Determinants of non-physical intimate partner violence: A cross-sectional study with nationally representative data from Canada.

Based on a nationally representative survey of the Canadian population conducted in 2019/2020, this study examined the prevalence and determinants of non-physical Intimate partner violence (NP-IPV). NP-IPV was defined as experiences of emotional abuse, controlling behaviours, or economic abuse during the past five years. Women (17.3%) and men (16.9%) were equally likely to report NP-IPV, often without co-occurring physical/sexual IPV. For both genders, the risk of NP-IPV decreased with age, and increased with financial strain and having a disability. Childhood maltreatment (sexual abuse, emotional abuse, and exposure to emotional IPV for women, and sexual abuse and emotional abuse for men) was associated with an increased likelihood of reporting NP-IPV in adulthood. Other risk factors included heavy episodic drinking (self and/or spouse/partner) for women and living in a neighbourhood with high levels of social disorder for men. Having confidence in the police was a protective factor for both genders. These associations generally persisted in regression analyses controlling for co-occurring physical/sexual IPV. Future research should focus on methods of preventing NP-IPV and the development of gender-specific interventions to reach and support those who experience NP-IPV. Furthermore, there is a need to improve and standardize measures of NP-IPV.

Childhood maltreatment as a risk factor for cancer: findings from a population-based survey of Canadian adults.

BACKGROUND: Childhood maltreatment (CM) is an established risk factor for various mental and substance use disorders. This study adds to existing evidence that CM may also be a risk factor for cancer. METHODS: Based on data from a sample of 9783 men and 12,132 women from the 2012 Canadian Community Health Survey - Mental Health (CCHS-MH), this analysis explores mediated associations between cancer in adulthood and different levels of exposure to three types of CM-childhood physical abuse (CPA), childhood sexual abuse (CSA), and childhood exposure to intimate partner violence (CEIPV). "Cancer" was defined as an affirmative response to either of these questions: "Do you have cancer?" or "Have you ever been diagnosed with cancer?" The potential mediators were: smoking, depression, alcohol abuse/dependence, life stress, obesity, and physical activity. RESULTS: For women, but not men, having experienced CM was significantly associated with a cancer diagnosis in adulthood, even when effects due to age and socio-demographic characteristics were controlled. Smoking, life stress, depression, and alcohol abuse/dependence reduced the strength of the association between CM and cancer in women. However, most associations remained statistically significant when controlling for effects due to these behavioural and other mediators. Evidence indicated a "dose-response" relationship, in that the likelihood of reporting cancer increased with the number of abuse types (CPA, CSA, CEIPV) reported, and with the severity of CPA. CONCLUSIONS: The analyses suggest an association between CM and cancer in women, even when the effects of known risk factors were taken into account. The association was graded, becoming stronger as CM exposure increased. Implications for the provision of cancer screening and other health care services to women with histories of CM to reduce health disparities are discussed.

Exposure to family violence from childhood to adulthood.

BACKGROUND: Both childhood maltreatment (CM) and intimate partner violence (IPV) are public health problems that have been related to a wide range of adverse health consequences. However, studies examining associations between specific types of CM and experiencing IPV in adulthood have yielded conflicting results. METHODS: Using data from 10,608 men and 11,458 women aged 18 or older from Canada's 2014 General Social Survey, we examined associations between three types of CM-childhood physical abuse (CPA), childhood sexual abuse (CSA), and childhood exposure to IPV -and subsequent intimate partner violence (IPV) in adulthood (physical, sexual or emotional). RESULTS: When potential confounders were controlled, CPA, CSA and childhood exposure to IPV were associated with IPV in adulthood for both sexes (odds ratios, 1.7, 1.8 and 2.0 for men, and 2.2, 2.0 and 2.1 for women). When severity and frequency of CM were examined, a dose-response relationship between all three types of CM and IPV in adulthood was observed among women (meaning that as the severity/frequency of CM increased, the likelihood of reporting IPV also increased); among men, a dose-response relationship was observed only for CPA. CONCLUSIONS: The association between CM and IPV in adulthood is particularly concerning because experiencing multiple forms of trauma has cumulative effects. Lifespan studies have shown that individuals who experience multiple incidents of abuse exhibit the highest levels of impairment. This underscores the importance of programs to eradicate both CM and IPV. This underscores the importance of programs to eradicate both CM and IPV. Future research should focus on assessing interventions designed to promote healthy relationships and the provision of emotional support and coping mechanisms to children and families in abusive situations.

