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Background: We investigated the effectiveness of Nurse‐Family Partnership (NFP), a prenatal‐to‐age‐two‐years home‐visiting programme, in British Columbia (BC), Canada. Methods: For this randomised controlled trial, we recruited participants from 26 public health settings who were: <25 years, nulliparous, <28 weeks gestation and experiencing socioeconomic disadvantage. We randomly allocated participants (one‐to‐one; computer‐generated) to intervention (NFP plus existing services) or comparison (existing services) groups. Prespecified outcomes were prenatal substance exposure (reported previously); child injuries (primary), language, cognition and mental health (problem behaviour) by age two years; and subsequent pregnancies by 24 months postpartum. Research interviewers were masked. We used intention‐to‐treat analyses. (ClinicalTrials.gov, NCT01672060.) Results: From 2013 to 2016 we enrolled 739 participants (368 NFP, 371 comparison) who had 737 children. Counts for child injury healthcare encounters [rate per 1,000 person‐years or RPY] were similar for NFP (223 [RPY 316.17]) and comparison (223 [RPY 305.43]; rate difference 10.74, 95% CI ‐46.96, 68.44; rate ratio 1.03, 95% CI 0.78, 1.38). Maternal‐reported language scores (mean, M [SD]) were statistically significantly higher for NFP (313.46 [195.96]) than comparison (282.77 [188.15]; mean difference [MD] 31.33, 95% CI 0.96, 61.71). Maternal‐reported problem‐behaviour scores (M [SD]) were statistically significantly lower for NFP (52.18 [9.19]) than comparison (54.42 [9.02]; MD ‐2.19, 95% CI −3.62, −0.75). Subsequent pregnancy counts were similar (NFP 115 [RPY 230.69] and comparison 117 [RPY 227.29]; rate difference 3.40, 95% CI ‐55.54, 62.34; hazard ratio 1.01, 95% CI 0.79, 1.29). We observed no unanticipated adverse events. Conclusions: NFP did not reduce child injuries or subsequent maternal pregnancies but did improve maternal‐reported child language and mental health (problem behaviour) at age two years. Follow‐up of long‐term outcomes is warranted given that further benefits may emerge across childhood and adolescence. [ABSTRACT FROM AUTHOR]

Background: The standard approach for classifying child/youth psychiatric disorder as present or absent in epidemiological studies is lay‐administered structured, standardized diagnostic interviews (interviews) based on categorical taxonomies such as the DSM and ICD. Converting problem checklist scale scores (checklists) to binary classifications provides a simple, inexpensive alternative. Methods: Using assessments obtained from 737 parents, we determine if child/youth behavioral, attentional, and emotional disorder classifications based on checklists are equivalent psychometrically to interview classifications. We test this hypothesis by (1) comparing their test–retest reliabilities based on kappa (κ), (2) estimating their observed agreement at times 1 and 2, and (3) in structural equation models, comparing their strength of association with clinical status and reported use of prescription medication to treat disorder. A confidence interval approach is used to determine if parameter differences lie within the smallest effect size of interest set at ±0.125. Results: The test–retest reliabilities (κ) for interviews compared with checklists met criteria for statistical equivalence: behavioral,.67 and.70; attentional,.64 and.66; and emotional,.61 and.65. Observed agreement between the checklist and interviews on classifications of disorder at times 1 and 2 was, on average, κ =.61. On average, the β coefficients estimating associations with clinical status were.59 (interviews) and.63 (checklists); and with prescription medication use,.69 (interviews) and.71 (checklists). Behavioral and attentional disorders met criteria for statistical equivalence. Emotional disorder did not, although the coefficients were stronger numerically for the checklist. Conclusions: Classifications of child/youth psychiatric disorder from parent‐reported checklists and interviews are equivalent psychometrically. The practical advantages of checklists over interviews for classifying disorder (lower administration cost and respondent burden) are enhanced by their ability to measure disorder dimensionally. Checklists provide an option to interviews in epidemiological studies of common child/youth psychiatric disorders. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effect of an intimate partner violence intervention education component on nurses' attitudes in addressing intimate partner violence; complementary aims included understanding nurses' perceptions of the education and how it influenced their attitudes and confidence to address intimate partner violence in practice. Design: An explanatory sequential mixed methods design embedded within a 15‐site cluster randomized clinical trial that evaluated an intimate partner violence intervention within the Nurse‐Family Partnership programme. Methods: Data were collected between February 2011 and September 2016. Quantitative assessment of nurses' attitudes about addressing intimate partner violence was completed by nurses in the intervention (n = 77) and control groups (n = 101) at baseline, 12 months and at study closure using the Public Health Nurses' Responses to Women Who Are Abused Scale. Qualitative data were collected from nurses in the intervention group at two timepoints (n = 14 focus groups) and focused on their perceptions of the education component. Data were analysed using content analysis. Results: Nurses in the intervention group reported large improvements in their thoughts, feelings and perceived behaviours related to addressing intimate partner violence; a strong effect of the education was found from baseline to 12 months and baseline to study closure timepoints. Nurses reported that the education component was acceptable and increased their confidence to address intimate partner violence. Conclusion: Nurses reported improved attitudes about and confidence in addressing intimate partner violence after receiving the education component. However, these findings need to be considered together with trial results showing no main effects for clients, and a low level of intervention fidelity. Impact: These evaluation findings underscore that improvement in nurses' self‐reported educational outcomes about addressing intimate partner violence cannot be assumed to result in adherence to intervention implementation or improvement in client outcomes. These are important considerations for developing nurse education on intimate partner violence. [ABSTRACT FROM AUTHOR]

