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Despite Canada having the highest disease burden globally for cannabis use disorder (CUD) and violence being ubiquitous in men's lives, little is known about how intersections among social determinants of health (SDOH) and cumulative lifetime violence severity (CLVS) influence CUD in men post-cannabis legalization. Using data collected in a survey with a national community sample of 597 men who self-identified as having experienced violence, we conducted a latent profile analysis using 11 subscales of the CLVS-44 scale and explored differential associations between CLVS profiles and CUD considering SDOH covariates. Four profiles were distinguished by intersections among CLVS-44 subscale severity and roles as target and perpetrator. CLVS profiles were significantly associated with CUD in the unadjusted model and in the adjusted model where age, adverse housing, and education were significant covariate controls. In the adjusted model, CUD was differentially associated with CLVS profiles and significantly higher in Profile 4 (highest severity target and perpetrator) than in Profile 1 (lowest severity target, no perpetration). Chi-square tests showed significant intersection between adverse housing, younger age, Profile 4 CLVS, and moderate to severe CUD among cannabis users. These results reveal the importance of understanding simultaneous intersections among indicators of CLVS in determining profiles of lifetime violence. Also critical are intersections among CLVS profiles and significant covariates as a basis for trauma- and violence-informed care for CUD that prioritizes men most disadvantaged by this convergence and attends to individual and structural health disparities at practice and policy levels., (© 2024 The Authors. Research in Nursing & Health published by Wiley Periodicals LLC.)

Background: Despite the prominent role that digital media play in the lives and mental health of young people as well as in violent radicalization (VR) processes, empirical research aimed to investigate the association between Internet use, depressive symptoms and support for VR among young people is scant. We adopt a person-centered approach to investigate patterns of digital media use and their association with depressive symptoms and support for VR., Methods: A sample of 2,324 Canadian young people (M age = 30.10; SD age = 5.44 ; 59% women) responded to an online questionnaire. We used latent profile analysis to identify patterns of digital media use and linear regression to estimate the associations between class membership, depressive symptoms and support for VR., Results: We identified four classes of individuals with regards to digital media use, named Average Internet Use/Institutional trust, Average internet use/Undifferentiated Trust, Limited Internet Use/Low Trust and Online Relational and Political Engagement/Social Media Trust. Linear regression indicated that individuals in the Online Relational and Political Engagement/Social Media Trust and Average Internet Use/Institutional trust profiles reported the highest and lowest scores of both depression and support for VR, respectively., Conclusions: It is essential to tailor prevention and intervention efforts to mitigate risks of VR to the specific needs and experiences of different groups in society, within a socio-ecological perspective. Prevention should consider both strengths and risks of digital media use and simulteaneously target both online and offline experiences and networks, with a focus on the sociopolitical and relational/emotional components of Internet use., (© 2024. The Author(s).)

Indigenous communities in Canada continue to feel the ongoing impacts of colonialism, including socio-economic disadvantage, high rates of violent victimization, systemic racism and discrimination, overrepresentation in the criminal justice system, and intergenerational trauma. Based on in-depth interviews with 10 gang-involved Indigenous young adults, using attachment theory as a guiding framework, we explore how colonialism continues to negatively impact the attachment these young people have to their families, communities, and social institutions, and leads to their gang involvement which perpetuates violence and trauma. Yet, they exhibit hope for a better future. Drawing on participant experiences we suggest key points at which provision of supports and resources can assist with increasing attachments and facilitating gang desistance. We share these insights while acknowledging the continued structural, embedded violence many Indigenous youth experience today that necessitates a commitment to decolonization at all levels of Canadian society., (© 2024 The Authors. Canadian Review of Sociology/Revue canadienne de sociologie published by Wiley Periodicals LLC on behalf of Canadian Sociological Association/La Société canadienne de sociologie.)

Objectives: We examine the association between perceived discrimination, mental health, social support, and support for violent radicalization (VR) in young adults from three locations across two countries: Montréal and Toronto, Canada, and Boston, United States. A secondary goal is to test the moderating role of location. Methods: A total of 791 young adults between the ages of 18 and 30, drawn from the Somali Youth longitudinal study and a Canada-based study of college students, participated in the study. We used multivariate linear regression to assess the association between scores on the Radical Intentions Scale (RIS) with demographic characteristics, anxiety, depression, social support, and discrimination. Results: In the full sample, discrimination, age, and gender were associated with RIS scores. When we examined moderation effects by location, RIS scores were associated with depression only in Montréal, and with social support (negatively) and discrimination in Toronto. None of the variables were significant in Boston. Conclusion: These findings suggest that an understanding of risk and protective factors for support of VR may be context-dependent. Further research should take into consideration local/regional differences., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ellis, Miller, Sideridis, Frounfelker, Miconi, Abdi, Aw-Osman and Rousseau.)

Objective: Although past studies suggest that the Structured Assessment of Violence Risk in Youth (SAVRY; Borum et al., 2006) has moderate predictive validity, its predictive validity with Asian youth in Western countries is unknown. We therefore compared the SAVRY's predictive validity in a sample of Asian Canadian versus White Canadian youth., Hypotheses: Given that the SAVRY is normed on samples comprising mostly youth who are White, we expected its predictive validity for recidivism would be lower for Asian Canadians than White Canadians., Method: We examined youth probation officers' SAVRY assessments for 573 youth (445 White Canadians, 56 East/Southeast Asian Canadians, and 72 South Asian Canadians) on community supervision (i.e. probation) in a Canadian province. Youth were prospectively followed for an average of 1.97 years (SD = 0.56 years) to determine if they were subsequently charged with violent or nonviolent offenses., Results: Asian Canadians scored significantly lower on risk total scores compared to White Canadians. Predictive validity for violent and nonviolent recidivism fell in the medium to large range for East/Southeast Asian Canadians (AUCs = .69 to .89) and South Asian Canadians (AUCs = .64 to .83). In comparison, predictive validity for White Canadians was generally lower (AUCs = .63 to .77; small to large range). Risk total scores and nonviolent risk ratings significantly predicted nonviolent recidivism better for East/Southeast Asian Canadians (AUCs = .89 and .87, respectively) than White Canadians (AUCs = .77 and .71, respectively). Despite few significant differences between Asian subgroups, predictive validity for nonviolent risk ratings was significantly higher in East/Southeast Asian Canadians (AUC = .87) than South Asian Canadians (AUC = .64)., Conclusions: The SAVRY may be a useful tool for predicting recidivism with Asian Canadians. However, future research should examine the SAVRY's predictive validity for youth of Asian descent in different countries and contexts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cyber space is an ever-expanding mode of perpetrating sexualized violence toward women. This article empirically examines the applicability of Susan Brownmiller's adaptation of the theory of social control to online interpersonal victimization (OIV) against women. Multiple regression analysis identified predictors of behaviors indicative of social control among a Canadian sample. Findings suggest that the theory of social control, which has been applied to violence against women in physical space, is applicable to OIV. This study also provides insights into the separate and compound effects of physical space and cyber space victimizations on women and identifies implications for improving methods and building theories for addressing violence against women in cyber space.

