Associations between Lifetime Spanking/Slapping and Adolescent Physical and Mental Health and Behavioral Outcomes.

BACKGROUND: Many parents use physical forms of punishment, including spanking to correct perceived misbehavior. While some authors suggest spanking/slapping is a distinct and "milder" form of physical punishment, parents' use of spanking is consistently associated with poor outcomes for their children. However, less is known about the relationship between spanking/slapping and health and behavioral outcomes in adolescence independent of other childhood adversities. OBJECTIVES: The objectives of this study were to examine the associations between lifetime experiences of spanking on the bottom and/or slapping on the hand and 3 adolescent outcomes: (a) mental health disorders, (b) physical health conditions, and (c) defiant behaviors, after adjusting for other types of childhood adversities and child maltreatment. METHODS: Cross-sectional data from the provincially representative 2014 Ontario Child Health Study (N = 6,537 dwellings, response rate = 50.8%) were used. The current study focused on one selected child aged 14 to 17 years within a household (n = 1,883) with data collected from the adolescent and the parent/caregiver. Logistic regression models were used to identify associations with lifetime experiences of spanking/slapping 3 or more times (vs. 0 to 2 times). RESULTS: Lifetime spanking/slapping was independently associated with increased odds of mental health disorders, physical health conditions, and defiant behaviors in adolescence after adjusting for childhood adversities and child maltreatment (unadjusted and adjusted odds ratios ranging from 1.29 to 2.19). CONCLUSIONS: These findings suggest that lifetime spanking/slapping is uniquely associated with harmful mental, physical, and behavioral outcomes in adolescence, and efforts should focus on its prevention.

Associations between spanking beliefs and reported spanking among adolescents-parent/caregiver dyads in a Canadian sample.

BACKGROUND: Research consistently demonstrates that physical punishment of children including "spanking" is harmful. Interest in effective prevention is growing rapidly. The aim of the current study is to examine spanking beliefs among adolescents and parents in relation to reports of spanking that the adolescents experienced before 11 years of age. METHODS: Data were drawn from Wave 1 of a study conducted in 2017-2018 that included adolescents (14-17 years old) and one of their parents/caregivers from Manitoba, Canada (n = 1000 pairs). The study objectives were to examine: 1) spanking beliefs of adolescents and their parents; 2) the correlation between parent and adolescent spanking beliefs; 3) whether parents perceive the words "spank" vs. "hit" differently using intraclass correlation; 4) the association between parents' beliefs about spanking and parent- and adolescent-reported use of it; and 5) the relationship between sociodemographic variables and spanking. The data were analyzed using descriptive statistics, Spearman's correlation, intraclass correlation, and binary and multinomial logistic regression analyses. RESULTS: The prevalence of adolescent-reported and parents'-reported spanking were 46.0% and 39.6%, respectively. The proportions agreeing that spanking is a normal part of parenting were similar among adolescents (22.0%) and parents (18.5%), and were moderately correlated (intraclass correlation = 0.38, SE = 0.038). More than five times as many parents believed that "spanking" is necessary (19.5%) than believed that "hitting" is necessary (3.5%). Parents' positive spanking beliefs were associated with increased likelihood of adolescent- and parent-reported spanking. Few significant associations were found between sociodemographic variables and parent-reported or adolescent-reported spanking. CONCLUSIONS: Adolescents' spanking beliefs are related to their parents' spanking beliefs, suggesting that they are transmitted across generations. Public education and law reform are needed to decrease the normalization and perceived necessity of spanking in child-rearing. Efforts should include improving the understanding that spanking is a form of violence against children. With only a few significant differences noted between sociodemographic variables and parent- and adolescent- reported spanking and the prevalent use of spanking across all sociodemographic variable categories, it may be useful to develop universal approaches to awareness-raising and implementation of education strategies in Canada.

Adolescent health outcomes: associations with child maltreatment and peer victimization.

