1
|
Guglielmin M, Shankardass K, O’Campo P, Bayoumi AM, Kokkinen L, Muntaner C. Developing a Research Agenda for HiAP Implementation: A Response to the Recent Commentaries. Int J Health Policy Manag 2023; 12:8326. [PMID: 38618764 PMCID: PMC10843367 DOI: 10.34172/ijhpm.2023.8326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/06/2023] [Indexed: 04/16/2024] Open
Affiliation(s)
- Maria Guglielmin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Carles Muntaner
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloomberg School of Nursing University of Toronto, Toronto, ON, Canada
| |
Collapse
|
2
|
Wankah P, Gordon D, Shahid S, Chandra S, Abejirinde IO, Yoon R, Wodchis WP, O’Campo P, Gray CS, Clark N, Shaw J. Equity Promoting Integrated Care: Definition and Future Development. Int J Integr Care 2023; 23:6. [PMID: 37867579 PMCID: PMC10588500 DOI: 10.5334/ijic.7614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023] Open
Abstract
Over the last three decades, integrated care has emerged as an important health system strategy to improve population health while addressing the unique needs of structurally marginalised communities. However, less attention has been given to the role of integrated care in addressing issues related to inequities in health and health care. In this commentary we introduce the concept of Equity Promoting Integrated Care (EPIC) that situates integrated care in a social justice context to frame the actions necessary to center equity as a priority for integrated care. We suggest that efforts to advance the design and implementation of integrated care should focus on three avenues for future research and practice, namely, the collaborative mobilization of a global network of integrated care stakeholders to advocate for social justice and health equity, investing in equity-focused approaches to implementation science that highlight the importance of social concepts such as colonialism and intersectionality to advance the theory and practice of implementing EPIC models of care, and leveraging innovative approaches to measuring equity-related aspects of integrated care to inform continuous improvement of health systems.
Collapse
Affiliation(s)
- Paul Wankah
- University of Toronto, CA
- Women’s College Hospital, CA
| | - Dara Gordon
- University of Toronto, CA
- Women’s College Hospital, CA
| | | | | | | | | | - Walter P. Wodchis
- University of Toronto, CA
- Institute for Better Health, Trillium Health Partners, CA
| | | | - Carolyn Steele Gray
- University of Toronto, CA
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, CA
| | | | - James Shaw
- University of Toronto, Women’s College Hospital, CA
| |
Collapse
|
3
|
Odhiambo AJ, O’Campo P, Nelson LRE, Forman L, Grace D. Structural violence and the uncertainty of viral undetectability for African, Caribbean and Black people living with HIV in Canada: an institutional ethnography. Int J Equity Health 2023; 22:33. [PMID: 36797746 PMCID: PMC9935247 DOI: 10.1186/s12939-022-01792-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/15/2022] [Indexed: 02/18/2023] Open
Abstract
Biomedical advances in healthcare and antiretroviral treatment or therapy (ART) have transformed HIV/AIDS from a death sentence to a manageable chronic disease. Studies demonstrate that people living with HIV who adhere to antiretroviral therapy can achieve viral suppression or undetectability, which is fundamental for optimizing health outcomes, decreasing HIV-related mortality and morbidity, and preventing HIV transmission. African, Caribbean, and Black (ACB) communities in Canada remain structurally disadvantaged and bear a disproportionate burden of HIV despite biomedical advancements in HIV treatment and prevention. This institutional ethnography orients to the concept of 'structural violence' to illuminate how inequities shape the daily experiences of ACB people living with HIV across the HIV care cascade. We conducted textual analysis and in-depth interviews with ACB people living with HIV (n = 20) and health professionals including healthcare providers, social workers, frontline workers, and health policy actors (n = 15). Study findings produce a cumulative understanding that biomedical HIV discourses and practices ignore structural violence embedded in Canada's social fabric, including legislation, policies and institutional practices that produce inequities and shape the social world of Black communities. Findings show that inequities in structural and social determinants of health such as food insecurity, financial and housing instability, homelessness, precarious immigration status, stigma, racial discrimination, anti-Black racism, criminalization of HIV non-disclosure, health systems barriers and privacy concerns intersect to constrain engagement and retention in HIV healthcare and ART adherence, contributing to the uncertainty of achieving and maintaining undetectability and violating their right to health. Biomedical discourses and practices, and inequities reduce Black people to a stigmatized, pathologized, and impoverished detectable viral underclass. Black people perceived as nonadherent to ART and maintain detectable viral loads are considered "bad" patients while privileged individuals who achieve undetectability are considered "good" patients. An effective response to ending HIV/AIDS requires implementing policies and institutional practices that address inequities in structural and social determinants of health among ACB people.
Collapse
Affiliation(s)
- Apondi J. Odhiambo
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Patricia O’Campo
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.415502.7St, Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - La Ron E. Nelson
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ,grid.415502.7St, Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada ,grid.47100.320000000419368710Yale School of Nursing, New Haven, CT USA
| | - Lisa Forman
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Daniel Grace
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| |
Collapse
|
4
|
O’Campo P, Nisenbaum R, Crocker AG, Nicholls T, Eiboff F, Adair CE. Women experiencing homelessness and mental illness in a Housing First multi-site trial: Looking beyond housing to social outcomes and well-being. PLoS One 2023; 18:e0277074. [PMID: 36763583 PMCID: PMC9916643 DOI: 10.1371/journal.pone.0277074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/19/2022] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE There is scant research on the effectiveness of permanent supportive housing for homeless women with mental illness. This study examines the effectiveness of Housing First with an unprecedentedly large sample of homeless women from five Canadian cities, and explore baseline risk factors that predict social, health and well-being outcomes over a 24 month-period. METHODS The At Home/Chez Soi multi-site randomized controlled Housing First trial recruited over 600 women between October 2009 and July 2011. This is a post-hoc subgroup exploratory analysis of self-identified women with at least one follow-up interview who were randomized to Housing First (HF) (n = 374) or treatment-as-usual (TAU) (n = 279) and had at least one follow-up interview. Linear mixed models and generalized estimating equations were used after multiple imputation was applied to address missing data. RESULTS At the end of follow-up, the mean percentage of days spent stably housed was higher for women in the intervention 74.8% (95%CI = 71.7%-77.8%) compared with women in the treatment-as-usual group, 37.9% (95%CI = 34.4%-41.3%), p<0.001. With few exceptions, social and mental health outcomes were similar for both groups at 6-, 12-, 18- and 24-months post-enrollment. Suicidality was a consistent predictor of increased mental health symptoms (beta = 2.85, 95% CI 1.59-4.11, p<0.001), decreased quality of life (beta = -3.99, 95% CI -6.49 to -1.49, p<0.001), decreased community functioning (beta = -1.16, 95% CI -2.10 to -0.22, p = 0.015) and more emergency department visits (rate ratio = 1.44, 95% CI 1.10-1.87, p<0.001) over the study period. Lower education was a predictor of lower community functioning (beta = -1.32, 95% CI -2.27 to -0.37, p = 0.006) and higher substance use problems (rate ratio = 1.27, 95% CI 1.06-1.52, p = 0.009) during the study. CONCLUSIONS Housing First interventions ensured that women experiencing homelessness are quickly and consistently stably housed. However, they did not differentially impact health and social measures compared to treatment as usual. Ensuring positive health and social outcomes may require greater supports at enrolment for subgroups such as those with low educational attainment, and additional attention to severity of baseline mental health challenges, such as suicidality. TRIAL REGISTRATION International Standard Randomized Control Trial Number Register Identifier: ISRCTN42520374.