The Decline of Child Sexual Abuse in Canada: Evidence From the 2014 General Social Survey.

OBJECTIVE: To provide evidence of trends in child sexual abuse (CSA) in Canada. METHODS: Using data from 15,801 males and 18,669 females who responded to the 2014 General Social Survey (GSS), we compared the prevalence of CSA by age cohorts. Age cohort patterns were examined for several sub-populations including males, females, Indigenous peoples, and people living in low-income households. RESULTS: After an increase in the post-World War II period, there has been a decline in CSA in Canada since the early 1990s. Findings indicate a decline for both sexes; although, the evidence is more compelling for females. There is also evidence of a decline for Indigenous peoples, for those living in low-income households, and regardless of the relationship to the perpetrator (i.e., family member, a teacher/professor/tutor, a babysitter, a nanny, other non-family member but known to the respondent, or a stranger). CONCLUSIONS: In Canada, evidence from 3 retrospective population surveys suggests a decline in CSA since the early 1990s. However, given the associated harm, continued progress to the eradication of CSA is essential.

Does mandatory reporting legislation increase contact with child protection? - a legal doctrinal review and an analytical examination.

BACKGROUND: Within Canadian provinces over the past half-century, legislation has been enacted to increase child protection organization (CPO) involvement in situations of child maltreatment (CM). This study had two objectives: 1) to document enactment dates of legislation for mandatory reporting of CM; 2) to examine reported CPO involvement among people reporting a CM history in relation to the timing of these legislative changes. METHODS: The history of mandatory reporting of CM was compiled using secondary sources and doctrinal legal review of provincial legislation. The 2012 Canadian Community Health Survey - Mental Health (CCHS-MH) with n = 18,561 was analyzed using birth cohorts to assess associations between the timing of legislation enactment and contact with CPO. RESULTS: All Canadian provinces currently have mandatory reporting of physical and sexual abuse; 8 out of 10 provinces have mandatory reporting for children's exposure to intimate partner violence. Increases in reporting CM to CPOs paralleled these laws' enactment, particularly for severe and frequent CM. CONCLUSIONS: These findings show that mandatory reporting laws increase reporting contact with CPO, particularly for severe and frequent CM. Whether they have had the intended effect of improving children's lives remains an important, unanswered question.

Childhood maltreatment as a risk factor for diabetes: findings from a population-based survey of Canadian adults.

BACKGROUND: It is well established that childhood maltreatment (CM) is a risk factor for various mental and substance use disorders. To date, however, little research has focused on the possible long-term physical consequences of CM. Diabetes is a chronic disease, for which an association with CM has been postulated. METHODS: Based on data from a sample of 21,878 men and women from the 2012 Canadian Community Health Survey - Mental Health (CCHS - MH), this study examines associations between three types of CM (childhood physical abuse (CPA), childhood sexual abuse (CSA), and childhood exposure to intimate partner violence (CEIPV)) and diabetes in adulthood. Multiple logistic regression models were used to examine associations between CM and diabetes controlling for the effects of socio-demographic characteristics and risk factors for type 2 diabetes. RESULTS: When controlling socio-demographic characteristics, diabetes was significantly associated with reports of severe and frequent CPA (OR = 1.8) and severe and frequent CSA (OR = 2.2). A dose-response relationship was observed when co-occurrence of CSA and CPA was considered with the strongest association with diabetes being observed when both severe and frequent CSA and CPA were reported (OR = 2.6). Controlling for type 2 diabetes risk factors attenuated associations particularly for CPA. CEIPV was not significantly associated with having diabetes in adulthood. CONCLUSION: CPA and CSA are risk factors for diabetes. For the most part, associations between CPA and diabetes are mediated via risk factors for type 2 diabetes. Failure to consider severity and frequency of abuse may limit our understanding of the importance of CM as a risk factor for diabetes.