Background: In youth, anxiety-depressive traits (ADT) and trait-aggression (TA) are important risk factors of exhibiting maladaptive behaviors in adulthood (i.e. violence and substance use). However, the developmental co-occurrence of these traits in youth remains unknown. We thus sought to investigate the developmental trajectories of ADT and TA within a data-driven approach. The aim was two-fold: (i) to examine the developmental trajectories of ADT and TA in youth from ages 10 to 16, and (ii) to investigate both childhood predictors and problematic outcomes of the identified joint trajectories., Method: The sample comprised 1354 children provided from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) Consortium. Group-based trajectory modeling was first employed to identify individual trajectory models of ADT and TA independently (from ages 10 to 16). Then, joint trajectory models were built on the found trajectories. Last, logistic regressions were used to evaluate the childhood characteristics and negative outcomes of the joint trajectory groups., Results: Our results showed five trajectory groups with varying levels of ADT and TA. A significant co-occurrence between ADT and TA was found in three of the trajectory groups. Notably, higher levels of childhood psychopathology and more severe/frequent childhood abuse were found in the groups with moderate to high ADT and high TA. The groups with higher ADT and high TA were also more likely to exhibit violence and substance use., Conclusions: This study exposes the importance of assessing ADT and TA simultaneously and early in childhood to prevent and manage the risk of problematic behaviors in adolescence.

Previous research has demonstrated that women who sell sex (women sex workers [WSWs]) consistently report high levels of posttraumatic stress symptoms. The present study explores multiple factors that may contribute to the variation in WSWs' experiences of posttraumatic stress symptoms, including workers' racial identity, experiences of discrimination and control over their working conditions, the site of selling sex, and their clients' perceived sexual entitlement and violence. The study sample consisted of 314 self-identified WSWs. Online invitations to participate in a 30-min survey were sent to WSWs in the United States and Canada who advertise their services online on sites such as Facebook, the Erotic Review, and Backpages. The hypothesized structure of associations between the variables was tested using structural equation modeling. The model accounted for 68% of the variation in the traumatic stress reported, with direct and indirect effects for workers' racial identity, the site where they sell sex, and experiences of discrimination, especially by police. Clients' violence, on the contrary, was indirectly associated with traumatic stress, as violent clients were also significantly more likely to be perceived as sexually entitled, which, in turn, was the strongest predictor of higher traumatic stress. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Food security is both a basic human right and a public health necessity. Despite known gendered contexts of food insecurity, there is a dearth of research on prevalence and factors driving increased food insecurity for sex workers in a criminalized setting. The current study longitudinally examines the prevalence and structural and individual factors associated with increased odds of food insecurity among street and off-street sex workers in a Canadian urban setting. Prospective analyses drew on data from a community-based longitudinal cohort of cis and trans women in street and off-street sex work in An Evaluation of Sex Workers Health Access (2010-2014). The primary outcome was a time-updated measure of food insecurity, using the Radimer-Cornell scale. We used bivariable and multivariable logistic regression using generalized estimating equations to prospectively model correlates of food insecurity over a five-year period. Of 761 cis and trans women sex workers, 72.4% (n = 551) were food insecure over the study period. Over a third (35.2%, n = 268) identified as Indigenous and a quarter, 25.6% (n = 195) were of a gender/sexual minority. Within the 11.0% (n = 84) of women living with HIV, 96.4% (n = 81) were food insecure over the follow-up period. In multivariable analysis, Indigenous ancestry (AOR = 1.58 [95% CI 1.18, 2.10]), unstable housing (AOR = 1.27 [95% CI 1.03, 1.57]), stimulant use (AOR = 1.97 [95% CI 1.57, 2.45]), heroin use (AOR = 1.72 [95% CI 1.36, 2.19]), mental health diagnosis (AOR = 2.38 [95% CI 1.85, 3.05]), recent violence (AOR = 1.54 [95% CI 1.24, 1.91]), means of food access: reliant on food services only vs. self-sufficient (AOR = 1.78 [95% CI 1.38, 2.29]), and means of food access: both vs. self-sufficient (AOR = 2.29 [95% CI 1.84, 2.86]) were associated with food insecurity. In separate multivariable models, both recent and lifetime physical and/or sexual violence remained independently associated with food insecurity (AOR 1.54 [95% CI 1.24, 1.91]; AOR 4.62 [95% CI 2.99, 7.14], respectively). Almost all study participants living with HIV reported being food insecure. These intersecting risks demonstrate the negative impacts associated with living with HIV, experiencing food insecurity and/or physical or sexual violence. This study also highlights the potential for interventions that address structural inequities (e.g., decriminalizing sex work) to have crosscutting impacts to reduce barriers to accessing necessities (including food) or health and social services (e.g., methadone; primary care).

Background/aim: Given that alcohol-related victimization is highly prevalent among young adults, the current study aimed to assess the potential impacts of Minimum Legal Drinking Age (MLDA) laws on police-reported violent victimization events among young people., Design: A regression-discontinuity (RD) approach was applied to victimization data from the Canadian Uniform Crime Reporting 2 (UCR2) Incident-based survey from 2009-2013. Participants/cases: All police-reported violent victimization events (females: n = 178,566; males: n = 156,803) among youth aged 14-22 years in Canada., Measurements: Violent victimization events, primarily consisting of homicide, physical assault, sexual assault, and robbery., Results: In comparison to youth slightly younger than the drinking age, both males and females slightly older than MLDA had significant and immediate increases in police-reported violent victimization events (females: 13.5%, 95% CI: 7.5%-19.5%, p < 0.001; males: 11.6%, 95% CI: 6.6%-16.7%, p < 0.001). Victimizations occurring in the evening rose sharply immediately after the MLDA by 22.8% (95% CI: 9.9%-35.7%, p =  0.001) for females and 19.3% (95% CI: 11.5%-27.2%, p < 0.001) for males. Increases in violent victimization immediately after MLDA were most prominent in bar/restaurant/open-air settings, with victimizations rising sharply by 44.9% (95% CI: 29.5%-60.2%, p < 0.001) among females and 18.3% (95% CI: 7.7%-29.0%, p =  0.001) among males., Conclusions: Young people gaining minimum legal drinking age incur immediate increases in police-reported violent victimizations, especially those occurring in the evening and at bar/restaurant/open-air settings. Evidence suggests that increasing the MLDA may attenuate patterns of violent victimization in newly restricted age groups., (Copyright © 2019. Published by Elsevier B.V.)