BACKGROUND: Child maltreatment (CM) and peer victimization (PV) are serious issues affecting children and adolescents. Despite the interrelatedness of these exposures, few studies have investigated their co-occurrence and combined impact on health outcomes. The study objectives were to determine the overall and sex-specific prevalence of lifetime exposure to CM and past-month exposure to PV in adolescents, and the impact of CM and PV co-occurrence on non-suicidal self-injury, suicidality, mental health disorders, and physical health conditions. METHODS: Adolescents aged 14-17 years (n = 2,910) from the 2014 Ontario Child Health Study were included. CM included physical, sexual, and emotional abuse, physical neglect, and exposure to intimate partner violence. PV included school-based, cyber, and discriminatory victimization. Logistic regression was used to compare prevalence by sex, examine independent associations and interaction effects in sex-stratified models and in the entire sample, and cumulative effects in the entire sample. RESULTS: About 10% of the sample reported exposure to both CM and PV. Sex differences were as follows: females had increased odds of CM, self-injury, suicidality, and internalizing disorders, and males had greater odds of PV, externalizing disorders, and physical health conditions. Significant cumulative and interaction effects were found in the entire sample and interaction effects were found in sex-stratified models, indicating that the presence of both CM and PV magnifies the effect on self-injury and all suicide outcomes for females, and on suicidal ideation, suicide attempts, and mental health disorders for males. CONCLUSIONS: Experiencing both CM and PV substantially increases the odds of poor health outcomes among adolescents, and moderating relationships affect females and males differently. Continued research is needed to develop effective prevention strategies and to examine protective factors that may mitigate these adverse health outcomes, including potential sex differences.

Adverse childhood experiences and other risk factors associated with adolescent and young adult vaping over time: a longitudinal study.

BACKGROUND: Vaping among adolescents and young adults is a significant public health concern worldwide. Understanding which risk factors are associated with vaping is important to help inform evidence-based prevention and intervention strategies. There are several gaps in the current literature examining these associations such as limited longitudinal research. We examined the association between parental smoking/vaping, adolescent sex, mental disorders in adolescence, 13 adverse childhood experiences (ACEs) and a) any vaping and b) course of vaping across two time points among adolescents and young adults. METHODS: Data were from Waves 1 and 2 of the longitudinal Well-Being and Experiences Study (The WE Study) in Manitoba, Canada which collected data from a community sample of adolescents (14 to 17 years) and their parent/caregiver in Wave 1 in 2017-18 and the adolescents/young adults only in Wave 2 in 2019. A total of 752 adolescents/young adults (72.4% of the original cohort) completed both waves of the study. Binary and multinomial logistic regressions were conducted to understand the relationship between the 16 risk factors and the two vaping outcomes. RESULTS: Vaping prevalence was 45.5% for any vaping, 2.7% for Wave 1 vaping only, 19.7% for new onset Wave 2 vaping, and 21.2% for vaping at both waves. After adjusting for covariates, the majority of risk factors examined were associated with any adolescent or young adult vaping, including: parental smoking or vaping, emotional abuse, emotional neglect, exposure to verbal intimate partner violence, household substance use, household mental illness, parental separation/divorce, parental problems with police, foster care or contact with a child protective organization, an unsafe neighbourhood, and peer victimization. The majority of these risk factors, as well as adolescent mental health and parental gambling, were associated with different courses of vaping across the two time points. CONCLUSIONS: The findings emphasize the need for early vaping prevention and identified several ACEs and other factors that were associated with adolescent and young adult vaping and course of vaping. These identified ACEs and risk factors can help inform programs, strategies, and potential groups to target for vaping interventions.

Non-magnitude sources of bias on duration judgements for blank intervals: conceptual relatedness of interval markers reduces subjective interval duration.

