Perceived discrimination and self-rated health in Canada: an exploratory study.

BACKGROUND: Our objective was to explore whether the link between discrimination and self-rated health status differed as a function of discrimination type, including discrimination based on ethnicity/culture, race, physical appearance (other than skin colour), religion, age, and disability. METHODS: A sample of 19,422 men and women aged 15 and older was included in this study. A multivariate logistic regression analysis was used to measure the association between perceived discrimination types and self-reported health status defined as excellent/good versus fair/poor. RESULTS: The prevalence of experiencing any discrimination in the past five years was higher among those who rated their health as fair or poor (21.8 %) compared to those who rated their health as excellent or good (14.5 %, p < 0.0001). After controlling for all other covariates, there was a positive association between poorer self-rated health and two of the six specific discrimination variables entered into the model: perceived discrimination based on physical appearance (other than skin colour) (OR = 1.79, 95 % CI: 1.24, 2.58) and perceived discrimination based on a having a disability (OR = 1.59, 95 % CI: 1.04, 2.41). CONCLUSIONS: Our main findings indicate that perceived discrimination based on physical appearance and disability may have an adverse impact on health. The results highlight the need for a comprehensive approach to improving health outcomes that should include policies that are targeted against specific types of discrimination.

Intimate partner violence among women with mental health-related activity limitations: a Canadian population based study.

BACKGROUND: There is strong evidence that women with serious or chronic mental illness experience higher rates of violence than women in the general population. Our objective was to examine the risk of intimate partner violence (IPV), a form of violence that is often recurrent and linked to negative physical and psychological consequences, among a representative sample of non-institutionalized women with activity limitations (ALs) due to a mental health condition. METHODS: Data from the 2009 General Social Survey were used, a national, population-based, cross-sectional survey. The sample included 6851 women reporting contact with a current or former partner in the previous five years, of whom 322 (4.7%) reported a mental health-related AL always/often or sometimes. RESULTS: The prevalence of any type of IPV was highest among women with mental health-related ALs always/often (54.4%), followed by women reporting ALs sometimes (49.9%), and those reporting no ALs (18.3%, p < 0.0001). The same pattern was observed for emotional (51.1%, 45.5%, 16.3%, p < 0.0001) and financial IPV (18.1%, 9.5%, 4.0%, p < 0.0001). For physical/sexual violence, rates were similar among women reporting mental health-related ALs always/often and sometimes, but were lower among those reporting no ALs (20.2%, 20.9%, 5.9%, p < 0.0001). In a logistic regression analysis the odds of having experienced any IPV remained greater for women reporting ALs always/often (OR = 3.65; 95% CI: 2.10, 6.32) and sometimes (OR = 3.20; 95% CI: 2.15, 4.75) than those reporting no ALs. Several social capital variables, including perceptions of having experienced discrimination, a weak sense of belonging in their local community, and low trust toward family members and strangers were also significantly associated with having experienced IPV. CONCLUSION: Findings suggest that women with mental health-related ALs may be at increased risk of IPV. Health and social service providers may need, therefore, to better target prevention and intervention initiatives to this population.

Incidence trends in head and neck cancers and human papillomavirus (HPV)-associated oropharyngeal cancer in Canada, 1992-2009.

PURPOSE: Recently, human papillomavirus (HPV) infection has been causally associated with a subset of head and neck cancers, particularly oropharyngeal cancer. As national cancer reporting systems typically report incidence rates of oropharyngeal cancer grouped with other cancers of the head and neck region, the objective of this study was to present age-standardized incidence trends in oropharyngeal cancer Canada-wide. METHODS: Data were obtained from the Canadian Cancer Registry for cases diagnosed between 1992 and 2009. Trends in age-standardized incidence rates were described for head and neck cancers overall and for HPV-associated oropharyngeal cancer using Joinpoint regression. RESULTS: The age-standardized incidence of head and neck cancers declined significantly in Canada from 1992 to 1998 (annual percentage change [APC] = -3.0, p < 0.01), then remained stable through to 2009. In contrast, the age-standardized incidence of HPV-associated oropharyngeal cancer increased significantly during the same time period, from 1.6 per 100,000 in 1992 to 2.6 in 2009 (APC = 2.7, p < 0.001). The increase in HPV-associated oropharyngeal cancer was greater in males than in females and increased significantly in all age groups, particularly those aged 50-59 (APC = 5.4, p < 0.001). The age-standardized incidence rate of head and neck cancer overall was stable or declined in all age groups except those aged 50-59 where incidence decreased from 1992 to 1997, then increased through to 2009. CONCLUSIONS: The incidence patterns of HPV-associated oropharyngeal cancer and head and neck cancer overall show contrasting trends. Findings highlight the need to surveil HPV-associated oropharyngeal cancer separately from other cancers of the head and neck region in order to monitor these emerging trends.