Despite the high prevalence of fetal alcohol spectrum disorder (FASD) in youth criminal justice settings, there is currently no research supporting the use of violence risk assessment tools in this population. This study examined the predictive validity of the Structured Assessment of Violence Risk in Youth (SAVRY) and the Youth Level of Service/Case Management Inventory (YLS/CMI) in justice-involved youth with FASD. Participants were 100 justice-involved youth (ages 12-23; 81% male), including 50 diagnosed with FASD and 50 without FASD or prenatal alcohol exposure. The SAVRY and YLS/CMI were prospectively coded based on interview and file review, with recidivism (both any and violent specifically) coded 1-year post-baseline assessment. Results provide preliminary support for the validity of the SAVRY and YLS/CMI in predicting recidivism in justice-involved youth with FASD. Higher ratings across SAVRY and YLS/CMI domains were found in youth with FASD, underscoring a critical need for assessments and interventions to buffer recidivism risk and address clinical needs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Background: The health care sector has a significant role to play in fostering equity in the context of widening global social and health inequities. The purpose of this paper is to illustrate the process and impacts of implementing an organizational-level health equity intervention aimed at enhancing capacity to provide equity-oriented health care., Methods: The theoretically-informed and evidence-based intervention known as 'EQUIP' included educational components for staff, and the integration of three key dimensions of equity-oriented care: cultural safety, trauma- and violence-informed care, and tailoring to context. The intervention was implemented at four Canadian primary health care clinics committed to serving marginalized populations including people living in poverty, those facing homelessness, and people living with high levels of trauma, including Indigenous peoples, recent immigrants and refugees. A mixed methods design was used to examine the impacts of the intervention on the clinics' organizational processes and priorities, and on staff., Results: Engagement with the EQUIP intervention prompted increased awareness and confidence related to equity-oriented health care among staff. Importantly, the EQUIP intervention surfaced tensions that mirrored those in the wider community, including those related to racism, the impacts of violence and trauma, and substance use issues. Surfacing these tensions was disruptive but led to focused organizational strategies, for example: working to address structural and interpersonal racism; improving waiting room environments; and changing organizational policies and practices to support harm reduction. The impact of the intervention was enhanced by involving staff from all job categories, developing narratives about the socio-historical context of the communities and populations served, and feeding data back to the clinics about key health issues in the patient population (e.g., levels of depression, trauma symptoms, and chronic pain). However, in line with critiques of complex interventions, EQUIP may not have been maximally disruptive. Organizational characteristics (e.g., funding and leadership) and characteristics of intervention delivery (e.g., timeframe and who delivered the intervention components) shaped the process and impact., Conclusions: This analysis suggests that organizations should anticipate and plan for various types of disruptions, while maximizing opportunities for ownership of the intervention by those within the organization. Our findings further suggest that equity-oriented interventions be paced for intense delivery over a relatively short time frame, be evaluated, particularly with data that can be made available on an ongoing basis, and explicitly include a harm reduction lens.

Purpose: The study's purpose was to determine individual-level and neighbourhood-level risk and protective factors for severe intentional injury among youth., Methods: We conducted a multilevel case-control study using registry data to determine individual-level and neighbourhood-level social determinants associated with severe violent injury/homicide among youth from Winnipeg, Manitoba., Results: The study includes 13 206 youth, aged 12-24 years (1222 cases, 11 984 controls). Individual-level risk predictors of being a victim of violence were male sex (OR 5.72 (95% CI 4.77 to 6.86)) and First Nations (OR 2.76 (95% CI 2.32 to 3.29)). Education was inversely associated with victimisation for individuals under (OR 0.36 (95% CI 0.26 to 0.51)) and over (OR 0.58 (95% CI 0.49 to 0.69)) 18 years. Ever having been in protective care (OR 1.66 (95% CI 1.39 to 1.99)), receiving income assistance from the government (OR 1.26 (95% CI 1.05 to 1.51)) or ever having criminal charges (OR 4.76 (95% CI 4.08 to 5.56)) were also significant predictors of being a victim of violence. Neighbourhood-level risk factors for victimisation included low socioeconomic status (OR 1.14 (95% CI 1.04 to 1.25)) and high levels of assault (OR 1.07 (95% CI 1.04 to 1.10))., Conclusions: This study demonstrates a complex web of risk and protective factors among youth injured by violence. It underscores the ongoing, injurious effects of historical trauma experienced by many Canadian First Nations people. Strong victim-perpetrator overlap suggests that intersectoral policies are needed to address these issues. Our findings highlight the need to improve education and family supports., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Aims: To estimate and test the difference in rates of violent and non-violent crime during medicated and non-medicated methadone treatment episodes., Design, Setting and Participants: The study involved linkage of population level administrative data (health and justice) for all individuals (n = 14 530) in British Columbia, Canada with a history of conviction and who filled a methadone prescription between 1 January 1998 and 31 March 2015. Methadone maintenance treatment was the primary independent variable and was treated as a time-varying exposure. Each participant's follow-up (mean: 8 years) was divided into medicated (methadone was dispensed) and non-medicated (methadone was not dispensed) periods with mean durations of 3.3 and 4.6 years, respectively., Measurements: Socio-demographics of participants were examined along with the main outcomes of violent and non-violent offences., Findings: During the first 2 years of treatment (≤ 2.0 years), periods in which methadone was dispensed were associated with a 33% lower rate of violent crime [0.67 adjusted hazard ratio (AHR), 95% confidence intervals (CI) = 0.59, 0.76] and a 35% lower rate of non-violent crime (0.65 AHR, 95% CI = 0.62, 0.69) compared with non-medicated periods. This equates to a risk difference of 3.6 (95% CI = 2.6, 4.4) and 37.2 (95% CI = 33.0, 40.4) fewer violent and non-violent offences per 100 person-years, respectively. Significant but smaller protective effects of dispensed methadone were observed across longer treatment intervals (2.0 to ≤ 5.0 years, 5.0 to ≤ 10.0 years)., Conclusions: Among a cohort of Canadian offenders, rates of violent and non-violent offending were lower during periods when individuals were dispensed methadone compared with periods in which they were not dispensed methadone., (© 2017 Society for the Study of Addiction.)

Objectives: In a large Canadian study, we examined: (1) the prevalence of hunger due to an inadequate food supply at home; (2) relations between this hunger and a range of health outcomes, and; (3) contextual explanations for any observed associations., Methods: A cross-sectional survey was conducted of 25,912 students aged 11-15 years from 436 Canadian schools. Analyses were descriptive and also involved hierarchical logistic regression models., Results: Hunger was reported by 25 % of participants, with 4 % reporting this experience "often" or "always". Its prevalence was associated with socio-economic disadvantage and family-related factors, but not with whether or not a student had access to school-based food and nutrition programs. The consistency of hunger's associations with the health outcomes was remarkable. Relations between hunger and health were partially explained when models controlled for family practices, but not the socio-economic or school measures., Conclusions: Societal responses to hunger certainly require the provision of food, but may also consider family contexts and basic essential elements of care that children need to thrive.

Resident-to-resident abuse involves aggression and violence that occurs between long-term care (LTC) home residents and can have serious consequences for both aggressors and victims. To date, there has been no attempt to systematically assess the breadth of the problem in Canada. To address this gap, we undertook a scoping review to enhance understanding of resident-to-resident abuse in LTC homes. A redacted Canadian data set on resident-to-resident abuse is also reported on. Nine electronic literature databases were searched; a total of 784 abstracts were identified, but only 32 satisfied the inclusion criteria. The majority of records (75%) were retrospective case studies, qualitative studies, and reviews/commentaries. Of these, only 14 focused exclusively on resident-to-resident abuse. The redacted Canadian data set suggests resident-to-resident abuse makes up approximately one-third of reported abuse cases. Recommendations for future research, clinical practice, and policy are provided to raise awareness of this phenomenon to help decrease its incidence.

