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Introduction: The prevalence of traumatic brain injury (TBI) in the criminal justice system (CJS) is well known. Furthermore, the impact of TBI on communication has been well documented; however, no study has explored the communication challenges of those with TBI in the CJS or considered their implications within CJS contexts. Moreover, no study has examined the possible differences in communication between those with TBI and CJS history and those with TBI but no CJS history. Purpose: This cross-sectional pilot study provides a preliminary exploration of the cognitive-communication challenges in a sample of adults with histories of TBI and CJS involvement compared with a sample of adults with histories of TBI but no CJS involvement. Method: Eight individuals with histories of TBI and CJS involvement were recruited through community agencies. The La Trobe Communication Questionnaire (LCQ) was administered to collect self-reported data on perceived cognitive-communication abilities, including social communication behaviors. Findings were examined and then compared with a previously studied sample of 160 individuals with TBI. Logistic regressions were calculated to determine whether response scores on the LCQ would be predictive of group membership (i.e., TBI + CJS or TBI only). Results: A range of cognitive-communication challenges were reported by both groups. A logistic regression analysis demonstrated a reasonable inference that LCQ responses may predict group membership and support the potential for statistically significant and meaningful results to justify future studies. Conclusions: These challenges have the potential to negatively impact the success of communication interactions within the CJS and illustrate a need for speech-language pathology services for individuals with TBI in the CJS. The nature and magnitude of between-group differences merits further investigation with larger samples to explore whether any specific cognitive-communication challenge is unique to, or predictive of, CJS involvement for purposes of targeted assessment and intervention.

Studies indicate that youth who experience homelessness are more likely than their peers to have mental health and substance use concerns. The objective of this study was to investigate youth views of ideal services and service provision environments that facilitate help seeking. Data were collected from two World Café events in Canada where youth (n=14) were asked to discuss their experiences with housing, mental health and addictions services. The discussions were captured visually by a graphic recorder and on paper tablecloths that were drawn and written on by the youth. These visual data, along with field notes prepared by the research team, were analyzed. The findings indicated that barriers to help seeking included stigma, institutional distrust and fear, negative relationships, and the lack of self-awareness. Facilitators included positive therapeutic relationships, services with the capacity to offer care, and non-judgmental environments. Youth wanted services that provide peer support, allow them to participate more in their care decisions, and use self-directed healing strategies. Service providers and policymakers should offer programming that facilitates youth access. They should consider the barriers that youth experience and seek to construct interventions for youth that are judgement free, confidential, and actively engage youth in their own care.

There is little research with people who experience intellectual/developmental disabilities and imprisonment.The study linked health and correctional data to examine prevalence of intellectual/developmental disabilities and health and correctional characteristics among adults experiencing their first federal incarceration between 1 January 2002 and 31 December 2011 (n = 9278) and two non-incarcerated groups (n = 10,086,802).The prevalence of intellectual/developmental disabilities was 2.1% in the incarcerated group and 0.9% in the non-incarcerated group. Before incarceration, those with, versus without, intellectual/developmental disabilities were at greater risk of traumatic brain injury, mental illness, and substance use disorders. While incarcerated, those with intellectual/developmental disabilities were more likely to incur serious institutional disciplinary charges. Post-incarceration, persons with intellectual/developmental disabilities were at greater risk of emergency department visits, and psychiatric and acute hospitalizations, than the non-incarcerated groups.People with intellectual/developmental disabilities are overrepresented in Canadian federal correctional institutions. The authors offer strategies to support people prior to, during, and post-incarceration.

Problem gambling and gambling disorder are serious public health issues that disproportionately affect persons experiencing poverty, homelessness, and multimorbidity. Several barriers to service access contribute to low rates of formal treatment-seeking for problem gambling compared with treatments for other addictions. Given these challenges to treatment and care, self-management may be a viable alternative or complement to formal problem gambling interventions. In this study, we described problem gambling self management strategies among persons experiencing poverty and homelessness. We conducted semi-structured interviews with 19 adults experiencing problem gambling and poverty/homelessness, and employed qualitative content analysis to code and analyze the data thematically. We identified five types of self-management strategies: (1) seeking information on problem gambling, (2) talking about gambling problems, (3) limiting money spent on gambling, (4) avoiding gambling providers, and (5) engaging in alternative activities. Although these strategies are consistent with previous research, the social, financial,housing, and health challenges of persons experiencing poverty and homelessness shaped their self-management experiences and approaches in distinct ways. Approaches to problem gambling treatment should attend to the broader context in which persons experience and attempt to self-manage problem gambling.