We report three experiments in which the events flanking a temporal interval were either related or unrelated, based on overlap in the letter identity of single letters (Experiment 1), in the conceptual congruency of color words and colored rectangles (Experiment 2), or in the conceptual congruency of sentence stems and their terminal words (Experiment 3). In all cases, we observed a bias for participants to judge the duration of temporal intervals as shorter when the flanking events were related. We draw an analogy between these temporal judgement distortions and those reported elsewhere (Alards-Tomalin et al. in J Exp Psychol Learn Mem Cogn 40(2):555-566, 2014) that revealed that the similarity in the relative magnitude of flanking events generate the same type of bias on duration judgements. The observation that non-magnitude dimensions of relatedness between flanking events can also bias duration judgements raise questions about the applicability of two influential theoretical frameworks for understanding the distorting effects that non-temporal stimulus dimensions can have on duration judgments, A Theory of Magnitude (Buetl and Walsh in Philos Trans R Soc B Biol Sci 12:1831-1840, 2009, Walsh in Trends Cogn Sci 7:483-488, 2003) and the Conceptual Metaphor Theory (e.g., Lakoff and Johnson in Philosophy in the flesh: the embodied mind and its challenge to western thought. Basic Books, New York, 1999). In our general discussion, we consider a number of alternative frameworks that may account for these findings.

Confirmatory factor analysis of adverse childhood experiences (ACEs) among a community-based sample of parents and adolescents.

BACKGROUND: Despite increased understanding of Adverse Childhood Experiences (ACEs), very little advancement has been made in how ACEs are defined and conceptualized. The current objectives were to determine: 1) how well a theoretically-derived ACEs model fit the data, and 2) the association of all ACEs and the ACEs factors with poor self-rated mental and physical health. METHODS: Data were obtained from the Well-Being and Experiences Study, survey data of adolescents aged 14 to 17 years (n = 1002) and their parents (n = 1000) in Manitoba, Canada collected from 2017 to 2018. Statistical methods included confirmatory factor analysis (CFA) and logistic regression models. RESULTS: The study findings indicated a two-factor solution for both the adolescent and parent sample as follows: a) child maltreatment and peer victimization and b) household challenges factors, provided the best fit to the data. All original and expanded ACEs loaded on one of these two factors and all individual ACEs were associated with either poor self-rated mental health, physical health or both in unadjusted models and with the majority of findings remaining statistically significant in adjusted models (Adjusted Odds Ratios ranged from 1.16-3.25 among parents and 1.12-8.02 among adolescents). Additionally, both factors were associated with poor mental and physical health. CONCLUSIONS: Findings confirm a two-factor structure (i.e., 1) child maltreatment and peer victimization and 2) household challenges) and indicate that the ACEs list should include original ACEs (i.e., physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, exposure to intimate partner violence (IPV), household substance use, household mental health problems, parental separation or divorce, parental problems with police) and expanded ACEs (i.e., spanking, peer victimization, household gambling problems, foster care placement or child protective organization (CPO) contact, poverty, and neighborhood safety).

Examining the relationships between parent experiences and youth self-reports of slapping/spanking: a population-based cross-sectional study.

BACKGROUND: Slapping/spanking is related to a number of poor health outcomes. Understanding what factors are related to the increased or decreased use of spanking/slapping is necessary to inform prevention. This study used a population-based sample to determine the prevalence of slapping/spanking reported by youth; the relationship between sociodemographic factors and slapping/spanking; and the extent to which parental exposures to victimization and maltreatment in childhood and current parental mental health, substance use and family circumstances, are associated with youth reports of slapping/spanking. METHODS: Data were from the 2014 Ontario Child Health Study, a provincially representative sample of households with children and youth aged 4-17 years. Self-reported lifetime slapping/spanking prevalence was determined using a sub-sample of youth aged 14-17 years (n = 1883). Parents/primary caregivers (i.e., person most knowledgeable (PMK) of the youth) self-reported their own childhood experiences including bullying victimization, slapping/spanking and child maltreatment, and current mental health, substance use and family circumstances including mental health functioning and emotional well-being, alcohol use, smoking, marital conflict and family functioning. Analyses were conducted in 2018. RESULTS: Living in urban compared to rural residence and family poverty were associated with decreased odds of slapping/spanking. PMK childhood experiences of physical and verbal bullying victimization, spanking, sexual abuse, emotional abuse, and exposure to physical intimate partner violence were associated with increased odds of youth reported slapping/spanking (adjusted odds ratio [AOR] ranged from 1.33-1.77). PMK experiences of physical abuse and exposure to emotional/verbal intimate partner violence in childhood was associated with decreased odds of youth reported slapping/spanking (AOR = 0.72 and 0.88, respectively). PMK's higher levels of marital conflict, languishing to moderate mental health functioning and emotional well-being, and moderate or greater alcohol use were associated with increased odds of youth reported slapping/spanking (AOR ranged from 1.36-1.61). CONCLUSIONS: It may be important to consider parent/primary caregiver's childhood experiences with victimization and maltreatment along with their current parental mental health, substance use and family circumstances when developing and testing strategies to prevent slapping/spanking.