Population health impact of statin treatment in Canada.

BACKGROUND: Statins are prescribed to treat dyslipidemia (abnormal amount of lipids such as cholesterol and/or fat in the blood) and reduce cardiovascular disease (CVD) risk. This study describes the CVD risk profile of Canadians aged 20 to 79, compares current treatment patterns with guideline recommendations, and investigates the population health impact of statin treatment. DATA AND METHODS: The baseline CVD risk of the Canadian population aged 20 to 79 was estimated by applying population-weighted risk factor data from the 2007 to 2011 Canadian Health Measures Survey (CHMS) to the Framingham Risk Score. Estimates of statin effectiveness from the literature were applied to baseline risk to assess the number of CVD events avoided owing to actual (CHMS-reported) and recommended (2012 Canadian Cardiovascular Society guidelines) statin treatment. RESULTS: An estimated 2.8 million Canadian adults (about 1 in 10) were treated with statin drugs. The mean 10-year CVD risk of those treated was 27%. Assuming optimal adherence, it was estimated that statin treatment avoided around 18,900 CVD events annually and yielded a number-needed-to-treat (average number of patients treated to prevent one additional CVD event) of 15 over 10 years. In comparison, 6.5 million Canadian adults (about 1 in 4) were recommended for treatment under the 2012 guidelines. The mean 10-year CVD risk of those recommended for treatment was 24%, which translates into a number-needed-to-treat of 17 over 10 years, or approximately 38,600 CVD events avoided annually. The largest gaps in treatment and potential CVD events avoided were among people at high and intermediate risk for CVD. INTERPRETATION: Canadians' CVD risk could be lessened with enhanced targeting of statin treatment to individuals at high and intermediate risk. Such a strategy would likely require additional investments.

Assessment of the quality of the childhood physical abuse measure in the National Population Health Survey.

BACKGROUND: The long-term health consequences of childhood physical abuse are often studied using retrospective self-reports collected from adults. This study assesses the quality of a question on childhood physical abuse in the National Population Health Survey (NPHS). DATA AND METHODS: All NPHS respondents aged 18 or older (n = 15,027) were asked a question about childhood physical abuse in cycles 1 (1994/1995), 7 (2006/2007) and 8 (2008/2009). The reliability of this question was assessed over these periods. Associations between response patterns to the abuse item and health conditions that are related to childhood physical abuse were examined. RESULTS: Across all NPHS cycles, very few respondents refused to answer or replied "don't know" to the item on childhood physical abuse. Reliability, as measured by Cohen's kappa statistic, was "substantial" for the two-year interval between cycles 7 and 8, and "moderate" for the 12- and 14-year intervals from cycle 1. Kappa estimates were similar when examined by various demographic factors. Compared with consistent deniers, respondents who consistently affirmed childhood physical abuse and those who provided inconsistent responses had increased odds of depression, fair or poor self-perceived health, disability, migraine, and heart disease. INTERPRETATION: Despite some limitations, the NPHS question on childhood physical abuse allows researchers to investigate long-term health consequences of abuse.

Smoking, smoking cessation and heart disease risk: A 16-year follow-up study.