Canadian legislation makes Review Boards (RBs) responsible for rendering dispositions for individuals found Not Criminally Responsible on account of Mental Disorder (NCRMD) after considering public safety, the mental condition of the accused, and his/her potential for community reintegration. We reviewed 6,743 RB hearings for 1,794 individuals found NCRMD in the three largest Canadian provinces to investigate whether items from two empirically supported risk assessment measures, the Historical Clinical Risk Management-20 and the Violence Risk Appraisal Guide, were considered. Less than half the items were included in expert reports or in RBs' reasons for dispositions, and consideration of these items differed according to gender and index offense severity of the accused. These items included evidence-based risk factors and/or legally specified criteria: mental health, treatment, and criminal history. These results illustrate the gap between research on risk factors and the integration of this evidence into practice. In particular, we recommend the implementation of structured measures to reduce the potential for clinicians to be unduly influenced by gender and offense severity., (Copyright © 2015 John Wiley & Sons, Ltd.)

Background: Women living in poor and vulnerable neighbourhoods like Vancouver's Downtown Eastside (DTES) face multiple burdens related to the social determinants of health. Many of them struggle with addiction, are involved in the sex trade and experience homelessness and gender-based violence. Such evidence suggests that psychological trauma is also a common experience for these women., Methods: The purpose of this qualitative study was to explore themes and subjective perspectives of trauma and gender-based violence in women who lived in an impoverished neighbourhood and struggled with substance use during pregnancy and early motherhood. We interviewed 27 individuals accessing harm reduction services for pregnant and postpartum women in Vancouver, Canada., Results: Key themes that emerged from these women's narratives highlighted the ubiquity of multiple and continuing forms of adversities and trauma from childhood to adulthood, in a variety of contexts, through a variety of offenders and on multiple levels. Both individual and environmental/structural conditions mutually intensified each other, interfering with a natural resolution of trauma-related symptoms and substance use. Women were also concerned that trauma could be passed on from one generation to the next, yet expressed hesitation when asked about their interest in trauma-specific counselling., Conclusions: In offering harm reduction services for poor and marginalized women, it is clear that an understanding of trauma must be integrated. It is recommended that service providers integrate trauma-informed care into their programme in order to offer this service in a trusted environment. However, it is also necessary to shift the focus from the individual to include environmental, social, economic and policy interventions on multiple levels and from issues of drug use and reduction of drug-related harms to include issues of gendered vulnerabilities and human rights.

The goal of the study is to examine how location (nationally, compared to Canadian regions) is related to indicators of a hostile school environment for sexual minority youth, particularly when physical abuse is used as the outcome variable. Data representing 5,766 Canadian students were analyzed using bivariate and multivariate techniques. Results from the multivariate analyses showed that non-physical abuse was the most significant predictor of homophobically based physical abuse, for both LGBQ and non-LGBQ students. Findings reiterate the importance of considering the progression of harmful events as an escalation of violence as well as the need to view homophobic bullying as having a significant impact on all students. Finally, while the presence of homophobia is prevalent across all Canadian regions, there are, nevertheless, many regional differences, which could be used to inform region-specific action plans.

Introduction: Studies from Australia, Sweden, the United States, and elsewhere have found that paramedics experience violence in the emergency medical services (EMS) workplace. The objective of this study was to describe and explore violence experienced by paramedics in the ground ambulance setting, including types of violence experienced, by whom the violence was perpetrated, actions taken by paramedics, and effects of these episodes., Method: A cross-sectional study utilizing a mixed-methods paper survey was provided to a convenience sample of rural, suburban, and urban-based ground ambulance paramedics in two Canadian provinces. Paramedics were asked to describe episodes of verbal assault, intimidation, physical assault, sexual harassment, and sexual assault they were exposed to during the past 12 months. Qualitative questions inquired about the impact of these experiences. Response selections were analyzed using descriptive statistics and regression analysis, and qualitative data was analyzed using descriptive content analysis., Results: A total of 1,884 paramedics were invited to participate and 1,676 responded (89.0%). Most participants (75%) reported experiencing violence in the past 12 months. The most common form of violence reported was verbal assault (67%), followed by intimidation (41%), physical assault (26%), sexual harassment (14%), and sexual assault (3%). Patients were identified as the most common perpetrators of violence. Serious sequellae were qualitatively reported., Conclusion: The majority of Canadian paramedics surveyed experience violence in the workplace, which can lead to serious personal and professional sequellae. Strategies should be devised and studied to reduce violent events toward paramedics and to mitigate the impact such events have on the wellbeing of paramedics.

Background: Vancouver's Downtown Eastside is home to Canada's largest street-based drug scene and only supervised injection facility (Insite). High levels of violence among men and women have been documented in this neighbourhood. This study was undertaken to explore the role of violence in shaping the socio-spatial relations of women and 'marginal men' (i.e., those occupying subordinate positions within the drug scene) in the Downtown Eastside, including access to Insite., Methods: Semi-structured qualitative interviews were conducted with 23 people who inject drugs (PWID) recruited through the Vancouver Area Network of Drug Users, a local drug user organization. Interviews included a mapping exercise. Interview transcripts and maps were analyzed thematically, with an emphasis on how gendered violence shaped participants' spatial practices., Results: Hegemonic forms of masculinity operating within the Downtown Eastside framed the everyday violence experienced by women and marginal men. This violence shaped the spatial practices of women and marginal men, in that they avoided drug scene milieus where they had experienced violence or that they perceived to be dangerous. Some men linked their spatial restrictions to the perceived 'dope quality' of neighbourhood drug dealers to maintain claims to dominant masculinities while enacting spatial strategies to promote safety. Environmental supports provided by health and social care agencies were critical in enabling women and marginal men to negotiate place and survival within the context of drug scene violence. Access to Insite did not motivate participants to enter into "dangerous" drug scene milieus but they did venture into these areas if necessary to obtain drugs or generate income., Conclusion: Gendered violence is critical in restricting the geographies of men and marginal men within the street-based drug scene. There is a need to scale up existing environmental interventions, including supervised injection services, to minimize violence and potential drug-related risks among these highly-vulnerable PWID., (Copyright © 2013 Elsevier B.V. All rights reserved.)

This article examines whether acculturation and experiences of discrimination help to explain observed ethnic disparities in rates of three health-compromising behaviors: interpersonal violence, drinking, and cannabis use. Data were drawn from a cross-sectional survey of 3,400 high school students from Toronto, Canada, sampled in 1998-2000. Multivariate ordinary least squares and logistic regression models tested for baseline differences in the health-compromising behaviors by ethnic identity. Subsequent models adjusted for control measures and introduced acculturation and discrimination measures. Results confirm that experiences of discrimination and acculturation are risk enhancing, whereas active cultural retention appears to protect ethnic youth from participation in health-compromising activities.

