The Good Heart, Good Life survey: self-reported cardiovascular disease risk factors, health knowledge and attitudes among Greek-Australians in Sydney

Representativeness of Three Survey Methods in Ethnic Health Research

Study objective: To identify the survey method which generates the most representative sample of respondents in an ethnic community

Design: Three survey methods (including sampling from the telephone book and telephone surveys, cluster sampling of households from areas with known high concentrations of migrants from the target community and face-to-face interviews, and sampling of persons listed on the electoral roll and a mailed survey) were employed concurrently in a defined area.

Setting: Metropolitan Sydney, Australia.

Participants: Persons aged 18 years or more born in Lebanon.

Main results: The telephone survey method consistently outperformed cluster sampling and sampling from the electoral roll in terms of cost, response and contact rates, ease and speed of administration and representativeness of the sample. All methods generated a similar age profile but over-represented females compared with census data for the study area. There was relatively little duplication of respondents. The proportion of respondents who rated their health as fair or poor was comparable.

Conclusions: Telephone surveying of migrant populations is a recommended strategy for health research in the Lebanese migrant population in metropolitan Sydney, and is also likely to be recommended for migrant populations with ethnically identifiable surnames.

"I have never experienced any problem with my health. So far, it hasn't been harmful": older Greek-Australian smokers' views on smoking: a qualitative study

Background

Smoking tobacco products is one of the largest preventable health risk factors for older people. Greek-Australians have the highest prevalence of cigarette use in Australia for older people, but there is a lack of knowledge about Greek-Australian’s perspectives on smoking cessation. The purpose of this exploratory, qualitative study was to progress the knowledge base in this area.

Methods

A qualitative study was designed to gather information on participants’ perspectives about, and understanding of, their reasons for smoking and their attitudes to quitting. A snowball sampling technique was used to identify twenty Greek–Australian current smokers, aged ≥50 years. Semi-structured, face-to-face interviews were conducted with the assistance of a Greek translator. The audio-taped interviews were transcribed and then qualitative content analysis was used to categorise responses to the questions.

Results

Participants’ perspectives on three broad topics were identified in the interviews: perceived benefits of smoking, perceptions of smoking and its effect on health, and barriers to cessation. Smoking behaviour was described as contributing to tiredness, and stress, and yet also was also a source of enjoyment. Level of knowledge about smoking-related diseases and the risks of smoking was very low. The number of cigarettes smoked each day, type of smoking (i.e. pipe rather than cigarettes), and previous family history of smoking were identified as indicators that limited harm flows from smoking. Most participants had a positive attitude towards smoking and described their own life experience and cultural norms as supporting smoking acceptability. Low confidence in quitting was linked to advanced age.

Conclusion

Smoking among older Greek-Australian smokers has been associated with a number of influences and these need to be addressed in smoking cessation efforts targeted at this group. Promoting knowledge about the health impacts of smoking, changing attitudes towards smoking, and ultimately, decreasing tobacco consumption are critical to the maintenance of health among older Greek Australians. Cultural and experiential influences may increase the difficulty associated with changing these outcomes, but may also serve as a framework from which to develop and implement an educational intervention tailored for older Greek-Australians.

Understanding socio-cultural influences on smoking among older Greek-Australian smokers aged 50 and over: facilitators or barriers? A qualitative study

Smokers of all ages can benefit by quitting, but many smokers continue to smoke. Older Greek-Australian smokers, one of the largest ethnic groups in Australia, have higher rates of smoking than other groups of older Australians. This qualitative study aimed to explore older Greek-Australians’ views about socio-cultural influences on their smoking. A snowball sampling technique was used to identify twenty Greek–Australian smokers (12 males and eight females), aged ≥ 50 years. They were recruited through the Greek Orthodox Community Center of South Australia (GOCSA). Qualitative data were collected using semi-structured face-to-face interviews. The audio-taped interviews were translated and transcribed, and then analysed using content analysis. Results suggested that smoking was considered as the “norm” by older Greek-Australian smokers. There were four groups embedded in the participants’ social networks that were reported to be important in relation to either encouraging smoking or, smoking abstinence. These support groups included: family members, friends, the Greek community, and physicians. Smokers’ family members (brothers) and friends were identified as facilitators of smoking whereas non-smoker family members (children and spouses) were reported as providing barriers to smoking. Different approaches were used by supporter groups to assist smokers to quit smoking—both planned and unplanned. Knowledge, planning of social and cultural supports, and addressing barriers to smoking cessation are a important part of health planning for older Greek-Australians. Social norms, including those arising from social interactions, and predisposing traits can influence smoking behaviour. Addressing the specific barriers to smoking cessation of older Greek-Australians is critical to addressing the risk for chronic disease in this group.

