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Although many young mothers (aged <21 years) are exposed to multiple adversities that increase their risk for mental illness, prevalence data are largely limited self-report questionnaires estimating only the prevalence of postpartum depression. Gaining a greater understanding of the burden of a broader range of common mental illnesses affecting these young women has the potential to improve their health as well as the development and functioning of their children. The Young Mothers Health Study recruited 450 mothers aged <21 years and 100 comparison mothers (aged >20 years old at first delivery) living in urban and rural central-west Ontario. Age-matched young mothers were also compared with 15- to 17-year-old women without children (N = 630) from the 2014 Ontario Child Health Study. The prevalence of current mental disorders was assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents. Nearly 2 of 3 young mothers reported at least one mental health problem, and almost 40% had more than one. Young mothers were 2 to 4 times as likely to have an anxiety disorder (generalized anxiety disorder, separation anxiety disorder, social phobia, and specific phobia), attention-deficit/hyperactivity disorder, oppositional defiant disorder, or conduct disorder and were 2 to 4 times more likely to have more than one psychiatric problem than older comparison mothers or women aged 15–17 years. Given the high rates of mental health problems and complex needs of young mothers in Canada and the possible adverse effects of maternal psychopathology on their children, further efforts should be directed at engaging and treating this high-risk group. [ABSTRACT FROM AUTHOR]

Current evidence suggests that the strength of the psychological control condition greatly impacts treatment outcomes. Psychological controls can be grouped into three general classes: no-treatment or waitlist (delayed treatment), attention placebo or the best available treatment comparison. Of these three, the use of the waitlist condition is the most common and is used in up to 73% of published psychological treatment studies. Many psychological interventions are in use today based on the efficacy demonstrated in waitlist controlled trials. In the field of anxiety disorders, cognitive behavioural therapy (CBT) is considered a first-line treatment. Meta-analyses in anxiety disorders have revealed that effect sizes for CBT compared to waitlist controls are much higher than those found using psychological placebos as comparators. Furthermore, waitlists have been associated with deleterious effects and have been described as “no-cebos” in related conditions such as major depressive disorder. Despite these findings, the use of waitlist controls continues to be a mainstay in the psychological anxiety disorders literature. The purpose of this paper is to examine the use of waitlists with a focus on the anxiety disorders. Methodological and ethical issues associated with waitlist controls will be explored, as well the use of alternative psychological placebos. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To identify factors associated with repeat emergency department (ED) presentations for suicide-related behaviors (SRB) – hereafter referred to as repetition – among children/youth to aid secondary prevention initiatives. To compare rates of repetition in children/youth with substantiated maltreatment requiring removal from their parental home with their peers in the general population. Methods: A population-based (retrospective) cohort study was established for children/youth with a first ED SRB presentation at risk for repetition in the Province of Ontario, Canada between 1 January 2004 and 31 December 2008. Children/youth legally removed from their parental home because of substantiated maltreatment (n =179) and their population-based peers (n =6,305) were individually linked to administrative health care records over time to ascertain social, demographic, and clinical information and subsequent ED presentations for SRB during follow-up. These children/youth were described and their repetition-free probabilities over time compared. To identify factors associated with repetition we fit multivariable, recurrent event survival analysis models stratified by repetition and present unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Children/youth with substantiated maltreatment (as noted) were two times more likely to have repetition than their peers after adjustments for social, demographic, and clinical factors (conditional on prior ED SRB presentations). A number of these factors were independently associated with repetition. No one factor distinguished between having a first and second repetition nor was more strongly associated with repetition than another. Conclusions: The risk of repetition is higher in children with substantiated maltreatment (as noted) than their peers. No one factor stood out as predictive of repetition. Implications for secondary prevention initiatives include a non-selective approach, sensitive to family difficulties and the need to better contextualize repetition and harness data linkages. [Copyright &y& Elsevier]