BACKGROUND: Smoking is a major risk factor for heart disease. Over the past decade, the prevalence of smoking and the number of cigarettes smoked per day have decreased in Canada. Using a contemporary cohort of Canadian men and women, this study measured associations between smoking, smoking cessation and heart disease. METHODS: The study is based on nine cycles of data (1994/1995 through 2010/2011) from the National Population Health Survey, which collected information on smoking status every two years. The study sample consists of 4,712 men and 5,715 women aged 25 or older and free from heart disease in 1994/1995. Heart disease was determined by self-report of diagnosis, medication for, or death from heart disease. Relative risks of incident heart disease were compared among current daily smokers, former daily smokers, and those who never smoked daily. RESULTS: Compared with those who had never smoked daily, current daily smokers had a 60% higher risk of incident heart disease during the follow-up period. The risks were lower among current daily smokers who consumed fewer cigarettes. Although smoking cessation was associated with a lower risk of heart disease, 20 or more years of continuous cessation were required for the risk to approach that of people who never smoked daily. INTERPRETATION: Smoking cessation and cutting down the number of cigarettes smoked per day reduce the risk of heart disease.

Dynamics of smoking cessation and health-related quality of life among Canadians.

BACKGROUND: People who smoke are at increased risk of lung and other cancers, heart attack, stroke, chronic lung disease and premature death. After smoking cessation, these risks diminish, but little is known about the time required to regain the level of health of people who have never smoked. This analysis describes trajectories of health-related quality of life (HRQL) in relation to smoking status, focusing on the time required for former smokers to achieve an HRQL level similar to that of never-smokers. METHODS: Data were from nine cycles (1994/1995 through 2010/2011) of the National Population Health Survey. Analyses were based on longitudinal data for 3,341 men and 4,143 women aged 40 or older in 1994/1995. Multi-level growth modelling was used to describe HRQL trajectories over the 16-year follow-up period in relation to smoking status, which was updated every two years. RESULTS: Across all ages and for both sexes, persistent smokers had lower HRQL than did never-smokers. Among men, HRQL improved after 5 years of quitting; after 20 years, HRQL was similar to that of never-smokers. Among women, after 10 years of cessation, the HRQL of former smokers was clinically similar to that of those who had never smoked. INTERPRETATION: At any age, and for both men and women, long-term smoking cessation results in improvements in HRQL.

Depression, parenting and the COVID-19 pandemic in Canada: results from three nationally representative cross-sectional surveys.

OBJECTIVES: Depression is associated with problems in functioning in many aspects of life, including parenting. COVID-19 has increased risk factors for depression. We investigated the prevalence of depression among parents during the pandemic and the association with dysfunctional parenting. DESIGN: Canadian nationwide cross-sectional study. SETTING AND PARTICIPANTS: The 2020 and 2021 Surveys on COVID-19 and Mental Health (SCMH) and the Canadian Community Health Survey (CCHS) (2015‒2019). Responding sample sizes for parents were 3121 for the 2020-SCMH; 1574 for the 2021-SCMH and 6076 for the CCHS. PRIMARY OUTCOME MEASURES: All three surveys collected information on symptoms of major depressive disorder (MDD). The SCMH measured harsh parenting. RESULTS: Based on data from the 2021-SCMH collected during wave 3 of COVID-19, 14.4% of fathers and 21.2% of mothers screened positive for MDD. These prevalence estimates were similar to those from the 2020-SCMH during wave 2, but at least two times higher than pre-COVID-19 estimates from the CCHS. Multivariate analyses revealed a linear association between MDD and harsh parenting. COVID-19-related stressors were associated with harsh parenting. Among mothers, feeling lonely or isolated because of COVID-19 was a risk factor for harsh parenting; among fathers, being a front-line worker was a risk factor. Meditation was a protective factor for mothers. CONCLUSIONS: After years of stability, the prevalence of MDD increased substantially among Canadian parents during the pandemic. Ongoing monitoring is vital to determine if elevated levels of depression persist because chronic depression increases the likelihood of negative child outcomes. Programmes aimed at addressing depression and bolstering parenting skills are needed as families continue to face stressors associated with COVID-19.