Is country of birth a risk factor for acute hospitalization for cardiovascular disease in Victoria, Australia?

International mortality studies show that some subgroups of migrants have a higher risk of Cardiovascular Disease (CVD) than the native-born. To investigate whether country of birth increases the risk for acute myocardial infarction (AMI) and cerebral infarction (stroke) hospitalization in Victoria, Australia. A retrospective analysis of Victorian AMI (ICD-10-AM codes I21 and I22) and stroke (ICD-10-AM I63 and I64) discharges from routinely collected hospital data in 2001-2002 was conducted. The outcome measures were directly age standardized rate ratios (RRs) of AMI and stroke hospitalization, calculated using 2001 Australian census data, with the Australian-born as the reference group. Males from 4 ethnic groups--USSR/Baltic; Southern Asia; Middle East; and Eastern Europe, displayed higher risk for AMI hospitalization than Australian-born men, whereas males and females from Southeast Asia and Northeast Asia were at lower risk. Furthermore, males from Western Europe and females from the Pacific were also at lower risk. Females from the Middle East, Southern Asia, and Southern Europe were at higher risk of stroke hospitalization than Australian-born women; in contrast, males from Eastern Europe, NorthAsia, Southern Asia, Southern Europe, and the United Kingdom and Ireland were at lower risk. Risk for AMI and stroke hospitalization varies by country of birth in comparison with the Australian-born population. It will be import to identify the factors associated with these varying risks in order to target preventive strategies aimed at reducing risk of AMI and stroke.

[Health promotion and cardiovascular risk factors. The level of knowledge among 510 inpatients of an acute coronary care unit]

PATIENTS AND METHODS

A total of 510 patients hospitalized on a cardiologic ward were questioned on cardiovascular disease risk factors using a questionnaire. The knowledge on these risk factors was assessed with a score system.

RESULTS

Knowledge of patients on cardiovascular disease risk factors was generally low: One out of 5 did not know about the consequences of obesity, high blood cholesterol or smoking on the coronary vessels. Over 30% did not name hypertension. Only 1 out of 3 patients mentioned diabetes mellitus as a risk factor. There was no change in the knowledge during the hospital stay despite a standardized and intensive information program. The results of the second survey on the day of discharge were equal to the results of the admission day. Hospital stays in the past had no influence on the knowledge. Patients with a diagnosed coronary heart disease had the same results in the survey as patients with other diseases. The presence of risk factors had hardly any influence on the knowledge of these patients.

CONCLUSION

The result of this study emphasizes the need for better health information for patients. The repetitive information on health related issues during inpatient treatment does not seem to have a positive effect on patients' knowledge. Therefore other ways of health education have to be introduced and evaluated in acute care.

Substance use in high school students in New South Wales, Australia, in relation to language spoken at home

PURPOSE

To examine for the first time adolescent substance use by ethnicity, given the high proportion of migrants from non-English-speaking countries in New South Wales, (NSW), Australia.

METHODS

Data from four surveys of NSW secondary school students in 1983, 1986, 1989, and 1992 were used for this analysis. The prevalence of substance use by whether English was spoken at home was stratified by sex and age using data from the most recent survey year. Adjusted odds ratios and 95% confidence intervals were produced by simultaneous logistic regression, adjusting for sex, age group, and the interaction term of sex and age for each of these substances, and for each survey year separately. Data from 1989 and 1992 were pooled together to examine rates of substance use by ethnic subgroups which reflect migration patterns.