Abstract: Background: Previous research has shown that various childhood risk factors are related to depression and chronic physical conditions (CPCs) later in life. However, little is known about risk factors associated with comorbidity for these conditions. The purpose of this study was to examine the association between individual (school performance, childhood physical and sexual abuse) and family risk variables (socioeconomic status, parental mental health, medical condition, and functional limitation) with depression only, chronic pain conditions (back pain and headaches) or other CPCs (respiratory, cardiovascular and digestive disorders, and diabetes) and the comorbidity of either CPC category with depression assessed in early adulthood. Methods: We used data from the Ontario Child Health Study, a prospective, population-based study of 3294 children (ages 4–16) enrolled in 1983 and meeting inclusion criteria at follow-up in 2001 (N = 1475; ages 21–35 years). Results: Using multinomial logistic regression models, controlling for sex and age, childhood history of physical abuse was associated with most outcomes (OR = 1.86, 95% confidence interval [CI] 1.16–2.97to 4.36, 95% CI, 1.74–10.97). Parental mental health, childhood functional limitation, childhood history of sexual abuse and family functioning were all related to comorbid depression and chronic pain conditions. Parental mental health was also related to increased risk of other CPCs (ORs = 1.66; 95% CI, 1.08–2.55). Conclusion: We found that the greatest disease risk (comorbid depression and chronic pain conditions) was related to the greatest number of childhood risk factors. Although there was some evidence of specificity, there was overlap in childhood physical abuse predicting almost all outcomes. Efforts targeting the prevention and treatment of childhood maltreatment are critical in order to prevent the long lasting impact of childhood adversity on mental and physical outcomes in early adulthood. [Copyright &y& Elsevier]

Abstract: Objectives: To determine whether the rates of a first presentation to the emergency department (ED) for suicide-related behavior (SRB) are higher among children/youth permanently removed from their parental home because of substantiated maltreatment than their peers. To describe the health care settings accessed by these children/youth before a first SRB presentation to help design preventive interventions. Methods: A population-based (retrospective) cohort of 12–17-year-olds in Ontario, Canada was established. Children/youth removed from their parental home because of the above noted maltreatment (n =4683) and their population-based peers (n =1,034,546) were individually linked to administrative health care records over time to ascertain health service use and subsequent ED presentations for SRB during follow-up. Person-time incidence rates were calculated and Cox regression models used to estimate adjusted hazard ratios (HR) and corresponding 95% confidence intervals (CI). Results: After controlling for demographic characteristics and prior health service use, maltreated children/youth were about five times more likely to have a first ED presentation for SRB compared to their peers, in both boys (HR: 5.13, 95% CI: 3.94, 6.68) and girls (HR: 5.36, 95% CI: 4.40, 6.54). Conclusions: Children/youth permanently removed from their parental home because of substantiated child maltreatment are at an increased risk of a first presentation to the ED for SRB. The prevention of child maltreatment and its recurrence and the promotion of resilience after maltreatment has occurred are important avenues to study toward preventing ED SRB presentations in children/youth. Provider and system level linkages between care sectors may prevent the need for such presentations by providing ongoing environmental support. [Copyright &y& Elsevier]

Abstract: Intimate partner violence (IPV) directed towards women is a serious public health problem. Women''s education may offer protection against IPV, but uncertainty exists over how it might reduce risk for IPV at the community and individual levels. The objectives of this study are to: (1) disentangle community from individual-level influences of women''s education on risk for IPV; (2) quantify the moderating influence of communities on individual-level associations between women''s education and IPV; (3) determine if women''s attitudes towards mistreatment and living standards at the community and individual levels account for the protective influence of women''s education; and (4) determine if the protective influence of education against IPV is muted among women living in communities exhibiting attitudes more accepting of mistreatment. Study information came from 68,466 married female participants in the National Family Health Survey conducted throughout India in 1998–1999. Multilevel logistic regression was used to address the study objectives. IPV showed substantial clustering at both the state (10.2%) and community levels (11.5%). At the individual level, there was a strong non-linear association between women''s education and IPV, partially accounted for by household living standards. The strength of association between women''s education and IPV varied from one community to the next with evidence that the acceptance of mistreatment at the community level mutes the protective influence of higher education. Furthermore, women''s attitudes towards mistreatment and their standards of living accounted for community-level associations between women''s education and IPV. Place of residence accounted for substantial variation in risk of IPV and also modified individual-level associations between IPV and women''s education. At the community level, women''s education appeared to exert much of its protective influence by altering population attitudes towards the acceptability of mistreatment. However, there was no residual association between women''s education and IPV at the community level once living standards are taken into account. While women''s education provides strong, independent leverage for reducing the risk of IPV, planners must keep in mind important community factors that modify its protective influence. [Copyright &y& Elsevier]

