a unanimite pour dire que la surconsomation d'alcool ou de drogues est un probleme complexe comprenant les spheres psychologique, economique, politique, biologique et surtout socio-culturelle. Il existe plusieurs programmes de desintoxication tels que les Alcooliques Anonymes. Par contre, tres peu de ces programmes remplissent adequatement les besoins des autochtones. Afin de contrer ce probleme croissant, certaines personnes des communautes des Premieres Nations proposent une approche "holistique" dans le but de retourner a une vie active et saine. Cette guerison "holistique" a comme premisse que la comprehension du probleme ne peut etre consideree que dans le cadre de l'environnement total de la personne. L'objet de cette recherche est une mise en lumiere, une comprehension de la surconsommation d'alcool chez les autochtones et de l'approche "holistique" utilisee dans un centre de desintoxication au sein d'une reserve de la Province de Quebec. Cette recherche a egalement comme objet de mettre en evidence la reception des autochtones vis-a-vis cette approche alternative de la toxicomanie. (Abstract shortened by UMI.)

Objective. To determine, in healthy children, the immune response induced at one month and one year by the serogroup C antigen of a quadrivalent meningococcal polysaccharide vaccine ($Menomune\sp{\rm TM}$) A/C/Y/W-135), during a mass vaccination campaign. Participants. 6 month-19 year old volunteers recruited during a Public Health Department mass immunization campaign. Methods. Serum was obtained pre, one month, and one year post immunization and measured by enzyme-linked immunosorbant assay (ELISA) and bactericidal assay (BA) for the immune response to serogroup C N. meningitidis polysaccharide antigen. Throat cultures were analyzed for oropharyngeal colonization of N. meningitidis and N. lactamica. Results. Pre-vaccination, almost all children had a negligible amount of ACPS antibody against group C N. meningitidis, regardless of age. At one month post-vaccination, a significant response was demonstrated in children older than 6 months of age with regard to total ACPS antibody concentration and in children older than 18 months of age with respect to SBA titre. In children less than 18 months old, despite a significant rise in total ACPS antibody concentration, this measure was not associated with the SBA titre. At one year post-vaccination, children less than 5 years of age had a substantial decline in their total ACPS antibody response, while children greater than 18 months old maintained their SBA levels. Implications. During an outbreak of invasive meningococcal disease, quadrivalent meningococcal polysaccharide vaccine can induce a 'protective' immune response in children older than 18 months and may be beneficial for children as young as 6 months of age. (Abstract shortened by UMI.)

Haemophilus influenzae type b (Hib) is the most important cause of serious invasive bacterial disease in young children in many countries, particularly industrialized countries. A 1986 study using PRP-D vaccine among Aboriginal infants in the Northwest Territories (N.W.T.) reported that all ethnic groups responded poorly, but the proportion of Inuit (44%) who responded with protective anti-PRP antibody levels of $\geq0.15\ \mu$/mL was smaller than that of the Dene (60%). This study was undertaken to explore possible reasons for the poorer results of the Inuit infants. Results. The results suggested that the difference between two vaccine lots and sex, and possibly age and region, were implicated in the difference between the groups. Conclusions. The research did not entirely achieve a resolution of the part which ethnicity and other factors played in Inuit response to PRP-D vaccine. The importance of the study, however, was that, by examining the data in more detail, factors other than ethnicity were identified as potentially having an effect on the poor immune response of the Inuit infants in the 1986 N.W.T. study. (Abstract shortened by UMI.)