The Ontario Marginalization Index (ON-Marg) is an area-based measure used widely to measure health inequalities in Ontario. Recently, the index was updated for 2011 and 2016. The loss of the 2011 long-form census required the use of alternative data sources for the 2011 version. This paper describes the update of ON-Marg, assesses consistency in the indices across census years using Dissemination Areas, and examines associations between ON-Marg 2016 and four health and social outcomes to demonstrate its potential to measure health inequalities.ON-Marg was created using factor analysis. Differences in quintile assignment was compared over time to assess whether the use of taxfiler, immigration, property assessment, and health card address data in 2011 affected consistency in measurement of marginalization. Inequalities in rates of overall mortality, gonorrhea incidence, mental health emergency department visits, and alcohol retail locations across quintiles of ON-Marg 2016 were quantified using the Relative Index of Inequality.Depending on the dimension, between 81% and 96% of DAs showed limited or no changes in quintiles of marginalization between 2006, 2011 and 2016. Of the 45-64% of DAs that did not change quintile between 2006 and 2016, 1.8% to 8.8% of DAs in 2011 differed by two or more quintiles. Findings showed significant differences in rates of health and social outcomes across quintiles of ON-Marg 2016, with strength and directionality varying by dimension of ON-Marg.Alternative data sources did not substantially affect the consistency of the 2011 version of ON-Marg. The updated ON-Marg is a comprehensive tool that can be used to study health inequalities in Ontario.RéSUMé: OBJECTIFS: L’indice de marginalisation ontarien (indice ON-Marg) est un indicateur par secteurs largement utilisé pour mesurer les inégalités en santé dans la province. Il a récemment été mis à jour pour 2011 et 2016. Avec l’élimination du recensement long en 2011, il a fallu se tourner vers d’autres sources de données. Le présent article décrit la mise à jour de l’indice ON-Marg, évalue l’uniformité des indices d’un recensement à l’autre d’après les aires de diffusion, et examine les liens entre l’indice ON-Marg 2016 et quatre résultats en matière de santé et sur le plan social pour illustrer son potentiel à mesurer les inégalités en santé. MéTHODOLOGIE: L’indice ON-Marg a été créé selon les principes de l’analyse factorielle. Ont été comparés au fil du temps les écarts entre les quintiles pour évaluer si l’utilisation en 2011 des données des déclarants, d’immigration et d’évaluation foncière et celles des adresses des cartes Santé avait eu une incidence sur l’uniformité de la mesure de la marginalisation. Les inégalités quant au taux global de mortalité, à l’incidence de la gonorrhée, au nombre de visites dans les services d’urgence pour des raisons de santé mentale et à l’emplacement des magasins de vente au détail d’alcool par quintiles de l’indice ON-Marg 2016 ont été quantifiées au moyen de l’indice d’inégalité relative. RéSULTATS: Selon l’aspect, il y avait peu ou pas de changements dans 81 % à 96 % des aires de diffusion pour les quintiles de marginalisation de 2006, 2011 et 2016. Parmi les aires de diffusions qui n’ont pas changé de quintile de 2006 à 2016 (45 % à 64 % d’entre elles), on a observé un écart de deux quintiles ou plus en 2011 dans 1,8 % à 8,8 % des cas. L’étude témoigne d’un écart significatif dans les taux des résultats en matière de santé et sur le plan social pour l’ensemble des quintiles de l’indice ON-Marg 2016, la force et la direction variant en fonction de l’aspect. CONCLUSION: L’utilisation d’autres sources de données n’a pas eu de grande incidence sur l’uniformité de la version 2011 de l’indice ON-Marg. La dernière version mise à jour est un outil complet pouvant servir à étudier les inégalités en santé en Ontario.

The prevalence of problem gambling in the correctional system is about 10 times higher than in the general population, but programming for gambling problems in the correctional system is scarce. Examined barriers to treatment for problem gamblers in the correctional system, sex or gender differences, and options for program design. We conducted interviews with 16 experts who had worked with problem gamblers in the correctional system and analyzed the data in terms of themes. For barriers, the experts discussed a lack of awareness about problem gambling, as well as stigmatization and lockdowns. Experts described the content of current programs as equally applicable to both men and women, but that emotional components were more important for women. Finally, the experts had mixed views on whether programming should be integrated with other programs such as substance abuse. Programming implications for this population are discussed.

The purpose of this review was to identify possible sources of bias in the study of gambling among older adults. These sources of bias included social desirability bias including issues of increased stigmatization of gambling behaviors in older adults, recall bias including deficits in the recall of negative experiences, and selection bias including increased reliance on survey methods that are more likely to exclude older adults. Due to the paucity of research directly examining sources of bias in the study of older adult gambling, this review took recent developments in the field of gambling research and compared them across known issues in researching older adults taken from other fields. Those sources of bias that have the most support in the literature were discussed. The trend of increased focus on the experiences of older adults in gambling research is likely to continue given the aging of the Global North and potential vulnerabilities to harm associated with old age. The field must make a more effort to directly assess unique sources of bias in this area in order to ensure that future findings are reflective of the wide range of experiences that is captured within the category of “older adult.”

People experiencing poverty/homelessness have higher rates of problematic gambling than the general population. Yet, research on gambling among this population is sparse, notably among women. This study examined prevalence of problematic gambling among women using shelter and drop-in services in Ontario, Canada. The NORC Diagnostic Screen for Disorders was administered to women during visits to 15 sites using time/location methodology. Within a sample of 162 women, the prevalence of at-risk (6.2%), problem (9.3%), and pathological gambling (19.1%) was higher than the general population. Among women who scored at-risk or higher, 55.4% met criteria for pathological gambling. The findings suggest that women seeking shelter and drop-in services are vulnerable to problematic gambling. Creating awareness of this vulnerability within the shelter and drop-in service sector is an important first step to support women with gambling problems who face financial and housing precarity.

The burden of gambling problems is felt more strongly among people who experience poverty. A small but emerging body of research is developing with no identified reviews exploring the scope of the ...

Background Data on the prevalence of developmental disabilities in people who experience imprisonment and on their characteristics are lacking. Methods The present authors identified adults with developmental disabilities who were released from Ontario provincial prisons in 2010 and a general population comparator group using administrative data. The present authors examined demographic characteristics, morbidity and healthcare use. Results The prevalence of developmental disabilities was 2.2% in the prison group (N = 52,302) and 0.7% in the general population (N = 10,466,847). The prevalence of psychotic illness, substance-related disorder and self-harm was higher among people in the prison group with developmental disabilities. People with developmental disabilities were more likely to have emergency department visits and hospitalizations in prison and in the year after release. Conclusions People with developmental disabilities are overrepresented in provincial prisons and have a high burden of disease. Strategies are indicated to prevent incarceration and to improve health.