Abstract: This study estimates the relative importance to child health (indicated by weight and height for age) of economic development level [gross domestic product (GDP) converted to international dollars using purchasing power parity (PPP) rates: GDP-PPP], household wealth and maternal education and examines the modifying influence of national contexts on these estimates. It uses information collected from mothers aged 15–49-years participating in Demographic Health Surveys (DHS) conducted in 42 developing countries. In multilevel regression models, the three study variables exhibited strong independent associations with child health: GDP-PPP accounted for the largest amount of unique variation, followed by maternal education and household wealth. There was also substantial overlap (shared variance) between maternal education and the other two study variables. The regressions of child health on household wealth and maternal education exhibited substantial cross-national variation in both strength and form of association. Although higher education levels were associated with disproportionately greater returns to child health, the pattern for household wealth was erratic: in many countries there were diminishing returns to child health at higher levels of household wealth. We conclude that there are inextricable links among different strategies for improving child health and that policy planners, associating benefits with these strategies, must take into account the strong moderating impact of national context. [Copyright &y& Elsevier]

Objective: There are few well-evaluated uncomplicated community-based interventions for childhood aggression. The authors assess the impact of a community-based anger management group on child aggressive behaviors, using a randomized, controlled trial (RCT).Method: Families with children 7 to 11 years old were recruited through advertisements and randomized (N = 123). Inclusion required parent concern about anger/aggressive behavior, RCT agreement, and a telephone behavior screen. Intervention participants were offered three parent education/skill-building group sessions, 10 weekly child group sessions, and three in-home family practice sessions. Nine groups ran from August 2002 to August 2004. Interviewers naïve to randomization collected data on all participants pre- and postgroup. Outcomes included child-rated anger and parent-rated child aggressive behavior, externalizing behavior and hostility, parent-child relationship, and parenting stress. Intent-to-treat analyses were done.Results: Pre/postoutcome comparisons indicated no significant differences between intervention versus control, with small effect sizes for most outcomes (0.27-0.29). Although not significant, the magnitude of improvement favored intervention families on all parent-rated measures.Conclusions: Overall, there was no differential impact of participating in a community-based anger management group versus control on child aggressive behaviors and other associated measures. The impact of regression to the mean, effect, and sample size estimates; child comorbidity; and programmatic and methodological issues are discussed. [ABSTRACT FROM AUTHOR]

In the present study, we examine whether higher rates of mental health service use observed among single-parent mothers is due to greater need (psychopathology) or other factors (predisposing and enabling characteristics) using a socio-behavioural model of health care use. We use data from two large surveys in Canada (the 1994–95 National Population Health Survey and the 1990 Ontario Mental Health Supplement). The bivariate results from both surveys revealed that single-parent mothers were two to three times more likely than married mothers to have sought professional help for mental health reasons over a 12-month period. Multivariate analyses showed that differences in predisposing and enabling characteristics between single and married mothers accounted for very little of the relationship between family structure and service use. Rather, differences in the prevalence of psychiatric disorders accounted for the higher use of services among single mothers. Single mothers are more likely than married mothers to seek professional help for mental health concerns. The use of services appears equitable in that need (higher rates of psychopathology) is the major factor differentiating use between married and single mothers. Further work should examine differences in pathways into formal care between single and married mothers. [Copyright &y& Elsevier]

Presents information on a study that examined the strength of association between single-mother family status and child outcome. Methodology of the study; Results and discussion on the study.

Presents the findings of a study which sought to determine whether measurement reliability was linked to risk factors and childhood psychiatric disorder. Orign of data ussed to conduct the study; Regression of selected risk factors on parental assessments of childhood oppositional defiant disorder and overanxious disorders.

Presents information on a study conducted on disorders in children. Purpose of the study; Methodology used to conduct the study; Results of the study.