Collapse
Affiliation(s)
- Patricia O’Campo
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- * E-mail:
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Anne G. Crocker
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, Canada
- Department of Psychiatry & Addictions, Université de Montréal, Montreal, Canada
- School of Criminology, Université de Montréal, Montreal, Canada
| | - Tonia Nicholls
- British Columbia Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Faith Eiboff
- Interdisciplinary Studies, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Carol E. Adair
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
5
|
Jairam JA, Vigod SN, Siddiqi A, Guan J, Boblitz A, Wang X, O’Campo P, Ray JG. Severe Maternal Morbidity and Mortality Among Immigrant and Canadian-Born Women Residing Within Low-Income Neighborhoods in Ontario, Canada. JAMA Netw Open 2023; 6:e2256203. [PMID: 36795412 PMCID: PMC9936351 DOI: 10.1001/jamanetworkopen.2022.56203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
IMPORTANCE Evidence indicates that immigrant women and women residing within low-income neighborhoods experience higher adversity during pregnancy. Little is known about the comparative risk of severe maternal morbidity or mortality (SMM-M) among immigrant vs nonimmigrant women living in low-income areas. OBJECTIVE To compare the risk of SMM-M between immigrant and nonimmigrant women residing exclusively within low-income neighborhoods in Ontario, Canada. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used administrative data for Ontario, Canada, from April 1, 2002, to December 31, 2019. Included were all 414 337 hospital-based singleton live births and stillbirths occurring between 20 and 42 weeks' gestation, solely among women residing in an urban neighborhood of the lowest income quintile; all women were receiving universal health care insurance. Statistical analysis was performed from December 2021 to March 2022. EXPOSURES Nonrefugee immigrant status vs nonimmigrant status. MAIN OUTCOMES AND MEASURES The primary outcome, SMM-M, was a composite outcome of potentially life-threatening complications or mortality occurring within 42 days of the index birth hospitalization. A secondary outcome was SMM severity, approximated by the number of SMM indicators (0, 1, 2 or ≥3 indicators). Relative risks (RRs), absolute risk differences (ARDs), and odds ratios (ORs) were adjusted for maternal age and parity. RESULTS The cohort included 148 085 births to immigrant women (mean [SD] age at index birth, 30.6 [5.2] years) and 266 252 births to nonimmigrant women (mean [SD] age at index birth, 27.9 [5.9] years). Most immigrant women originated from South Asia (52 447 [35.4%]) and the East Asia and Pacific (35 280 [23.8%]) regions. The most frequent SMM indicators were postpartum hemorrhage with red blood cell transfusion, intensive care unit admission, and puerperal sepsis. The rate of SMM-M was lower among immigrant women (2459 of 148 085 [16.6 per 1000 births]) than nonimmigrant women (4563 of 266 252 [17.1 per 1000 births]), equivalent to an adjusted RR of 0.92 (95% CI, 0.88-0.97) and an adjusted ARD of -1.5 per 1000 births (95% CI, -2.3 to -0.7). Comparing immigrant vs nonimmigrant women, the adjusted OR of having 1 SMM indicator was 0.92 (95% CI, 0.87-0.98), the adjusted OR of having 2 indicators was 0.86 (95% CI, 0.76-0.98), and the adjusted OR of having 3 or more indicators was 1.02 (95% CI, 0.87-1.19). CONCLUSIONS AND RELEVANCE This study suggests that, among universally insured women residing in low-income urban areas, immigrant women have a slightly lower associated risk of SMM-M than their nonimmigrant counterparts. Efforts aimed at improving pregnancy care should focus on all women residing in low-income neighborhoods.
Collapse
Affiliation(s)
- Jennifer A. Jairam
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Simone N. Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Women’s College Hospital, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill
| | | | | | | | - Patricia O’Campo
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Joel G. Ray
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Keenan Research Centre, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St Michael’s Hospital, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Guglielmin M, Shankardass K, Bayoumi A, O’Campo P, Kokkinen L, Muntaner C. A Realist Explanatory Case Study Investigating How Common Goals, Leadership, and Committed Staff Facilitate Health in All Policies Implementation in the Municipality of Kuopio, Finland. Int J Health Policy Manag 2022; 11:2651-2659. [PMID: 35247936 PMCID: PMC9818123 DOI: 10.34172/ijhpm.2022.6355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/05/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Health in All Policies (HiAP) encompasses collaboration across government and the consideration of health in various governmental sector's policies and decisions. Despite increasing advocacy, interest, and uptake in HiAP globally, empirical and evaluative studies are underrepresented in this growing literature, particularly literature on HiAP implementation at the local level. Finland has been a pioneer in and champion for HiAP. METHODS A realist explanatory case study design was used to test hypotheses about how HiAP is implemented in Kuopio, Finland. Semi-structured interviews with ten government employees from various sectors were conducted. Data from interviews and literature were analyzed with the aims of uncovering explanatory mechanisms in the form of context-strategy-mechanism-outcome (CSMO) configurations related to implementation strategies. Evidence was evaluated for quality based on triangulation of sources and strength of evidence. We hypothesized that having or creating a common goal between sectors and having committed staff and local leadership would facilitate implementation. RESULTS Strong evidence supports our hypothesis that having or creating a common goal can aid in positive implementation outcomes at the local level. Common goals can be created by the strategies of having a city mandate, engaging in cross-sectoral discussions, and/or by working together. Policy and political elite leadership led to HiAP implementation success because leaders supported HiAP work, thus providing justification for using time to work intersectorally. How and why the wellbeing committee facilitated implementation included by providing opportunities for discussion and learning, which led to understanding of how non-health decisions impact community wellbeing, and by acting as a conduit for the communication of wellbeing goals to government employees. CONCLUSION At the municipal level, having or creating a common goal, leadership from policy and political elites, and the presence of committed staff can facilitate HiAP implementation. Inclusion of not only strategies for HiAP, but also the explanatory mechanisms, aids in elucidating how and why HiAP is successfully implemented in a local setting.