We present the findings from a one-day, multidisciplinary meeting to gather feedback for an integrated knowledge translation research project addressing the integration of health services and supports for individuals with traumatic brain injury, mental health, and/or addictions; especially those who experience homelessness/vulnerably housed, intersect with the criminal justice system, and are survivors of intimate partner violence. This meeting brought together persons with lived experience, service providers, decision makers, and researchers, who provided feedback that further refined the research methodology and highlighted existing gaps. This event was successful in inviting collaboration, knowledge exchange and dissemination, and advancing an important knowledge-to-action cycle for this research.

Problem gambling is a major public health concern, especially among persons who are precariously housed, living in poverty or have complex health and social needs. Problem gambling has been connected to negative health and social outcomes; however, current healthcare services rarely screen for problem gambling. With support from community partners, the purpose of this study was to understand factors related to screening for problem gambling. Concept mapping, a mixed-method approach driven by participatory involvement, was conducted with healthcare and social service providers from Ontario, Canada in 2019. Three phases were conducted with participants either in-person or online: Brainstorming, Sorting/Rating and Mapping. Brainstorming sessions were conducted to generate statements, guided by the focal prompt: "If you were directed to routinely screen for problem gambling, what would help you do this in your daily practice?" Participants sorted statements into categories and rated them based on their importance and feasibility. A mapping session was conducted with participants to co-create visual representations of the data. Thirty participants took part in the in-person or online concept mapping sessions. During the brainstorming sessions, participants generated 213 statements, which the research team condensed into a final list of 45 statements. Participants decided that the five-cluster map best represented these 45 statements and labelled the five clusters: (a) top level (macro), (b) screening tool, (c) staff skills and training, (d) screening, and (e) team resources and support. Staff skills and training was rated as the most important and the most realistic cluster to implement, while screening was rated relatively as the least important when compared to the other clusters. Team resources and support was rated relatively as the least realistic cluster. By identifying the needs of healthcare and social service providers, this study co-developed actionable suggestions that will assist providers in routinely screening for problem gambling.

When people leave correctional institutions, they face myriad personal, social and structural barriers to reentry, including significant challenges with mental health, substance use, and homelessness. However, there are few reentry programs designed to support people’s health, wellbeing, and social integration, and there are even fewer evaluations of such programs. The purpose of this article is to report the qualitative findings from an early process evaluation of the Reintegration Centre—a peer-led service hub designed to support men on the day they are released from custody. We conducted semi-structured qualitative interviews and examined quantitative service intake data with 21 men who accessed the Reintegration Centre immediately upon release. Participants encountered significant reentry challenges and barriers to service access and utilization. The data suggest that the peer-led service hub model enhanced the service encounter experience and efficiently and effectively addressed reentry needs through the provision of basic supports and individualized service referrals. Notably, the Reintegration Centre’s proximity to the detention centre facilitated rapid access to essential services upon release, and the peer-support workers affirmed client autonomy and moral worth in the service encounter, fostering mutual respect and trust. Locating reentry programs near bail courts and detention centres may reduce barriers to service access. A peer-led service hub that provides immediate support for basic needs along with individualized service referrals is a promising approach to reentry programs that aim to support post-release health, wellbeing, and social integration. A social system that fosters cross-sectoral collaboration and continuity of care through innovative funding initiatives is vital to the effectiveness and sustainability of such reentry programs.

BackgroundAccessing HIV-related care is challenging for formerly incarcerated people with HIV. Interventions informed by the perspectives of these individuals could facilitate engagement with care and address competing priorities that may act as barriers to this process.MethodsWe used concept mapping to identify and prioritize the main obstacles to engaging with HIV-related care following prison release. In brainstorming sessions, formerly incarcerated people with HIV generated responses to a focused prompt regarding the main barriers to reengaging with care. These were consolidated in 35 statements. Next, participants sorted the consolidated list of responses into groups and rated each from lowest to highest in terms of its importance and feasibility of being addressed. We used cluster analysis to generate concept maps that were interpreted with participants.ResultsOverall, 39 participants participated in brainstorming sessions, among whom 18 returned for rating and sorting. Following analysis, a seven-cluster map was generated, with participants rating the ‘Practical Considerations’ (e.g. lack of transportation from prison) and ‘Survival Needs’ (e.g. securing housing and food) clusters as most important. Although ratings were generally similar between women and men, women assigned greater importance to barriers related to reconnecting with children.ConclusionsUsing concept mapping, we worked with formerly incarcerated people with HIV to identify and prioritize key challenges related to accessing health and social services following prison release. Transitional intervention programs should include programs and processes that address meeting basic subsistence needs and overcoming logistical barriers related to community re-entry.

Summary The COVID-19 pandemic is highlighting the harm perpetuated by gender-blind programs for marginalized citizens, including sexual and gender minorities (SGMs) and cisgender women. Gender-blind programs are known to augment harms associated with violence and structural stigmatization by reinforcing rather than challenging unequal systems of power. The intersecting marginalization of these populations with systems of class, race, and settler-colonialism is exacerbating the impact that policies such as physical distancing, school closures, and a realignment of healthcare priorities are having on the wellbeing of these populations. The overarching reasons why women and SGM are marginalized are well known and stem from a hegemonic, patriarchal system that fails to fully integrate these groups into planning and decision making regarding public health programming—including the response to COVID-19. In this perspective, we aim to highlight how the exclusion of cisgender women and SGM, and failure to use a gender redistributive/transformative approach, has (i) hampered the recovery from the pandemic and (ii) further entrenched the existing power structures that lead to the marginalization of these groups. We also argue that COVID-19 represents a once-in-a-century opportunity to realign priorities regarding health promotion for cisgender women and SGM by using gender redistributive/transformative approaches to the recovery from the pandemic. We apply this framework, which aims to challenge the existing power structures and distribution of resources, to exemplars from programs in health, housing, employment, and incarceration to envision how a gender redistributive/transformative approach could harness the COVID-19 recovery to advance health equity for cisgender women and SGM.