Background: Screening strategies for childhood physical abuse (CPA) need to be improved in order to identify those most at risk. This study uses two regionally representative community samples to examine whether a cluster or cumulative model of risk indicators (i.e. parental divorce, parental unemployment, and parental addictions) explains a larger proportion of the variation in CPA., Methods: Data were drawn from Statistics Canada's National Population Health Survey (1994-1995) and Canadian Community Health Survey 3.1 (2005). Response rates were greater than 80% in both samples. Each survey had approximately 13,000 respondents aged 18 and over who answered questions about the above adverse childhood experiences., Results: A gradient was shown with similar outcomes in each data set. Only 3.4% of adults who experienced none of the three risk indicators reported they had been physically abused during childhood or adolescence. The prevalence of CPA was greater among those who experienced parental divorce alone (8.3%-10.7%), parental unemployment alone (8.9%-9.7%) or parental addictions alone (18.0%-19.5%). When all three risk indicators were present, the prevalence of CPA ranged from 36.0%-41.0% and the age-sex-race adjusted odds were greater than 15 times that of individuals with none of the three risk indicators. The cluster model explained a statistically significantly larger proportion of the variation than the cumulative model although the difference between the two models was modest. For the purposes of parsimony, the cumulative model may be the better alternative., Conclusions: Adults who were exposed to two or more childhood risk indicators were much more likely to report that they were physically abused during their childhood than those with only one or no risk factors. Medical professionals may use this information on cumulative risk factors to more effectively target screening for potential CPA. Future research should include prospective studies., (© 2012 John Wiley & Sons Ltd.)

Background: Intimate partner violence (IPV) is the leading cause of non-fatal injury to women worldwide. Musculoskeletal injuries, which are often seen by orthopaedic surgeons, are the second most common manifestation of IPV. We aimed to establish the 12-month and lifetime prevalence of IPV in women presenting to orthopaedic fracture clinics., Methods: The PRAISE team of 80 investigators did a cross-sectional study of a consecutive sample of 2945 female participants at 12 orthopaedic fracture clinics in Canada, the USA, the Netherlands, Denmark, and India. Participants who met the eligibility criteria anonymously answered direct questions about physical, emotional, and sexual IPV, and completed two previously developed questionnaires (Women Abuse Screening Tool [WAST] and Partner Violence Screen [PVS]). We did a multivariable logistic regression analysis to investigate the risk factors associated with IPV., Findings: The overall response rate was 85% (2344 of 2759 patients provided informed consent). One in six women (455/2839, 16·0%, 95% CI 14·7-17·4%) disclosed a history of IPV within the past year, and one in three (882/2550, 34·6%, 32·8-36·5%) had experienced IPV in their lifetime. 49 women (1·7%, 1·3-2·2%) attended their clinic visit as a direct consequence of IPV, only seven of whom (14%) had ever been asked about IPV in a health-care setting. Women in short-term relationships (OR 0·584, 99% CI 0·396-0·860, p=0·0001) were at increased risk of IPV and physical abuse in the past 12 months in this study. Compared with women in Canada and the USA, those in the Netherlands and Denmark were at reduced risk of any abuse in the past 12 months, physical abuse in lifetime, and any abuse in lifetime (OR 0·595, 99% CI 0·427-0·830, p<0·0001; 0·630, 0·445-0·890, p=0·001; and 0·464, 0·352-0·612, p<0·0001, respectively)., Interpretation: PRAISE is the largest prevalence study done so far in orthopaedics. Orthopaedic surgeons should be confident in the assumption that one in six women have a history of physical abuse, and that one in 50 injured women will present to the clinic as a direct result of IPV. Our findings warrant serious consideration for fracture clinics to improve identification of, respond to, and provide referral services for, victims of IPV., Funding: Orthopaedic Trauma Association, Canadian Orthopaedic Foundation, and the McMaster University Surgical Associates. MB is partly funded by a Canada Research Chair., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Aims: To provide novel, population-based estimates of the influence of minimum legal drinking age (MLDA) legislation on target in-patient hospital events in Canada., Design: Regression-discontinuity analyses on rates of Canadian in-patient admissions., Setting: All in-patient hospitalizations in Canada (except Québec) between 1 April 1997 and 31 March 2007., Participants: Individuals aged 15-22 years admitted to hospital., Measurements: International Classification of Diseases-9/10 codes for alcohol-use disorders/poisoning, injury, suicide, assault and motor vehicle accidents were considered as target morbidity conditions., Findings: Compared with the baseline hospitalization rate just prior to the MLDA, admissions at the MLDA rose significantly (P ≤ 0.001) for alcohol-use disorders/poisoning for males (17.3%) and females (21.1%), as well as for suicide events for the combined sample (9.6%, P = 0.029). Among males, there was a significant 4.4% increase (P = 0.001) in a broad class of injuries, including a 9.2% jump (P = 0.020) in admissions for motor vehicle accidents compared with the baseline hospitalization rate just prior to the MLDA., Conclusion: Removal of minimum legal drinking age restrictions is associated with significant population-level increases in hospital admissions among young adults in Canada for alcohol-use disorders/poisoning, as well as for other serious injuries, especially among males. Current international minimum legal drinking age policy discussions should account for the impact of the minimum legal drinking age on severe morbidity outcomes., (© 2013 Society for the Study of Addiction.)

Objective: To examine the contribution of socio-economic position (SEP) in explaining the excess of any abuse and intimate partner violence (IPV) among Aboriginal versus non-Aboriginal women in Canada. This comparison has not been studied before., Methods: We conducted logistic regression analysis, using nationwide data from a weighted sample of 57,318 Canadian-born mothers of singletons who participated in the Canadian Maternity Experiences Survey 2006-7., Results: The unadjusted odds of any abuse and IPV were almost four times higher among Aboriginal compared to non-Aboriginal mothers; OR 3.91 (95% CI 3.12-4.89) and OR 3.78 (2.87-4.97), respectively. Adjustment for SEP reduced the unadjusted OR of any abuse and IPV by almost 40%. However, even with this adjustment, the odds of any abuse and IPV for Aboriginal mothers remained twice that of non-Aboriginal mothers; OR 2.34 (1.82-2.99) and OR 2.19 (1.60-3.00), respectively., Conclusions: SEP is a predominant contributor to the excess of abuse against Aboriginal vs. non-Aboriginal women in Canada. Reducing violence against Aboriginal women can be achieved mostly by improving their SEP, and simultaneously be informed by social processes and services that can mitigate abuse. The fact that SEP did not fully explain the excess of abuse among the Aboriginal women might lend support to "colonization or postcolonial theories," and related contextual factors such as differences in community social resources (e.g., social capital) and services. The effect of these factors on the excess of abuse warrants future research.

Introduction: Most televised National Hockey League (NHL) games include violent body checks, illegal hits and fights. We postulated that minor league players imitated these behaviours and that not seeing these games would reduce the rate of injuries among younger hockey players., Methods: Using a quasi-experimental design, we compared 7 years of televised NHL matches (2002-2009) with the year of the NHL lock-out (2004/2005). Data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were used to identify the injuries and to ascertain whether they were due to intentional contact and illegal acts including fights., Results: We found no significant differences in the proportions of all injuries and those involving intentional contact, violations or illegal acts among male minor league hockey players during the year when professional players were locked out and the years before and after the lock-out., Conclusion: We concluded that not seeing televised NHL violence may not reduce injuries, although a possible effect may have been obscured because there was a striking increase in attendance at equally violent minor league games during the lock-out.