Rates of depression and anxiety in urban and rural Canada.

BACKGROUND: Studies of urban-rural differences in rates of non-psychotic psychiatric disorders have produced contradictory results, with some finding higher urban rates and others no difference. AIMS: This study aimed to compare geographic variability of rates of depression and three anxiety disorders in a large, random community sample of Canadian residents. METHOD: Data from the 2002 Canadian Community Health Survey 1.2 were analyzed, using a four-category classification of urban-rurality. RESULTS: Significant bivariate urban-rural differences were found for age, marital status, country of birth, ethnicity, education, household income, income adequacy, employment, home ownership, physical activity, perceived stress, and physical health. In addition, participants in the urban core and urban fringe had a weaker sense of belonging to their community and reported lower social support. There was a modest urban excess of depression in the previous 12 months but no difference in rates of agoraphobia, panic disorder or social phobia across the geographical areas. The multivariate modeling showed a lower prevalence of depression for people living in the most rural environment only (odds ratio = 0.76, 95% confidence interval = 0.59, 0.98). Factors associated with an increased rate of depression in the model were female gender, younger age, being not married, being born in Canada, white ethnicity, higher education, unemployment, not owning one's home, and poor physical health. Also, participants with a stronger sense of belonging to their community and higher social support reported lower rates of depression. CONCLUSIONS: These results confirmed a lower risk of depression amongst rural dwellers, which was associated with a stronger sense of community belonging. Further research on this topic could usefully include community-level variables, usually subsumed under the rubric of social capital.

Factors associated with child witnessing of intimate partner violence in Canada.

Knowing the characteristics associated with child exposure to spousal abuse could aid in early identification of at-risk children. The purpose of our study is to determine possible factors associated with child witnessing of intimate partner violence (IPV) in Canada using data from the 1999 General Social Survey, a representative telephone survey of Canadians aged 15 years and older. Respondents reporting IPV in the five years prior to the survey were asked whether a child had witnessed the incident. Multivariate logistic regression was used to determine the association between child witnessing of IPV and victim, assault, and help-seeking characteristics. Households in which child witnessing of IPV was reported were distinguished by the following factors: female respondent, visible minority, over age 30, separated, divorced, or widowed, low income, and the presence of children aged 0-14 years. Other significant variables associated with child witnessing of IPV were related to the frequency, reporting, and disclosure of violent incidents.

Help-seeking behavior for intimate partner violence among racial minority women in Canada.

INTRODUCTION: Intimate partner violence (IPV) is experienced by women of all ethnoracial backgrounds. Despite the serious adverse impacts of IPV on women's lives, many abused women do not seek help. The main objective of this paper was to determine whether a woman's racial minority status was a significant predictor of help-seeking for IPV after controlling for other factors associated with help-seeking. METHODS: Data from a national Canadian, cross-sectional, telephone survey were used. Help-seeking variables included disclosure of IPV, reporting IPV to police, the use of social services subsequent to IPV, and barriers to social service use. RESULTS: In the bivariate analyses, rates of disclosure and reporting to police were similar for racial minority and white women, however, racial minority women, compared to white women, were significantly less likely to use social services. After adjustment for age, marital status, household income, number of young children at home, immigration status, household language, and severity of IPV, racial minority status was not a significant predictor of help-seeking in the multivariate analysis. DISCUSSION: Our findings suggest that further investigation is necessary to understand what aspects of membership in a racial minority group or sytemic factors may be contributing to inequalities in accessing help for IPV.

Who is most at risk for intimate partner violence? A Canadian population-based study.

Whole population studies on intimate partner violence (IPV) have given contradictory information about prevalence and risk factors, especially concerning gender. The authors examined the 1999 Canadian General Social Survey data for gender patterns of physical, sexual, emotional, or financial IPV from a current or ex-partner. More women (8.6%) than men (7.0%, p = .001) reported partner physical abuse in general, physical IPV causing physical injury (p < .0001), sexual abuse (1.7% vs. 0.2%, p < .0001), and financial abuse (4.1% vs. 1.6%, p < .0001). There were no gender differences for partner emotional abuse. Significant risk factors after multivariate modeling for physical/sexual IPV were younger age, being divorced/separated or single, having children in the household, and poor self-rated physical health. These findings from a large, randomly generated data set further refine our understanding of the risk profile for IPV in the developed world.