Collapse
Affiliation(s)
- Maria Guglielmin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ahmed Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Carles Muntaner
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloomberg School of Nursing University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
Mejia-Lancheros C, Lachaud J, Gogosis E, Thulien N, Stergiopoulos V, Da Silva G, Nisenbaum R, O’Campo P, Hwang S. Providing Housing First services for an underserved population during the early wave of the COVID-19 pandemic: A qualitative study. PLoS One 2022; 17:e0278459. [PMID: 36454981 PMCID: PMC9714853 DOI: 10.1371/journal.pone.0278459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE We assessed the critical role of Housing First (HF) programs and frontline workers in responding to challenges faced during the first wave of the COVID-19 pandemic. METHOD Semi-structured interviews were conducted with nine HF frontline workers from three HF programs between May 2020 and July 2020, in Toronto, Canada. Information was collected on challenges and adjustments needed to provide services to HF clients (people experiencing homelessness and mental disorders). We applied the Analytical Framework method and thematic analysis to our data. RESULTS Inability to provide in-person support and socializing activities, barriers to appropriate mental health assessments, and limited virtual communication due to clients' lack of access to digital devices were among the most salient challenges that HF frontline workers reported during the COVID-19 pandemic. Implementing virtual support services, provision of urgent in-office or in-field support, distributing food aid, connecting clients with online healthcare services, increasing harm reduction education and referral, and meeting urgent housing needs were some of the strategies implemented by HF frontline workers to support the complex needs of their clients during the pandemic. HF frontline workers experienced workload burden, job insecurity and mental health problems (e.g. distress, worry, anxiety) as a consequence of their services during the first wave of the COVID-19 pandemic. CONCLUSION Despite the several work-, programming- and structural-related challenges experienced by HF frontline workers when responding to the needs of their clients during the first wave of the COVID-19 pandemic, they played a critical role in meeting the communication, food, housing and health needs of their clients during the pandemic, even when it negatively affected their well-being. A more coordinated, integrated, innovative, sustainable, effective and well-funded support response is required to meet the intersecting and complex social, housing, health and financial needs of underserved and socio-economically excluded groups during and beyond health emergencies.
Collapse
Affiliation(s)
- Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Research Group in Nursing Care and Practice, Family Health Nursing and Health Measures; Nursing Faculty, Universidad Nacional de Colombia, Bogotá, Colombia
- * E-mail:
| | - James Lachaud
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Evie Gogosis
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Naomi Thulien
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - George Da Silva
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Amri M, O’Campo P, Enright T, Siddiqi A, Di Ruggiero E, Bump JB. Probing key informants’ views of health equity within the World Health Organization’s Urban HEART initiative. BMC Public Health 2022; 22:1989. [PMID: 36316679 PMCID: PMC9620663 DOI: 10.1186/s12889-022-14395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
To date, no studies have assessed how those involved in the World Health Organization’s (WHO) work understand the concept of health equity. To fill the gap, this research poses the question, “how do Urban Health Equity Assessment and Response Tool (Urban HEART) key informants understand the concept of health equity?”, with Urban HEART being selected given the focus on health equity. To answer this question, this study undertakes synchronous electronic interviews with key informants to assess how they understand health equity within the context of Urban HEART. Key findings demonstrate that: (i) equity is seen as a core value and inequities were understood to be avoidable, systematic, unnecessary, and unfair; (ii) there was a questionable acceptance of need to act, given that political sensitivity arose around acknowledging inequities as “unnecessary”; (iii) despite this broader understanding of the key aspects of health inequity, the concept of health equity was seen as vague; (iv) the recognized vagueness inherent in the concept of health equity may be due to various factors including country differences; (v) how the terms “health inequity” and “health inequality” were used varied drastically; and (vi) when speaking about equity, a wide range of aspects emerged. Moving forward, it would be important to establish a shared understanding across key terms and seek clarification, prior to any global health initiatives, whether explicitly focused on health equity or not.
Collapse
Affiliation(s)
- Michelle Amri
- grid.38142.3c000000041936754XTakemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Bldg. 1, 02115-6021 Boston, MA United States of America ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada
| | - Patricia O’Campo
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada ,grid.415502.7Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, M5B 1T8 Toronto, ON Canada
| | - Theresa Enright
- grid.17063.330000 0001 2157 2938Department of Political Science, University of Toronto, 100 St George Street, M5S 3G3 Toronto, ON Canada
| | - Arjumand Siddiqi
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada ,grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, USA
| | - Erica Di Ruggiero
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 1P8 Toronto, ON Canada
| | - Jesse Boardman Bump
- grid.38142.3c000000041936754XTakemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Bldg. 1, 02115-6021 Boston, MA United States of America ,grid.7914.b0000 0004 1936 7443Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway
| |
Collapse
|
9
|
Kim C, Chum A, Nielsen A, Allin S, Penney TL, Rittenbach K, MacMaster FP, O’Campo P. Associations between recreational cannabis legalization and cannabis-related emergency department visits by age, gender, and geographic status in Ontario, Canada: An interrupted time series study. PLoS One 2022; 17:e0268718. [PMID: 36288275 PMCID: PMC9604957 DOI: 10.1371/journal.pone.0268718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/29/2022] [Indexed: 11/18/2022] Open
Abstract
Legalization of recreational cannabis in Ontario included the legalization of flower and herbs (Phase 1, October 2018), and was followed by the deregulation of cannabis retailers and sales of edibles (Phase 2, February 2020). Research on the impact of cannabis legalization on acute care utilization is nascet; no research has investigated potential age, gender, and geographically vulnerable subgroup effects. Residents living in Northern Ontario not only have higher levels of substance use problems, but also have inadequate access to primary healthcare. Our study investigated the impact of Ontario's recreational cannabis policy (including Phase 1 and 2) on cannabis-attributable emergency department (ED) visits, and estimated the impact separately for different age and gender groups, with additional analyses focused on Northern Ontarians. We created a cohort of adults (18 and over) eligible for provincial universal health insurance with continuous coverage from 2015-2021 (n = 14,900,820). An interrupted time series was used to examine the immediate impact and month-to-month changes in cannabis-related ED visits associated with Phase 1 & 2 for each subgroup. While Northern Ontario has higher rates of cannabis-related ED visits, both Northern and Southern Ontario show similar patterns of changes. Phase 1 was associated with significant increases in adults 25-64, with the strongest increases seen in women 45-64. Month-to-month trends were flattened in most groups compared to pre-legalization. Phase 2 was associated with significant immediate increases for adults aged 18-44 in both genders, but the increases were larger in women than men. No significant month-to-month changes were detected in this period. While current preventive efforts are largely focused on reducing cannabis-related harms in youths and younger adults, our results show that adults 25-64, particularly women, have been significantly impacted by cannabis policies. Further research on gender-specific cannabis dosage and targeted interventions for adult women should be investigated. Legalization did not appear to have a differential impact on Northern versus Southern Ontario, but higher rates of ED visits in the North should be addressed.