The burden of harm from problem gambling weighs heavily on those experiencing poverty and homelessness, yet most problem gambling prevention and treatment services are not designed to address the complex needs and challenges of this population. To redress this service gap, a multi-service agency within a shelter setting in a large urban centre developed and implemented a population-tailored, person-centred, evidence-informed gambling addiction program for its clients. The purpose of this article is to report on qualitative findings from an early evaluation of the program, the first designed to address problem gambling for people experiencing poverty and/or homelessness and delivered within a shelter service agency. Three themes emerged which were related to three program outcome categories. These included increasing awareness of gambling harms and reducing gambling behaviour; reorienting relationships with money; and, seeking, securing, and stabilizing shelter. The data suggest that problem gambling treatment within the context of poverty and homelessness benefits from an approach and setting that meets the unique needs of this community. The introduction of gambling treatment into this multi-service delivery model addressed the complex needs of the service users through integrated and person-centered approaches to care that responded to client needs, fostered therapeutic relationships, reduced experiences of discrimination and stigma, and enhanced recovery. In developing the Gambling Addiction Program, the agency drew on evidence-based approaches to problem gambling treatment and extensive experience working with the target population. Within a short timeframe, the program supported participants in the process of recovery, enhancing their understanding and control of their gambling selves, behaviours, and harms. This project demonstrates that gambling within the context of poverty requires a unique treatment space and approach.

Background Non-fatal opioid overdoses can lead to serious complications and consequently, long-term health effects. We sought to characterize trends of hospitalizations for serious complications associated with opioid overdoses in Ontario, Canada and report health services utilization and mortality in the year following hospital discharge. Methods We conducted a cross-sectional study in Ontario among individuals who experienced a hospitalization for a serious complication (required intubation, rhabdomyolysis, or a brain injury) associated with an opioid overdose between 2010 and 2019. We examined inpatient characteristics at the time of hospital admission, and health services utilization and mortality rates in the year following hospital discharge. Results The rate of hospitalizations for serious complications associated with opioid overdoses increased by 66.7 % from 1.8 per 100,000 population in 2010 to 3.0 per 100,000 population in 2019 in Ontario. Individuals that were discharged alive from hospital experienced high health services utilization in the following year; 71.2 % (N = 953 of 1,338) visited the emergency department (ED), 34.2 % (N = 458) were admitted to hospital, and 16.4 % (N = 219) were treated in hospital for an opioid overdose. However only a quarter of individuals (N = 332; 24.8 %) initiated on opioid agonist therapy within 90 days. Additionally, 8.0 % (N = 127) of hospitalizations resulted in death within 1 year. Conclusions This study highlights increasing rates of serious complications associated with opioid overdoses, with a high demand of health services and a high mortality rate in the following year. These findings highlight an ongoing need for support and harm reduction services to allow for early intervention and follow-up care.

ObjectivesPeople experiencing homelessness have a high prevalence and incidence of traumatic brain injury (TBI) due to violence. Little is known about the effectiveness of interventions to reduce TBI in this population. This study assessed the effect of Housing First (HF) on violence-related TBI in adults with experiences of homelessness and mental illness.DesignPragmatic randomised trial.Participants381 participants in the Toronto site of the At Home/Chez randomised trial.InterventionHF participants were provided with scattered-site housing using rent supplements and supports from assertive community treatment or intensive case management teams (n=218, 57.2%). Control participants had access to treatment as usual (TAU) in the community (n=163, 42.8%).Main outcome measuresPrimary outcomes were an incident physical violence-related TBI event and the number of physical violence-related TBI events during the follow-up period (January 2014 to March 2017). Interval-censored survival time regression and zero-inflated negative binomial regression were used to assess the effect of HF on primary outcomes.ResultsAmong study participants, 9.2% (n=35) had an incident physical violence-related TBI event, and the mean physical violence-related TBI events was 0.16 (SD ±0.6). Compared with TAU participants, HF participants did not have a significantly lower risk of an incident violence-related TBI event (adjusted HR : 0.58 (95% CI, 0.29 to 1.14)), but they had a significantly lower number of physical violence-related TBI events (unadjusted incidence rate ratio (IRR): 0.22 (95% CI, 0.06 to 0.78); adjusted IRR: 0.15 (95% CI, 0.05 to 0.48)).ConclusionHF may be a useful intervention to reduce the burden of TBI due to physical violence among homeless individuals with mental illness.Trial registration numberISRCTN42520374.

Background Amid increasing opioid overdose deaths in Canada since 2010 and a changing naloxone access landscape, there is a need for up-to-date research on Canadian women’s experiences with opioids. Studies on Canadian take-home naloxone programs are promising, but research beyond these programs is limited. Our study is the first to focus on women’s experiences and perspectives on the opioid crisis in Ontario, Canada’s most populous province, since the opioid crisis began in 2010. Objective Our objective was to address research knowledge gaps involving Canadian women with criminal justice involvement who use opioids, and identify flaws in current policies, responses, and practices. While the opioid overdose crisis persists, this lack of research inhibits our ability to determine whether overdose prevention efforts, especially involving naloxone, are meeting their needs. Methods We conducted semi-structured, qualitative interviews from January to April 2018 with 10 women with experience of opioid use. They were recruited through the study’s community partner in Toronto. Participants provided demographic information, experiences with opioids and naloxone, and their perceptions of the Canadian government’s responses to the opioid crisis. Interviews were transcribed verbatim and inductive thematic analysis was conducted to determine major themes within the data. Results Thematic analysis identified seven major concerns despite significant differences in participant life and opioid use experiences. Participants who had used illicit opioids since naloxone became available over-the-counter in 2016 were much more knowledgeable about naloxone than participants who had only used opioids prior to 2016. The portability, dosage form, and effects of naloxone are important considerations for women who use opioids. Social alienation, violence, and isolation affect the wellbeing of women who use opioids. The Canadian government’s response to the opioid crisis was perceived as inadequate. Participants demonstrated differing needs and views on ideal harm reduction approaches, despite facing similar structural issues surrounding stigma, addiction management, and housing. Conclusions Participants experienced with naloxone use found it to be useful in preventing fatal overdose, however many of their needs with regards to physical, mental, and social health, housing, harm reduction, and access to opioid treatment remained unmet.