A comparison of Indigenous and non-Indigenous survivors of sexual assault and their receipt of and satisfaction with specialized health care services.

In Canada, Indigenous women are more likely than non-Indigenous women to be survivors of sexual assault and experience sexual assaults that are more serious in terms of physical injury and other health-related consequences. Despite their related needs for care and support, there is a paucity of research to date that has examined their uptake of specialized acute health services post sexual assault. To address this gap, we explored the presentation, sociodemographic, assailant, assault, and service use characteristics of Indigenous women, as compared to non-Indigenous adult and adolescent women aged 12 and older presenting to 30 of 35 hospital-based sexual assault treatment centres in Ontario from 2009 to 2011, using bivariate analyses. Of the 948 women in our sample, 116 (12%) identified as being Indigenous. Indigenous survivors differed significantly from non-Indigenous survivors on many presentation, sociodemographic, and assault characteristics. For example, they were more likely to present to a hospital within 24 hours of being assaulted and a treatment centre serving a primarily rural population. They tended to be younger, were more likely to be living in an institutional setting, report community or group affiliations and government or community services as sources of social support, and be assaulted by a parent, guardian, or other relative. In terms of receipt of services, they were more likely to have undergone safety planning and to be referred to child protection or community agencies. They reported high levels of satisfaction with the services received, however, were less likely than non-Indigenous survivors to rate the overall care provided as excellent or good. On the whole, the results of our study suggest that Indigenous women value acute hospital-based sexual assault services. However, they experience sexual assaults in contexts different from non-Indigenous survivors. It is important for health care providers to be attuned to this so that they can appropriately respond to their unique needs.

Adding insult to injury: intimate partner violence among women and men reporting activity limitations.

PURPOSE: Women with activity limitations (ALs) are at risk for Intimate partner violence (IPV). This study examined IPV in men versus women with ALs. METHODS: Data from the Canadian 1999 General Social Survey compared physical, sexual, emotional, and financial IPV from a current/expartner in 5 years for men and women with ALs compared with those without ALs. Logistic regression examined sex differences in IPV among those with ALs, adjusting for sociodemographic factors. RESULTS: Rates of physical (11.9% versus 7.8%; p < 0.0001), sexual (3.5% versus 1.4%; p < 0.0001), emotional (27.1% versus 17.7%; p < 0.0001), and financial (7.5% versus 3.4%; p < 0.0001) IPV were greater in women with compared with without ALs. A similar pattern was seen for men, with greater rates of physical (9.2% versus 6.6%; p = 0.006), emotional (22.6% versus 18.2%; p = 0.002), and financial (2.6% versus 1.4%; p = 0.005) IPV in men with ALs than men without ALs. Risk factors for IPV included younger age, being divorced/separated or single, and having lower income and poorer health. Women with ALs were more likely than men to experience any IPV (29.1% versus 24.9%) and more severe and more incidents of IPV. In multivariable analysis, women were no longer at greater risk for "any IPV" after adjusting for sociodemographic variables (odds ratio = 1.09; 95% confidence interval, 0.88-1.36). CONCLUSION: This is the first study to document IPV rates in men with ALs. Women with ALs were more likely to be divorced/separated, living in poverty, and in poorer health than men with ALs. These factors accounted for sex differences in IPV rates.

Intimate partner violence among Canadian women with activity limitations.

OBJECTIVE: To determine the prevalence of intimate partner violence (IPV) in the previous five years among women reporting activity limitations (AL). DESIGN AND SETTING: A community based, representative telephone survey of Canadians aged 15 and over. AL was assessed by the question: "Does a long term physical or mental condition or health problem reduce the amount or the kind of activity that you can do at home, at school, at work or in other activities?" Response categories were: often, sometimes, or never. PARTICIPANTS: 8771 women who had a current/former partner of whom 1483 reported AL. MAIN RESULTS: IPV was reported more often for AL (often or sometimes) compared with no AL women (emotional abuse (27.1, 26.4 v 17.7%, p<0.0001), physical-severe (7.3, 6.7 v 3.6%, p<0.0001), sexual abuse (3.5, 3.6 v 1.4%, p<0.0001)), or any IPV (30.5, 27.8 v 19.6%, p<0.0001). Adjusting for age, marital status, education, income, employment, children in the household, Aboriginal or visible minority status, place of birth, urban or rural residence, region of Canada, time in current residence, and religious attendance, AL women had higher odds of IPV (adjusted odds ratio: AL often=2.12; 95% CI: 1.64, 2.74; AL sometimes: OR=1.64; 95% CI:1.40, 2.29). CONCLUSION: These findings call for increased recognition of violence that occurs in the lives of women with AL. This community based study suggests that abuse among those reporting AL is high. Women with AL represent a high risk group to be targeted in terms of IPV prevention and intervention.