Life Interference Due to Gambling in Three Canadian Provinces.

The gambling landscape among provinces in Canada is diverse. Yet, few studies have investigated provincial differences related to life interference due to gambling. The objectives of the current study were to examine: (1) provincial differences with regard to gambling types and (2) if gender, family history of gambling, and alcohol or drug use while gambling were related to an increased likelihood of life interference in three Canadian provinces. Data were drawn from the 2013 and 2014 cycles of the Canadian Community Health Survey from Manitoba, Saskatchewan, and British Columbia (n = 30,150). Analyses were conducted stratified by provinces and also combined using logistic regression models. Provincial differences were noted with individuals from British Columbia compared to Manitoba being less likely to play VLTs outside of casinos, play live horse racing at a track or off track, and participate in sports gambling. Those in Saskatchewan compared to Manitoba were more likely to play VLTs inside a casino. When examining all provinces combined, family history of gambling was associated with increased odds of life interference. Gender was not associated with life interference. Provincial differences were noted, which may be in part related to differences in gambling landscapes. Family history of gambling may have clinical relevance for understanding which individuals may be more likely to experience life interference due to gambling. Further research is needed to clarify the link between alcohol and drug use while gambling and life interference due to gambling as the models in the current research were likely underpowered.

Risk Factors, Clinical Presentations, and Functional Impairments for Generalized Anxiety Disorder in Military Personnel and the General Population in Canada.

OBJECTIVE: This study sought to examine differences in sociodemographic risk factors, comorbid mental conditions, clinical presentations, and functional impairments associated with past-year generalized anxiety disorder (GAD) between Canadian Armed Forces (CAF) Regular Force personnel and the Canadian general population (CGP). METHOD: Data were from 2 nationally representative surveys collected by Statistics Canada: 1) the Canadian Community Health Survey on Mental Health, collected in 2012 ( N = 25,113; response rate = 68.9%); and 2) the Canadian Forces Mental Health Survey, collected in 2013 ( N = 8,161; response rate = 79.8%). RESULTS: The prevalence of lifetime and past-year GAD was significantly higher in the CAF (12.1% and 4.7%) than in the CGP (9.5% and 3.0%). Comorbid mental disorders were strongly associated with GAD in both populations. Although the content area of worry and the GAD symptoms endorsed were similar, CAF personnel were significantly more likely to endorse specific types of worries (i.e., success at school/work, social life, mental health, being away from home or loved ones, and war or revolution) and specific symptoms of GAD (i.e., restless, keyed up, or on edge and more irritable than usual) than civilians, after adjusting for sociodemographic covariates and comorbid mental disorders. CAF personnel with past-year GAD reported significantly higher functional impairment at home than civilians with past-year GAD. CONCLUSION: GAD is a substantial public health concern associated with significant impairment and disability in both military and civilian populations. GAD in military and civilian populations shows similarities and differences: Key similarities include its extensive comorbidity and significant functional impairment, whereas key differences include the focus of worries and symptom profile.

Bullying victimization experiences among middle and high school adolescents: Traditional bullying, discriminatory harassment, and cybervictimization.

