Cold Weather Conditions and Risk of Hypothermia Among People Experiencing Homelessness: Implications for Prevention Strategies.

Hypothermia is a preventable condition that disproportionately affects individuals who experience homelessness, yet limited data exist to inform the response to cold weather. To fill this gap, we examined the association between meteorological conditions and the risk of hypothermia among homeless individuals. Hypothermic events were identified from emergency department charts and coroner's records between 2004 and 2015 in Toronto, Canada. A time-stratified case-crossover design with conditional logistic regression was used to assess the relationship between the meteorological conditions (minimum temperature and precipitation) and the risk of hypothermia. There were 97 hypothermic events identified: 79 injuries and 18 deaths. The odds of experiencing a hypothermic event increased 1.64-fold (95% CI: 1.30-2.07) with every 5 °C decrease in the minimum daily temperature and 1.10-fold (95% CI: 1.03-1.17) with every 1 mm increase in precipitation. The risk of hypothermia among individuals experiencing homelessness increased with declining temperature; however, most cases occurred during periods of low and moderate cold stress. 72% occurred when the minimum daily temperatures were warmer than -15 °C. These findings highlight the importance of providing a seasonal cold weather response to prevent hypothermia, complemented by an alert-based response on extremely cold days.

Ready for policy? Stakeholder attitudes toward menu labelling in Toronto, Canada.

OBJECTIVES: The purpose of this research was to assess key stakeholder attitudes regarding menu labelling in Toronto, the largest municipality in Canada. Menu labelling is a population health intervention where food-labelling principles are applied to the eating-out environment through disclosure of nutrient content of food items on restaurant menus at the point of sale. Menu-labelling legislation has been implemented in the United States, but has yet to be adopted in Canada. As provincial voluntary programs and federal analyses progress, municipal jurisdictions will need to assess the feasibility of moving forward with parallel interventions. METHODS: Data were collected and analyzed in late 2011 to early 2012, including: a consumer eating-out module incorporated into a public health surveillance telephone survey (n=1,699); an online survey of independent restaurant operators (n=256); in-depth key informant interviews with executives and decision makers at chain restaurants (n=9); and a policy consultation with local restaurant associations. RESULTS: Toronto residents, particularly men, younger adults, and those with higher income or education, frequently eat out. A majority indicated that nutrition information is important to them; 69% note that they currently use it and 78% reported they would use it if it were readily available. Resistance to menu-labelling requirements at the municipal level was articulated by franchise/chain restaurant executives and industry associations. Despite overall low interest among independent restaurant operators, 57% reported feeling some responsibility to provide nutrition information and 50% believed it could be good for business. CONCLUSIONS: This research supports earlier literature that indicates strong public support for menu labelling alongside perceived barriers among the restaurant and foodservices sector. Leverage points for effective operator engagement for menu-labelling adoption were identified, nonetheless, highlighting the need for public health support.

Psychosocial consequences of intimate partner violence for women and men in Canada.

Although the negative health consequences of intimate partner violence (IPV) are well documented, most research has conceptualized IPV as a unitary construct and has primarily focused on the impact of physical violence. However, recent theoretical and empirical work suggests that IPV may be heterogeneous, with different consequences associated with different patterns of violence, abuse, and control. This study used latent class analysis to examine the psychosocial consequences associated with different patterns of physical violence, sexual coercion, psychological abuse, and controlling behavior. Data from 676 women and 455 men who were interviewed for the 2004 Canadian General Social Survey on Victimization were analyzed. The results suggest that experiencing any pattern of violence is associated with a range of negative psychosocial outcomes for both women and men. However, they also show the increasingly negative impact and perceived dangerousness of IPV for those experiencing more severe and chronic patterns of violence and control. These findings were particularly pronounced for women as they experienced the most chronic pattern of abuse and control documented in the study. The psychosocial consequences were also greater for women than for men with similar experiences of IPV. These results suggest that the psychosocial impact of IPV is influenced by gender and by the nature of the violence, abuse, and control experienced.

Formal and informal help-seeking associated with women's and men's experiences of intimate partner violence in Canada.