Traumatic Brain Injury (TBI) is a serious hidden health issue disproportionately affecting people who experience incarceration.We examined the association between TBI and serious disciplinary charges among men and women sentenced by the courts to terms of two or more years.The study originated in Ontario, Canada and used linked administrative health and correctional data. The cohort included adults experiencing their first federal sentence between 1998 and 2011 (N = 12,038). We examined disciplinary charges incurred 2 years post-sentence commencement. TBI was defined using the International Classification of Diseases (ICD-9 and ICD-10) diagnostic codes. Robust Poisson regression was conducted to assess the association between TBI and disciplinary charges.The prevalence of TBI for the full sample was 13.2%. One-third of adults with a recent TBI had a serious disciplinary charge. The unadjusted risk of incurring a serious charge for those with a history of TBI was 39% higher than those with no history of TBI (CI: 1.29-1.49). The adjusted risk was 1.14 (CI: 1.06-1.22).TBI is a serious health concern that makes it difficult for incarcerants to adjust to prison. Additional support/resources are needed to support those with histories of TBI.

Over the last decade, there has been a dramatic increase in the number of incarcerated Indigenous women within Canada’s federal prisons. More than half of these women also identify as single mothers of multiple children, extending the scope of incarceration’s impact across generations. While maternal incarceration has been shown to contribute to a myriad of issues in children, including mental illness and increased mortality, there are few qualitative studies where previously incarcerated Indigenous women have been asked directly about the impact of incarceration on their wellbeing and mothering. This project will utilize a community-based research methodology that centers the voices of previously incarcerated Indigenous mothers by examining the commonalities and distinctions in their lived experiences. We will (1) identify the mental, emotional, spiritual, physical, and relational implications of incarceration for Indigenous mothers, (2) explore Indigenous concepts of motherhood and kinship, (3) identify the unique needs of this population in the criminal justice system, and (4) inform new and existing programs and services directed towards Indigenous mothers involved in the criminal justice system. Semi-structured individual interviews with previously incarcerated Indigenous mothers and Sharing Circles (focus groups) with key stakeholders, including Elders, Healers, and community partners involved in the criminal justice field will form the core knowledge for the project. This project will address a critical gap in public health research concerning the wellbeing of marginalized and incarcerated individuals and contribute significantly to our understanding of the experiences of Indigenous women in the criminal justice system. Through a collaborative partnership with several key Indigenous-centred organizations, the knowledge generated will be used to inform and develop decarceration programming and supports for previously incarcerated Indigenous mothers, establishing concrete measures to reduce the overrepresentation of Indigenous women in the Canadian criminal justice system, now and into the future.

Objective: To describe the evidence regarding communication partner training (CPT) interventions for individuals with traumatic brain injury (TBI) and their conversation partners. Data Sources: Eleven key databases—PubMed, CINAHL, Cochrane Registry of Controlled Trials, Embase, Linguistic and Language Behavior Abstracts, ProQuest, Scopus, Web of Science, PsycBITE, SpeechBITE, and ERIC—were searched from inception through 2019. Study Selection: Selected articles had to be peer reviewed, written in English, experimental or quasiexperimental design, report on TBI communication partners, and describe interventions or strategies targeting communication partners. Data Extraction: Of 1088 articles identified, 12 studies were selected for data extraction, critical appraisal, and analysis with considerations of sex and gender. The Oxford Centre for Evidence-Based Medicine’s guideline was used to critically appraise Levels of Evidence. Assessment of bias was conducted using the Cochrane Collaboration tools for randomized controlled trials and risk of bias in nonrandomized studies of interventions for nonrandomized controlled trials and the risk of bias in N-of-1 trials scale. Data Synthesis: A systematic review with a qualitative meta-analysis of themes and findings across the selected studies identified 3 major categories: (1) benefits of the training for those with TBI, (2) risks of CPT, and (3) suggestions to improve its efficacy. Conclusion: Most of the evidence comes from 1 research group, which may be viewed as a weakness in the current body of literature. However, although the evidence to date is modest, CPT may help to increase accessibility and reduce participation inequities in the community for individuals with TBI. Keywords: Communication, Rehabilitation, Systematic review, Traumatic brain injuries

The increasing popularity of gambling as a leisure activity among older adults (+ 55) coupled with the rapid aging of the population makes it increasingly important to understand what divides problem and non-problem gambling for this age group. This study investigated the association of different types of motivations to visit a gambling venue with problem gambling. Using a sample of 2103 older adults collected at 7 gambling venues in Southern Ontario, principal component analysis was completed to identify groupings of motivations dividing them into three types: entertainment, emotions, and money. These types were then incorporated into a series of logistic regressions predicting problem gambling. The study found that motivations related to money and emotion were associated with higher odds of problem gambling while motivations related to entertainment were related to lower odds of problem gambling. An interaction effect with gender indicated that the association between emotion motivations and problem gambling was significantly stronger among males. Motivations to visit a gambling venue may be useful in identifying those who are at greater risk of harm. The findings of this study also suggest that typical associations of emotionally motivated gambling with women may distract from the association of emotionally motivated with gambling-related harm among men.