The objectives of the current study were to estimate the prevalence of nine types of bullying victimization among adolescents in Grades 7 to 12, and examine how these experiences vary according to gender and school grade. Data were drawn from the Manitoba Youth Health Survey. The sample size was N = 64 174 and included boys and girls from Grades 7 to 12. Nine types of bullying victimization were assessed. Gender and grade differences were noted with girls being more to likely than boys to report six types of victimization. The odds of bullying victimization were higher in Grades 8 to 12 compared to Grade 7. Effective anti-bullying intervention strategies need to address a range of victimization types and should consider gender and school grade. Interventions should start before Grade 7 and continue until the end of Grade 12.

Child maltreatment and eating disorders among men and women in adulthood: Results from a nationally representative United States sample.

OBJECTIVE: Child maltreatment is associated with an increased likelihood of having mood disorders, anxiety disorders, post-traumatic stress disorder, substance use disorders, and personality disorders, but far less is known about eating disorders. The objective of the current study was to examine the associations between child maltreatment, including harsh physical punishment, physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, and exposure to intimate partner violence, and eating disorders in adulthood among men and women. METHOD: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions wave 3 (NESARC-III) collected in 2012-2013. The sample was nationally representative of the United States adult population (N = 36,309). Lifetime eating disorders (anorexia nervosa [AN], bulimia nervosa [BN], and binge-eating disorder [BED]) were assessed using diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) criteria and the alcohol use disorder and associated disabilities interview schedule-5 (AUDADIS-5). RESULTS: The prevalence of any lifetime eating disorder was 1.7% (0.8% among men and 2.7% among women). All child maltreatment types were associated with AN, BN, and BED with notable differences among men and women. Overall, the types of child maltreatment with the strongest relationships with any eating disorder were sexual abuse and physical neglect among men and sexual abuse and emotional abuse among women. DISCUSSION: Clinicians should be mindful that child maltreatment experiences are associated with increased odds of eating disorders including AN, BED, and BN. Such relationships are significant among men and women although notable gender differences in these relationships exist. Abstract word count = 248.

Pandemic-related experiences, mental health symptoms, substance use, and relationship conflict among older adolescents and young adults from Manitoba, Canada.

There is growing awareness of the negative impact of the COVID-19 pandemic on young people. The purpose of this study was to examine older adolescents' and young adults' pandemic-related experiences, including financial difficulties, emotional support, social connections, mental health symptoms, substance use, and relationship conflict. Data from the Well-being and Experiences Study (The WE Study) were gathered from November to December 2020 in Manitoba, Canada, among a community sample (n = 664; ages 16-21 years). Over half of the sample self-reported increased stress/anxiety (57.6%) and depression (54.2%) attributed to the pandemic. Increased alcohol consumption was reported by 18.2% of alcohol-users. Among cannabis-users, 35.1% reported increased use. Conflict with parents, siblings, and an intimate partner increased for 19.9%, 15.2%, and 24.0% of respondents, respectively. Females reported greater financial burden, mental health burden, and conflict with parents than males. Young adults reported greater financial and mental health burden than older adolescents. Higher household income was protective of some experiences. The current study adds to growing evidence that young people were adversely impacted by the COVID-19 pandemic. Increased access to virtual support resources is needed and should continue following the pandemic. Evidence-based interventions may need to be tailored to females and young adults.

Adverse Childhood Experiences and Education Outcomes among Adolescents: Linking Survey and Administrative Data.