While numerous studies have documented the prevalence, correlates, and consequences of intimate partner violence (IPV); most of this research has used a criminal justice framework that has focused on acts of physical violence. However, critics argue that this narrow conceptualization of IPV belies the heterogeneity in this experience with respect to the nature of coercive control in the relationship. Moreover, they contend that the different types of abusive and controlling relationships not only have a different etiology, health consequences, and help-seeking characteristics, they also have a different relationship by gender. This study examined the extent to which different patterns of violence, abuse, and control were differentially associated with formal and informal help-seeking in a national Canadian sample. Data from the 2004 General Social Survey were analyzed, which included 696 women and 471 men who reported physical or sexual violence by a current or ex-spouse or common-law partner. The most commonly reported formal sources for women and men were health professionals (i.e., doctors, nurses, counselors, psychologists) and the police. For women, informal sources (i.e., family, friends, neighbors) were commonly reported across all IPV subgroups. However, the importance of almost all of the formal sources (e.g., health professionals, police, lawyers, shelters, crisis centers) increased as the severity of the violence and control increased. Shelters and crisis centers were also reported by a notable proportion of women who experienced the most severe pattern of violence and control. For men, both formal and informal sources were more commonly reported by those who experienced moderate violence and control compared with those who experienced relatively less severe acts of physical aggression. The results suggest that research that more sensitively examines people's experiences of violence and control can help identify their health, social, and safety needs; and ultimately better inform the development of programs and services aimed at addressing these needs.

Exploring gender differences in the patterns of intimate partner violence in Canada: a latent class approach.

BACKGROUND: There has been an ongoing debate about the extent and nature of gender differences in the experience of intimate partner violence (IPV). Disagreement about the appropriate definition of IPV is central to this debate. METHODS: This study used latent class analysis (LCA) to map the patterns of physical violence, sexual coercion, psychological abuse and controlling behaviour, and examined whether LCA can better illuminate the gendered nature of this experience than conventional measures of IPV. Data from the 2004 Canadian General Social Survey were analysed, which included 8360 women and 7056 men 15 years of age and over who reported a current or ex-spouse or common-law partner. RESULTS: Results revealed more variation in the patterns of IPV for women than for men. Six classes were found for women, whereas four classes were found for men. Women and men were equally likely to experience less severe acts of physical aggression that were not embedded in a pattern of control. However, only women experienced a severe and chronic pattern of violence and control involving high levels of fear and injury. For women and men, intermediate patterns of violence and control, and patterns describing exclusively non-physical acts of abuse were also found. The results also revealed substantial differences in the IPV subtypes for those reporting about a current versus an ex-partner. CONCLUSION: These results support the use of LCA in identifying meaningful patterns of IPV and provide a more nuanced understanding of the role of gender than conventional measures. Implications for sampling within IPV research are discussed.

Perpetration of intimate partner aggression by men and women in the Philippines: prevalence and associated factors.

This study uses data from the 2002 Cebu Longitudinal Health and Nutrition Survey to examine the prevalence of and factors associated with intimate partner violence perpetration by husbands and wives in Cebu, Philippines. Multinomial logistic regression was used to identify the factors associated with wife-only, husband-only, and reciprocal perpetration. About 26% of women reported that either they or their partner perpetrated at least one physically aggressive act during the past year, whereas 22% reported sexual coercion by their husband during their relationship. The most common reason cited for hurting the partner was his or her alcohol use, partner nagging, the wife fighting back, and jealousy. In the regression analysis, the wife's alcohol use and violence between the wife's parents were predictors of all three perpetrator groups. The importance of regular church attendance and husband control and dominance varied for the groups. Research and prevention implications are discussed.

Predictors of women's physical health problems after childbirth.

The objectives of this study were to document the extent and the correlates of common physical health symptoms in women two months after childbirth. Of special interest was determining whether violence and depression histories increase the risk for experiencing these symptoms. Participants were recruited in six Toronto-area hospitals and were interviewed by telephone 8-10 weeks later. Two hundred of the 332 (60.2%) women who were approached completed the study. Most women (96%) reported at least one physical health symptom 2 months postnatally (Mean = 3.4, SD = 2.0). Stepwise logistic regression was conducted for each outcome. Antenatal depression was a significant predictor of excessive fatigue and bad headaches. Sick leave during pregnancy predicted postpartum backaches. Adult emotional abuse and household income were associated with bowel problems. Episiotomy, maternal complications, and planned pregnancy predicted perineal pain. Finally, being Canadian born and having an assisted vaginal delivery increased the risk for hemorrhoids while cesarean section decreased the risk. A high prevalence of physical symptoms was found in women after childbirth. History of depression and violence were implicated in the occurrence of some of these symptoms. Other important predictors included demographic, maternal, and delivery-related factors.

