Effectiveness of nurse-home visiting in improving child and maternal outcomes prenatally to age two years: a randomised controlled trial (British Columbia Healthy Connections Project).

BACKGROUND: We investigated the effectiveness of Nurse-Family Partnership (NFP), a prenatal-to-age-two-years home-visiting programme, in British Columbia (BC), Canada. METHODS: For this randomised controlled trial, we recruited participants from 26 public health settings who were: <25 years, nulliparous, <28 weeks gestation and experiencing socioeconomic disadvantage. We randomly allocated participants (one-to-one; computer-generated) to intervention (NFP plus existing services) or comparison (existing services) groups. Prespecified outcomes were prenatal substance exposure (reported previously); child injuries (primary), language, cognition and mental health (problem behaviour) by age two years; and subsequent pregnancies by 24 months postpartum. Research interviewers were masked. We used intention-to-treat analyses. (ClinicalTrials.gov, NCT01672060.) RESULTS: From 2013 to 2016 we enrolled 739 participants (368 NFP, 371 comparison) who had 737 children. Counts for child injury healthcare encounters [rate per 1,000 person-years or RPY] were similar for NFP (223 [RPY 316.17]) and comparison (223 [RPY 305.43]; rate difference 10.74, 95% CI -46.96, 68.44; rate ratio 1.03, 95% CI 0.78, 1.38). Maternal-reported language scores (mean, M [SD]) were statistically significantly higher for NFP (313.46 [195.96]) than comparison (282.77 [188.15]; mean difference [MD] 31.33, 95% CI 0.96, 61.71). Maternal-reported problem-behaviour scores (M [SD]) were statistically significantly lower for NFP (52.18 [9.19]) than comparison (54.42 [9.02]; MD -2.19, 95% CI -3.62, -0.75). Subsequent pregnancy counts were similar (NFP 115 [RPY 230.69] and comparison 117 [RPY 227.29]; rate difference 3.40, 95% CI -55.54, 62.34; hazard ratio 1.01, 95% CI 0.79, 1.29). We observed no unanticipated adverse events. CONCLUSIONS: NFP did not reduce child injuries or subsequent maternal pregnancies but did improve maternal-reported child language and mental health (problem behaviour) at age two years. Follow-up of long-term outcomes is warranted given that further benefits may emerge across childhood and adolescence.

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.

Prevalence of suicidal ideation among adults in Canada: Results of the second Survey on COVID-19 and mental health.

Introduction: Data from the first round of the nationally representative Survey on COVID-19 and Mental Health (SCMH) revealed that the prevalence of recent suicidal ideation in the fall of 2020 in Canada did not differ significantly from that in the pre-pandemic period in 2019. The objective of the present study was to reassess the prevalence of recent suicidal ideation in the spring of 2021. Methods: The prevalence of suicidal ideation among adults in Canada was examined using the 2021 SCMH (conducted between February 1 and May 7, 2021), and it was compared with the prevalence in the 2019 Canadian Community Health Survey. Unadjusted logistic regression analysis was used to assess the differential likelihood of reporting suicidal ideation in population subgroups. Results: Among adults in Canada, the prevalence of suicidal ideation since the pandemic began was 4.2%, which was significantly higher than the pre-pandemic prevalence of 2.7% in 2019. A statistically significant increase in prevalence was observed among females and males, age groups younger than 65, and several other sociodemographic groups, as well as in British Columbia, the Prairie provinces and Ontario. People who were younger than 65 years, were born in Canada, had lower educational attainment, or were never married were significantly more likely to report suicidal ideation than others during the pandemic. Conclusion: As the second year of the pandemic began, the prevalence of recent suicidal ideation in Canada was higher than it had been before the pandemic in 2019. Continuous monitoring of suicide-related outcomes and risks is necessary so that population-level changes can be detected and inform public health action.

Changes over time in means of suicide in Canada: an analysis of mortality data from 1981 to 2018.