It is well established that adverse childhood experiences (ACEs) are associated with detrimental health outcomes in adulthood. Less is known about the relationships between ACEs and education outcomes and among adolescents. The aim of this study was to examine the associations between ACEs and adolescents' self-reported education outcomes and provincial education assessments among adolescents in Manitoba, Canada. Data were gathered from 1002 adolescents who participated in the Well-Being and Experiences (WE) Study. A subsample of the adolescents (84%) consented to having their WE survey data linked to administrative education databases. Binary and multinomial logistic regression models were computed to examine associations between ACE history and self-reported education outcomes and provincial education assessments, adjusting for sociodemographic variables. Adolescents with an ACE history had significantly increased likelihood of having ever been suspended from school (adjusted odds ratio (aOR) = 3.33, 95% CI 1.60-6.92), of lower grades (adjusted relative risk ratio (aRRR) = 3.21, 95% CI 1.42-7.29), and of chronic school absenteeism (aRRR = 2.45, 95% CI 1.28-4.68) compared with adolescents without an ACE history after adjusting for sociodemographic variables. Findings from this study illuminate the important relationship between childhood adversity and poor education outcomes assessed directly by adolescents. Increasing awareness of the public health risk associated with ACEs and education outcomes may inform education policy and school-based interventions.

Older adolescents and young adults willingness to receive the COVID-19 vaccine: Implications for informing public health strategies.

IMPORTANCE: The success in ending the COVID-19 pandemic rests partly on the mass uptake of the COVID-19 vaccine. Little work has been done to understand vaccine willingness among older adolescents and young adults. This is important since this age group may be less likely to adhere to public health guidelines. OBJECTIVE: To understand willingness of getting a vaccine and reasons for vaccine hesitancy among a sample of older adolescents and young adults. DESIGN: Data were from the Well-Being and Experiences study (The WE Study), a longitudinal community-based sample of older adolescents and young adults collected from Winnipeg, Manitoba, Canada from 2017 to 2020 (n = 664). SETTING: The study setting was a community-based observational longitudinal study. PARTICIPANTS: Participants for the study were aged 14 to 17 years old at baseline in 2016-17 (n = 1000). Data were also collected on one parent/caregiver. Waves 2 (n = 747) and 3 (n = 664) were collected in 2019 and 2020, respectively. EXPOSURES: The main exposures were sociodemographic factors, health conditions, COVID-19 knowledge, and adversity history. MAIN OUTCOMES: The main outcomes were COVID-19 vaccine willingness, hesitancy, and reasons for hesitancy. RESULTS: Willingness to get a COVID-19 vaccine was 65.4%. Willingness did not differ by age, sex, or mental health conditions, but did differ for other sociodemographic characteristics, physical health conditions, COVID-19 knowledge, practicing social/physical distancing, and adversity history. The most common reasons for not wanting a vaccine were related to safety, knowledge, and effectiveness. Sex differences were noted. CONCLUSIONS AND RELEVANCE: Increasing uptake of the COVID-19 vaccine among older adolescents and young adults may rely on targeting individuals from households with lower income, financial burden, and adversity history, and generating public health messaging specifically aimed at vaccine safety, how it works to protect against illness, and why it is important to protect oneself against a COVID-19 infection.

Victimization Experiences and Mental Health Outcomes Among Grades 7 to 12 Students in Manitoba, Canada.

Victimization experiences, including traditional forms of bullying, discriminatory harassment, and cyber victimization, are associated with numerous detrimental consequences in adolescence and over the life course. The objective of the current study was to understand the relationships between nine experiences of victimization and mental health outcomes among students in grades 7 to 12 in Manitoba, Canada. Data were drawn from the 2012-2013 Manitoba Youth Health Survey (N = 64,174; response rate = 67%). Mental health outcomes included mental health functioning and emotional well-being, and feelings of sadness and hopelessness. The prevalence of moderate/languishing mental health functioning and emotional well-being ranged from 35.2% (boys in grades 7 to 9) to 51.0% (girls in grades 10 to 12). The prevalence of feeling sad and hopeless ranged from 31.4% (boys in grades 7 to 9) to 57.7% (girls in grades 10 to 12). All nine victimization types were associated with increased odds of having moderate/languishing mental health functioning and emotional well-being and feeling sad and hopeless for both boys and girls in grades 7 to 9 and 10 to 12, although some gender and grade differences were noted. A dose-response trend was found with increased odds of moderate/languishing mental health functioning and emotional well-being corresponding with increased frequency of being victimized. A similar trend was noted for girls only for feeling sad and hopeless. Effective prevention and intervention strategies targeting boys and girls and across grades 7 to 12 are needed to improve mental health functioning and emotional well-being, and reduce feelings of sadness and hopelessness among adolescents with victimization experiences.