This study examines the association between childhood abuse and intimate relationship quality and attachment security in young adults. Data were drawn from the Ontario Child Health Study, a province-wide communitybased survey that collected baseline data in 1983 from 3,294 children (aged 4 to 16 years) and follow-up data in 2000/2001 (then aged 21 to 35 years). The sample comprised 1,885 men and women who had completed questionnaires regarding retrospective accounts of childhood abuse and current relationship status in 2000/2001. Childhood physical and sexual abuse was assessed using the short form of the Childhood Experiences of Violence Questionnaire. It was hypothesized that childhood physical and sexual abuse would be associated with adult intimate relationship functioning, adjusting for childhood family and individual factors, and that these associations would be mediated by participants' current mental health. The analysis for intimate relationship quality showed that current mental health reduced the association between physical abuse and poor relationship quality (beta 0.09 (se 0.02) to 0.08 (0.02)) and between sexual abuse and this outcome to a non-significant level ((beta 0.07 (se 0.03) to 0.05 (0.03)). The analysis for adult attachment security showed that current mental health reduced the association between physical abuse and insecure attachment to a non-significant level (OR 1.33 (95% CI 1.02-1.76) to OR 1.31 (0.98-1.76)) and between sexual abuse and this outcome (OR 1.89 (1.36-2.65) to OR 1.74 (1.19-2.52)). The importance of current mental health functioning in accounting for continuity in intimate relationship functioning from childhood to young adulthood is discussed. [ABSTRACT FROM AUTHOR]

Objectives. We identified courses of depressive symptoms in an epidemiological sample of emerging adults. Methods. We used latent class growth modeling to identify trajectories of depressive symptoms measured by the 12-item Center for Epidemiological Studies Depression Scale (CES-D) during a 14-year follow-up of 2825 Canadian youths aged 10 to 25 years enrolled in the National Longitudinal Survey of Children and Youth between 1994 and 2009. Results. After adjustment for youth, parent, and family factors, the 3 distinct trajectories of depressive symptoms were minimal (55%; CES-D < 6), subclinical (39%; CES-D = 9-13), and clinical (6%; CES-D > 18). All trajectories exhibited a parallel course, with peak symptoms at 15 to 17 years of age. Subclinical and clinical symptoms were more common than minimal symptoms in female youths and in respondents with lower self-concept, lower socioeconomic status, poorer interpersonal relations, and chronic health conditions (P < .01). Conclusions. Among emerging adults, trajectories of depressive symptoms do not trend upward or downward, and variables associated with identified trajectories demonstrated dose--response effects that agreed with vulnerability--stress theories of depression. [ABSTRACT FROM AUTHOR]