Employer-provided support services and job dissatisfaction in Canadian registered nurses.

BACKGROUND: Previous research indicates that nurses' job dissatisfaction relates to their work organization and environment; rarely has the contribution of employer provided support services been examined while controlling for the influence of other factors. OBJECTIVE: The objective of this study was to examine job dissatisfaction among Canadian registered nurses in relation to employer-provided programs for child care and fitness or recreation. METHODS: Data are from 2,993 respondents to the 2005 National Survey of the Work and Health of Nurses, weighted to represent Canada's 91,600 registered nurses in full-time, permanent positions who deliver direct care in hospitals or long-term care facilities. Multivariate modeling was used to examine job dissatisfaction in relation to employer-provided support programs, controlling for personal characteristics and variables reflecting work organization and the work environment. RESULTS: Employer-provided child care assistance programs were available to 16% of nurses, and fitness or recreation programs were available to 38%. An estimated 13% of nurses were dissatisfied with their jobs. Even when controlling for personal characteristics, overtime, shift work, shift length, weekly hours, overload, staffing inadequacy, autonomy, nurse-physician relations, and coworker respect, inverse associations with job dissatisfaction emerged for employer-supported child care (odds ratio = 0.49, 95% confidence interval = 0.27-0.88) and fitness programs (odds ratio = 0.65, 95% confidence interval = 0.42-0.99). DISCUSSION: This study provides new information suggesting that employer-provided support programs are protective against nurses' job dissatisfaction. This is a key finding in view of nursing shortages and the importance of job satisfaction to retention.

Concerns about Household Violence during the COVID-19 Pandemic.

Evidence about how the pandemic affected household violence in Canada is mixed, but inarguably, the risk factors increased. This study used data from the 2020 Canadian Perspective Survey Series and the 2020 and 2021 Surveys of COVID-19 and Mental Health to examine the following: changes in the prevalence of concern about violence in individuals' own homes during the pandemic; the characteristics of those who expressed concern; and the prevalence of concerns for specific household members. Among Canadians, the prevalence of concern about violence in individuals' own homes decreased significantly between July and Fall 2020 (5.8% to 4.2%). Among women, the characteristics that were significantly associated with higher adjusted odds of concern about household violence included larger household size and lower household income. Lower education among women was associated with lower adjusted odds of concern. The associations with higher adjusted odds of concern among men included: being an immigrant, larger household size, and lower household income. From Fall 2020 to Spring 2021, the prevalence of concerns for oneself and for a child/children increased (1.7% to 2.5% and 1.0% to 2.5%, respectively), but concern for other adults in the household decreased (1.9% to 1.2%). Ongoing surveillance is needed to understand vulnerable populations' exposure to household violence and to inform policies and programs.

Employer-provided support services and job dissatisfaction in Canadian registered nurses.

BACKGROUND: Previous research indicates that nurses' job dissatisfaction relates to their work organization and environment; rarely has the contribution of employer provided support services been examined while controlling for the influence of other factors. OBJECTIVE: The objective of this study was to examine job dissatisfaction among Canadian registered nurses in relation to employer-provided programs for child care and fitness or recreation. METHODS: Data are from 2,993 respondents to the 2005 National Survey of the Work and Health of Nurses, weighted to represent Canada's 91,600 registered nurses in full-time, permanent positions who deliver direct care in hospitals or long-term care facilities. Multivariate modeling was used to examine job dissatisfaction in relation to employer-provided support programs, controlling for personal characteristics and variables reflecting work organization and the work environment. RESULTS: Employer-provided child care assistance programs were available to 16% of nurses, and fitness or recreation programs were available to 38%. An estimated 13% of nurses were dissatisfied with their jobs. Even when controlling for personal characteristics, overtime, shift work, shift length, weekly hours, overload, staffing inadequacy, autonomy, nurse-physician relations, and coworker respect, inverse associations with job dissatisfaction emerged for employer-supported child care (odds ratio = 0.49, 95% confidence interval = 0.27-0.88) and fitness programs (odds ratio = 0.65, 95% confidence interval = 0.42-0.99). DISCUSSION: This study provides new information suggesting that employer-provided support programs are protective against nurses' job dissatisfaction. This is a key finding in view of nursing shortages and the importance of job satisfaction to retention.