Effects of greens+: a randomized, controlled trial.

Greens+ is a popular natural health product marketed as energy-enhancing; however, no objective data substantiate this claim. The study objective was to determine if ingestion of greens+ 1. increases vitality, energy, and perception of well-being; 2. increases overall mental health and general health, and 3. decreases the incidence of colds and flus in an otherwise healthy female population. A total of 105 women were enrolled in this 12-week, randomized, double-blind, placebo-controlled clinical trial; 63 (60%) completed the treatment protocol. Both treatment and placebo groups showed a significant time trend effect, scoring better on all outcome measures as the trial progressed. Compared with the placebo group, the greens+ group scored marginally higher on vitality, the primary outcome measure (p=0.055), and significantly higher on energy (a secondary outcome measure, p=0.018). Findings were based on repeated measures analysis of variance; baseline scores were used as covariates. Although a trend toward greater improvement in the greens+ group was noted in the other secondary outcome measures, this trend did not reach statistical significance. Overall, our findings were positive but not conclusive that greens+ increases vitality and energy. These results provide justification for further study of the effects of greens+.

An exploratory study on the consequences and contextual factors of intimate partner violence among immigrant and Canadian-born women.

OBJECTIVE: To compare immigrant and Canadian-born women on the physical and psychological consequences of intimate partner violence (IPV), as well as examine important sociodemographic, health and social support and network factors that may shape their experiences of abuse. METHOD: National, population-based, cross-sectional survey conducted in 2009. PARTICIPANTS: 6859 women reported contact with a current or former partner in the previous 5 years, of whom 1480 reported having experienced emotional, financial, physical and/or sexual IPV. Of these women, 218 (15%) were immigrants and 1262 (85%) were Canadian-born. RESULTS: Immigrant women were less likely than Canadian-born women to report having experienced emotional abuse (15.3% vs 18.2%, p=0.04) and physical and/or sexual violence (5.1% vs 6.9%, p=0.04) from a current or former partner. There were no differences between immigrant and Canadian-born women in the physical and psychological consequences of physical and/or sexual IPV. However, compared with Canadian-born women, immigrant women reported lower levels of trust towards their neighbours (50.7% vs 41.5%, p=0.04) and people they work or go to school with (38.6% vs 27.5%, p=0.02), and were more likely to report having experienced discrimination based on ethnicity or culture (18.8% vs 6.8%, p<0.0001), race or skin colour (p=0.003) and language (10.1% vs 3.2%, p<0.0001). Immigrant women were less likely than Canadian-born women to report activity limitations (p=0.01) and medication use for sleep problems (14.1% vs 20.6%, p=0.05) and depression (11.5% vs 17.6%, p=0.05). CONCLUSIONS: Our exploratory study revealed no differences between immigrant and Canadian-born women in the physical and psychological consequences of IPV. Abused immigrant women's lower levels of trust for certain individuals and experiences of discrimination may have important implications for seeking help for IPV and underscores the need for IPV-related intervention and prevention services that are culturally sensitive and appropriate.

The association between role overload and women's mental health.

OBJECTIVE: To determine the importance of role overload (the extent to which a person feels overwhelmed by her total responsibilities) relative to other known social determinants of women's mental health. METHODS: A Canadian national, random sample, cross-sectional telephone survey in 2003 assessed the association among role overload, types and quality of roles (parent, employee, spouse), sociodemographics, and mental health (using the SF-12) using linear regression. Analysis included 716 women aged 25-54 who indicated that their youngest child living in the household was aged < or =17 years. RESULTS: Perceptions of greater role overload were associated with poorer mental health (p < 0.0001). Women working <35 hours per week (p = 0.04) or 35-40 hours per week (p 5 0.002) reported better mental health than nonemployed women, as did women with the highest annual household income ($70,000+)(p = 0.001). Also associated with better mental health were higher marital status quality scores for both married and single women (p < 0.001), higher job quality scores among employed women (p = 0.02), greater homemaking quality scores among unemployed women (p = 0.03), and women reporting high parental quality (p = 0.04) CONCLUSIONS: Role overload showed a stronger relationship to mental health than other sociodemographic variables, including income. Our findings indicate the importance of measuring women's experience of their multiple roles rather than focusing on single roles. More research is warranted on the totality of women's experiences of their many social role obligations.