Multiple Roles and Women's Mental Health in Canada.

HEALTH ISSUE: Research on the relationship between women's social roles and mental health has been equivocal. Although a greater number of roles often protect mental health, certain combinations can lead to strain. Our study explored the moderating affects of different role combinations on women's mental health by examining associations with socioeconomic status and differences in women's distress (depressive symptoms, personal stress (role strain) and chronic stress (role strain plus environmental stressors). KEY FINDINGS: Women with children, whether single or partnered, had a higher risk of personal stress. Distress, stress and chronic stress levels of mothers, regardless of employment, or marital status, are staggeringly high. Single, unemployed mothers were significantly more likely than all other groups to experience financial stress and food insecurity. For partnered mothers, rates of personal stress and chronic stress were significantly lower among unemployed partnered mothers. Married and partnered mothers reported better mental health than their single counterparts. Lone, unemployed mothers were twice as likely to report a high level of distress compared with other groups. Lone mothers, regardless of employment status, were more likely to report high personal and chronic stress. DATA GAPS AND RECOMMENDATIONS: National health surveys need to collect more data on the characteristics of women's work environment and their care giving responsibilities. Questions on household composition should include inter-generational households, same sex couples and multifamily arrangements. Data disaggregation by ethno-racial background would be helpful. Data should be collected on perceived quality of domestic and partnership roles and division of labours.

Personal Health Practices.

HEALTH ISSUE: There are differences in health practices and self-rated health among different socio-demographic groups of women. The relationship between socio-demographic status and a) a range of health behaviours and b) a combination of multiple risk and multiple health promoting practices were examined. The relationship between self-rated health and health practices was also assessed. KEY FINDINGS: There were geographic differences in health practices with women in British Columbia having the highest odds of engaging in multiple health promoting practices, while women in Quebec had the lowest. Reports of engaging in multiple risk behaviours were most common in Ontario. Women from Ontario had the highest odds of reporting very good/excellent health and women from British Columbia had among the lowest odds.The data supported a strong social gradient between an increase in income/education and healthy practices, especially those that are health promoting. However, women with higher education were more likely to be overweight and those with higher incomes were more likely to drink alcohol regularly.Immigrant women were less likely to engage in multiple health risk practices compared to Canadian-born women. However, they were less likely to report very good/ excellent health than non- immigrants. While marriage appeared to have a generally protective effect on women's health practices, single women were more likely to be physically active and have a normal weight. DATA GAPS AND RECOMMENDATIONS: More sensitive indicators need to be developed to better understand possible reasons for the socioeconomic gradient. Data collection should focus on both rural and Aboriginal populations.

Posttraumatic stress disorder after pregnancy, labor, and delivery.

OBJECTIVES: Other studies of posttraumatic stress disorder (PTSD) after birth did not include questions about prior traumatic life events. This study sought to determine if a difficult birth was associated with symptoms of PTSD as well as considering sociodemographics, history of violence, depression, social support, and traumatic life events. METHODS: New mothers were recruited on the postpartum ward of six Toronto-area hospitals (n = 253) and were interviewed by telephone 8-10 weeks postpartum (n = 200). We dichotomized the postpartum stress (PTS) into high PTS (answered "yes" to 3 or more items) or low PTS (answered "yes" to 0-2 items). We calculated the odds ratios between difficult birth, other factors, and the binary PTS variable. RESULTS: Results of multivariable logistic regression revealed that no factor suggestive of a difficult birth was significantly related to high PTS scores, except having two or more maternal complications (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 1.3-12.8). Other independent predictors of high PTS scores were depression during pregnancy (OR = 18.9, 95% CI = 5.8-62.4), having two or more traumatic life events (OR = 3.2, 95% CI = 1.2-8.3), being Canadian born (OR = 3.2, 95% CI = 1.3-8.1), and having higher household income (lowest income group, OR = 0.1, 95% CI = 0.02-0.5), intermediate income group OR = 0.4, 95% CI = 0.2-0.8). CONCLUSIONS: In this study, postpartum stress symptoms appeared to be related more to stressful life events and depression than to pregnancy, labor, and delivery.