RESULTS

The prevalence of smoking and alcohol and illicit drug use was consistently lower among NSW adolescents speaking a language other than English at home, compared with those speaking English at home in all survey years. Only the prevalence of solvent sniffing was higher among younger adolescents speaking a language other than English at home. Students from Southeast Asia showed consistently lower rates of usage of all substances compared to all other groups.

CONCLUSIONS

There may be different opportunities for the prevention of adolescent substance use among native English speakers to be gained from non-English-speaking cultures.

A longitudinal study of smoking in year 7 and 8 students speaking English or a language other than English at home in Sydney, Australia

OBJECTIVE

To compare the rates and predictors of smoking uptake between adolescents speaking English and those speaking a language other than English (LOTE) at home.

DESIGN

A cross-sectional survey of year 7 and 8 students (aged 12 and 13 years) was conducted in 1994 and repeated 12 months later. A cohort of students was identified with respondents at baseline matched at follow up. chi 2 and logistic regression were used for analysis.

SETTING

38 schools in southern, east, and northern Sydney, Australia.

SUBJECTS

Year 7 and 8 students in the schools were included and examined on two occasions, with complete data for 5947 (80%) students at baseline and 6177 (98%) students at a 12-month follow up. Records were able to be matched perfectly for 3513 respondents (59%).

MAIN OUTCOME MEASURES

Smoking rates and predictors of smoking uptake among students speaking English or a LOTE at home.

RESULTS

At baseline, 6.1% of students surveyed were smokers. Twelve months later, 15.8% of student surveyed were smokers. There were significantly lower smoking rates among students speaking a LOTE at home compared with those speaking English at home at baseline and at 12 months. Using matched data, for students speaking English at home, five variables were significant predictors of smoking uptake: thinking it acceptable to smoke, perceived benefits of smoking, and having a brother, sister, or close friend who smokes. For students speaking a LOTE, the only predictor was the smoking status of close friends.

CONCLUSIONS

Despite the higher smoking prevalence among men with a non-English-speaking background, and the reported strong association between fathers' smoking status and smoking onset of their children, adolescents speaking a LOTE at home were significantly less likely to be smokers than their English-speaking counterparts. Thus, there would seem to be a delay of smoking onset among students speaking a LOTE at home. The smoking rates among respondents speaking a LOTE at home in this study are lower than those obtained from the studies conducted in Europe and the United States. Effective smoking prevention interventions need to be implemented at an early stage of adolescence.

Mental health status of Iranian migrants in Sydney

OBJECTIVE

The aim of this study was to determine the levels and predictors of psychological distress within the Iranian community in Sydney, Australia.

METHOD

Participants (n = 161) were identified using snowball sampling, and a questionnaire incorporating the General Health Questionnaire (GHQ-20) and other migration-related factors was mailed to their preferred address.

RESULTS

A relatively high proportion of respondents (37%) had GHQ-20 scores above the recommended threshold (4+). Students were significantly more likely to report psychological distress compared with respondents who worked full-time. A feeling that migration had contributed to their distress was also found to be significantly associated with above-threshold GHQ-20 scores.

CONCLUSIONS

Iranian migrants in Sydney may need mental health programs to address migration-related distress.

The development and application of a scale of acculturation

As Australia is one of the most multicultural societies in the world, acculturation of migrants and changes in migrants' health status should be an important focus of public health research. The absence of an accepted measure of acculturation is one barrier to exploring the relationship between acculturation and health. This paper presents data from a study of 851 Arabic-speaking adults attending 20 Arabic-speaking general practitioners in Canterbury, Sydney. An eight-item scale assessing acculturation was developed with a structural equation modelling program (LISREL). This acculturation scale was based on similar scales used with Hispanic populations, was theoretically grounded and had high internal consistency and criterion-related validity. To show the application of a scale of acculturation, patients' preferences for participation in medical decision making, according to level of acculturation, were examined. After adjustment for age, sex and highest level of formal education, significant inverse associations between acculturation and preferences for patient (versus family) involvement in medical decision making were found. Mechanisms for how acculturation affects health need to be explored.