One objective of the 'Ecosystem Recovery on the St. Lawrence" project is to assess the community's perception of the impact of contamination of the St Lawrence River on their quality of life. More precisely, the Health Sciences component of the project has been assigned the task of evaluating the public's perception of health risks associated with contamination of the St. Lawrence River. The survey presented in this paper was designed to evaluate the perception of residents of Cornwall regarding various environmental health risks associated with the Cornwall area and the St. Lawrence River; compare their perception of certain environmental health risks to the perception of the general Canadian population found in the Health-Risk Perception in Canada report; identify their main sources of information on environmental health risks and compare them to those of the Canadian population; evaluate the level of confidence in various sources of information regarding environmental health risks and compare it to the Canadian population: obtaining a general idea of their attitudes and opinions concerning a variety of environmental health risk perception issues; gather data on behaviours related to health risks, and collect personal and demographic data. To obtain this information, a random sample telephone survey was conducted on 497 adults living in Cornwall. The results reveal that the respondents are significantly more concerned about health risks to themselves and their family from river water, air pollution, chemical pollution, PCB or dioxin, and tap water, than to the Canadian public in general. A significantly lower percentage of the respondents perceive chemical pollution, PCB or dioxin, pesticides in food and bottled water to be a high health risk to the Canadian public than in the "Health-Risk Perception in Canada" survey concluded across Canada. The most important source of information regarding health issues and risk is the media, but the greatest confidence is to medical doctors. In general, the respondents feel that Cornwall is an unhealthy place to live, are concerned about the health risks from chemicals, but feel they have very little control over the risks to their health. The majority of respondents do not eat sportfish from the St. Lawrence River mainly because of concern about water pollution. The respondents that do eat sportfish mostly consume yellow perch. In addition, about three-quarters of respondents do not swim in the St. Lawrence River for various reasons. The most common reported medical conditions are asthma, arthritis, allergies, heart conditions, diabetes and hypertension. Multivariate analyses reveal that the less educated, older sportfish consumers who have been living in Cornwall for several years are less likely to associate environmental pollution with health problems. This survey identifies the major concerns of the residents of Cornwall and is useful to direct risk communication. Recommendations are made based on the results of this survey.

Despite the great success of the worldwide Expanded Programme on Immunization (EPI), there are still 2 million third world children who die every year from the vaccine-preventable diseases. While the great majority of children in Uganda and other third world countries receive vaccination against tuberculosis (BCG) and the first dose of oral polio vaccine, many do not complete the EPI vaccination series; and neonatal tetanus is still a major concern, since most fertile women in the third world are not covered with two doses of tetanus toxoid (TT). Main objectives. Using data of the 1988-89 Uganda Demographic and Health Survey (UDHS): (1) To assess risk factors for children not getting immunized against tuberculosis, diphtheria, tetanus, whooping cough, polio and measles. (2) To assess risk factors for not completing the EPI vaccination series (the "drop-out" problem). (3) To assess risk factors for pregnant women not receiving tetanus toxoid for protection against neonatal tetanus; and hence: (a) To identify high risk groups/populations where children are less likely to get immunized (partly thru fully). (b) To identify high risk groups of pregnant women in terms of not receiving tetanus toxoid during pregnancy. (Abstract shortened by UMI.)

This thesis begins by describing a partially successful survey to study anabolic steroid use by high school students that was intended to address some of the gaps in knowledge regarding those drugs in the adolescent population. Three major themes were judged critical to the success of health promotion survey research: (1) the community being surveyed must consider the topic of sufficient importance to have an interest in participating in the research, (2) the design of the study and any data collection instrument must meet a set of guiding criteria: be applicable and acceptable to the study population, be feasible within the constraints of the community, produce good quality data and be of reasonable cost, and finally, (3) a method to ensure age appropriate consent that does not compromise data duality should be available for use. These themes are developed using the steroid survey as a case study. The public response to the topic is examined, the burden of ill health that may be caused by steroids is explored and the literature on the prevalence of use among adolescents is summarized. Finally, the ethics of consent requirements in survey research, with an emphasis on research involving children, are explored. (Abstract shortened by UMI.)

The transfer of inappropriate health technology to less developed countries constitutes a large obstacle to the improvement of health in the Third World. Technology transferred through three major mechanisms is examined: Multinational Corporations, Foreign Aid and Education. The technology is evaluated based on a criteria of appropriateness determined from the needs of less developed countries. The criteria of appropriateness incorporated morbidity and mortality, economic, sociocultural, and political factors. Recommendations to redress the inappropriate transfer of technology are set forth in the conclusions.

Abstract not available.

Abstract not available.