Collapse
Affiliation(s)
- Chungah Kim
- York University, School of Kinesiology and Health Sciences, Toronto, Ontario, Canada
| | - Antony Chum
- York University, School of Kinesiology and Health Sciences, Toronto, Ontario, Canada
- Unity Health Toronto, MAP Centre for Urban Health Solutions, Toronto, Ontario, Canada
- * E-mail:
| | - Andrew Nielsen
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Sara Allin
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Tarra L. Penney
- York University Faculty of Health, School of Global Health, Toronto, Ontario, Canada
- University of Cambridge School of Clinical Medicine, MRC Epidemiology Unit, Cambridge, Cambridgeshire, United Kingdom
| | - Katherine Rittenbach
- Alberta Health Services, Strategic Clinical Networks, Edmonton, Alberta, Canada
- University of Calgary, Department of Psychiatry, Calgary, Alberta, Canada
| | - Frank P. MacMaster
- Alberta Health Services, Strategic Clinical Networks, Edmonton, Alberta, Canada
- University of Calgary, Department of Psychiatry, Calgary, Alberta, Canada
| | - Patricia O’Campo
- Unity Health Toronto, MAP Centre for Urban Health Solutions, Toronto, Ontario, Canada
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Yakubovich AR, Heron J, Metheny N, Gesink D, O’Campo P. Measuring the Burden of Intimate Partner Violence by Sex and Sexual Identity: Results From a Random Sample in Toronto, Canada. J Interpers Violence 2022; 37:NP18690-NP18712. [PMID: 34376084 PMCID: PMC9554278 DOI: 10.1177/08862605211037433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Debates on how sex, gender, and sexual identity relate to intimate partner violence (IPV) are longstanding. Yet the role that measurement plays in how we understand the distribution of IPV has been understudied. We investigated whether people respond differently to IPV items by sex and sexual identity and the implications this has for understanding differences in IPV burdens. Our sample was 2,412 randomly selected residents of Toronto, Canada, from the Neighborhood Effects on Health and Well-being (NEHW) study. IPV was measured using short forms of the Physical and Nonphysical Partner Abuse Scales (20 items). We evaluated the psychometric properties of this measure by sex and sexual identity. We examined whether experiences of IPV differed by sex and sexual identity (accounting for age and neighborhood clustering) and the impacts of accounting for latent structure and measurement variance. We identified differential item functioning by sex for six items, mostly related to nonphysical IPV (e.g., partner jealousy). Males had higher probabilities of reporting five of the six items compared to females with the same latent IPV scores. Being female and identifying as lesbian, gay, or bisexual were positively associated with experiencing IPV. However, the association between female sex and IPV was underestimated when response bias was not accounted for and outcomes were dichotomized as "any IPV." Common practices of assuming measurement invariance and dichotomizing IPV can underestimate the association between sex or gender and IPV. Researchers should continue to attend to gender-based and intersectional differences in IPV but test for measurement invariance prior to comparing groups and analyze scale (as opposed to binary) measures to account for chronicity or intensity.
Collapse
Affiliation(s)
| | | | | | | | - Patricia O’Campo
- Unity Health Toronto, ON, Canada
- University of Toronto, ON,
Canada
| |
Collapse
|
11
|
Mejia-Lancheros C, Lachaud J, Aubry T, Wiens K, O’Campo P, Stergiopoulos V, Hwang SW. Multi-trajectory group profiles of well-being and associated predictors among adults experiencing homelessness and mental illness: findings from the At Home/Chez Soi study, Toronto site. Soc Psychiatry Psychiatr Epidemiol 2022; 57:67-81. [PMID: 33866385 PMCID: PMC8761129 DOI: 10.1007/s00127-021-02093-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 04/07/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE To conduct a multi-dimensional and time-patterned analysis to identify distinct well-being trajectory profiles over a 6-year follow-up period among adults experiencing homelessness and mental illness. METHODS Data from 543 participants of the At Home Chez Soi study's Toronto site were examined over a 6-year follow-up period, including measures of quality of life, community functioning, housing stability, and substance use. Well-being trajectories were identified using Group-Based Trajectory Modelling. Multinomial regression was used to identify predictor variables that were associated with each well-being trajectory profile. RESULTS Four well-being profiles were identified: low well-being, moderate well-being, good well-being, and high well-being. Factors associated with a greater likelihood of following a better well-being profile included receiving Housing First, reporting female gender and non-white ethnicity, having post-secondary studies, and reporting a high resilience level. Concurrently, factors associated with a lower likelihood of better well-being profiles were having a history of chronic homelessness, experiences of discrimination in the healthcare setting, having comorbid mental disorders and a high level of symptom severity, and reporting a history of traumatic brain injury and childhood adversity. CONCLUSIONS Individuals experiencing homelessness follow distinct well-being profiles associated with their socio-demographic characteristics, health status, trauma history, resilience capabilities, and access to housing and support services. This work can inform integrated housing and support services to enhance the well-being trajectories of individuals experiencing homelessness. TRIAL REGISTRATION At Home/Chez Soi trial was registered with ISRCTN, ISRCTN42520374, http://www.isrctn.com/ISRCTN42520374 .
Collapse
Affiliation(s)
- Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON, M5B 1W8, Canada.
| | - James Lachaud
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON M5B 1W8 Canada
| | - Tim Aubry
- School of Psychology, University of Ottawa, Ottawa, ON Canada
| | - Kathryn Wiens
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON M5B 1W8 Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON M5B 1W8 Canada ,Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON Canada ,Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON M5B 1W8 Canada ,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON Canada
| |
Collapse
|
12
|
Grewal EK, Campbell RB, Booth GL, McBrien KA, Hwang SW, O’Campo P, Campbell DJT. Using concept mapping to prioritize barriers to diabetes care and self-management for those who experience homelessness. Int J Equity Health 2021; 20:158. [PMID: 34243783 PMCID: PMC8272311 DOI: 10.1186/s12939-021-01494-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/08/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Diabetes is a chronic medical condition which demands that patients engage in self-management to achieve optimal glycemic control and avoid severe complications. Individuals who have diabetes and are experiencing homelessness are more likely to have chronic hyperglycemia and adverse outcomes. Our objective was to collaborate with individuals experiencing homelessness and care providers to understand the barriers they face in managing diabetes, as a first step in identifying solutions for enhancing diabetes management in this population. METHODS We recruited individuals with lived experience of homelessness and diabetes (i.e. clients; n = 32) from Toronto and health and social care providers working in the areas of diabetes and/or homelessness (i.e. providers; n = 96) from across Canada. We used concept mapping, a participatory research method, to engage participants in brainstorming barriers to diabetes management, which were subsequently categorized into clusters, using the Concept Systems Global MAX software, and rated based on their perceived impact on diabetes management. The ratings were standardized for each participant group, and the average cluster ratings for the clients and providers were compared using t-tests. RESULTS The brainstorming identified 43 unique barriers to diabetes management. The clients' map featured 9 clusters of barriers: Challenges to getting healthy food, Inadequate income, Navigating services, Not having a place of your own, Relationships with professionals, Diabetes education, Emotional wellbeing, Competing priorities, and Weather-related issues. The providers' map had 7 clusters: Access to healthy food, Dietary choices in the context of homelessness, Limited finances, Lack of stable, private housing, Navigating the health and social sectors, Emotional distress and competing priorities, and Mental health and addictions. The highest-rated clusters were Challenges to getting healthy food (clients) and Mental health and addictions (providers). Challenges to getting healthy food was rated significantly higher by clients (p = 0.01) and Competing priorities was rated significantly higher by providers (p = 0.03). CONCLUSIONS Experiencing homelessness poses numerous barriers to managing diabetes, the greatest of which according to clients, is challenges to getting healthy food. This study showed that the way clients and providers perceive these barriers differs considerably, which highlights the importance of including clients' insights when assessing needs and designing effective solutions.