This study investigated whether inflammation may explain the relationship between depression and incident cardiovascular hospitalisations. Participants (55-85 years) completed baseline depression and physical assessment. Those without self-reported cardiovascular events were followed prospectively for hospital admissions for angina, myocardial infarction and cerebral infarction (median 937 days). Across 5140 person-years of risk ( N = 1692), there were 47 incident cardiovascular hospitalisations (2.8 %). Controlling for age and gender, interleukin (IL)-6, C-reactive protein (CRP), body mass index (BMI) and waist-to-hip ratio were associated with future cardiovascular events. Mediation analysis showed that CRP accounted for 8.1 % and IL-6 10.9 % of the effect of depression on cardiovascular events, and including the indirect effect in the model substantially reduced the direct relationship between depression and cardiovascular hospitalisations. BMI and waist-to-hip ratio accounted for indirect effects of 7.7 and 10.4 %, respectively. Inflammatory markers partly explain the association between depression and cardiovascular events, although other shared factors also likely contribute. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the risk for psychiatric disorders among extremely low birth weight (ELBW) survivors in their early to mid-30s and to determine whether those born small for gestational age or those exposed to a full course of antenatal corticosteroids (ACS) were at particularly high risk. METHODS: A prospective, longitudinal, population-based cohort of 84 ELBW survivors and 90 normal birth weight (NBW) control participants born in Ontario, Canada from 1977 to 1982 were assessed by interviewers naive to birth weight status using the Mini-International Neuropsychiatric Interview. RESULTS: ELBW survivors had lower odds of an alcohol or substance use disorder but higher odds of current non-substance-related psychiatric problems (odds ratio [OR] = 2.47; 95% confidence interval [CI], 1.19-5.14). Those born ELBW and SGA exhibited the same patterns with larger effects. ACS-exposed ELBW survivors had even higher odds of any current non-substance-related psychiatric disorder (OR = 4.41; 95% CI, 1.65-11.82), particularly generalized anxiety disorder (OR = 3.42; 95% CI, 1.06-11.06), the generalized type of social phobia (OR = 5.80; 95% CI, 1.20-27.99), and the inattentive subtype of attention-deficit/hyperactivity disorder (OR = 11.45; 95% CI, 2.06-63.50). CONCLUSIONS: In their early to mid-30s, ELBW survivors were less likely to have alcohol or substance use disorders but may be at greater risk for other psychiatric problems. Those exposed to ACS were at especially high risk and manifested no reduction in alcohol or substance use disorders. ELBW survivors exposed to ACS may be a special group at risk for psychopathology in adulthood. [ABSTRACT FROM AUTHOR]

Research suggests that attending religious services could provide small yet important protective benefits against coronary heart disease (CHD) and CHD risk factors (e.g., diabetes, hypertension). The extent to which these benefits apply to Canada deserves study because approximately one-third of adult Canadians attend religious services at least monthly. Therefore, the objective of this study is to examine the association between frequency of religious service attendance and prevalence of (1) CHD, (2) diabetes, and (3) hypertension in Canada. We used the Saskatchewan sample ( n = 5,442) of the Canadian Community Health Survey (CCHS-4.1) and built multivariable logistic regression models to evaluate associations between religious service attendance and self-reported CHD, diabetes, and hypertension. After controlling for demographic, socioeconomic and health behavior variables, the association between religious service attendance and prevalence of CHD was not significant (OR = 0.82; 95 % CI 0.61-1.11). However, persons who attended religious services more than once a week exhibited lower prevalence odds of diabetes (OR = 0.60; 95 % CI 0.45-0.80) and hypertension (OR = 0.82; 95 % CI 0.68-0.99) compared to persons who attended less than once a year. The findings of this study are the first to suggest religious service attendance may be associated with a lower prevalence of CHD risk factors in Canada. [ABSTRACT FROM AUTHOR]