BACKGROUND: Ongoing surveillance of the means of suicide is necessary for effective prevention. We examined how mortality rates owing to different means of suicide changed in Canada from 1981 to 2018. METHODS: We obtained data from 1981 to 2018 on suicide deaths of individuals aged 10 years and older, from the Canadian Vital Statistics Death Database. We used joinpoint regression analysis to examine changes over time in the suicide mortality rate for the 3 most common means of suicide. RESULTS: The age-standardized suicide mortality rate declined in earlier decades for both sexes, but did not significantly change in recent decades for either sex. The age-standardized rate of suicide by suffocation increased from 1993 for females (2.1% per year) and from 1996 for males (0.4% per year). The age-standardized rate of suicide by poisoning decreased for females (2.2% per year) and males (2.1% per year) from 1981 to 2018. The age-standardized rate of suicide by firearm decreased from 1981 to 2008 (7.4% per year) but did not significantly change there-after for females; for males, it decreased 2.1% per year from 1981 to 1993 and 5.7% per year from 1993 to 2007, but did not significantly change thereafter. INTERPRETATION: For both sexes, the rate of suicide by poisoning is decreasing, the rate of suicide by suffocation is increasing, and the rate of suicide by firearm has not significantly changed in the last decade. Given the high proportion of suicide deaths by suffocation, its increasing rate and the difficulty of restricting the means of suffocation, other approaches to suicide prevention are needed.

Suicide in Newfoundland and Labrador, Canada: a time trend analysis from 1981 to 2018.

BACKGROUND: The suicide rate in Canada decreased by 24% during the past four decades. However, rates vary between provinces and territories, and not all jurisdictions experienced the same changes. This study examined suicide rates over time in the province of Newfoundland and Labrador. METHODS: We used cross-sectional surveillance data from the Canadian Vital Statistics Death Database to examine suicide rates in Newfoundland and Labrador from 1981 to 2018. We calculated annual age-standardized suicide mortality rates and used joinpoint regression to estimate the average annual percent change (AAPC) in suicide rates overall and by sex, age group, and means of suicide. RESULTS: From 1981 to 2018, 1759 deaths by suicide were recorded among people in Newfoundland and Labrador. The age-standardized suicide mortality rate increased more than threefold over the study period, from 4.6 to 15.4 deaths per 100,000. The suicide rate was higher among males than females, and accounted for 83.1% of suicide deaths (n = 1462); the male-to-female ratio of suicide deaths was 4.9 to 1. The average annual percent change in suicide rates was higher among females than males (6.3% versus 2.0%). Age-specific suicide rates increased significantly for all age groups, except seniors (aged 65 or older); the largest increase was among youth aged 10 to 24 years old (AAPC 3.5; 95% CI, 1.6 to 5.5). The predominant means of suicide was hanging/strangulation/suffocation, which accounted for 43.8% of all deaths by suicide. CONCLUSIONS: The suicide rate in Newfoundland and Labrador increased steadily between 1981 and 2018, which was in contrast to the national rate decline. The disparity between the provincial and national suicide rates and the variations by sex and age underscore the need for a public health approach to prevention that accounts for geographic and demographic differences in the epidemiology of suicide.

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.

Emergency Department Presentations and Youth Suicide: A Case-Control Study.

OBJECTIVE: We estimate associations between emergency department (ED) diagnoses and suicide among youth to guide ED care. METHOD: This ED-based case-control study used data from the Office of the Chief Coroner and all EDs in Ontario, Canada. Cases ( n = 697 males and n = 327 females) were aged 10 to 25 years who died by suicide in Ontario between April 2003 and March 2014, with an ED contact in the year before their death. Same-aged ED-based controls were selected during this time frame. Crude and adjusted odds ratios (aORs) and 95% confidence intervals were calculated. RESULTS: Among youth diagnosed with a mental health problem at their most recent ED contact (41.9% cases, 5% controls), suicide was elevated among nonfatal self-inflicted: 'other' injuries, including hanging, strangulation, and suffocation in both sexes (aORs > 14); cut/pierce injuries in males (aOR > 5); poisonings in both sexes (aORs > 2.2); and mood and psychotic disorders in males (aORs > 1.7). Among those remaining, 'undetermined' injuries and poisonings in both sexes (aORs > 5), 'unintentional' poisonings in males (aOR = 2.1), and assault in both sexes (aORs > 1.8) were significant. At least half of cases had ED contact within 106 days. CONCLUSIONS: The results highlight the need for timely identification and treatment of mental health problems. Among those with an identified mental health problem, important targets for suicide prevention efforts are youth with self-harm and males with mood and psychotic disorders. Among others, youth with unintentional poisonings, undetermined events, and assaults should raise concern.