Objectives: To compare the health-related quality of life (HRQL) trajectories of a regional cohort of extremely low birth weight (ELBW, <1000 g) survivors (births from 1977 to 1982) and a group of normal birth weight (NBW) controls, at 3 ages: 12-16 years, 22-26 years, and 29-36 years, spanning over 20 years. We hypothesized that the HRQL of the ELBW cohort would be significantly compromised compared with their NBW peers, and that neurosensory impairments (NSI) would have an additional negative effect.Study Design: We used the Health Utilities Index Mark 3, in which health status was self-assessed and utility scores were derived from community preferences; multilevel modeling was used to delineate trajectories of HRQL among ELBW survivors with (n = 37) and without NSI (n = 116), and NBW controls (n = 137).Results: Adjusting for participant sex and socioeconomic status at age 8 years, ELBW survivors with NSI had consistently lower HRQL compared with both ELBW survivors without NSI and NBW controls, from adolescence through to adulthood (β = -0.264; P < .001). ELBW survivors without NSI also had significantly lower HRQL compared with NBW controls (β = -0.092; P < .01). At all ages, differences seen in the Health Utilities Index Mark 3 scores between ELBW participants and NBW controls were clinically important, though there was no differential rate of decline between the 2 groups.Conclusions: ELBW survivors manifest meaningfully poorer HRQL from their early teens through their mid-30s. Individuals with NSI appear to represent a distinct group of ELBW survivors with substantially lower HRQL at all ages. Information on HRQL can be helpful in prioritizing research and intervention strategies. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To identify individual and family level characteristics that might explain differences in rates of tobacco use among immigrant and nonimmigrant adolescents. Methods: Data for analysis come from a probability sample of 5401 adolescents aged 12–18 years participating in the Ontario Health Survey (OHS). Three groups were compared: (a) adolescents born in Canada to Canadian-born parents (n = 3886), (b) adolescents born in Canada to immigrant parents (n = 1233), and (c) adolescents born outside of Canada (n = 282). Discrete, multilevel logistic regression was used in the analysis. Results: Adolescents born outside of Canada report the lowest rates of tobacco use, despite greater economic hardship. A negative association emerges between family socioeconomic status and tobacco use among adolescents born in Canada but not among adolescents born outside of Canada. Immigrant youth are less likely to affiliate with peers who smoke and are more likely to come from families where parents do not smoke: these differences partially explain the decreased rates of tobacco use among immigrant adolescents. Conclusions: Although subject to greater economic hardship, immigrant youth are less likely to engage in tobacco use. Protective factors associated with immigrant family life, such as lower rates of parental tobacco use and less exposure among immigrant adolescents to peers who smoke, may counteract some of the negative effects of poverty and social hardship. Future research should begin to address the processes that lead to adaptive outcomes among adolescents from immigrant families, despite greater exposure to social disadvantage. [Copyright &y& Elsevier]

Abstract: Background: The impact of childhood epilepsy can only be appreciated by understanding that epilepsy comprises a set of complex neurobehavioral conditions with significant social consequences, and not simply disorders of recurrent seizures. Our objective is to describe the hypotheses and methodology behind a large prospective longitudinal study that is based on a conceptual framework for understanding health outcomes. The study will quantify the specific influences—direct, mediating or moderating—that various epilepsy, comorbid, child, and family variables exert on health over the early life course. Methods: The target population is 8- to 14-year-old children with epilepsy and their caregivers from across Canada. Children, caregivers, and health professionals are completing 17 measures at five visits over a 28-month period. We have selected measures based on content, the source of the items, psychometric properties, and provisions for child self-report. Our cross-sectional and longitudinal design includes a relational model for structural equation modeling of specific biomedical and psychosocial variables with hierarchical direction of influence. To measure change over time, we will use hierarchical linear modeling. Significance: This article reports the framework for interpreting future data. We believe that it will help researchers consider their methodology and encourage them to plan and execute longitudinal studies. Furthermore, the article will help clinical readers identify what to look for when evaluating outcomes research. It is our belief that the next generation of research to understand life-course effect in the lives of children and youth with chronic conditions and their families must occur over real time. [Copyright &y& Elsevier]

The article presents a study which explores the associations between young adult functioning and being born to a teen mother at the time of birth and being born to a teen mother later in her life. Data from the Ontario Child Health Study (OCHS), a community survey of the determinants of child health among Ontario children, were analyzed. Findings of the study revealed that being born to a teen mother is associated with poorer educational achievement, personal income, and life satisfaction.

