Women's Agency as Reason for Life Threats Among the Pashtuns in Pakistan: Narratives of Women Fleeing Honor Killing and Masculine Domination.

This article uses the narratives of survivors of honor killing to show that women's agency is the reason for life threats because it undermines masculine domination. The findings show that life threats are made against women engaging in behaviors not aligned to cultural norms as perceived by male members of their family, to escape shame and gossip, and it is a manifestation of men losing control over women. These survivors of honor-based violence have undermined masculine domination by acting in unanticipated ways and by fleeing to a shelter home in the face of overwhelming cultural sanctions and structural inequalities.

Accuracy of matching residential postal codes to census geography.

BACKGROUND: Postal codes are often the only geographic identifier available to match subjects in a health dataset to census geography. This paper describes the characteristics of postal codes reported by the Canadian population on the census and, as an indicator of geocoding accuracy, the proportion that are linked to a single dissemination area (DA). DATA AND METHODS: Postal codes reported on the 2016 Census questionnaire were matched to a combination of the Postal Code Conversion File (PCCF) and the Postal Code Conversion File Plus (PCCF+ version 7B) (reference date November 2018) to calculate population-weighted counts and the number of matches to DAs by province or territory, delivery mode type (DMT), population centre or rural area size, and census metropolitan area. The number of single matches to census tracts (CTs), census subdivisions (CSDs) and census divisions (CDs) was also calculated. RESULTS: In Canada, 72.6% of the population reported postal codes that matched to a single DA. This proportion was higher in urban cores (87.1%) and among postal codes for an urban street address (DMT=A) (85.3%) or apartment building (DMT=B) (95.3%), and was lower in rural areas (26.2% to 38.1%) and among rural postal codes (13.9%). In comparison, 89.3% and 95.4% of the population reported postal codes matching to a single CSD or CD, respectively, while 92.1% of the population that live within CT boundaries were matched to a single CT. DISCUSSION: Matching postal codes to census geography is relatively accurate and frequently one to one in urban centres. In rural areas and for some types of postal code DMTs, alternative approaches to using the PCCF and PCCF+ for attaching census geography might be explored.

Positional accuracy of geocoding from residential postal codes versus full street addresses.

BACKGROUND: Postal codes are often the only geographic identifier available for assigning contextual or environmental information to a study population. This analysis assesses the influence of three factors-delivery mode type (mode of postal delivery), representative point type (source of latitude-longitude coordinates), and community size-on the accuracy of postal code spatial assignment. DATA AND METHODS: PCCF+ (Postal Code Conversion File Plus) was used to assign delivery mode type, representative point type and community size to each individual in the 2011 Census of Canada. A sample (n = 1,004) was randomly selected with a minimum of 90 observations for each category of those three factors. Based on the address information of individuals in the sample, measures of positional accuracy for geocoding from residential postal codes (PCCF+) versus reference locations as determined by full street addresses (Google Maps) were calculated using a geographic information system. Accuracy was measured as the distance that the geocoded position differed from the full street address. RESULTS: Positional accuracy was related primarily to mode of postal delivery. Rural and mixed (partly urban, partly rural) modes had much higher geocoding error than did urban modes. Rural and small-town Canada and latitude and longitude based on dissemination area centroids had low accuracy, largely because of their close relationship to rural and mixed modes of delivery. DISCUSSION: The accuracy of geocoding from postal codes can vary. Geocoding imprecision may result in misclassification, depending on the spatial resolution of the environmental or contextual measures. The spatial resolution required for a study helps to identify subpopulations that should be excluded because of inadequate positional accuracy.

Concurrent mental and substance use disorders in Canada.

Based on results of the 2012 Canadian Community Health Survey-Mental Health, 1.2% of Canadians aged 15 to 64 (an estimated 282,000) experienced mental and substance use disorders concurrently in the previous year (at least one mood/anxiety disorder and one substance use disorder). Demographic, socioeconomic, health status and service use characteristics of the concurrent disorder group were compared with those of people who had only a mood/ anxiety disorder or only a substance use disorder. Those with concurrent disorders had consistently poorer psychological health and higher use of health services and were more likely to report partially met/unmet needs than the substance use disorder group, even when demographic and socioeconomic factors and number of chronic health conditions were taken into account. Apparent similarities in health status, service use and partially met/unmet needs between the concurrent disorders and mood/anxiety disorder groups did not persist in multivariate analysis. The findings suggest that the complexity of concurrent disorders contributes to poorer psychological health outcomes and higher health service use, compared with having only a mood/anxiety disorder or a substance use disorder.

Modelling risk factor information for linked census data: The case of smoking.

BACKGROUND: Statistics Canada has initiated a series of data linkages of Census of Population long form and health outcome data. These linked data lack risk factor information. This study assesses the feasibility of using statistical modelling techniques to assign smoking status to census respondents. DATA AND METHODS: The 2000/2001 Canadian Community Health Survey (CCHS) was used to develop age-/sex-specific predictive models to model smoking status based on variables available on the 1991 Census. The 2002/2003 CCHS was used to validate the modelled variable. Data from the 2002/2003 CCHS linked to data from the Hospital Morbidity Database (2001/2002 to 2004/2005) were used to evaluate the use of modelled versus self-reported smoking status on smoking-related hospitalizations. RESULTS: For the current daily smoker models, income, education, marital status, dwelling ownership and region of birth were significant predictors. For the never smoker models, marital status, dwelling ownership, Aboriginal identity and region of birth were significant predictors. Modelled current daily smoker status was associated with increased odds of smoking-related hospitalization, compared with being a never smoker, even when adjusting for covariates. INTERPRETATION: This study demonstrates the feasibility of using statistical modelling techniques to assign smoking status to census data, provided socio-economic and identity information is available.