The British Columbia Healthy Connections Project: findings on socioeconomic disadvantage in early pregnancy.

BACKGROUND: Maternal exposure to socioeconomic disadvantage increases the risk of child injuries and subsequent child developmental and mental health problems - particularly for young mothers. To inform early intervention planning, this research therefore aimed to describe the health and social adversities experienced by a cohort of girls and young women in early pregnancy in British Columbia (BC), Canada. METHODS: Participants were recruited for the BC Healthy Connections Project (BCHCP), a randomized controlled trial examining the effectiveness of Nurse-Family Partnership, a home visitation program, in improving child and maternal outcomes. Baseline data were collected from 739 participants on trial entry. Participants were selected on the basis of preparing to parent for the first time and experiencing socioeconomic disadvantage. Analyses involved descriptive statistics and age-group comparisons. RESULTS: Most participants reported having low income (84%), having limited education (52%) and being single (91%) at trial entry. Beyond these eligibility criteria, other health and social adversities included: housing instability (52%); severe anxiety or depression (47%); other diagnosed mental disorders (22%); prenatal nicotine and cannabis use (27 and 21%); physical health problems (20%); child maltreatment when younger (56%); and intimate partner violence recently (50%). As well, few (29%) had received income assistance entitlements. More than two thirds (70%) were experiencing four or more forms of adversity. Age-group differences were observed for cognitive functioning, being single, low income, limited education, psychological distress and service use (p-value ≤0.05). CONCLUSIONS: This cohort was selected on the basis of socioeconomic disadvantage. Yet all participants were experiencing substantial added adversities - at higher rates than other Canadians. Furthermore, despite Canada's public programs, these pregnant girls and young women were not being adequately reached by social services. Our study adds new data to inform early intervention planning, suggesting that unacceptably high levels of socioeconomic disadvantage exist for some young British Columbians. Therefore greater health and social supports and services are warranted for these young mothers and their children. TRIAL REGISTRATION: Registered August 24, 2012 with ClinicalTrials.gov Identifier: NCT01672060 . Active not recruiting.

Sentinel surveillance of child maltreatment cases presenting to Canadian emergency departments.

BACKGROUND: The Canadian Hospitals Injury Reporting Prevention Program (CHIRPP) is a sentinel surveillance program that collects and analyzes data on injuries and poisonings of people presenting to emergency departments (EDs) at 11 pediatric and eight general hospitals (currently) across Canada. To date, CHIRPP is an understudied source of child maltreatment (CM) surveillance data. This study: (1) describes CM cases identified in the CHIRPP database between1997/98 to 2010/11; (2) assesses the level of CM case capture over the 14-year period and; (3) uses content analysis to identify additional information captured in text fields. METHODS: We reviewed cases of children under 16 whose injuries were reported as resulting from CM from 1997/98 to 2010/11. A time trend analysis of cases to assess capture was conducted and content analysis was applied to develop a codebook to assess information from text fields in CHIRPP. The frequency of types of CM and other variables identified from text fields were calculated. Finally, the frequency of types of CM were presented by age and gender. RESULTS: A total of 2200 CM cases were identified. There was a significant decrease in the capture of CM cases between 1999 and 2005. Physical abuse was the most prevalent type (57%), followed by sexual assault (31%), unspecified maltreatment (7%), injury as the result of exposure to family violence (3%) and neglect (2%). Text fields provided additional information including perpetrator characteristics, the use of drugs and/or alcohol during the injury event, information regarding the involvement of non-health care professionals, whether maltreatment occurred during a visitation period with a parent and, whether the child was removed from their home. CONCLUSIONS: The findings from this initial study indicate that CHIRPP could be a complimentary source of CM data. As an injury surveillance system, physical abuse and sexual assault were better captured than other types of CM. Text field data provided unique information on a number of additional details surrounding the injury event, including risk factors.

Les soins médicaux de jeunes hommes et de jeunes femmes qui décèdent par suicide.