Gender and psychotropic medication use: the role of intimate partner violence.

OBJECTIVE: Women are known to use more psychotropic medications than men which may be linked to women's greater exposure to intimate partner violence (IPV). METHOD: The use of medications for sleep, depression and anxiety in adults in the 1999 Canadian General Social Survey was assessed. Rates of medication use by adults exposed to IPV (physical, sexual, emotional and financial) were compared to rates of those reporting no IPV. RESULTS: More women (14.9%) than men (9.6%) reported use of psychotropic medications in the preceding month. Rates were significantly higher in both women and men who reported IPV. This link was still present after key sociodemographic and health predictors of medication use were held constant. CONCLUSION: This random population based study provides the first data to support the idea that IPV may explain at least some of the increased psychotropic medication use by women. IPV should be included as a predictor variable in future studies investigating psychotropic medication use which itself can be added to the list of adverse health risks of IPV.

Help-seeking rates for intimate partner violence (IPV) among Canadian immigrant women.

We examined rates of help seeking for intimate partner violence (IPV) among recent (0-9 years in Canada) and non-recent (10+ years in Canada) immigrant women. Data from a national, cross-sectional, telephone survey were used. Help-seeking variables included disclosure of IPV, reporting IPV to police, use of social services subsequent to IPV, and barriers to social service use. Recent immigrant women, compared with non-recent immigrant women, were significantly more likely to report IPV to police and less likely to use social services. Findings have important implications for prevention and detection of IPV in immigrant communities and in future research.

The association between length of stay in Canada and intimate partner violence among immigrant women.

OBJECTIVE: We examined the prevalence of intimate partner violence (IPV) among recent (0-9 years) and nonrecent (>/= 10 years) immigrant women in Canada to determine whether differences in IPV were associated with length of stay in Canada. METHODS: We analyzed data from the 1999 General Social Survey, a national cross-sectional telephone survey. We used weighted logistic regression analysis to examine the effect of length of stay in Canada on IPV and controlled for socio-cultural and other factors associated with IPV. RESULTS: The crude prevalence of IPV was similar among recent and nonrecent immigrant women. However, after adjustment, the risk for IPV was significantly lower among recent immigrant women compared with nonrecent immigrant women. Country of origin, age, marital status, and having an activity limitation (physical/mental disability or health problem) also were associated with a higher risk for IPV. CONCLUSIONS: Our findings have important implications for both prevention and detection of IPV among immigrant women.

Changing help-seeking rates for intimate partner violence in Canada.

The adverse physical and psychological sequelae of intimate partner violence (IPV) are well documented, as are government initiatives in Canada since the early 1990s to address the problem through public awareness campaigns and service enhancement programs. While these initiatives have been designed to encourage abused women to come forward, there has been little research examining changes over time in help-seeking rates among this group. To fill this void, we compared data from two large Canadian population-based, cross-sectional telephone surveys: the 1993 Violence Against Women Survey (1993-VAWS) and the 1999 General Social Survey (1999-GSS). Among women who reported physical and/or sexual violence by a current or previous partner, we examined differences in rates of disclosure of abuse, help-seeking by type of service, and barriers to service use. Abused women in the 1999-GSS were significantly more likely than those in the 1993-VAWS to have reported disclosing a violent incident(s) to a family member (66.4% v. 43.9%), friend or neighbor (67.4% v. 45.4%), doctor or nurse (31.9% v. 23.0%), and/or minister, priest, or cleric (11.5% v. 7.3%). The 1999-GSS cohort was also more likely to have presented to a shelter or transition house (11.0% v. 7.8%), a crisis center (17.3% v. 4.2%), a counselor or psychologist (39.1% v. 14.7%), a women's center (11.2% v. 3.4%), and/or a community or family center (15.4% v. 4.7%). Among those women who did not seek help, fewer in the 1999-GSS reported that they did not know of any services (6.4% v. 17.0%), or that services were not available (0.8% v. 14.5%). Although we found a demonstrable increase in the numbers of abused women seeking help, overall, rates of service utilization were still low as late as 1999, highlighting the importance of continued government commitment to funding IPV initiatives.