As levels of immigration and ethnic diversity continue to rise in most Western societies, the social demography of schools is changing rapidly. Although schools represent a prominent developmental context, relatively little is known about the extent to which the racial/ethnic composition of schools influences mental health outcomes in students. The objective of the present study is to examine the association between immigrant and racial/ethnic congruence in school-the numerical representation of a student's immigrant generational status and race/ethnicity in the student body-and levels of emotional and behavioral problems. This study also examines the extent to which the association between congruence and emotional-behavioral problems differs across racial/ethnic immigrant sub-groups and is accounted for by individual perceptions of school belonging. Data come from the in-school survey of the Longitudinal Study of Adolescent Health (Add Health) conducted in the United States. The sample is nationally representative, and includes 128 schools and 77,150 adolescents in grades 7-12 (50 % female, M = 14.9 years, SD = 1.78). After controlling for school and family socio-demographic characteristics, immigrant and racial/ethnic congruence in school exhibited a negative association with emotional and behavioral problems for most sub-groups examined. School belonging was associated negatively with emotional and behavioral problems, and partially accounted for the effects linked to congruence in schools. The immigrant and racial/ethnic composition of schools and perceptions of belonging have strong links with emotional and behavioral problems and may represent important targets for intervention. [ABSTRACT FROM AUTHOR]

We examined the associations between childhood physical and sexual abuse and labor force outcomes in young adults and the possible mediating effects of educational attainment, current mental health, and physical health. Data from the Ontario Child Health Study (N = 1,893), a province-wide longitudinal study were analyzed. Controlling for childhood and demographic variables, severe childhood physical abuse was significantly associated with reduced income with small mediating effects. There was a sex difference in the association between child abuse and employment. Severe childhood physical abuse was significantly associated with lower likelihood of employment only among males; mediators partially reduced this association. Further research is needed to explore the mechanisms linking exposure to child abuse and economic vulnerability in young adults. [ABSTRACT FROM AUTHOR]

Self-reported self-esteem, life orientation, satisfaction with life, and bullying were examined in relation to victimization experiences among 54 students who stuttered and 54 students who did not stutter. Those who stuttered reported greater, i.e., clinically significant, victimization (44.4%) than students who did not stutter (9.2%). Significant differences were found between means for self-esteem and life orientation, with students who stuttered reporting lower self-esteem and less optimistic life orientation than those who did not stutter. In both groups of students, high victimization scores had statistically significant negative correlations with optimistic life orientation, high self-esteem, and high satisfaction with life scores. Given the increased likelihood of students who stuttered being bullied, the negative relation of adjustment variables and bullying, and the potentially negative long-term effects of bullying, increased vigilance and early intervention are discussed. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine: (1) if childhood cognitive and academic abilities mediate the association between being born at extremely low birth weight (ELBW) and socioeconomic attainment at age 29 to 36 years; (2) which cognitive abilities (IQ, verbal abilities, fluid intelligence, mathematical abilities, or academic achievement) most strongly mediate this association; and (3) if the mediating role of cognition is different in ELBW survivors with significant neurosensory impairment (NSI). METHODS: A prospective, longitudinal cohort of 100 Canadian ELBW survivors born between 1977 and 1982 and 89 normal birth weight comparison participants were used to examine the mediating role of childhood cognition by using 5 cognitive mediators assessed at age 8 years (overall IQ, verbal IQ, performance IQ, quantitative ability, and academic achievement) on socioeconomic attainment at adulthood. Socioeconomic attainment was defined as personal annual earnings and full-time employment assessed via self-report at age 29 to 36 years. RESULTS: Mediation models revealed that childhood cognition mediated the association between ELBW status and income attainment, with mathematical abilities and overall IQ each accounting for 26% of the direct effect. Mediated effects were not statistically significant in full-time employment models. For both outcomes, the mediating effect of cognition was stronger for ELBW survivors with NSI. CONCLUSIONS: Childhood cognitive abilities partially mediate associations between ELBW status and adult income attainment. Early life cognition is a critical predictor of socioeconomic attainment in ELBW survivors, particularly in those born with NSI. Interventions aimed at enhancing early cognition in ELBW survivors may help optimize their later socioeconomic attainment. [ABSTRACT FROM AUTHOR]