Symptoms of major depressive disorder during the COVID-19 pandemic: results from a representative sample of the Canadian population. / Symptômes du trouble dépressif majeur pendant la pandémie de COVID 19 : résultats obtenus à partir d'un échantillon représentatif de la population canadienne.

INTRODUCTION: Since the outbreak of COVID-19, numerous studies from around the world have reported declines in mental health. However, most of these studies were of low-to-moderate quality and many were based on convenience samples or used mental health measures with low validity, or both. Consequently, it has been difficult to draw conclusions. METHODS: Both the 2020 Survey on COVID-19 and Mental Health (SCMH) and the Canadian Community Health Survey (CCHS) (2015-2019) used the Patient Health Questionnaire-9 to screen for major depressive disorder (MDD) in adults aged 18 or older. The prevalence of MDD was compared between the SCMH and the CCHS. Risk and protective factors for MDD in the SCMH were examined using bivariate and logistic regression analyses. RESULTS: Based on SCMH data, 15.2% (95% CI: 14.2-16.2) of Canadians screened positive for MDD. The prevalence of MDD was more than two times higher in the SCMH (during COVID-19) than in the CCHS (predating COVID-19). In bivariate analysis, Canadians reporting five or more COVID-19-related risk factors were close to 30 times more likely to have MDD than those reporting no risk factors. Mastery and a sense of community belonging were protective factors for MDD. CONCLUSION: After remaining stable for two decades, the prevalence of depression among Canadians increased substantially with the onset of COVID-19. Ongoing monitoring of this common condition associated with major morbidity is vital to determine if elevated levels of MDD persist as we progress through and beyond future waves of COVID-19.

Employer-provided support services and job dissatisfaction in Canadian registered nurses.

BACKGROUND: Previous research indicates that nurses' job dissatisfaction relates to their work organization and environment; rarely has the contribution of employer-provided support services been examined while controlling for the influence of other factors. OBJECTIVE: The objective of this study was to examine job dissatisfaction among Canadian registered nurses in relation to employer-provided programs for child care and fitness or recreation. METHODS: Data are from 2,993 respondents to the 2005 National Survey of the Work and Health of Nurses, weighted to represent Canada's 91,600 registered nurses in full-time, permanent positions who deliver direct care in hospitals or long-term care facilities. Multivariate modeling was used to examine job dissatisfaction in relation to employer-provided support programs, controlling for personal characteristics and variables reflecting work organization and the work environment. RESULTS: Employer-provided child care assistance programs were available to 16% of nurses, and fitness or recreation programs were available to 38%. An estimated 13% of nurses were dissatisfied with their jobs. Even when controlling for personal characteristics, overtime, shift work, shift length, weekly hours, overload, staffing inadequacy, autonomy, nurse-physician relations, and coworker respect, inverse associations with job dissatisfaction emerged for employer-supported child care (odds ratio = 0.49, 95% confidence interval = 0.27-0.88) and fitness programs (odds ratio = 0.65, 95% confidence interval = 0.42-0.99). DISCUSSION: This study provides new information suggesting that employer-provided support programs are protective against nurses' job dissatisfaction. This is a key finding in view of nursing shortages and the importance of job satisfaction to retention.

Childhood Maltreatment as a Risk Factor for Arthritis: Findings From a Population-Based Survey of Canadian Adults.