Collapse
Affiliation(s)
- Eshleen K. Grewal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Rachel B. Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Gillian L. Booth
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Kerry A. McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Stephen W. Hwang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Patricia O’Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - David J. T. Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
13
|
Amri MM, Jessiman-Perreault G, Siddiqi A, O’Campo P, Enright T, Di Ruggiero E. Scoping review of the World Health Organization's underlying equity discourses: apparent ambiguities, inadequacy, and contradictions. Int J Equity Health 2021; 20:70. [PMID: 33658033 PMCID: PMC7931570 DOI: 10.1186/s12939-021-01400-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Given the heightened rhetorical prominence the World Health Organization has afforded to equity in the past half-century, it is important to better understand how equity has been referred to and its conceptual underpinning, which may have broader global implications. ELIGIBILITY CRITERIA Articles were included if they met inclusion criteria - chiefly the explicit discussion of the WHO's concept of health equity, for example in terms of conceptualization and/or definitions. Articles which mentioned health equity in the context of WHO's programs, policies, and so on, but did not discuss its conceptualization or definition were excluded. SOURCES OF EVIDENCE We focused on peer-reviewed literature by scanning Ovid MEDLINE and SCOPUS databases, and supplementing by hand-search. RESULTS Results demonstrate the WHO has held - and continues to hold - ambiguous, inadequate, and contradictory views of equity that are rooted in different theories of social justice. CONCLUSIONS Moving forward, the WHO should revaluate its conceptualization of equity and normative position, and align its work with Amartya Sen's Capabilities Approach, as it best encapsulates the broader views of the organization. Further empirical research is needed to assess the WHO interpretations and approaches to equity.
Collapse
Affiliation(s)
- Michelle M. Amri
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Bldg. 1, Boston, MA 02115-6021 USA
- School of Public Health and Social Policy, Human and Social Development Building, University of Victoria, 3800 Finnerty Road, Victoria, British Columbia V8P 5C2 Canada
| | | | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, USA
| | - Patricia O’Campo
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, Ontario M5B 1T8 Canada
| | - Theresa Enright
- Department of Political Science, University of Toronto, 100 St George Street, Toronto, Ontario M5S 3G3 Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
| |
Collapse
|
14
|
Mejia-Lancheros C, Lachaud J, O’Campo P, Wiens K, Nisenbaum R, Wang R, Hwang SW, Stergiopoulos V. Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PLoS One 2020; 15:e0229385. [PMID: 32106225 PMCID: PMC7046214 DOI: 10.1371/journal.pone.0229385] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/04/2020] [Indexed: 12/27/2022] Open
Abstract
Stigma and discrimination toward individuals experiencing homelessness and mental disorders remain pervasive across societies. However, there are few longitudinal studies of stigma and discrimination among homeless adults with mental illness. This study aimed to identify the two-year group trajectories of stigma and discrimination and examine the predictive role of mental health characteristics among 414 homeless adults with mental illness participating in the extended follow-up phase of the Toronto At Home/Chez Soi (AH/CS) randomized trial site. Mental health-related perceived stigma and discrimination were measured at baseline, one, and two years using validated scales. Group-based-trajectory modelling was used to identify stigma and discrimination group trajectory memberships and the effect of the Housing First treatment (rent supplements and mental health support services) vs treatment as usual on these trajectories. The associations between mental health-related characteristics and trajectory group memberships were also assessed using multinomial logistic regression. Over two-years, three group trajectories of stigma and discrimination were identified. For discrimination, participants followed a low, moderate, or increasingly high discrimination group trajectory, while for stigma, participants followed a low, moderate or high stigma group trajectory. The Housing First treatment had no significant effect on discrimination or stigma trajectories groups. For the discrimination trajectories, major depressive episode, mood disorder with psychotic features, alcohol abuse, suicidality, severity of mental health symptoms, and substance use severity in the previous year were predictors of moderate and increasingly high discrimination trajectories. History of discrimination within healthcare setting was also positively associated with following a moderate or high discrimination trajectory. For the stigma trajectories, substance dependence, high mental health symptoms severity, substance use severity, and discrimination experiences within healthcare settings were the main predictors for the moderate trajectory group; while substance dependence, suicidality, mental health symptom severity, substance use severity and discrimination experiences within health care setting were also positive predictors for the high stigma trajectory group. Ethno-racial status modified the association between having a major depression episode, alcohol dependence, and the likelihood of being a member of the high stigma trajectory group. This study showed that adults experiencing mental illness and homelessness followed distinct stigma and discrimination group trajectories based on their mental health-problems. There is an urgent need to increase focus on strategies and policies to reduce stigma and discrimination in this population.
Collapse
Affiliation(s)
- Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - James Lachaud
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kathryn Wiens
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Ri Wang
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
15
|
Kouyoumdjian FG, Wang R, Mejia-Lancheros C, Owusu-Bempah A, Nisenbaum R, O’Campo P, Stergiopoulos V, Hwang SW. Interactions between Police and Persons Who Experience Homelessness and Mental Illness in Toronto, Canada: Findings from a Prospective Study. Can J Psychiatry 2019; 64:718-725. [PMID: 31248276 PMCID: PMC6783665 DOI: 10.1177/0706743719861386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We aimed to describe interactions between police and persons who experience homelessness and serious mental illness and explore whether housing status is associated with police interactions. METHOD We conducted a secondary analysis of 2008 to 2013 data from the Toronto, Canada, site of the At Home/Chez Soi study. Using police administrative data, we calculated the number and types of police interactions, the proportion of charges for acts of living and administration of justice, and the proportion of occurrences due to victimization, involuntary psychiatric assessment, and suicidal behavior. Using generalized estimating equations, we estimated the odds of police interaction by housing status. RESULTS This study included 547 adults with mental illness who were homeless at baseline. In the year prior to randomization, 55.8% of participants interacted with police, while 51.7% and 43.0% interacted with police in Study Years 1 and 2, respectively. Of 2,228 charges against participants, 12.6% were due to acts of living and 21.2% were for administration of justice. Of 518 occurrences, 41.1% were for victimization, 45.6% were for mental health assessment, and 22.2% were for suicidal behavior. The odds of any police interaction during the past 90 days was 47% higher for those who were homeless compared to those who were stably housed (95% CI 1.26 to 1.73). CONCLUSIONS For people who experience homelessness and mental illness in Toronto, Canada, interactions with police are common. The provision of stable housing and changes in policy and practice could decrease harms and increase health benefits associated with police interactions for this population.
