Nutrition, Immigration and Health Determinants Are Linked to Verbal Fluency among Anglophone Adults in the Canadian Longitudinal Study on Aging (CLSA).

OBJECTIVES: Later-life cognitive impairment is an important health issue; however, little is known about the condition among diverse groups such as immigrants. This study aims to examine whether the healthy immigrant effect exists for verbal fluency, an indicator of cognitive functioning, among anglophone middle-aged and older adults in Canada. METHODS: Using from the baseline data of the Canadian Longitudinal Study on Aging (CLSA), multiple linear regression was employed to compare associations among immigrants (recent and long-term) and Canadian-born residents without dementia for two verbal fluency tests, the Controlled Oral Word Association Test (COWAT) and the Animal Fluency (AF) task. Covariates included socioeconomic, physical health, and dietary intake. RESULTS: Of 8,574 anglophone participants (85.7% Canada-born, 74.8% aged 45-65 years, 81.8% married, 81.9% with a post-secondary degree), long-term immigrants (settled in Canada >20 years) performed significantly better than Canadian-born residents for the COWAT (42.8 vs 40.9) but not the AF task (22.4 vs 22.4). Results of the multivariable adjusted regression analyses showed that long-term immigrants performed better than Canadian-born peers in both the COWAT (B=1.57, 95% CI: 0.80-2.34) and the AF test (B=0.57, 95% CI: 0.19-0.95), but this advantage was not observed among recent immigrants. Other factors associated with low verbal fluency performance included being single, socioeconomically disadvantaged, having hypertension, excess body fat, and consuming low amounts of pulses/nuts or fruit/vegetables. CONCLUSIONS: Long-term immigrants had higher verbal fluency test scores than their Canadian-born counterparts. Immigration status, social, health and nutritional factors are important considerations for possible intervention and prevention strategies for cognitive impairment.

Attention-deficit/hyperactivity disorder casts a long shadow: findings from a population-based study of adult women with self-reported ADHD.

BACKGROUND: To develop a sociodemographic and health profile of women with self-reported attention deficit/hyperactivity disorder (ADHD) in comparison to women without. METHODS: Chi-square tests and logistic regression analyses were conducted on data from the nationally representative Canadian Community Health Survey-Mental Health (2012) comparing 107 women aged 20 to 39 years (inclusive) with ADHD to 3801 without ADHD. Depression, generalized anxiety disorder and substance abuse were measured using the WHO-CIDI. RESULTS: Women with ADHD had triple the prevalence of insomnia, chronic pain, suicidal ideation, childhood sexual abuse and generalized anxiety disorder and double the prevalence of substance abuse, current smoking, depressive disorders, severe poverty and childhood physical abuse in comparison with women without ADHD (all P < 0.001). Even after adjustments for age, race, education and income, women with ADHD had substantially higher odds of a wide range of problems. CONCLUSION: Our results suggest that women with ADHD are particularly vulnerable to early adversities, health and mental health problems.

The association between adverse childhood experiences (ACEs) and suicide attempts in a population-based study.

OBJECTIVES: To further our understanding of the relationship between Adverse Childhood Experiences (ACEs) and suicidal behaviour, this study investigates the association between three types of ACEs and lifetime suicide attempts, while considering potential gender-specific and mediating effects. METHODS: Data were obtained from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH), a cross-sectional, population-based survey comprised of respondents aged 18 or older who provided self-reported data on past experiences of suicide attempts, as well as childhood sexual abuse (CSA), childhood physical abuse (CPA) and parental domestic violence (PDV) (n = 22 559). After testing for ACE by gender interactions, we estimated the odds of lifetime suicide attempts for each ACE and then investigated whether depression, anxiety, substance abuse and chronic pain acted as mediators of the relationship. RESULTS: The odds of suicide attempts are significantly higher among those with a history of CPA (OR = 3.29; 99.9% CI 2.33-4.64), CSA (OR = 4.42; 99.9% CI 3.14-6.23) or PDV (OR = 2.52; 99.9% CI 1.69-3.76), when ACEs are mutually adjusted. There is little evidence that gender acts as a moderator; however, depression, anxiety, substance abuse and chronic pain appear to partially mediate the associations. Depression alone accounts for about a quarter of the associations with CSA and CPA. CONCLUSIONS: Mental health factors and chronic pain appear only to partially mediate relationships between ACEs and lifetime suicide attempts. Future research should look at other pathways with the goal of developing multi-level interventions.

Is the cluster risk model of parental adversities better than the cumulative risk model as an indicator of childhood physical abuse?: findings from two representative community surveys.