Intimate partner violence (IPV) is an important public health concern, yet little is known about the combined effects of individual- and neighbourhood-level characteristics on IPV among immigrants. The aim of this study is to examine: (1) the association between immigrant status and IPV victimisation and whether sex modifies this association, and (2) the association between the neighbourhood concentration of immigrants and IPV victimisation, and whether immigrant status modifies this association. Our sample of 10,964 males and females comes from the 2009 Canadian General Social Survey. After controlling for covariates, immigrant status was not associated with IPV, and sex significantly modified the association between immigrant status and financial and physical/sexual IPV. Compared to males, second-generation females were less likely to report financial IPV and first-generation females were more likely to report physical/sexual IPV. Immigrant status modified the association between the neighbourhood concentration of immigrants and emotional and physical/sexual IPV. Compared to third-generation males, first-generation males living in neighbourhoods with a higher concentration of immigrants were more likely to report emotional IPV, whereas second-generation males in these neighbourhoods were less likely to report physical/sexual IPV. Interventions to reduce IPV should pay equal attention to individual- and neighbourhood-level influences.

Although much attention has been granted to the perpetrators and victims of gun violence, limitations exist in our understanding of the psychological well-being of parents grieving children lost to gun violence. The purpose of this study was to examine the mediating effects of social support, cognitive appraisal, and quality health care on the relationship between traumatic stress and resilience among Black mothers bereaving children to gun violence. A cross-sectional design and network sampling method were used to recruit 48 Black mothers living in a large Canadian city. Participants completed a survey either by phone or in person. Social support and positive appraisal were found to be protective factors of resilience for study participants. The traumatic stress experienced by the sample decreased with increased social support (beta = -.291, p = .045), leading to an increase of their resilience (beta = .297, p = .032). With positive appraisal of the loss, the stress levels of study participants decreased (beta = -.334, p = .023), leading to increased resilience (beta = .441, p = .003). Quality health care showed a significant positive relationship with the resilience of the women (beta = .313, p = .023) but did not mediate the relationship between their stress and resilience. For Black mothers who experience loss of a child to gun violence, policy and social change efforts should focus on strengthening their access to formal and informal supports and improving their abilities to find meaning in their loss.

Over the last two decades, considerable scholarly attention has been directed toward explaining the "cycle of violence"-a phenomenon whereby victimization and offending appear inexorably linked to one another. Extant work has greatly contributed to our understanding of this cycle for different types of abuse and different types of offending, such as sex offending. The link between sexual abuse and later offending cannot be overstated, with research suggesting the impact of sexual abuse on sex offending to be more pronounced than any other type of abuse. However, in the literature, questions remain regarding sex offenders' patterns of offending. Specifically, it remains unclear whether type of abuse experienced has a differential impact on type of offending in adulthopd. Using retrospective data from sexual offenders in a Canadian penitentiary, we address this research gap by examining the impact of abuse experienced during childhood and adolescence on various types of offending in adulthood. Results indicate partial support for the cycle of violence hypothesis-the extent of criminal involvement can be explained as being a consequence of prior maltreatment; however, findings also suggest refinements to the theory, because the influence of type of abuse varies depending on the type of offending examined. Research and policy implications are discussed.

Background: No studies investigate work-related injuries experienced by Canadian occupational therapists., Purpose: To identify the nature and prevalence of work-related injuries, impact of practice context, cultural and structural factors that influence response to these injuries, and strategies used to manage return-to-work after injury., Methods: Members of the Canadian Association of Occupational Therapists were sent an electronic survey in June 2009., Findings: Over half of the 600 respondents reported at least one injury episode. Patient-handling and equipment-related incidents accounted for the largest proportion of injuries. Almost one-third of respondents reported being threatened at work or experiencing workplace violence., Implications: Injured occupational therapists tended to minimize the extent and impact of their injuries by underreporting incidents and continuing to work after injury. These behaviours may contribute to a failure to recognize the reality of work-related injuries in occupational therapy practice and thereby limit the development of profession-specific, risk-minimization strategies.

Introduction: This study sought to identify factors associated with health service utilisation by individuals with mental disorders in a Canadian catchment area., Methods: To be included in the study, participants had to be aged between 15 and 65 and reside in the study location. Data was collected randomly from June to December 2009 by specially trained interviewers. A comprehensive set of variables (including geospatial factors) was studied using the Andersen's behavioural health service model. Univariate, bivariate, and multivariate analyses were carried out., Results: Among 406 individuals diagnosed with mental disorders, 212 reported using a mental health service at least once in the 12 months preceding the interviews. Emotional problems and a history of violence victimisation were most strongly associated with such utilisation. Participants who were middle-aged or deemed their mental health to be poor were also more likely to seek mental healthcare. Individuals living in neighbourhoods where rental accommodations were the norm used significantly fewer health services than individuals residing in neighbourhoods where homeownership was preponderant; males were also less likely to use services than females., Conclusions: Our study broke new ground by uncovering the impact of longstanding violence victimisation, and the proportion of homeownership on mental health service utilisation among this population. It also confirmed the prominence of some variables (gender, age, emotional problems and self-perceived mental health) as key enabling variables of health-seeking. There should be better promotion of strategies designed to change the attitudes of males and youths and to deal with violence victimisation. There is also a need for initiatives that are targeted to neighbourhoods where there is more rental housing.

Accounts in both the scientific literature and popular media have brought about increased recognition of the reality of elder abuse. However, relatively little work has examined intimate partner victimization with respect to older adults. In this study, weighted data from cycles 13 (1999) and 18 (2004) of the General Social Survey are pooled to examine how factors uniquely influence the prevalence and risk of emotional, financial, and physical abuse among adults aged 60 and over. Considerations regarding elder abuse committed by spouses, versus abuse of older adults more broadly (by their children and other adults), are also discussed.

Canadian frontline careworkers are six times more likely to experience daily physical violence than their Scandinavian counterparts. This paper draws on a comparative survey of residential careworkers serving older people across three Canadian provinces (Manitoba, Nova Scotia, Ontario) and four countries that follow a Scandinavian model of social care (Denmark, Finland, Norway, Sweden) conducted between 2005 and 2006. Ninety percent of Canadian frontline careworkers experienced physical violence from residents or their relatives and 43 percent reported physical violence on a daily basis. Canadian focus groups conducted in 2007 reveal violence was often normalized as an inevitable part of elder-care. We use the concept of "structural violence" (Galtung, 1969) to raise questions about the role that systemic and organizational factors play in setting the context for violence. Structural violence refers to indirect forms of violence that are built into social structures and that prevent people from meeting their basic needs or fulfilling their potential. We applied the concept to long-term residential care and found that the poor quality of the working conditions and inadequate levels of support experienced by Canadian careworkers constitute a form of structural violence. Working conditions are detrimental to careworker's physical and mental health, and prevent careworkers from providing the quality of care they are capable of providing and understand to be part of their job. These conditions may also contribute to the physical violence workers experience, and further investigation is warranted., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Objective: To review the empirical literature on the prevalence of interpersonal violence (IPV) against people with disabilities., Method: The authors searched for, obtained, and reviewed 6,000 abstracts published between January, 2000 and August, 2010 via searches in PsycINFO and PubMed. Subsequently, 177 potentially applicable full-text articles were independently assessed for inclusion; 22 articles describing 21 individual studies were included in this review., Results: The prevalence of IPV varied depending on the time frame, the definition and type of violence, perpetrator, and disability. Prevalence of any type of IPV among women with disabilities ranged from 26.0%-90.0% for lifetime; 4.9%-29.1% for the past 5 years; and 2.0%-70.0% for the past year. In some studies, when compared to women without disabilities, women with disabilities experienced more lifetime, 5 year, and past year physical and sexual IPV. Prevalence of any IPV in men with disabilities ranged from 28.7%-86.7% for lifetime; 24.9% for the past 5 years; and 36.7% for the past year., Conclusions/implications: IPV occurs at elevated and disproportionate rates among women and men with disabilities, especially when assessed over the course of their lives. Future research that relies on standard definitions of disability and violence, uses accessible measurement, and examines IPV in diverse populations of people with disabilities will strengthen future reviews and better inform research and policy priorities on disability and violence.