Collapse
Affiliation(s)
- Fiona G. Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario,
Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto,
Ontario, Canada
- Fiona Kouyoumdjian, Department of Family Medicine,
McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th Floor,
Hamilton, Ontario, Canada L8P 1H6.
| | - Ri Wang
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto,
Ontario, Canada
| | - Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto,
Ontario, Canada
| | - Akwasi Owusu-Bempah
- Department of Sociology, University of Toronto, Toronto, Ontario,
Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto,
Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario,
Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of
Toronto, Toronto, Ontario, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto,
Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario,
Canada
| | - Vicky Stergiopoulos
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto,
Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario,
Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario,
Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto,
Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario,
Canada
| |
Collapse
|
16
|
Chum A, Atkinson P, O’Campo P. Does time spent in the residential neighbourhood moderate the relationship between neighbourhood walkability and transport-related walking? a cross-sectional study from Toronto, Canada. BMJ Open 2019; 9:e023598. [PMID: 30948565 PMCID: PMC6500339 DOI: 10.1136/bmjopen-2018-023598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Studies have investigated the influence of neighbourhood walkability on residents' walking behaviour, aiming to increase physical activity and reduce dependence on automobiles. Previous research, however, has not considered how the amount of time spent in the residential neighbourhood may modify this relationship. Our objective was to determine how time spent in the residential neighbourhood affects the relationship between neighbourhood walkability and walking for transport. DESIGN Using a cross-sectional sample of 2411 adults, we analysed the association between walkability (an index combining land-use mix, dwelling density and street connectivity) and transport-related walking (controlling for the effects of gender, age, income, self-rated health and regular access to private transport) testing for interactions by time spent in the neighbourhood. PRIMARY OUTCOME MEASURE Minutes spent walking for transport per week. SETTING Toronto, Canada. PARTICIPANTS Participants were aged 25 to 65. The survey had a 72% response rate. RESULTS After adjusting for potential confounders, the walkability index was weakly associated with walking (1 SD of walkability score is associated with 0.25 more minutes walking/week, p<0.01). Land-use mix was more strongly associated with walking than the walkability index. Time spent at the residential neighbourhood modified the relationship between land-use mix and transport-related walking in a dose-effect manner (p<0.01), those spending 5 hours on average at their residential neighbourhood have 0.2 min/day more walking for each additional land-use mix score and those spending 12 hours have 0.5 min/day more walking for each additional land-use mix score. CONCLUSIONS Our findings suggest that walkability is associated with increased walking time, but it is modified by time spent in the neighbourhood. Our study underscores the importance of testing 'time spent in the neighbourhood' as a modifier of environmental exposures in studies of environmental correlates of walking.
Collapse
Affiliation(s)
- Antony Chum
- Department of Health Sciences, Brock University, Saint Catharines, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
| | | | | |
Collapse
|
17
|
Daoud N, Berger-Polsky A, Sergienko R, O’Campo P, Leff R, Shoham-Vardi I. Screening and receiving information for intimate partner violence in healthcare settings: a cross-sectional study of Arab and Jewish women of childbearing age in Israel. BMJ Open 2019; 9:e022996. [PMID: 30796117 PMCID: PMC6398676 DOI: 10.1136/bmjopen-2018-022996] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We studied the proportion of women who have ever been screened (ES) for intimate partner violence (IPV) in a healthcare setting, received information (RI) about relevant services, or both, and explored disparities in screening and information provision by ethnicity and other characteristics. DESIGN In 2014-2015, we undertook a cross-sectional study, conducting interviews using a structured questionnaire among a stratified sample of 1401 Arab and Jewish women in Israel. SETTING A sample of 63 maternal and child health clinics (MCH) clinics in four geographical districts. PARTICIPANTS Women aged 16-48 years, pregnant or up to 6 months after childbirth. PRIMARY AND SECONDARY OUTCOME MEASURES We used multivariable generalised estimating equation analysis to determine characteristics of women who were ES (Has anyone at the healthcare services (HCS) ever asked you whether you have experienced IPV?); RI (Have you ever received information about what to do if you experience IPV?); and both (ES&RI). RESULTS Less than half of participants (48.8%) reported ES; 50.5% RI; and 30% were both ES&RI. Having experienced any IPV was not associated with ES or ES&RI, but was associated with RI in an unexpected direction. Women at higher risk for IPV (Arab minority women, lower education, unmarried) were less likely to report being ES, RI or both. The OR and 95% CI for not ER&RI were: 1.58 (1.00 to 2.49) among Arab compared with Jewish women; 1.95 (1.42 to 2.66) among low education versus academic education women; 1.34 (1.03 to 1.73) among not working versus working. ES, RI and both differ across districts. CONCLUSIONS While Israel mandates screening and providing information regarding IPV for women visiting the HCS, we found inequalities, suggesting inconsistencies in policy implementation and missed opportunities to detect IPV. To increase IPV screening and information provision, the ministry of health should circulate clarification and provide support to healthcare providers to conduct these activities.