Selection bias from sampling frames: telephone directory and electoral roll compared with door-to-door population census: results from the Blue Mountains Eye Study

Many Australian public health research studies use the telephone directory or the electoral roll as a sampling frame from which to draw study subjects. The sociodemographic, disease-state and risk-factor characteristics of subjects who could be recruited using only the telephone directory or only the electoral roll sampling frames were compared with the characteristics of subjects who would have been missed using only these sampling frames, respectively. In the first phase of the Blue Mountains Eye Study we interviewed and examined 2557 people aged 49 and over living in a defined postcode area, recruited from a door-to-door census. This represented a participation rate of 80.9 per cent and a response rate of 87.9 per cent. The telephone directory was searched for each subject's telephone number and the electoral roll was searched for each subject. Subject characteristics for those who were present in each of these sampling frames were compared with the characteristics of those subjects not included in the sampling frames. The telephone directory listed 2102 (82.2 per cent) of the subjects, and 115 (4.5 per cent) had no telephone connected. The electoral roll contained 2156 (84.3 per cent) of the subjects, and 141 subjects (5.5 per cent) could not be found in either the electoral roll or the telephone directory. Younger subjects, subjects who did not own their own homes and subjects born outside of Australia were significantly less likely to be included in either of these sampling frames. The telephone directory was also more likely to exclude subjects with higher occupational prestige, while the electoral roll was more likely to exclude unmarried persons and males. Researchers using the telephone directory and electoral roll to select subjects for study should be aware of the potential selection bias these sampling frames incur and need to take care when generalising their findings to the wider community.

Lipoprotein(a) concentrations in non-selected hospitalised patients between 18 and 100 years of age: comparison with cholesterol fractions and triacylglycerols in patients with lipid status requests

In a study designed to measure lipoprotein(a), cholesterol, cholesterol fractions and triacylglycerols in serum 4004 hospitalised individuals aged between 18 and 100 years were examined. Lipoprotein(a) was determined in 1313 patients (438 males, 875 females) aged 18-59 years and 489 patients (234 males, 255 females) aged 60-100 years. Cholesterol, cholesterol fractions and triacylglycerols were determined in a further 2037 patients (1084 males, 953 females) aged 18 to 100 years, for whom a lipid-status request had been made. Lipoprotein(a) concentrations in 619 females measured directly postpartum were not significantly different from aged-matched female in-patients (n = 104) and age-matched female hospital staff (n = 114). Lipoprotein(a) concentrations in women (n = 77) aged 30-74 undergoing chronic haemodialysis were significantly higher (p < 0.001) than in men (n = 95) of the corresponding age group. Median lipoprotein(a) serum concentrations showed a peak between 60-69 years in both men and women, i.e. at times of reported increased cardiovascular disease in both sexes. The lipoprotein(a) levels found in old age are comparable with those found in children and adolescents. The lipoprotein(a) patient group was assessed according to age and clinic. Eight groups of patients were analysed. The maternity patients were significantly younger (median age 26 a) than the other seven groups (p < 0.05 - < 0.01), the hospital employees (median age 31 a) attending the annual check-up being younger than the remaining six groups (p < 0.01). Lipoprotein(a) concentrations were marginally higher (p = 0.05) in the dialysis patients, when compared with those on internal medical wards. Of the 'traditional' lipid analytes, the ratio LDL-cholesterol:HDL-cholesterol was of interest, being significantly higher in males aged 70-79 years of age, when compared with males under 30 years of age. Triacylglycerols were higher in men aged between 30 and 59 years (p = 0.05 - < 0.01). The relationship between median analyte concentration and age was different for lipoprotein(a) than for the ratio LDL-cholesterol:HDL-cholesterol and triacylglycerols, thus further supporting the fact that lipoprotein(a) may be an independent risk factor for the development of atherosclerotic disease.