OBJECTIVE: Prior year medical care was compared among youth dying by suicide to their peers. Effect modification of these associations by age or place of residency (rural versus larger community sizes) was examined in a large, medically insured population. METHOD: This population-based case control study used data from the Office of the Chief Coroner in Ontario, Canada, linked to health care administrative data to examine associations between medical care for mental health or other reasons (versus no medical care) and suicide. Decedents ( n = 1203 males and n = 454 females) were youth (aged 10 to 25 years) who died by suicide in Ontario between April 2003 and March 2014, inclusive. Peers of the same ages were frequency matched to decedents on sex and place of residency. Logistic regression was used to calculate odds ratios and 95% confidence intervals and to test effect modification. RESULTS: Associations with mental health care were stronger in decedents than peers with a gradation of care (i.e., outpatient only, emergency department [ED], inpatient care) in both sexes. However, these associations were weaker among youth living in rural communities. Furthermore, older males (aged 18 to 25 years) were less likely than younger males (aged 10 to 17 years) to access the ED (ambulatory care only). This decrease was observed in rural and larger communities alongside no increase in medical care for other reasons. CONCLUSIONS: Geographical and age-related barriers to mental health care exist for youth who die by suicide. Preventive efforts can address these barriers, intervening early and integrating services, including the ED.

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.

Global research priorities for interpersonal violence prevention: a modified Delphi study.

OBJECTIVE: To establish global research priorities for interpersonal violence prevention using a systematic approach. METHODS: Research priorities were identified in a three-round process involving two surveys. In round 1, 95 global experts in violence prevention proposed research questions to be ranked in round 2. Questions were collated and organized according to the four-step public health approach to violence prevention. In round 2, 280 international experts ranked the importance of research in the four steps, and the various substeps, of the public health approach. In round 3, 131 international experts ranked the importance of detailed research questions on the public health step awarded the highest priority in round 2. FINDINGS: In round 2, "developing, implementing and evaluating interventions" was the step of the public health approach awarded the highest priority for four of the six types of violence considered (i.e. child maltreatment, intimate partner violence, armed violence and sexual violence) but not for youth violence or elder abuse. In contrast, "scaling up interventions and evaluating their cost-effectiveness" was ranked lowest for all types of violence. In round 3, research into "developing, implementing and evaluating interventions" that addressed parenting or laws to regulate the use of firearms was awarded the highest priority. The key limitations of the study were response and attrition rates among survey respondents. However, these rates were in line with similar priority-setting exercises. CONCLUSION: These findings suggest it is premature to scale up violence prevention interventions. Developing and evaluating smaller-scale interventions should be the funding priority.

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.

Substantiated Reports of Child Maltreatment From the Canadian Incidence Study of Reported Child Abuse and Neglect 2008: Examining Child and Household Characteristics and Child Functional Impairment.

OBJECTIVE: Identifying child and household characteristics that are associated with specific child maltreatment types and child functional impairment are important for informing prevention and intervention efforts. Our objectives were to examine the distribution of several child and household characteristics among substantiated child maltreatment types in Canada; to determine if a specific child maltreatment type relative to all other types was associated with increased odds of child functional impairment; and to determine which child and household characteristics were associated with child functional impairment. METHOD: Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect (collection 2008) from 112 child welfare sites across Canada (n = 6163 children). RESULTS: Physical abuse, sexual abuse, and emotional maltreatment were highly prevalent among children aged 10 to 15 years. For single types of child maltreatment, the highest prevalence of single-parent homes (50.6%), social assistance (43.0%), running out of money regularly (30.7%), and unsafe housing (30.9%) were reported for substantiated cases of neglect. Being male, older age, living in a single-parent home, household running out of money, moving 2 or more times in the past year, and household overcrowding were associated with increased odds of child functional impairment. CONCLUSIONS: More work is warranted to determine if providing particular resources for single-parent families, financial counselling, and facilitating adequate and stable housing for families with child maltreatment histories or at risk for child maltreatment could be effective for improving child functional outcomes.

The association between immigrant generational status, child maltreatment history and intimate partner violence (IPV): evidence from a nationally representative survey.