Canadian law protects people from discrimination on the grounds of sexual orientation, but our public schools do not fulfill their ethical and legal obligations where sexual and gender minority youth are concerned. This article reports on a national survey study on homophobia and transphobia in Canadian high schools. Participants (n = 3,607) were questioned about school climate, harassment, school attachment, and institutional interventions. We found that schools were neither safe nor respectful for sexual and gender minority students, and we argue that ongoing exposure to this situation undermines students' respect for the Charter of Rights and their faith in adults.

Opioid-dependent individuals with a history of abuse have exhibited worse mental and physical health compared to those without such a history; however, the evidence regarding the influence of abuse histories on addiction treatment outcomes are conflicting. In the present study, we identified history of physical or sexual abuse at treatment initiation in relation to drug use and health among long-term opioid-dependent individuals and we determined the relationship of abuse histories with treatment outcomes following substitution treatment. We analyzed data from a randomized controlled trial that compared the effectiveness of opioid-agonists in the treatment of chronic opioid dependence. The North American Opiate Medication Initiative (NAOMI) was conducted in Vancouver and Montreal (Canada) and provided oral methadone, injectable diacetylmorphine or injectable hydromorphone, the last two on a double blind basis, over 12 months. A total of 112 (44.6%) participants reported a history of physical or sexual abuse at baseline. Participants with an abuse history reported a significantly higher number of chronic medical problems, suicide attempts, and previous drug treatments and had poorer psychiatric, family and social relations, and quality of life status compared to those without abuse histories. No differences in current and past substance use were found between those with and without abuse histories. Following 12 months of treatment, the participants with abuse histories improved to a similar degree as those without a history of abuse in all of the European Addiction Severity Index sub-scales, with the exception of medical status. The findings suggest that individuals with abuse histories were able to achieve similar outcomes as those without abuse histories following treatment despite having poorer scores in physical and mental health, social status and quality of life at treatment initiation. These findings suggest that the substitution treatments as provided in this study can benefit the most vulnerable and access needs to be expanded to reach this population., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

This study surveyed 199 forensic clinicians about the practices that they use in assessing violence risk in juvenile and adult offenders. Results indicated that the use of risk assessment and psychopathy tools was common. Although clinicians reported more routine use of psychopathy measures in adult risk assessments compared with juvenile risks assessments, 79% of clinicians reported using psychopathy measures at least once in a while in juvenile risk assessments. Extremely few clinicians, however, believe that juveniles should be labeled or referred to as psychopaths. Juvenile risk reports were more likely than adult reports to routinely discuss treatment and protective factors, and provide recommendations to reevaluate risk. The implications of these findings are discussed.

Objective: To examine the career prevalence of abusive encounters for family physicians in Canada., Design: A 7-page cross-sectional mailed survey in English and French., Setting: Canada., Participants: A total of 3802 randomly selected practising family physicians who were members of the College of Family Physicians of Canada., Main Outcome Measures: Demographic characteristics of survey participants, career prevalence of abusive encounters, and perpetrators of abuse., Main Findings: Twenty percent (20.4%) of the surveys (n = 774) were returned. Of the respondents, 44% were men and 56% were women. Most were in private practice in urban settings. The average number of years in practice was 15. The career prevalence of abusive encounters was divided into "minor," "major," and "severe" incidents. Of all the respondents, 98% had experienced at least 1 incident of minor abuse, 75% had experienced at least 1 incident of major abuse, and 39% had experienced at least 1 incident of severe abuse. Using chi(2) analysis, a number of demographic variables were found to be significantly associated with abuse including the physician's race and sex. Patients were the most common perpetrators of abuse. Ninety percent of family physicians surveyed reported that they had been abused by patients, while 70% reported that they had been abused by family members of patients., Conclusion: Approximately 2 in 5 family physicians surveyed were subjected to a considerable amount of severe abuse during practice. Abuse in the office setting might have grave consequences for the health and well-being of the victimized physicians and might hinder service retention where the risk of abuse is greatest.

Differences in developmental trajectories of physical violence, vandalism, theft, and alcohol-drug use from ages 10 to 15 were studied. For females and for males, three trajectories of theft and of alcohol-drug use increased from 10 years to 15 years, while only the high trajectory of vandalism increased from ten to 14. All trajectories of physical violence decreased. Children who engaged in the high trajectories of vandalism, theft, and alcohol-drug use had a high probability of also being high in physical violence. Compared to males, females were less likely to be on the high trajectory of physical violence, and their trajectories of other antisocial behaviors were less strongly associated with high levels of physical violence. The results suggest that physical violence during pre-adolescence and adolescence has a different developmental pattern than other forms of antisocial behavior, and that its relation to these other forms of antisocial behavior differs by sex.

Background: Physical aggression is an important issue in North American populations. The importance of students' social environments in the occurrence of physical aggression requires focused study. In this study, reports of physical aggression were examined in relation to social environment factors among national samples of students from Canada and the United States., Methods: Students in grades 6-10 from the United States (n = 14,049) and Canada (n = 7058) who had participated in the Health Behaviour in School-aged Children Survey (HBSC) were studied. Rates of students' physical aggression were compared between the 2 countries. School, family, socioeconomic, and peer-related factors were considered as potential risk factors. A simple social environment risk score was developed using the US data and was subsequently tested in the Canadian sample., Results: Risks for physical aggression were consistently higher among United States versus Canadian students, but the magnitude of these differences was modest. The relative odds of physical aggression increased with reported environmental risk. To illustrate, US boys in grades 6-8 reporting the highest social environment risk score (5+) experienced a relative odds of physical aggression 4.02 (95% CI 2.7-5.9) times higher than those reporting the lowest score (adjusted OR for risk scores 0 through 5+ was 1.00, 1.19, 2.10, 2.01, 3.71, and 4.02, respectively, p(trend) < .001)., Conclusions: Unexpectedly, rates of physical aggression and associations between social environments and students' aggression were remarkably similar in Canada and the United States. Family, peer, and school social environments serve as risk or protective factors, with significant cumulative impact on physical aggression in both countries. Given the observed high rates and the many negative effects of aggression on long-term health, school policies aimed at the reduction of such behavior remain a clear priority.