Child maltreatment and sleep problems among adolescents in Ontario: A cross sectional study.

INTRODUCTION: Child maltreatment has a negative impact on health and well-being. Healthy sleep patterns are an important indicator of health and are particularly important for adolescent growth and development. Few studies examine the relationship between child maltreatment and sleep problems using a general population, adolescent sample. The objective of the current study was to examine the relationship between five different types of child maltreatment and four sleep outcomes among adolescents. METHODS: Data were from a subset of the Ontario Child Health Study 2014, a representative sample of 14 to 17- year-olds in Ontario, Canada (n=2,910). Sexual abuse, physical abuse and exposure to intimate partner violence (EIPV) were measured using the Childhood Experiences of Violence Questionnaire (CEVQ). Emotional maltreatment and physical neglect were measured using items derived from survey questions designed for the National Longitudinal Study of Adolescent to Adult Health. Sleep outcomes included time it takes to fall asleep, waking during the night, and hours of sleep on weekdays and weekends. Models were adjusted for sociodemographic variables. RESULTS: Findings indicate that all types of child maltreatment were associated with increased odds of taking more than 10 min to fall asleep (adjusted odds ratio [AOR]: 1.21-1.58), waking more often during the night (AOR: 1.62-5.73) and fewer hours slept on weekdays (adjusted beta [AB]: -0.39 to -0.15). Child sexual abuse, emotional maltreatment, and EIPV were associated with decreased hours of sleep on weekends (AB: -0.63 to -0.28). CONCLUSION: Preventing child maltreatment may improve sleep outcomes among adolescents, thereby improving overall health and well- being.

What type of survey research questions are identified by adults as upsetting? A focus on child maltreatment.

BACKGROUND: Research on child maltreatment is imperative to inform evidence-based prevention and intervention efforts. Nonetheless, researchers continue to face barriers due to the perceived sensitivity and possibility of harm when asking about these experiences. While studies have started to explore reactions to participating in research on sensitive topics, there are notable limitations and fewer have focused on child maltreatment. OBJECTIVE: The objective of this study was to better understand adult respondents' identification of, and reactions to, potentially upsetting questions in the context of a well-being and experiences survey, with a focus on child maltreatment. METHODS: Data were from the first wave of the Well-Being and Experiences Study in Manitoba, Canada: a computerized self-reported community-based survey of adolescents and their parents/caregivers administered individually at a research facility. The current study focused on parents/caregivers' responses (N = 1000). The study utilized a mixed methods approach with descriptive statistics and qualitative thematic analyses of open-ended responses of their perceptions of upsetting questions. RESULTS: Overall, few respondents (15.1 %) identified any questions as upsetting. Ten themes emerged in respondents' recall of upsetting questions, including maltreatment and other themes often perceived as less sensitive. Only 4% identified maltreatment-related questions as upsetting. Among those who identified any questions or maltreatment-specific questions as upsetting, most felt they were important to ask and should not be removed (92.7 %-97.5 %). These findings suggest that retrospective survey questions about experiences of child maltreatment involving adult samples are not associated with major upset and should be included in future health and social surveys.

School personnel and community members' perspectives in implementing PAX good behaviour game in first nations grade 1 classrooms.