PURPOSE: The extent to which immigrant-specific factors influence the intergenerational transmission of family violence is unknown. The objectives of this paper are to examine the associations between immigrant generational status (IGS), child maltreatment (CM), intimate partner violence (IPV) and acculturation (i.e., the extent to which an individual adopts the values, language and attitudes of a new culture). METHODS: The sample was drawn from wave two of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 34,653), a nationally representative survey of United States (US) residents aged 20 years and older. Logistic regression was used to estimate the associations between IGS, CM history, IPV, and acculturation. RESULTS: Compared to 3rd generation (or later) respondents, 1st generation immigrants were less likely to report a history of sexual (AOR = 0.74, CI0.95 = 0.62, 0.90) and emotional abuse (AOR = 0.69, CI0.95 = 0.55, 0.87), but were more likely to report physical neglect (AOR = 1.30, CI0.95 = 1.11, 1.52). After adjusting for covariates, IGS was not associated with IPV among respondents with or without a CM history. Among those without a CM history, highly acculturated 1st generation immigrants (AOR = 1.07, CI0.95 = 1.01, 1.13) were more likely to report perpetrating IPV, with highly acculturated 3rd generation respondents having lower odds of reporting IPV perpetration (AOR = 0.93, CI0.95 = 0.88-1.00). CONCLUSION: IGS and acculturation are important factors in CM and IPV. Longitudinal studies are needed to clarify the influence of IGS, recency of immigration, acculturation and acculturative stress on the experiences and relationship between CM and IPV.

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.

How has child maltreatment surveillance data been used in Canada?

BACKGROUND: Recently, a survey was performed as part of a larger study at the Public Health Agency of Canada (PHAC) to develop and pilot a series of tools to measure the uptake and use of PHAC-produced or -supported knowledge products by its key partners and stakeholders. This article aims to i) examine the uptake and use of the Canadian Incidence Study of Reported Child Abuse and Neglect 2008 (CIS-2008) and to ii) assess the utility of a knowledge uptake survey for collecting performance measurement data. METHODS: Using the knowledge utilization ladder as a theoretical framework, a short survey was developed around the themes of reception, cognition, conversation, reference, effort, influence, and implementation. The survey was administered electronically to potential end-users of the CIS-2008. The final sample comprised 85 respondents. RESULTS: The results demonstrated that the majority of the respondents were aware of CIS-2008 and had read and used it. A wide array of disciplines and sectors were identified as end-users. Types of use included discussion of CIS data with social workers, child welfare and health advocates, students, medical and legal professionals, and senior government decision makers. Further, CIS was referenced in reports, articles, policy research, community programs, and funding proposals and was used to influence or support the development of policies, programs, and projects. Valuable information on the use of surveillance reports, such as CIS-2008, can be gathered from a brief survey that was easy to administer, cost effective, and that respondents needed minimal time to complete. CONCLUSIONS: Piloting of the survey demonstrated that the tool, while not perfect, is quite useful for capturing performance measurement information; CIS-2008 is appreciated and used. There is an increased recognition of the importance of the CIS as a unique source of Canadian child maltreatment surveillance data that can influence and lead to the implementation of new programs and policies. Although suggestions for improvement of the CIS-2008 were provided, the present findings offer support for ongoing national child maltreatment surveillance.

Rates of out-of-home care among children in Canada: an analysis of national administrative child welfare data. / Taux de placement des enfants hors de leur foyer familial : analyse des données administratives nationales du système de protection de l'enfance au Canada.

INTRODUCTION: As a part of the public health approach to child welfare, data about children placed in out-of-home care are needed to assess population trends, understand drivers of social and health inequities, and examine outcomes for children and families. We analyzed administrative data from Canada to describe the population of children in out-of-home care, and estimate and compare rates of out-of-home care by province/territory, year, sex/gender, age group and placement type. METHODS: We conducted a cross-sectional analysis of point-in-time data from all provinces and territories for the period 2013/2014 to 2021/2022. We used frequencies and percentages to describe the population of children (and youth up to age 21 years) in out-of-home care and estimated overall and stratified rates and rate ratios. RESULTS: An estimated 61 104 children in Canada were in out-of-home care on 31 March 2022. The national rate of out-of-home care was 8.24 children per 1000 population. Rate variations by province/territory were substantial and changed over time. Rates were highest among males and children aged 1 to 3 and 16 to 17 years. Foster homes were the most common type of placement, although kinship homes accounted for an increasing share. CONCLUSION: This analysis demonstrated that administrative data can be used to generate national indicators about children involved in the child welfare system. These data can be used for tracking progress towards health and social equity for children and youth in Canada.