Objective: To determine whether exposure to particular types of traumatic events was differentially associated with suicide attempts in a representative sample of active military personnel., Method: Data came from the Canadian Community Health Survey: Mental Health and Well-Being Canadian Forces Supplement (CCHS-CFS), a cross-sectional survey that provided a comprehensive examination of mental disorders, health, and the well-being of currently active Canadian military personnel (n = 8441; aged 16 to 54 years; response rate 81.1%). Respondents were asked about exposure to 28 traumatic events that occurred during their lifetime. Suicide attempts were measured using a question about whether the person ever "attempted suicide or tried to take [his or her] own life.", Results: The prevalence of lifetime suicide attempts for currently active Canadian military men and women was 2.2% and 5.6%, respectively. Sexual and other interpersonal traumas (for example, rape, sexual assault, spousal abuse, child abuse) were significantly associated with suicide attempts in both men (adjusted odds ratios [AORs] ranging from 2.31 to 4.43) and women (AORs ranging from 1.73 to 3.71), even after adjusting for sociodemographics and mental disorders. Additionally, the number of traumatic events experienced was positively associated with increased risk of suicide attempts, indicating a dose-response effect of exposure to trauma., Conclusions: The current study is the first to demonstrate that sexual and other interpersonal traumatic events are associated with suicide attempts in a representative sample of active Canadian military men and women.

Objective: To determine whether the effects of factors associated with the development of childhood (aged 6 years or younger) physical aggression were immediate (cross-sectional), sustained (longitudinal), or both., Methods: A longitudinal subsample (n = 975) of children born between December 1994 and April 1995 was drawn from the Canadian National Longitudinal Survey of Children and Youth and followed from birth to 6 years of age. Using random- and fixed-effects logistic panel regression models, child (sex and preterm birth), maternal (education, employment, and positive or hostile/ineffective parenting), and family (lone-parent, older and younger siblings, and income) indicators were regressed on childhood physical aggression., Results: Hostile/ineffective parenting contributed significantly to explaining the variance in aggression. At each measurement time point (birth, 2, 4, and 6 years of age), a change in hostile/ineffective parenting had an effect on aggression, and this effect carried forward across time up to 6 years. Being a boy, having a mother with less education, and living in a lone-parent family with siblings also contributed significantly to aggression. Preterm birth, maternal employment, depressive symptoms, positive interaction, and income failed to contribute significantly to aggression., Conclusions: These results support the hypothesis that hostile/ineffective parenting has an immediate effect on aggression. Contrary to predictions that it would have an immediate effect only at the time it was occurring, hostile/ineffective parenting had a sustained effect on aggression that carried forward in time up to 6 years of age. The results suggest that hostile/ineffective parenting has an effect on aggression prior to any evidence of aggressive behaviour in the child.

Objectives: Consistent evidence has shown that young people are significantly overrepresented among victims of violence due to another person's drinking. Yet little research has examined factors that explain alcohol-related victimization among young adults, particularly in Canada. The present study examines the influence of hazardous drinking and illicit drug use on the likelihood of experiencing alcohol-related physical victimization among young adult drinkers in a Canadian general population sample and determines whether gender differences exist in the roles of these explanatory variables., Methods: A secondary analysis of the 2004 Canadian Addiction Survey (CAS) was conducted, restricting analyses to young adult (ages 18 to 25) drinkers (785 females, 745 males). Logistic regression analyses were conducted to examine associations between explanatory variables and victimization. To assess gender differences in effects, interaction effects of gender by hazardous drinking and illicit drug use were tested., Results: Alcohol-related victimization was more likely among men than among women, hazardous drinkers than non-hazardous drinkers, and illicit drug users than non-users. Multivariate analyses indicated that, among women, illicit drug use was associated with victimization whereas, among men, hazardous drinking was significant. An interaction effect between gender and hazardous drinking indicated that hazardous drinking was more strongly associated with victimization among men than among women., Conclusion: These results highlight the important role of substance use in explaining alcohol-related victimization among young adult Canadian drinkers and suggest that gender-specific prevention programs may be needed.

Health professionals have long been involved with advocacy around the social determinants of health, including protesting against war and mitigating the production, trade and use of specific weapon systems. Small arms and light weapons are a key area on which to focus, as they are responsible for the majority of injuries and deaths in war and their availability is related to increased levels of crime and suicide. Challenges for health professionals hoping to engage in such advocacy include a lack of adequate data, the need to confront political questions and the gun-lobby, and difficulty in measuring the effectiveness of campaigns. This article discusses some examples of successful advocacy and suggests future directions for health professionals in this area.

Although dramatically heightened rates of violence have been observed among injection drug users (IDU), little is known about the gender differences associated with violence among this population. Employing a risk environment framework, we performed an analysis of the factors associated with experiencing violence among participants enrolled in a prospective cohort study of IDU during the years 1996-2005 using generalized estimating equations (GEE). Among 1114 individuals, 291 (66%) of females and 470 (70%) of males reported experiencing violence during the study period. In multivariate analyses, mental illness, frequent alcohol use, frequent crack use, homelessness, Downtown Eastside residency, and requiring help injecting were positively associated with experiencing violence for both sexes (all p<0.05). For females, binge drug use (AOR=1.30) and drug dealing (AOR=1.42) were positively associated with violence, while younger age (AOR=1.02), frequent heroin injection (AOR=1.24), and incarceration (AOR=1.50) were significant for males. Women were more likely to be attacked by acquaintances, partners, and sex trade clients, while men were more likely to experience violence from strangers and the police. These findings indicate that susceptibility to violence among IDU is structured by environmental factors such as homelessness and drug-related factors such as frequent alcohol use and involvement in drug economies. Furthermore, important gender differences with respect to the predictors and characteristics of violent attacks do exist. These findings indicate an urgent need for the development of comprehensive programs and structural interventions that take a gender-focused approach to violence among IDU.

Objective: This study examined the power of child, perpetrator, and socio-economic characteristics to predict injury in cases of reported child physical abuse. The study was designed to assess the validity of the assumption that physically injurious incidents of child physical abuse are qualitatively different from those that do not result in injury, that their generative factors are distinctive, and that the quality of caregiving in these two types of incidents is different., Method: A weighted, nationally representative sample of 8,164 substantiated punishment abuse cases in Canada was used. Various models were constructed and evaluated through logistic regression., Results: Of six potential predictors - child age, perpetrator sex, child functioning, parent functioning, economic stress, and social stress - none predicted injury to the child., Conclusions: The findings suggest that injurious and non-injurious physical abuse cannot be distinguished on the basis of the personal characteristics or circumstances of the child or perpetrator., Practice Implications: A common criterion for child welfare intervention into cases of suspected physical abuse is injury or risk of injury. This criterion assumes that injurious and non-injurious assaults are qualitatively different phenomena, predicted by different risk factors. In the present study an attempt was made to differentiate between injurious and non-injurious cases of punitive physical abuse on the basis of characteristics of the child, perpetrator, family, and social context. None of these factors explained the likelihood of injury, suggesting that the prediction of injury as an intervention criterion may be questionable.