OBJECTIVE: To establish whether there is a relationship between the frequency and severity of different types of childhood maltreatment and adulthood arthritis. METHODS: Analysis of the 2012 Canadian Community Health Survey-Mental Health included 21,889 respondents ages ≥18 years. Severity and frequency of childhood physical abuse (CPA), and childhood sexual abuse (CSA), and the frequency of childhood exposure to intimate partner violence (CEIPV) were assessed by asking about "things that may have happened to you before you were 16 in your school, in your neighborhood, or in your family." Respondents were also asked about chronic conditions diagnosed by a health professional, including arthritis. Covariates were sociodemographic characteristics, health risk variables (e.g., obesity), mental disorders, and a count of other chronic conditions. Multivariate logistic regression analysis was used to examine associations between childhood maltreatment and arthritis. RESULTS: A total of 17.5% of respondents reported arthritis. A higher prevalence of arthritis was observed for those who had experienced severe and/or frequent childhood maltreatment (32% for CPA and 27% for both CSA and CEIPV). These relationships persisted after controlling for sociodemographic variables. After controlling for all covariates, arthritis remained independently associated with severe and/or frequent CPA (dose-response relationship) and frequent CEIPV. CONCLUSION: We found that the greater the frequency and severity of childhood maltreatment, the greater the magnitude of association with arthritis. This might reflect the role of the enduring immune and metabolic abnormalities and chronic inflammation associated with childhood maltreatment in the etiopathogensis of osteoarthritis (OA) or be an indicator of the role of joint injury in causing OA.

Can coders abstract child maltreatment variables from child welfare administrative data and case narratives for public health surveillance in Canada?

BACKGROUND: Public health surveillance is essential to inform programs that aim to eradicate child maltreatment (CM) and to provide services to children and families. However, collection of CM data imposes a burden on child welfare workers (CWWs). This study assesses the feasibility of hiring coders to abstract the required information from administrative records and case narratives. METHODS: Based on a convenience sample of child welfare data from Manitoba, Canada, two coders abstracted information on 181 alleged CM cases. The coders completed a short web-based questionnaire for each case to identify which of five types of CM had been investigated, level of substantiation for each type, and risk of future CM. The CWWs responsible for each case completed the same questionnaire. Percentages of the occurrence of CM by the three sources were compared. The validity of the coders' classifications was assessed by calculating sensitivity, specificity, and positive and negative predictive values, against the CWWs' classifications as the "gold standard." Cohen's kappa was also calculated. RESULTS: The coders' classifications of physical abuse, sexual abuse and neglect generally matched those of CWWs; for exposure to intimate partner violence, agreement was weak for one coder. Coding of emotional maltreatment and risk investigations could not be evaluated. CONCLUSION: Results were promising. Abstraction was not time-consuming. Differences between coders and CWWs can be largely explained by the administrative data system, child welfare practice, and legislation. Further investigation is required to determine if additional training could improve coders' classifications of CM.

Childhood sexual abuse and substance abuse: A gender paradox?

We examine associations between childhood sexual abuse (CSA) and substance abuse, the role of mental health indicators as mediators in these associations and whether or not associations differ by gender. Data are from 14,063 respondents aged 18-76 years from the 2004-2005 Canadian Gender, Alcohol, and Culture: An International Study (GENACIS). Multiple logistic regression models were used to examine associations between CSA and substance abuse variables, controlling for socio-demographic factors. Odds were adjusted by indicators of mental health to assess if these variables mediated associations between CSA and substance abuse. Tests of interactions between sex and CSA were conducted to see if gender differences exist in associations. In 2004/2005, CSA was reported by 14% of women and 5% of men. CSA was associated with heavy drinking, hazardous drinking, and the use of marijuana, other illicit drugs, and off-label drugs. Associations were only very marginally attenuated when controlling for depression and self-perceived emotional/mental health. In all cases previously observed significant associations persisted. Evidence of gender differences in associations between CSA and substance abuse was negligible. Preventing CSA may also reduce substance abuse.