Gambling is a popular leisure activity for older adults (55+), and existing research suggests that overall older adults are less prone to problem gambling compared to younger cohorts. People born a...

Previous studies that have explored the association between childhood trauma and homelessness indicate that traumatic events can lead to survivor distrust of interpersonal relationships and institutions, prolonged homelessness and poor health and social outcomes. The majority of this literature relies on quantitative data and fails to investigate the personal experiences of childhood trauma that are found to impact housing status later in life. Semi-structured, qualitative interviews were conducted with 25 men living in an urban area in Ontario who had spent more than 30 consecutive nights in an emergency shelter over the course of their housing histories. During data analysis, it was observed that all of the men had experienced some form of trauma or neglect in childhood which contributed to their entries into homelessness. Using a case study approach, three entry pathways into long term homelessness are described: 1) youth; 2) emerging or early adulthood; and 3) middle adulthood. Participants are classified into the pathways by the developmental period at which they first entered homelessness. These findings have implications for policy makers and service providers, as key intervention points are identified. Establishing effective interventions that address crises experienced at these points could assist with homelessness prevention across the life course.

As police officers are often the first responders to mental health crises, a number of approaches have emerged to support skilled police crisis responses. One such approach is the police-mental health co-responding team model, whereby mental health nurses and police officers jointly respond to mental health crises in the community. In the present mixed-method study, we evaluated outcomes of co-responding team interactions at a large Canadian urban centre by analysing administrative data for 2743 such interactions, and where comparison data were available, compared them to 16 226 police-only team responses. To understand service user experiences, we recruited 15 service users for in-depth qualitative interviews, and completed inductive thematic analysis. Co-responding team interactions had low rates of injury and arrest, and compared to police-only teams, co-responding teams had higher overall rates of escorts to hospital, but lower rates of involuntary escorts. Co-responding teams also spent less time on hospital handovers than police-only teams. Service users valued responders with mental health knowledge and verbal de-escalation skills, as well as a compassionate, empowering, and non-criminalizing approach. Current findings suggest that co-responding teams could be a useful component of existing crisis-response systems.

BACKGROUND AND AIMS Little research has examined the relationship between incentives used by gambling venues to attract customers and the experience of gambling-related harm. Organized and subsidized bus tours are a common example of such incentives. The aim of this study was to examine whether bus-tour patronage was associated with increased odds of problem gambling among older adults. This study also compared rates of bus-tour use by socio-demographic characteristics and gambling behaviours. DESIGN Pearson's χ2 tests and Mann-Whitney U-tests were applied for bivariate analyses. Multivariate generalized mixed-effects regression modelling was used to examine the relationship between bus-tour patronage and problem gambling while controlling for possible confounding factors. SETTING Seven gambling venues located in Central and Southwestern Ontario, Canada. PARTICIPANTS A total of 1978 gambling venue patrons over the age of 55 years. MEASUREMENTS Problem gambling as indicated by the Problem Gambling Severity Index, bus-tour patronage in the 12 months prior to the survey, spending per gambling visit and past-month slot machine participation. FINDINGS Regression analyses showed that bus-tour patronage was associated with higher odds of problem gambling [odds ratio (OR) = 1.71, confidence interval (CI) = 1.06, 2.76] after controlling for several demographic characteristics, type of gambling and gambling expenditures. Bivariate analyses showed past-year bus-tour patronage was associated with more frequent slot machine play (χ2 = 48.16, P

Background Despite the growing recognition for the need to improve the health of prisoners in Canada and the need for health research, there has been little discussion of the ethical issues with regards to health research with prisoners in Canada. The purpose of this paper is to encourage a national conversation about what it means to conduct ethically sound health research with prisoners given the current realities of the Canadian system. Lessons from the Canadian system could presumably apply in other jurisdictions. Main text Any discussion regarding research ethics with Canadian prisoners must begin by first taking into account the disproportionate number of Indigenous prisoners (e.g., 22–25% of prisoners are Indigenous, while representing approximately 3% of the general Canadian population) and the high proportion of prisoners suffering from mental illnesses (e.g., 45% of males and 69% of female inmates required mental health interventions while in custody). The main ethical challenges that researchers must navigate are (a) the power imbalances between them, the correctional services staff, and the prisoners, and the effects this has on obtaining voluntary consent to research; and (b), the various challenges associated to protecting the privacy and confidentiality of study participants who are prisoners. In order to solve these challenges, a first step would be to develop clear and transparent processes for ethical health research, which ought to be informed by multiple stakeholders, including prisoners, the correctional services staff, and researchers themselves. Conclusion Stakeholder and community engagement ought to occur in Canada with regards to ethical health research with prisoners that should also include consultation with various parties, including prisoners, correctional services staff, and researchers. It is important that national and provincial research ethics organizations examine the sufficiency of existing research ethics guidance and, where there are gaps, to develop guidelines and help craft policy.

Recent studies found that providing low threshold access to housing increased housing stability in individuals experiencing long-term homelessness. The Housing First model, traditionally designed to assist those with complex needs, has become increasingly popular in North America and elsewhere. This study used data from semi-structured interviews with fifteen men who were enrolled in and received assistance with finding, financing and maintaining housing through a Housing First program called Transitions to Home (T2H) in Hamilton, Ontario, Canada. The objective of this paper was to describe men’s understandings, definitions, and experiences of housing stability once housed. When asked to provide definitions of stability, many of the men referred to factors associated with the concept of home such as comfort, safety and independence. We found that men’s descriptions of “housing stability” and “home” were multifaceted and included elements not traditionally captured in typical definitions of housing...