First Nations peoples in Canada have a history of poor mental health outcomes, as the result of colonisation and the legacy of residential schools. The PAX Good Behaviour Game (PAX-GBG) is a school-based intervention shown to improve student behaviour, academic outcomes, and reduce suicidal thoughts and actions. This study examines the use of PAX-GBG in First Nations Grade 1 classrooms in Manitoba. Researchers collected qualitative data via interviews and focus groups from 23 participants from Swampy Cree Tribal Council (SCTC) communities. Participants reported both positive effects and challenges of implementing PAX-GBG in their classrooms. PAX-GBG created a positive environment where children felt included, recognised, and empowered. Children were calmer, more on-task, and understood the behaviours that are expected of them. However, for many reasons, PAX-GBG is not being used consistently across SCTC schools. Participants described barriers in implementation due to teacher turnover, lack of on-going training and support, developmental and behavioural difficulties of students, and larger community challenges. Participants provided suggestions on how to improve PAX-GBG to be a better fit for these communities, including important cultural and contextual adaptations. PAX-GBG has the potential to improve outcomes for First Nations children, however attention must be given to implementation within community context.

Adverse childhood experiences (ACEs), peer victimization, and substance use among adolescents.

BACKGROUND: Adverse childhood experiences (ACEs) are common and related to substance use problems in adulthood. Less is known about these relationships in adolescence and if experiencing ACEs in addition to peer victimization (or bullying) would have an interaction or cumulative effect on the odds of adolescent substance use. METHOD: Data were used from the Well-Being and Experiences Study (The WE Study), a cross-sectional survey of adolescents aged 14-17 years (n = 1002) in Manitoba, Canada collected between July 2017 and October 2018. Statistical methods included descriptive statistics and logistic regression models. RESULTS: The prevalence of experiencing any of the 12 ACEs was 75.1 %. The prevalence of any peer victimization (monthly or more often) was 24.1 %. All individual ACEs were associated with increased odds of substance use. No significant interaction effects between ACEs and peer victimization on substance use were found. Significant cumulative effects were found, indicating that experiencing both ACEs and peer victimization, compared with experiencing ACEs only, significantly increased the odds of substance use among adolescents. CONCLUSION: The odds of substance use becomes significantly greater if the adolescent with a history of ACEs also experiences peer victimization. Further research aimed at effective prevention of ACEs, peer victimization, and substance use is needed.

Associations of Harsh Physical Punishment and Child Maltreatment in Childhood With Antisocial Behaviors in Adulthood.

Importance: Inquiry into what childhood experiences are associated with antisocial behaviors in adulthood is necessary for prioritizing and informing efforts for effective prevention. Objective: To examine whether harsh physical punishment in the absence of child maltreatment and child maltreatment with and without harsh physical punishment are associated with antisocial behaviors in adulthood. Design, Setting, and Participants: Cross-sectional study using data on the general US population obtained from the National Survey on Alcohol and Related Conditions Wave 3 from April 2012 to June 2013. Participants were civilian, noninstitutionalized adults 18 years and older. This study used a multistage probability sampling design (response rate, 60.1%). Data were analyzed from January 25 to November 27, 2018. Exposures: Harsh physical punishment included pushing, grabbing, shoving, slapping, and hitting. Child maltreatment included physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, and exposure to intimate partner violence. Main Outcomes or Measures: Lifetime antisocial personality disorder behaviors since age 15 years were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria. Results: The number of study participants was 36 309, with 15 862 men (weighted percentage, 48.1%) and 20 447 women (weighted percentage, 51.9%); mean (SE) age was 46.54 (0.19) years. The prevalence of harsh physical punishment and child maltreatment was 18.1% and 46.7%, respectively. Harsh physical punishment only (adjusted ß, 0.62; 95% CI, 0.50-0.75), child maltreatment only (adjusted ß, 0.65; 95% CI, 0.60-0.69), and harsh physical punishment and child maltreatment (adjusted ß, 1.46; 95% CI, 1.38-1.54) were associated with adult antisocial behaviors. It is estimated that harsh physical punishment and/or child maltreatment might account for approximately 45.5% of antisocial behaviors among men in the United States and 47.3% antisocial behaviors among women in the United States. Conclusions and Relevance: Harsh physical punishment and child maltreatment appear to be associated with adult antisocial behaviors. Preventing harsh physical punishment and child maltreatment in childhood may reduce antisocial behaviors among adults in the United States.