BACKGROUND: Screening strategies for childhood physical abuse (CPA) need to be improved in order to identify those most at risk. This study uses two regionally representative community samples to examine whether a cluster or cumulative model of risk indicators (i.e. parental divorce, parental unemployment, and parental addictions) explains a larger proportion of the variation in CPA. METHODS: Data were drawn from Statistics Canada's National Population Health Survey (1994-1995) and Canadian Community Health Survey 3.1 (2005). Response rates were greater than 80% in both samples. Each survey had approximately 13,000 respondents aged 18 and over who answered questions about the above adverse childhood experiences. RESULTS: A gradient was shown with similar outcomes in each data set. Only 3.4% of adults who experienced none of the three risk indicators reported they had been physically abused during childhood or adolescence. The prevalence of CPA was greater among those who experienced parental divorce alone (8.3%-10.7%), parental unemployment alone (8.9%-9.7%) or parental addictions alone (18.0%-19.5%). When all three risk indicators were present, the prevalence of CPA ranged from 36.0%-41.0% and the age-sex-race adjusted odds were greater than 15 times that of individuals with none of the three risk indicators. The cluster model explained a statistically significantly larger proportion of the variation than the cumulative model although the difference between the two models was modest. For the purposes of parsimony, the cumulative model may be the better alternative. CONCLUSIONS: Adults who were exposed to two or more childhood risk indicators were much more likely to report that they were physically abused during their childhood than those with only one or no risk factors. Medical professionals may use this information on cumulative risk factors to more effectively target screening for potential CPA. Future research should include prospective studies.

Gender-specific association between childhood adversities and smoking in adulthood: findings from a population-based study.

OBJECTIVE: To investigate gender-specific differences between individual adverse childhood experiences (ACEs) and smoking behaviours in adulthood; while controlling for several known risk factors, including adult health behaviours, adult mental health, adult socio-economic indicators and social support. METHODS: Data were obtained from the 2010 Behavioral Risk Factor Surveillance System. The sample included 19,356 individuals (11,506 females and 7850 males) aged ≥18 years who were asked questions about their ACEs. Using logistic regression, the independent factors associated with ever smoking and current smoking were determined. RESULTS: Childhood physical abuse was associated with ever smoking for both males and females. Neither sexual abuse nor verbal abuse were significantly associated with ever smoking for males, but they were for females [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.13-1.63 and OR 1.14, 95% CI 1.02-1.27, respectively]. For both genders, childhood exposure to parental separation or divorce, household drug abuse or household problem drinking, were significantly associated with ever smoking. CONCLUSION: These findings underscore the need for future research that investigates gender-specific differences, and the possible mechanisms, linking individual ACEs and smoking behaviours.

Is childhood physical abuse associated with anxiety disorders among adults?

Several studies have examined the association between childhood physical abuse (CPA) and anxiety disorders with inconsistent results. In order to help clarify this relationship, we investigated the association between CPA and current anxiety disorders while controlling for the following groups of factors: (1) demographics; (2) family background; (3) current socioeconomic status (SES); (4) current stressors; and (5) current mood disorders. Data from the 2005 Canadian Community Health Survey were analyzed. The sample included 12,481 respondents from the Canadian provinces of Manitoba and Saskatchewan. The regional-level response rate was 84%. Fully 7.3% (n = 964) of respondents reported they had been physically abused as a child or adolescent by someone close to them and 4.4% (n = 540) reported they had been diagnosed with an anxiety disorder by a health professional. A significant association between CPA and anxiety disorders was found when controlling for demographic factors, family background, current SES and stressors (OR = 1.61; 95% CI = 1.25, 2.08). The odds of anxiety disorders declined to non-significance when further statistical adjustments were made for current mood disorders. The findings of this research suggest that the relationship between CPA and anxiety may be largely explained by co-morbid mood disorders.

Risk of premature stroke in recent immigrants (PRESARIO): population-based matched cohort study.