Background In recent years, obesity-related diseases have been on the rise globally resulting in major challenges for health systems and society as a whole. Emerging research in population health suggests that interventions targeting the built environment may help reduce the burden of obesity and type 2 diabetes. However, translation of the evidence on the built environment into effective policy and planning changes requires engagement and collaboration between multiple sectors and government agencies for designing neighborhoods that are more conducive to healthy and active living. In this study, we identified knowledge gaps and other barriers to evidence-based decision-making and policy development related to the built environment; as well as the infrastructure, processes, and mechanisms needed to drive policy changes in this area. Methods We conducted a qualitative thematic analysis of data collected through consultations with a broad group of stakeholders (N = 42) from Southern Ontario, Canada, within various sectors (public health, urban planning, and transportation) and levels of government (federal, provincial, and municipalities). Relevant themes were classified based on the specific phase of the knowledge-to-action cycle (research, translation, and implementation) in which they were most closely aligned. Results We identified 5 themes including: 1) the need for policy-informed and actionable research (e.g. health economic analyses and policy evaluations); 2) impactful messaging that targets all relevant sectors to create the political will necessary to drive policy change; 3) common measures and tools to increase capacity for monitoring and surveillance of built environment changes; (4) intersectoral collaboration and alignment within and between levels of government to enable collective actions and provide mechanisms for sharing of resources and expertise, (5) aligning public and private sector priorities to generate public demand and support for community action; and, (6) solution-focused implementation of research that will be tailored to meet the needs of policymakers and planners. Additional research priorities and key policy and planning actions were also noted. Conclusion Our research highlights the necessity of involving stakeholders in identifying inter-sectoral solutions to develop and translate actionable research on the built environment into effective policy and planning initiatives.

OBJECTIVE: To examine attachment to primary care and team-based primary care in the community for people who experienced imprisonment in Ontario, and to compare these attachment data with data for the general population. DESIGN: Population-based retrospective cohort study. SETTING: Ontario. PARTICIPANTS: All persons released from provincial prison in Ontario to the community in 2010 who were linked with provincial health administrative data, and an age- and sex-matched general population group. MAIN OUTCOME MEASURES: Primary care attachment and team-based primary care attachment in the 2 years before admission to provincial prison (baseline) and in the 2 years after release in 2010 (follow-up) for the prison release group, and for the corresponding periods for the general population group. RESULTS: People in the prison release group (n = 48 861) were less likely to be attached to primary care compared with the age- and sex-matched general population group (n = 195 444), at 58.9% versus 84.1% at baseline (P < .001) and 63.0% versus 84.4% during follow-up (P < .001), respectively. The difference in attachment to team-based primary care was small in magnitude but statistically significant, at 14.4% versus 16.1% at baseline (P < .001) and 19.9% versus 21.6% during follow-up (P < .001), respectively. CONCLUSION: People who experience imprisonment have lower primary care attachment compared with the general population. Efforts should be made to understand barriers and to facilitate access to high-quality primary care for this population, including through initiatives to link people while in prison with primary care in the community.

Problem gambling is a hidden public health concern, especially among people who experience poverty and homelessness, with combined prevalence of lifetime problem and pathological gambling ranging from 29.8 to 58.2% based on studies from North America. Service providers in the non-addiction sectors (e.g., housing and primary health care) have not traditionally screened their clients for problem gambling behaviours or concerns. In an effort to build multi-sector awareness and stimulate discussion about problem gambling, poverty, and homelessness, we invited practitioners from the social, health and human services community and people with lived experience to join a knowledge translation and mobilisation event using the World Café method. The purpose of this paper is to summarize the knowledge generated about problem gambling, poverty, and homelessness, from the perspectives of the World Café participants. We identified themes that align with quality of care espoused by the World Health Organization, Health Quality Ontario, and the Organisation for Economic Co-operation and Development. These include delivering care that is highly accessible to clients experiencing poverty in a one-stop-shop that is timely, and efficient; patient-centred and equitable with respect to gender and sexual orientation; culturally sensitive; trauma-informed; that provides a therapeutic alliance and a safe space to enhance well-being. Participants identified the need for a plain language, accessible definition of problem gambling and the need to create awareness of the harm associated with problem gambling in targeted messages that engage clients, policy makers and the general public.RésuméLe jeu problématique est un problème de santé publique caché, en particulier chez les personnes en situation de pauvreté et d'itinérance, avec une prévalence combinée du jeu problématique et du jeu pathologique au cours de la vie allant de 29,8 à 58,2%, selon des études réalisées en Amérique du Nord. Les fournisseurs de services dans les secteurs non liés à la toxicomanie (p. ex., le logement et les soins de santé primaires) n’ont pas toujours soumis leurs clients à un dépistage de comportements ou de problèmes liés au jeu. Dans le but de sensibiliser les différents secteurs et de stimuler la discussion sur la dépendance au jeu, la pauvreté et l’itinérance, nous avons invité des praticiens de la communauté des services sociaux, de la santé et communautaires et des personnes ayant une vécue cette expérience à se joindre à un événement d’application des connaissances et de mobilisation, en nous fondant sur la méthode « World Café ». Le but de cet article est de résumer les connaissances générées sur le jeu problématique, la pauvreté et l’itinérance, du point de vue des participants au World Café. Nous avons relevé des thèmes correspondant à la qualité des soins préconisés par l’Organisation mondiale de la santé, Qualité des services de santé Ontario et l’Organisation de coopération et de développement économiques. Ces thèmes incluent la fourniture de soins 1) grandement accessibles pour les clients en situation de pauvreté, dans un guichet unique rapide et efficace 2) centrés sur le patient et équitables en ce qui concerne le genre et l’orientation sexuelle; 3) adaptés à la culture; 4) sensibles aux traumatismes; 5) offerts en alliance thérapeutique et 6) prodigués dans un espace sécuritaire pour améliorer le bien-être. Les participants ont relevé la nécessité de formuler une définition de la dépendance au jeu en termes simples et accessibles, ainsi que la nécessité de sensibiliser le public au préjudice associé au jeu problématique dans des messages ciblés qui engagent les clients, les décideurs et le grand public.