Collapse
Affiliation(s)
- Nihaya Daoud
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer -Sheva, Israel
| | - Alexandra Berger-Polsky
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer -Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer -Sheva, Israel
| | - Patricia O’Campo
- Centre for Urban Health Solutions, St.Michael’s Hospital, Toronto, Ontario, Canada
| | - Rebecca Leff
- School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer -Sheva, Israel
| | - Ilana Shoham-Vardi
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer -Sheva, Israel
| |
Collapse
|
18
|
Katz AS, O’Campo P, Brisbois B, Zerger S, Hwang SW. Katz et al. Respond. Am J Public Health 2018; 108:e6-e8. [DOI: 10.2105/ajph.2018.304549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Amy S. Katz
- Amy S. Katz is with the Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada. Patricia O’Campo is with the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and the Dalla Lana School of Public Health, University of Toronto. Benjamin Brisbois is with the Dalla Lana School of Public Health, University of Toronto. Suzanne Zerger is with the Provincial System Support Program, Centre for Addictions and Mental Health, Toronto. Stephen W. Hwang is with the Centre for Urban
| | - Patricia O’Campo
- Amy S. Katz is with the Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada. Patricia O’Campo is with the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and the Dalla Lana School of Public Health, University of Toronto. Benjamin Brisbois is with the Dalla Lana School of Public Health, University of Toronto. Suzanne Zerger is with the Provincial System Support Program, Centre for Addictions and Mental Health, Toronto. Stephen W. Hwang is with the Centre for Urban
| | - Benjamin Brisbois
- Amy S. Katz is with the Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada. Patricia O’Campo is with the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and the Dalla Lana School of Public Health, University of Toronto. Benjamin Brisbois is with the Dalla Lana School of Public Health, University of Toronto. Suzanne Zerger is with the Provincial System Support Program, Centre for Addictions and Mental Health, Toronto. Stephen W. Hwang is with the Centre for Urban
| | - Suzanne Zerger
- Amy S. Katz is with the Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada. Patricia O’Campo is with the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and the Dalla Lana School of Public Health, University of Toronto. Benjamin Brisbois is with the Dalla Lana School of Public Health, University of Toronto. Suzanne Zerger is with the Provincial System Support Program, Centre for Addictions and Mental Health, Toronto. Stephen W. Hwang is with the Centre for Urban
| | - Stephen W. Hwang
- Amy S. Katz is with the Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada. Patricia O’Campo is with the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, and the Dalla Lana School of Public Health, University of Toronto. Benjamin Brisbois is with the Dalla Lana School of Public Health, University of Toronto. Suzanne Zerger is with the Provincial System Support Program, Centre for Addictions and Mental Health, Toronto. Stephen W. Hwang is with the Centre for Urban
| |
Collapse
|
19
|
Januwalla A, Pulver A, Wanigaratne S, O’Campo P, Urquia ML. Interventions to reduce adverse health outcomes resulting from manifestations of gender bias amongst immigrant populations: a scoping review. BMC Womens Health 2018; 18:104. [PMID: 29921247 PMCID: PMC6008916 DOI: 10.1186/s12905-018-0604-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Immigrants to Western countries increasingly originate from countries with pervasive gender inequalities, where women experience disproportionately high rates of threats to their well-being. Health and social services in countries of settlement encounter several adverse outcomes linked to gender bias among immigrant groups. Little is known about interventions implemented to address manifestations of gender bias among immigrant populations. METHODS A scoping review was undertaken to describe the literature on existing interventions and determine knowledge gaps. Nine academic and grey literature databases were searched for literature, with four reviewers screening the results. RESULTS Of the 29 included reports, most targeted domestic violence amongst the Latino population in the United States, with few interventions focusing on other outcomes, populations, and settings. The majority reported achieving their objective, although 13 interventions were not evaluated. CONCLUSIONS Future research and practice to address gender bias among immigrants may benefit from expanding on ethnic diversity, designing and reporting evaluations, addressing the context of gender inequities, tailoring to local community needs, and engaging community-based groups.
Collapse
Affiliation(s)
- Alia Januwalla
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
| | - Ariel Pulver
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
| | - Susitha Wanigaratne
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Patricia O’Campo
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
| | - Marcelo L. Urquia
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
- Rady Faculty of Health Sciences, S113 Medical Services Building – 70 Bannatyne Avenue, University of Manitoba, Winnipeg, MB R3E 0W3 Canada
| |
Collapse
|
20
|
Durbin A, Lunsky Y, Wang R, Nisenbaum R, Hwang SW, O’Campo P, Stergiopoulos V. The Effect of Housing First on Housing Stability for People with Mental Illness and Low Intellectual Functioning. Can J Psychiatry 2018; 63:706743718782940. [PMID: 29916270 PMCID: PMC6299190 DOI: 10.1177/0706743718782940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Housing First (HF) has been linked to increased tenure in housing for homeless people with mental illness, but the effect of HF on housing stability for people with borderline or lower intellectual functioning has not been examined. This study of homeless adults with mental illness in Toronto, Ontario assessed whether the association between housing stability and HF differed for adults with borderline or lower intellectual functioning, compared to adults with above borderline intellectual functioning. METHOD This study included 172 homeless adults with mental illness from the Toronto site of the At Home-Chez Soi randomized trial that compared receiving HF relative to treatment as usual. This sample was divided into two intellectual functioning groups: 1) adults with borderline or lower intellectual functioning (IQ < 85, 16%), and 2) adults with above borderline intellectual functioning (IQ ≥ 85, 84%). We compared these groups by modelling the percentage of days stably housed using a linear multivariable generalized estimating equation and included interaction between treatment and intellectual functioning. An interaction between treatment and time was also included. RESULTS There were no overall differences in housing stability for individuals with borderline or lower intellectual functioning compared to people with higher than borderline intellectual functioning in either the HF or the treatment as usual groups. CONCLUSION This study is the first to demonstrate that for homeless adults with mental illness, borderline or lower intellectual functioning did not significantly affect housing stability. This accentuates the need for more research and potentially wider consideration of their inclusion in housing interventions, such as HF.
Collapse
Affiliation(s)
- Anna Durbin
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Yona Lunsky
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Institute for Clinical Evaluative Sciences, Toronto, Ontario
- Centre for Addiction and Mental Health, Toronto, Ontario
| | - Ri Wang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
| | - Rosane Nisenbaum
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Stephen W. Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Patricia O’Campo
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Vicky Stergiopoulos
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Centre for Addiction and Mental Health, Toronto, Ontario
| |
Collapse
|
21
|
Oneka G, Vahid Shahidi F, Muntaner C, Bayoumi AM, Mahabir DF, Freiler A, O’Campo P, Shankardass K. A glossary of terms for understanding political aspects in the implementation of Health in All Policies (HiAP). J Epidemiol Community Health 2017; 71:835-838. [DOI: 10.1136/jech-2017-208979] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 11/04/2022]
|
22
|
Muntaner C, Davis O, McIsaack K, Kokkinen L, Shankardass K, O’Campo P. Retrenched Welfare Regimes Still Lessen Social Class Inequalities in Health. Int J Health Serv 2017. [DOI: 10.1177/0020731417712509] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article builds on recent work that has explored how welfare regimes moderate social class inequalities in health. It extends research to date by using longitudinal data from the EU-SILC (2003–2010) and examines how the relationship between social class and self-reported health and chronic conditions varies across 23 countries, which are split into five welfare regimes (Nordic, Anglo-Saxon, Eastern, Southern, and Continental). Our analysis finds that health across all classes was only worse in Eastern Europe (compared with the Nordic countries). In contrast, we find evidence that the social class gradient in both measures of health was significantly wider in the Anglo-Saxon and Southern regimes. We suggest that this evidence supports the notion that welfare regimes continue to explain differences in health according to social class location. We therefore argue that although downward pressures from globalization and neoliberalism have blurred welfare regime typologies, the Nordic model may continue to have an important mediating effect on class-based inequalities in health.