BACKGROUND: New immigrants to North America, most of whom are under age 50 years, exhibit fewer risk factors for cardiovascular disease than their native-born counterparts, yet the stress of resettlement may conceivably place them at higher risk of stroke. We determined the risk of acute stroke associated with recency of immigration. METHODS: We completed a population-based matched cohort study in Ontario, the largest province in Canada, from April 1, 1995, to March 31, 2007. Overall, 965,829 new immigrants were matched to 3,272,393 long-term residents by year of birth, sex, and location. New immigrants were identified as new recipients of universally available public health insurance, and long-term residents were those insured for 5 years or longer. RESULTS: The mean age of the participants at study entry was about 34 years and the total number of observed strokes was 6,216 after a median duration of follow-up of about 6 years. The incidence rate of acute stroke was 1.69 per 10,000 person-years among new immigrants and 2.56 per 10,000 person-years among long-term residents (crude hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.62-0.71). After adjusting for age, income quintile, urban vs rural residence, history of hypertension, diabetes mellitus and smoking, and number of health insurance claims, the HR for stroke was 0.69 (95% CI 0.64-0.74). Similar risk estimates were seen for both ischemic and hemorrhagic stroke subtypes. CONCLUSION: New immigrants appear to be at lower risk of premature acute stroke than long-term residents. This finding does not appear to be explained by the availability of health care services or income level.

Myocardial infarction associated with recency of immigration to Ontario.

BACKGROUND: New immigrants to North America exhibit lower rates of obesity and hypertension than their native-born counterparts. Whether this is reflected by a lower relative risk of acute myocardial infarction (AMI) is not known. OBJECTIVE: To determine the risk of AMI among new immigrants compared to long-term residents, and, among those who develop AMI, their short- and long-term mortality rate. DESIGN: Population-based, matched, retrospective cohort study. SETTING: Entire province of Ontario, the most populated province in Canada, from 1 April 1995 to 31 March 2007. PARTICIPANTS: A total of 965,829 new immigrants were matched to 3,272,393 long-term residents by year of birth, sex and geographic location. MEASUREMENTS: The main study outcome was hospitalization with a most responsible diagnosis of AMI. Secondary study outcomes among those who sustained an AMI were in-hospital, 30-day and 1-year mortality. RESULTS: The mean age of the participants at study entry was approximately 34 years. The incidence rate of AMI was 4.14 per 10,000 person-years among new immigrants and 6.61 per 10,000 person-years among long-term residents. After adjusting for age, income quintile, urban vs. rural residence, history of hypertension, diabetes mellitus and smoking and number of health insurance claims, the hazard ratio for AMI was 0.66 [95% confidence interval (CI): 0.63-0.69]. CONCLUSION: New immigrants appear to be at lower risk of AMI than long-term residents. This finding does not appear to be explained by the availability of health-care services or income level.

Basic ADL disability and functional limitation rates among older AMERICANS from 2000-2005: the end of the decline?

BACKGROUND: This study sought to determine whether the rates of basic activities of daily living (ADL) disabilities and functional limitations declined, remained the same, or increased between 2000 and 2005 when (a) only community-dwelling Americans aged 65 and older were examined and (b) when institutionalized older adults were included. METHOD: Using data from the American Community Survey and the National Nursing Home Survey, we calculated annual prevalence rates of basic ADL disabilities and functional limitations and fitted regression lines to examine trends over time. RESULTS: The rates of basic ADL disabilities among community-dwelling adults aged 65 and older increased 9% between 2000 and 2005. When institutionalized elders were included, basic ADL disability rates were stable among men but increased among women. Functional limitation rates did not significantly change between 2000 and 2005. CONCLUSION: These findings suggest an end of the decline in disability rates among older Americans, which, if confirmed, could have important implications for health care.

American grandparents providing extensive child care to their grandchildren: prevalence and profile.

PURPOSE: This study sought to determine the prevalence and profile of grandparents providing extensive care for a grandchild (grandparents who provide 30+ hours per week or 90+ nights per year of child care, yet are not the primary caregiver of the grandchild). DESIGN AND METHODS: Secondary analysis of the 3,260 grandparent respondents in the 1992-94 National Survey of Families and Households (NSFH). Extensively caregiving grandparents were compared with custodial grandparents (those with primary responsibility for raising a grandchild for 6+ months), noncaregivers, occasional caregivers (<10 hours per week), and intermediate caregivers using chi-square tests, one-way analysis of variance tests, and logistic regression analyses. RESULTS: Close to 7% of all grandparents provided extensive caregiving, as did 14.9% of those who had provided any grandchild care in the last month. Extensive caregivers most closely resembled custodial caregivers and had least in common with those grandparents who never provided child care. IMPLICATIONS: Areas for future research, policy, and practice are highlighted, including the potential impact of welfare reform legislation on extensively caregiving grandparents.

Canadians without regular medical doctors. Who are they?