Purpose: In this study we examined the effect of biofuel smoke exposure at the national and child levels on child anemia. Methods: Data are from Demographic and Health Surveys conducted between 2003 and 2007. The respondents were women (15−49 years) and their children (0−59 months) (n = 117,454) in 29 developing countries. Results: In multinomial logistic regression models, both moderate and high exposure to biofuel smoke at the country level are associated with moderate/severe anemia (odds ratio [OR], 2.36; 95% confidence interval [95% CI], 1.28−4.36 vs OR, 2.80; 95% CI, 1.37−5.72) after adjusting for covariates. Exposure to biofuel smoke at home is associated with mild anemia (OR, 1.07; 95% CI, 1.01−1.13), and there are interactions between biofuel smoke exposure and child age in months on mild anemia (OR, 1.004; 95% CI, 1.002−1.006) and moderate/severe anemia (OR, 1.006; 95% CI, 1.004−1.008). There are also interactions between biofuel smoke exposure at home and diarrhea on mild anemia (OR, 1.22; 95% CI, 1.10−1.34) and on moderate/severe anemia (OR, 1.11; 95% CI, 1.01−1.22); and fever on moderate/severe anemia (OR, 1.33; 95% CI, 1.22−1.45). Conclusions: Given the increasing number of people relying on biofuels in developing countries, policies and programs are necessary to protect children from being exposed to this harmful smoke at home. [ABSTRACT FROM AUTHOR]

Although the developmental course of self-esteem has been examined in general population samples, there is a lack of research examining the trajectory of self-esteem in populations who experience unique developmental challenges. We compared the trajectory of self-esteem in extremely low birth weight (ELBW; <1000 g) survivors and normal birth weight (NBW) controls from mid-adolescence through their early 30s. Self-esteem was reported during three follow-up periods (age 12–16, age 22–26, age 30–35). Adjusting for sex, chronic health problems, socioeconomic status, and social support, no difference was noted in self-esteem in the two groups in adolescence, but birth weight status predicted rate of change of self-esteem from adolescence to adulthood. The NBW controls showed the expected, normative increases in self-esteem from mid-adolescence to young adulthood, while ELBW individuals displayed stable, relatively low levels of self-esteem into young adulthood. Our findings highlight that ELBW survivors may not experience the normative trajectory of self-esteem into young adulthood. [ABSTRACT FROM AUTHOR]

Research on factors associated with good mental health following child maltreatment is often based on unrepresentative adult samples. To address these limitations, the current study investigated the relationship between individual-level factors and overall mental health status among adolescents with and without a history of maltreatment in a representative sample. The objectives of the present study were to: 1) compute the prevalence of mental health indicators by child maltreatment types, 2) estimate the prevalence of overall good, moderate, and poor mental health by child maltreatment types; and 3) examine the relationship between individual-level factors and overall mental health status of adolescents with and without a history of maltreatment. Data were from the National Comorbidity Survey of Adolescents (NCS-A; n  = 10,123; data collection 2001–2004); a large, cross-sectional, nationally representative sample of adolescents aged 13–17 years from the United States. All types of child maltreatment were significantly associated with increased odds of having poor mental health (adjusted odds ratios ranged from 3.2 to 9.5). The individual-level factors significantly associated with increased odds of good mental health status included: being physically active in the winter; utilizing positive coping strategies; having positive self-esteem; and internal locus of control (adjusted odds ratios ranged from 1.7 to 38.2). Interventions targeted to adolescents with a history of child maltreatment may want to test for the efficacy of the factors identified above. [ABSTRACT FROM AUTHOR]

Research on factors associated with good mental health following child maltreatment is often based on unrepresentative samples and focuses on individual-level factors. To address these gaps, the present study examined the association between relationship- and community-level factors and overall mental health status among adolescents with and without a history of maltreatment in a representative sample. Data were drawn from the National Comorbidity Survey of Adolescents (NCS-A; n = 10,148; data collection 2001–2004); a large, cross-sectional, nationally representative sample of adolescents aged 13–17 years from the United States. Having supportive parent and family relationships were significantly associated with good mental health (AOR ranging from 2.1 to 7.1). Positive community and school experiences were also significantly associated with good mental health (AOR ranging from 2.0 to 9.8). In most models, support from friends and siblings was not related to better mental health. Factors to be tested for efficacy in interventions targeted to adolescents with a history of child maltreatment include encouraging supportive parent and family relationships, and fostering positive community and school experiences. [ABSTRACT FROM AUTHOR]