Background Problem gambling (PG) is a serious public health concern that disproportionately affects people experiencing poverty, homelessness, and multimorbidity including mental health and substance use concerns. Little research has focused on self-help and self-management in gambling recovery, despite evidence that a substantial number of people do not seek formal treatment. This study explored the literature on PG self-management strategies. Self-management was defined as the capacity to manage symptoms, the intervention, health consequences and altered lifestyle that accompanies a chronic health concern. Methods We searched 10 databases to identity interdisciplinary articles from the social sciences, allied health professions, nursing and psychology, between 2000 and June 28, 2017. We reviewed records for eligibility and extracted data from relevant articles. Studies were included in the review if they examined PG self-management strategies used by adults (18+) in at least a subset of the sample, and in which PG was confirmed using a validated diagnostic or screening tool. Results We conducted a scoping review of studies from 2000 to 2017, identifying 31 articles that met the criteria for full text review from a search strategy that yielded 2662 potential articles. The majority of studies examined self-exclusion (39%), followed by use of workbooks (35%), and money or time limiting strategies (17%). The remaining 8% focused on cognitive, behavioural and coping strategies, stress management, and mindfulness. Conclusions Given that a minority of people with gambling concerns seek treatment, that stigma is an enormous barrier to care, and that PG services are scarce and most do not address multimorbidity, it is important to examine the personal self-management of gambling as an alternative to formalized treatment. Electronic supplementary material The online version of this article (10.1186/s12889-019-6755-8) contains supplementary material, which is available to authorized users.

Background There is recent evidence to suggest that sustaining a traumatic brain injury (TBI) increases risk of criminal justice system involvement, including incarceration. The objective of this study was to explore the association between TBI and risk of incarceration among men and women in Ontario. Methods We identified a cohort of 1.418 million young adults (aged 18-28 yr) on July 1, 1997, living in Ontario, Canada, from administrative health records; they were followed to Dec. 31, 2011. History of TBI was obtained from emergency and hospital records, and incarceration history was obtained from the Correctional Service of Canada records. We estimated the hazard of incarceration using Cox proportional hazard models, adjusting for relevant sociodemographic characteristics and medical history. Results There were 3531 incarcerations over 18 297 508 person-years of follow-up. The incidence of incarceration was higher among participants with prior TBI compared with those without a prior TBI. In fully adjusted models, men and women who had sustained a TBI were about 2.5 times more likely to be incarcerated than men and women who had not sustained a TBI. Interpretation Traumatic brain injury was associated with an increased risk of incarceration among men and women in Ontario. Our research highlights the importance of designing primary, secondary and tertiary prevention strategies to mitigate risk of TBI and incarceration in the population.

As older adults continue to make up a greater proportion of the Canadian population, it becomes more important to understand the implications that their leisure activities have for their physical and mental health. Gambling, in particular, is a form of leisure that is becoming more widely available and has important implications for the mental health and financial well-being of older adults. This study examines a large sample (2103) of casino-going Ontarian adults over the age of 55 and identifies those features of their gambling participation that are associated with problem gambling. Logistic regression analysis is used to analyze the data. Focusing on types of gambling participated in and motivations for visiting the casino, this study finds that several forms of gambling and motivations to gamble are associated with greater risk of problem gambling. It also finds that some motivations are associated with lower risk of problem gambling. The findings of this study have implications related to gambling availability within an aging population.

OBJECTIVES: The objective of the study is to characterize the associations between a history of incarceration and subsequent housing stability over a two-year follow-up period among a sample of homeless and vulnerably housed individuals. METHODS: The study was a prospective cohort study of homeless and vulnerably housed adults in three Canadian cities. Between 2009 and 2012, data were collected using structured, in-person interviews at baseline and two follow-up interviews. Generalized estimating equations were employed to determine the association between reported incarceration within the past 12 months and being housed during the subsequent year over a two-year follow-up period. RESULTS: Baseline data were available for 1,189 homeless and vulnerably housed adults. Recent incarceration was reported by 337 (29%) individuals at baseline. In adjusted analyses, incarceration in the past 12 months was independently associated with a decreased likelihood of being housed during the subsequent year over the two-year follow-up period (adjusted odds ratio = 0.67, 95% confidence interval: 0.50–0.90). CONCLUSION: Homeless and vulnerably housed individuals reporting recent incarceration were less likely to be housed over a two-year follow-up period. These findings highlight the importance of assisting individuals experiencing incarceration with securing stable housing during discharge and post-release planning.

Engaging peer-interviewers in qualitative inquiry is becoming more popular. Yet, there are differing opinions as to whether this practice improves the research process or is prohibitively challenging. Benefits noted in the literature are improved awareness/acceptance of disenfranchised groups, improved quality of research, and increased comfort of participants in the research process. Challenges include larger investment in time and money to hire, train, and support peer-interviewers, and the potential to disrupt peer recovery. We illustrate, through case study, how to engage peer-interviewers, meet potential challenges, and the benefits of such engagement. We draw upon our experience from a qualitative study designed to understand men’s experiences of problem gambling and housing instability. We hired three peers to conduct semi-structured qualitative interviews with 30 men from a community-based organization. We contend, that with appropriate and adequate resources (time, financial investment), peer-interviewing produces a positive, capacity building experience for peer-interviewers, participants and researchers.