Risk of nonaccidental and cardiovascular mortality in relation to long-term exposure to low concentrations of fine particulate matter: a Canadian national-level cohort study.

BACKGROUND: Few cohort studies have evaluated the risk of mortality associated with long-term exposure to fine particulate matter [≤ 2.5 µm in aerodynamic diameter (PM(2.5))]. This is the first national-level cohort study to investigate these risks in Canada. OBJECTIVE: We investigated the association between long-term exposure to ambient PM(2.5) and cardiovascular mortality in nonimmigrant Canadian adults. METHODS: We assigned estimates of exposure to ambient PM(2.5) derived from satellite observations to a cohort of 2.1 million Canadian adults who in 1991 were among the 20% of the population mandated to provide detailed census data. We identified deaths occurring between 1991 and 2001 through record linkage. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for available individual-level and contextual covariates using both standard Cox proportional survival models and nested, spatial random-effects survival models. RESULTS: Using standard Cox models, we calculated HRs of 1.15 (95% CI: 1.13, 1.16) from nonaccidental causes and 1.31 (95% CI: 1.27, 1.35) from ischemic heart disease for each 10-µg/m(3) increase in concentrations of PM(2.5). Using spatial random-effects models controlling for the same variables, we calculated HRs of 1.10 (95% CI: 1.05, 1.15) and 1.30 (95% CI: 1.18, 1.43), respectively. We found similar associations between nonaccidental mortality and PM2.5 based on satellite-derived estimates and ground-based measurements in a subanalysis of subjects in 11 cities. CONCLUSIONS: In this large national cohort of nonimmigrant Canadians, mortality was associated with long-term exposure to PM(2.5). Associations were observed with exposures to PM(2.5) at concentrations that were predominantly lower (mean, 8.7 µg/m(3); interquartile range, 6.2 µg/m(3)) than those reported previously.

Child care in Quebec: access to a universal program.

BACKGROUND: Five cycles of data from the Canadian National Longitudinal Survey of Children and Youth (1994/5-2002/3) were used to examine patterns of child care use in Quebec and the rest of Canada to explore the impact of Quebec's implementation of universal child care. METHODS: Rates of overall use as well as use of regulated (child care centre, family child care) and non-regulated care (sitter, nanny, relative, family child care) were examined for preschoolers aged 0-5 years in Quebec as compared to the other provinces and by family household income. Chi-square tests were used to examine significance of differences. RESULTS: Since the implementation of Quebec's child care program, Quebec demonstrated substantial increases in child care use, particularly in the use of regulated care (from 10% prior to program compared to 30% by 2002) whereas the use of unregulated care did not demonstrate a significant increase in Quebec as compared to the other provinces (1994 to 2002). Furthermore, the use of regulated care by low-income families was greater in Quebec than elsewhere in Canada, although the greatest increase in use of regulated care was for children from high-income families. CONCLUSION: Findings suggest that since the introduction of Quebec's universal child care program, there was an increase in the use of regulated child care for families of preschool-aged children in the province, although by 2002 Quebec had not achieved the coverage of universal child care programs attained by many European countries.

The predictive validity of health-related quality of life measures: mortality in a longitudinal population-based study.

OBJECTIVE: This study examined the association between health-related quality of life (HRQL) and mortality risk, and compared the predictive ability of Health Utilities Index Mark 3 (HUI3) with self-rated health (SRH). METHODS: Data were from the 1994/95 Canadian National Population Health Survey, consisting of 12,375 women and men aged 18 and older. Cox proportional hazards regression models were performed to estimate mortality risk over eight years. RESULTS: Mortality risks for people reporting good, fair, and poor health at baseline were, respectively, 1.44 (95% confidence interval [CI] 1.04, 2.00), 1.97 (1.35, 2.88), and 3.21 (2.08, 4.95) times greater than those who reported excellent health. In a model excluding SRH, the effect of HUI3 on mortality was strong and significant (HR = 0.47; 95%, 0.33, 0.67) when adjusted for possible confounders. When HUI3 and SRH were considered simultaneously, the effect of the HUI3 on mortality was somewhat attenuated, but still significant (HR = 0.61, 0.42, 0.89) after adjusting for potential confounders. CONCLUSIONS: Although SRH is a modestly stronger predictor of mortality than HUI3, HUI3 adds to the mortality prediction ability of SRH.

Body mass index in urban Canada: neighborhood and metropolitan area effects.

OBJECTIVES: We investigated the influence of neighborhood and metropolitan area characteristics on body mass index (BMI) in urban Canada in 2001. METHODS: We conducted a multilevel analysis with data collected from a cross-sectional survey of men and women nested in neighborhoods and metropolitan areas in urban Canada during 2001. RESULTS: After we controlled for individual sociodemographic characteristics and behaviors, the average BMIs of residents of neighborhoods in which a large proportion of individuals had less than a high school education were higher than those BMIs of residents in neighborhoods with small proportions of such individuals (P< .01). Living in a neighborhood with a high proportion of recent immigrants was associated with lower BMI for men (P<.01), but not for women. Neighborhood dwelling density was not associated with BMI for either gender. Metropolitan sprawl was associated with higher BMI for men (P=.02), but the effect was not significant for women (P= .09). CONCLUSIONS: BMI is strongly patterned by an individual's social position in urban Canada. A neighborhood's social condition has an incremental influence on the average BMI of its residents. However, BMI is not influenced by dwelling density. Metropolitan sprawl is associated with higher BMI for Canadian men, which supports recent evidence of this same association among American men. Individuals and their environments collectively influence BMI in urban Canada.