The co-morbidity of motor coordination and mental health problems is an increasing concern. While links between poor motor coordination and mental health have been examined extensively in individuals born at normal birth weight (NBW; >2500 g), relatively little research has examined these associations in special populations, particularly those born at extremely low birth weight (ELBW; <1000 g). In this study, we examined whether birth weight status (ELBW vs. NBW) moderated associations between motor coordination problems and levels of mental health problems from childhood into the fourth decade of life. The present study utilized the oldest known prospectively followed, population-based cohort of ELBW survivors ( n = 151). This group was born between 1977 and 1982 in Ontario, Canada and was compared to a matched group of NBW controls ( n = 145). Mental health problems were measured at age 8 using parent and teacher reports, and at age 22–26 and 29–36 using self-reports. Childhood motor coordination was retrospectively reported at age 29–36. In both ELBW and NBW groups, childhood coordination problems were associated with elevated levels of inattention and symptoms of anxiety and depression. However, we observed stronger associations between childhood motor coordination problems and mental health problems in NBW controls at 22–26 and 29–36 years of age than in ELBW survivors. Our findings highlight the importance of recognizing and screening for motor coordination problems not only in vulnerable, at-risk children, but in all children, as motor difficulties appear to be associated with mental health problems well into adult life. [ABSTRACT FROM AUTHOR]

Highlights: [•] An initial report on personality of extremely low birth weight (ELBW) young adults. [•] This is the oldest continuously followed cohort of ELBW survivors in the world. [•] ELBW survivors display higher levels of cautiousness in their 30s compared to controls. [•] During adulthood, cautiousness appears to be stable in those born at ELBW. [ABSTRACT FROM AUTHOR]

Abstract: We evaluated the effects of socioeconomic status on the prevalence of current smoking, number of cigarettes smoked per day and pack-years, and the extent to which prevalence and consumption co-vary across communities, health regions, and provinces in Canada between 2001 and 2010. Current smoking, cigarettes per day, and pack-years were considered as outcomes within individuals using a multilevel analytical framework. Markers of SES were education, income, and occupation. Residual covariance estimated at the different levels of geography was used to determine if areas high in current smoking were also high on levels of consumption. A strong inverse gradient was found between education and current smoking and level of consumption with large variation found in levels of consumption between individual smokers. The co-variation between current smoking and level of consumption was positive and statistically significant at the level of communities and health regions. Our findings suggest that novel policy efforts may be needed to encourage smoking prevention/cessation among certain population groups and in places with high levels of smoking prevalence and tobacco use intensity. [Copyright &y& Elsevier]

Abstract: Objectives: Exposure to child maltreatment is associated with physical, emotional, and social impairment, yet in Canada there is a paucity of community-based information about the extent of this problem and its determinants. We examined the prevalence of child physical and sexual abuse and the associations of child abuse with early contextual, family, and individual factors using a community-based sample in Ontario. Methods: The Ontario Child Health Study is a province-wide health survey of children aged 4 through 16 years. Conducted in 1983, a second wave was undertaken in 1987 and a third in 2000–2001. The third wave (N =1,928) included questions about exposure to physical and sexual abuse in childhood. Results: Males reported significantly more child physical abuse (33.7%), but not severe physical abuse (21.5%), than females (28.2% and 18.3%, respectively). Females reported significantly more child sexual abuse (22.1%) than males (8.3%). Growing up in an urban area, young maternal age at the time of the first child''s birth, and living in poverty, predicted child physical abuse (and the severe category), and sexual abuse. Childhood psychiatric disorder was associated with child physical abuse (and the severe category), while parental adversity was associated with child sexual abuse and severe physical abuse. Siblings of those who experienced either physical abuse or sexual abuse in childhood were at increased risk for the same abuse exposure; the risk was highest for physical abuse. Conclusions: These findings highlight important similarities and differences in risk factors for physical and sexual abuse in childhood. Such information is useful in considering approaches to prevention and early detection of child maltreatment. Clinicians who identify physical abuse or sexual abuse in children should be alert to the need to assess whether siblings have experienced similar exposures. This has important implications for assessment of other children in the home at the time of identification with the overall goal of reducing further occurrence of abuse. [Copyright &y& Elsevier]

