The role of income and occupation in the association of education with healthy aging: results from a population-based, prospective cohort study.

BACKGROUND: The beneficial effects of higher education on healthy aging are generally accepted, but the mechanisms are less well understood. Education may influence healthy aging through improved employment opportunities that enhance feelings of personal control and reduce hazardous exposures, or through higher incomes that enable individuals to access better health care or to reside in better neighbourhoods. Income and occupation have not been explored extensively as potential mediators of the effect of education on healthy aging. This study investigates the role of income and occupation in the association between education and healthy aging including potential effect modification by gender. METHODS: Logistic regression was used to explore the association of education, income (perceived income adequacy, life satisfaction with finances) and occupation (occupational prestige) with healthy aging five years later in 946 community-dwelling adults 65+ years from a population-based, prospective cohort study in Manitoba, Canada. RESULTS: Higher levels of education generally increased the likelihood of healthy aging. After adjusting for education, both income measures, but not occupation, predicted healthy aging among men; furthermore, the association between education and healthy aging was no longer significant. Income and occupation did not explain the significant association between education and healthy aging among women. CONCLUSIONS: Perceived income adequacy and life satisfaction with finances explained the beneficial effects of higher education on healthy aging among men, but not women. Identifying predictors of healthy aging and the mechanisms through which these factors exert their effects can inform strategies to maximize the likelihood of healthy aging.

Impact of methadone maintenance treatment on women offenders' post-release recidivism.

Drug--including opioid--dependence is common in correctional populations, however little research exists on interventions for women offenders. Based on retrospective administrative data, we examined rates of return to custody (RTC) among three samples of Canadian federal women offenders with problematic opioid use (total n=137): (1) a group initiated on MMT during incarceration who continued MMT post-release (MMT-C; n=25); (2) a group initiated on MMT but who terminated treatment post-release (MMT-T; n=67), and (3) a non-MMT control group (MMT-N; n=45). Study groups were similar regarding socio-demographic, drug use and criminogenic indicators. Based on an unadjusted Cox proportional hazards model, the MMT-C group had a 65% lower risk of RTC than the MMT-N (reference) group (HR 0.35, CI 0.13-0.90); RTC risk was not different between the MMT-T and the reference group. Most RTCs were for technical revocations (e.g. violation of a legal condition of their release). Continuous MMT following release from corrections appears to be effective in reducing recidivism in women offenders with opioid problems; barriers to MMT in the study population should be better understood and ameliorated.

Prevalence and trends of non-medical opioid and other drug use histories among federal correctional inmates in methadone maintenance treatment in Canada.

BACKGROUND: The prevalence of illicit drug use among correctional populations is high, and associated with high levels of drug related morbidity risks and harms. The purpose of this study was to examine temporal and regional patterns of illicit drug use among a sample of Canadian federal correctional inmates participating in correctional methadone maintenance treatment (MMT). METHODS: Socio-demographic and drug use data collected from 1272 male federal offenders admitted to Correctional Service Canada's (CSC) MMT program between 2003 and 2008 were examined. Univariate analyses were conducted on inmates' key demographic and correctional characteristics, pre-MMT opioid use and other problematic drug use, and opioid and injecting use while incarcerated. Bivariate associations on drug use measures across regions and over time were computed. RESULTS: Prevalence of heroin use decreased, and prevalence of prescription opioid (PO) use increased over the study period. Significant regional differences existed for PO use, specifically for morphine/hydromorphone and oxycodone use. The majority used opioids and injected while incarcerated, with overall downward trends over time and regional variations. Approximately half the sample indicated a history of lifetime non-opioid problematic drug use, most commonly cocaine (72%) for which substantial regional differences were found. CONCLUSIONS: Pre-MMT opioid and other problematic non-opioid drug use in the sample was high. Temporal and regional patterns of drug use observed may reflect developments in the general population, e.g. increasing PO misuse. The observed drug use patterns underscore the need for targeted drug specific prevention/treatment measures in correctional environments beyond existing interventions.