OBJECTIVE: Because having a regular medical doctor is associated with positive outcomes, this study attempted to determine the characteristics of Canadians without regular doctors so that alternative methods of delivering care to people with those characteristics can be studied. DESIGN: Secondary data analysis of the National Population Health Survey using bivariate analyses and logistic regression. PARTICIPANTS: A total of 15,777 respondents older than 20 years. MAIN OUTCOME MEASURES: Responses to the question "Do you have a regular medical doctor?" and analysis of 11 variables covering demographics, health status, and lifestyle factors. RESULTS: One in seven respondents did not have a regular doctor. Younger respondents, men, single people, poorer respondents, respondents who perceived themselves in better health, recent immigrants, those without confidants, and smokers were more likely not to have regular doctors. Comparing provinces, participants from Quebec were least likely to have regular doctors. CONCLUSION: Primary care reform might need to consider alternative ways of providing care to certain people. Future primary care programs could be targeted to improve coverage of relatively underserviced people, particularly men, people on low incomes, those without confidants, and recent immigrants.

Does having regular care by a family physician improve preventive care?

OBJECTIVE: To assess whether regular care from a family physician is associated with receiving preventive services. DESIGN: Secondary analysis of the 1994 National Population Health Survey. SETTING: Cross-sectional sample of the Canadian population. PARTICIPANTS: A total of 15,731 non-institutionalized adults. MAIN OUTCOME MEASURES: Reported visits to general practitioners and specialists in the previous year and reports of having had blood pressure measurements, mammography, and Pap smears. RESULTS: A graded relationship was observed between level of regular care by a family physician in the previous year (none, some, regular) and receiving preventive services. Those without regular doctors and those reporting only some care by a family physician were less likely to have ever had their blood pressure checked than adults receiving ongoing care from a regular family physician. Women reporting some or no care were less likely to have had mammography within 2 years or to have ever had Pap smears. CONCLUSION: Adults who receive regular care from a family physician are more likely to receive recommended preventive services.

Second time around parenting: factors predictive of grandparents becoming caregivers for their grandchildren.

More than one in ten American grandparents raise a grandchild for at least six months, with most of these providing care for three years or more. This longitudinal study, utilizing data from the National Survey of Families and Households, identifies the pre-existing personal characteristics and contextual variables which are predictive of individuals becoming primary caregivers for their grandchildren. Contrary to hypothesis, pre-caregiving attitudes concerning intergenerational solidarity bore little relationship to the likelihood of becoming a caregiver. In contrast, being female, younger, African American, and having not completed high school were significantly predictive of becoming a custodial grandparent. Implications of these findings for research, practice, and policy in gerontology, mental health, and related areas are discussed.

The housing/health relationship: what do we know?

Research into the relationship between housing and health has frequently been narrowly focused, fragmented, and of marginal practical relevance to either housing or health policy. From an extensive review of the literature, this paper reports on the current state of knowledge about the relationship between housing and health. The research falls into four distinct categories: (1) specific physical or chemical exposures; (2) specific biological exposures; (3) physical characteristics of the house; and (4) social, economic, and cultural characteristics of housing. Much of the general literature on the effects of housing on health cites previous studies and then proceeds to advocate housing policies and strategies that are aimed at improving population health. Studies providing original data on the relationship, which is the vast majority of the literature, focus on very specific physical, chemical, and biological exposures with a known or suspected effect on health within the house, or they focus on the social, economic, and cultural characteristics of the house. The mechanisms through which specific aspects of housing affect health are extremely complicated, but they do exist. Researchers have made a great deal of progress in clarifying some of these mechanisms. A large gap still exists in our knowledge about the links and pathways between housing, socio-economic status and health status.

African American grandparents raising grandchildren: a national profile of demographic and health characteristics.

Social workers are seeing, in health care settings, an increasing number of grandparent caregivers among their clients. A disproportionate number of these are African American. This article compares the demographic and physical and mental health characteristics of African American grandparents who are raising their grandchildren with non-caregiving African American grandparents, using the National Survey of Families and Households (1992-94). Caregivers reported significantly higher levels of limitations in four of five activities of daily living (ADL) and were almost twice as likely as their peers to report clinically relevant levels of depression.

The health of grandparents raising grandchildren: results of a national study.