Background: The extent to which the prevalence of smoking in Canada varies across geographic areas independently of individual characteristics has not been quantified. Purpose: To estimate the extent and potential sources of geographic variation in smoking among communities, health regions, and provinces/territories in Canada. Methods: Data are from the Canadian Community Health Surveys conducted between 2001 and 2008 (n=461,709). Current cigarette smoking among adults (aged ≥18 years) was the primary outcome. Individual-level markers of SES were education, household income, and occupation. Contextual variables potentially related to smoking considered were provincial cigarette taxes, workplace smoking bans, and collective family norms discouraging smoking in communities. A multilevel logistic regression analysis was conducted to model variation in smoking at the geographic scale of communities, health regions, and provinces. Results: Overall, the contribution of geography as a percentage of the total variation in smoking was 8.4%, with 2.4% attributable to provinces, 1.2% attributable to health regions, and 4.8% attributable to communities after adjusting for age, gender and survey period. In models that accounted for socioeconomic and demographic characteristics in addition to age and gender, the contribution of geography to the total variation in smoking was attenuated to 4.1%; with 2.0% at the province level, 0.4% at the health region level, and 1.7% at the community level. Within provinces/territories, the community variation in smoking ranged from 2.4% in Prince Edward Island to 9.1% in British Columbia. Nationally, 71% of community and 21% of provincial differences in smoking were explained by individual, socioeconomic, and demographic factors alone; the inclusion of contextual covariates explained an additional 27% of the variation among communities. Collective family norms discouraging smoking in a community was the strongest contextual predictor of individual smoking; provincial cigarette taxes and workplace bans were only modestly related to individual smoking behavior. Conclusions: Geographic variation in smoking remained after accounting for individual, socioeconomic, and demographic characteristics, suggesting the importance of place, at the level of provinces and communities in Canada. Remaining community variation in smoking was largely attenuated after accounting for collective family norms discouraging smoking. Area-level influences such as the social and/or environmental conditions of provinces and communities may be important sources of variation in smoking and therefore need to be considered if rates of smoking are to be modified. [Copyright &y& Elsevier]

Background: Few studies have examined stress reactivity and its relationship to major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) among maltreated youth. We examined differences between maltreated and control participants in heart rate and cortisol resting and reactivity levels in response to a psychosocial stressor. Methods: We recruited 67 female youths aged 12 to 16 with no prior history of depression from child protection agencies and a control group of 25 youths matched on age and postal code. Child maltreatment was measured with two self-report instruments. Psychiatric status was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. Results: Piecewise multilevel growth curve analysis was used to model group differences in resting and reactivity cortisol levels and heart rate in response to the Trier Social Stress Test (TSST). During the resting period, both the maltreated and control groups showed a similar decline in levels of cortisol. During the reactivity phase, youth in the control group showed an increase in cortisol levels following the TSST and a gradual flattening over time; maltreated youth exhibited an attenuated response. This blunted reactivity was not associated with current symptoms of MDD or PTSD. There were no group differences in resting and reactivity levels of heart rate. Conclusions: These findings provide further support for hypothalamic-pituitary-adrenal axis dysregulation among maltreated youth. Since the ability to respond to acute stressors by raising cortisol is important for health, these findings may assist in understanding the vulnerability of maltreated youth to experience physical and mental health problems. [Copyright &y& Elsevier]

Objective: This study presents evaluative data on the Childhood Experiences of Violence Questionnaire (CEVQ), a brief, self-report measure of youth victimization. Methods: Literature reviews, expert consultations and qualitative interviews informed the development of the CEVQ. Test–retest reliability of the preliminary and final versions of the CEVQ was examined. Child welfare workers (n =11) assessed content validity. Construct validity was assessed by comparing levels of emotional and behavioral problems of youth with self-reports (n =177) of victimization. Criterion validity was tested by comparing clinicians’ judgment of child physical abuse (PA) and child sexual abuse (SA) with youths’ self-reports (n =93). Results: In general, test–retest intra-class correlations (ICCs) for the preliminary version of the questionnaire were good to excellent. Reliability estimates for the stem questions in the final version of the CEVQ were excellent, except for peer violence items which showed fair to good agreement. ICCs for PA, severe PA, SA, and severe SA of the CEVQ were .85, .77, .92, and .87, respectively. Youth with self-reported victimization had significantly higher scores for most categories of emotional and behavioral disorders. Experts classified victimization items as relevant. Kappa coefficients comparing clinician's judgments and youth's self-reports for PA, severe PA, SA, and severe SA were .67, .64, .70, and .50, respectively. Conclusions: The present findings provide preliminary evidence that the CEVQ is a brief, reliable, valid and informative instrument for assessing exposure to victimization and maltreatment among youth. Practice implications: Although this instrument is not appropriate for clinical use at this time, its psychometric properties will make it useful in conducting further epidemiological research and studies evaluating interventions aimed at reducing victimization. [Copyright &y& Elsevier]

Abstract: Background: This study examined seasonality in a community sample of five diagnostic groups: normal subjects, those with non-seasonal depression (NSD), seasonal depression (SD), non-seasonal bipolar disorder (NSBD) and seasonal bipolar disorder (SBD). Methods: Telephone interviews were conducted across the Province of Ontario. Seasonal changes in mood and behaviour were determined using the Seasonal Pattern Assessment Questionnaire (SPAQ). Five additional seasonality items consisting of depressive symptoms were included in the interview. The mean global severity of seasonality (GSS) scores were obtained and the entire inventory of 11 seasonality items were compared across the identified groups. Results: The mean GSS score for the controls was 5.2 (S.D.=4.0), 8.0 (S.D.=4.9) for NSD, 10.5 (S.D.=3.9) for SD, 10.5 (S.D.=5.4) for NSBD and 13.4 (S.D.=5.4) for SBD. These scores differed significantly (F=61.68, df=4, p<0.001). For the majority of the individual items, the SBD group rated the highest degree of seasonal fluctuation, while the NSBD and SD groups had nearly identical item scores. Limitations: Limitations in this study include the relatively small number of subjects in the NSBD and SBD groups, and the inherent limitations in a telephone interview. Conclusions: Individuals with bipolar disorder experience greater seasonality than those with depression or healthy controls. Even the non-seasonal bipolar group had as much seasonal fluctuation as the seasonal depression group, which has important implications for the management of bipolar illness. [Copyright &y& Elsevier]

• Neighbourhood antisocial behaviour exacerbates the effect of inadequate housing on child mental health. • The joint effect of inadequate housing and neighborhood antisocial behaviour is stronger for younger vs. older children. • Greater government investment is required to provide families with adequate housing. • Reductions in neighbourhood antisocial behaviour may attenuate the effect of inadequate housing. • Policies and interventions must be implemented early in the life course to have maximum impact. The objectives of this study are to (1) quantify the joint association of inadequate housing (presence of pests, mold, and need for repairs) and neighbourhood antisocial behaviour (assault, victimization, theft, and break-ins) with children's mental health problems (externalizing and internalizing); and (2) assess whether this joint association varies as a function of child age – the latter critical for understanding when interventions will have maximum impact. Using data from the 2014 Ontario Child Health Study and multilevel modeling, our findings indicate that (1) the magnitude of the association between inadequate housing and child mental health problems is stronger in neighbourhoods characterized by high levels of antisocial behaviour; and (2) the cross-level interaction between inadequate housing and neighbourhood antisocial behaviour is more pronounced among younger vs. older children for externalizing but not internalizing problems. Greater government intervention is required to ensure that families have access to adequate and affordable housing in neighbourhoods free from safety concerns. Policies and interventions must be implemented as early as possible in the life course to have maximum impact. [ABSTRACT FROM AUTHOR]

An abstract of the article "The Association Between Cyberbullying Victimization and Adolescent Mental health: A Comparative Study Between Traditional Types of Bullying Versus Cyberbullying" by Soyeon Kim and colleagues is presented.