OBJECTIVES: This study sought to compare the functional and self-rated health of grandparents raising grandchildren with that of noncaregiving grandparents. METHODS: A secondary analysis of data from the 1992 to 1994 National Survey of Families and Households was conducted. Bivariate and logistic analyses compared 173 custodial and 3304 noncustodial grandparents in terms of functional health limitations, self-rated health, and satisfaction with health. RESULTS: Custodial grandparents were significantly more likely to have limitations in 4 of the 5 activities of daily living (ADLs) examined, with more than half reporting some limitation in 1 of the 5 ADLs. A logistic regression analysis indicated that caregiving grandparents had 50% higher odds of having an ADL limitation. Caregivers were significantly more likely to report lower satisfaction with health, and a statistical trend indicated that the caregivers had lower self-rated health. CONCLUSIONS: Further research is needed to determine whether the differences observed reflect artifacts or actual differences in functional abilities and other health measures. The need for policies that support rather than penalize grandparents raising grandchildren is stressed.

Who has screening mammography? Results from the 1994-1995 National Population Health Survey.

OBJECTIVE: To determine the characteristics of Canadian women aged 35 to 49 who receive screening mammograms not recommended by the Canadian Task Force on the Periodic Health Examination. DESIGN: Secondary data analysis of the 1994-1995 National Population Health Survey. SETTING: Patients' homes. PARTICIPANTS: From a full national representative sample of 17,626 Canadian residents, we selected 2053 women aged 35 to 49 with no breast problems. MAIN OUTCOME MEASURES: Age, education, employment status, marital status, immigrant status, region of residence, self-reported health status, having a regular doctor, smoking status, alcohol consumption, and having a confidant. RESULTS: Of the 2053 women in the sample, 825 (40.2%) had had a screening mammogram as part of a regular medical checkup; 1228 (59.8%) had never had one. Logistic analysis showed that respondents who were approaching age 50, had higher incomes, lived in Quebec, and had regular medical doctors were more likely to have screening mammograms. Statistical trends indicated that heavy drinkers were less likely and immigrants more likely to have mammograms (not significant at P < .01: P = .012 and P = .02, respectively). CONCLUSIONS: Most of these findings are consistent with those of other studies of women 50 and younger. The findings suggest that the patient variables associated with having mammograms in those younger than 50 might be similar to those in women older than 50. An important next step is to determine whether this pattern of use has more to do with younger patients' demand for screening or with physicians' ordering of tests. Further research is also needed to understand the dynamics of the doctor-patient relationship in this situation.

Depression in grandparents raising grandchildren: results of a national longitudinal study.

OBJECTIVES: To assess the effect of undertaking custodial care of a grandchild on grandparents' depression levels and to determine what characteristics are associated with higher depression levels among caregiving grandparents. DESIGN: A longitudinal national probability panel study: the National Survey of Families and Households. The first wave of data (n= 13 008) was collected in 1987 and 1988, and the second wave of data (n=10008) was collected from 1992 through 1994. SETTING: The survey was conducted in respondents' households in the coterminous United States. PARTICIPANTS: The subsample for this study was composed of 3111 respondents who reported being grandparents during the 1992-1994 interviews and for whom complete depression information was available. Of these grandparents, 158 were the primary caregivers for their grandchildren in the 1990s. MAIN OUTCOME MEASURES: Depression was measured using a modified version of the Center for Epidemiological Studies Depression Scale. RESULTS: Those who provide primary care for a grandchild are almost twice as likely to have levels of depressive symptoms above the traditional Center for Epidemiological Studies Depression Scale cut point of 16 (25.1% vs 14.5%). Even when controlling for baseline depression and demographic variables known to affect depressive symptoms, undertaking the care of a grandchild was associated significantly with higher depression levels in a multivariate prospective analysis (P<.01). Among caregiving grandparents, those who recently assumed caregiving responsibilities (P<.05) and women (P<.10) were more depressed and older respondents (P<.10) and those in good health (P<.001) were less depressed. CONCLUSIONS: Undertaking the primary care of a grandchild is associated with an increase in levels of depression. Particularly in light of the recent dramatic increase in the prevalence of grandparent caregiving in the United States, physicians need to explore familial role changes with midlife and older patients who have symptoms of depression. Special attention should be paid to the most at-risk subsets of grandparent caregivers: those who are new caregivers, those in poor health, those who are younger, and women.

A profile of grandparents raising grandchildren in the United States.

This article examines the prevalence of grandparent caregiving in the U.S. and presents a national profile of grandparent caregivers based on current data from the national Survey of Families and Households. More than one in ten grandparents are found to have cared for a grandchild for at least 6 months, with most of these having engaged in a far longer-term commitment. Although custodial grandparenting cuts across gender, class, and ethnic lines, single women, African Americans, and low income persons are disproportionately represented. Multivariate logistic analysis indicates that three groups--women, recently bereaved parents, and African Americans--have approximately twice the odds of becoming caregiving grandparents. Implications for further research, policy, and practice are discussed.