Collapse
Affiliation(s)
- C. Muntaner
- Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - O. Davis
- School of Social Policy, Sociology and Social Research, University of Kent, UK
| | - K. McIsaack
- Nova Scotia Health Authority, Research Services, Nova Scotia, Canada
| | - L. Kokkinen
- Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Tampere and Helsinki, Finland
| | - K. Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Centre for Urban Health Solutions, The Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - P. O’Campo
- Centre for Urban Health Solutions, The Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
23
|
Tsang J, Mishra S, Rowe J, O’Campo P, Ziegler C, Kouyoumdjian FG, Matheson FI, Bayoumi AM, Zahid S, Antoniou T. Transitional care for formerly incarcerated persons with HIV: protocol for a realist review. Syst Rev 2017; 6:29. [PMID: 28193290 PMCID: PMC5307639 DOI: 10.1186/s13643-017-0428-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/04/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Little is known about the mechanisms that influence the success or failure of programs to facilitate re-engagement with health and social services for formerly incarcerated persons with HIV. This review aims to identify how interventions to address such transitions work, for whom and under what circumstances. METHODS We will use realist review methodology to conduct our analysis. We will systematically search electronic databases and grey literature for English language qualitative and quantitative studies of interventions. Two investigators will independently screen citations and full-text articles, abstract data, appraise study quality and synthesize the literature. Data analysis will include identifying context-mechanism-outcome configurations, exploring and comparing patterns in these configurations, making comparisons across contexts and developing explanatory frameworks. DISCUSSION This review will identify mechanisms that influence the success or failure of transition interventions for formerly incarcerated individuals with HIV. The findings will be integrated with those from complementary qualitative and quantitative studies to inform future interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016040054.
Collapse
Affiliation(s)
- Jenkin Tsang
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
| | - Sharmistha Mishra
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Medicine, University of Toronto, Toronto, ON Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada
| | - Janet Rowe
- Prisoners with HIV/AIDS Support Action Network, Toronto, ON Canada
| | - Patricia O’Campo
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Carolyn Ziegler
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
| | - Fiona G. Kouyoumdjian
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada
- Department of Family Medicine, McMaster University, Hamilton, ON Canada
| | - Flora I. Matheson
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Ahmed M. Bayoumi
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Medicine, University of Toronto, Toronto, ON Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada
| | - Shatabdy Zahid
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
| | - Tony Antoniou
- The Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON Canada
- Department of Family and Community Medicine, St. Michael’s Hospital and University of Toronto, 410 Sherbourne Street, 4th Floor, Toronto, ON M4X 1K2 Canada
| |
Collapse
|
24
|
Abstract
Intimate partner violence has been demonstrated to be a significant public health problem among African American women. This study provided an opportunity to examine prevalence of intimate partner violence and health consequences among a group of primarily middle-class, employed African American women enrolled in a privately insured HMO (n = 109 abused and 97 never-abused women). Significantly more abused African American women were divorced or widowed and had incomes less than $50,000 a year. Abused women had more health problems (central nervous system, gynecological, STDs, gastrointestinal), more health problems per medical visits, and more emergency room visits (p < .05) compared to never-abused women. The health consequences of abuse and its association with health disparities are discussed.
Collapse
|
25
|
Woodhall-Melnik J, Hamilton-Wright S, Daoud N, Matheson FI, Dunn JR, O’Campo P. Establishing stability: exploring the meaning of 'home' for women who have experienced intimate partner violence. J Hous Built Environ 2016; 32:253-268. [PMID: 29323349 PMCID: PMC5744605 DOI: 10.1007/s10901-016-9511-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 05/06/2016] [Indexed: 06/07/2023]
Abstract
There is evidence that involuntary housing instability may undermine health and well-being. For women who have experienced intimate partner violence (IPV), achieving stability is likely as important for other groups, but can be challenging. Through our analysis of 41 interviews with women who have experienced low income and IPV, we argue that definitions of housing stability are multifaceted and for many centred on a shared understanding of the importance of creating an environment of "home". We found that obtaining housing that satisfied material needs was important to women. However, in asking women to define what housing stability meant to them, we found that other factors related to ontological security and the home, such as safety, community, and comfort, contributed to women's experiences of stability. Through our discussion of the importance these women placed on establishing stable homes, we argue that future research on women's experiences with housing stability and IPV should include definitions of stability that capture both material security and women's experiences with building emotionally stable homes.
Collapse
Affiliation(s)
- Julia Woodhall-Melnik
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael’s Hospital, 3rd Floor, 30 Bond Street, Toronto, ON M5B 1W8 Canada
- Department of Health, Aging and Society, McMaster University, Hamilton, ON Canada
| | - Sarah Hamilton-Wright
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael’s Hospital, 3rd Floor, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Nihaya Daoud
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael’s Hospital, 3rd Floor, 30 Bond Street, Toronto, ON M5B 1W8 Canada
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Flora I. Matheson
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael’s Hospital, 3rd Floor, 30 Bond Street, Toronto, ON M5B 1W8 Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - James R. Dunn
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael’s Hospital, 3rd Floor, 30 Bond Street, Toronto, ON M5B 1W8 Canada
- Department of Health, Aging and Society, McMaster University, Hamilton, ON Canada
| | - Patricia O’Campo
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael’s Hospital, 3rd Floor, 30 Bond Street, Toronto, ON M5B 1W8 Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| |
Collapse
|
26
|
Renahy E, Molnar A, O’Campo P, Freiler A, Shankardass K. L’intégration de la santé dans toutes les politiques : résultats d’une étude de cas multiples sur les processus d’implantation. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2015.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
27
|
O’Campo P, BeLue R, Borenstein H, Reed-Vance M, Lanzi RG, Schafer P, Jones L, Woolord R. Issues and Solutions for Collecting Biological Specimen in Longitudinal Studies: Experience from the Community Child Health Network Research Network. J Health Care Poor Underserved 2016; 27:339-351. [DOI: 10.1353/hpu.2016.0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
28
|
Kingston D, Heaman M, Urquia M, O’Campo P, Janssen P, Thiessen K, Smylie J. Correlates of Abuse Around the Time of Pregnancy: Results from a National Survey of Canadian Women. Matern Child Health J 2015; 20:778-89. [DOI: 10.1007/s10995-015-1908-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
29
|
Daoud N, Matheson FI, Pedersen C, Hamilton-Wright S, Minh A, Zhang J, O’Campo P. Pathways and trajectories linking housing instability and poor health among low-income women experiencing intimate partner violence (IPV): Toward a conceptual framework. Women Health 2015; 56:208-25. [DOI: 10.1080/03630242.2015.1086465] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
30
|
Zerger S, Bacon S, Corneau S, Skosireva A, McKenzie K, Gapka S, O’Campo P, Sarang A, Stergiopoulos V. Differential experiences of discrimination among ethnoracially diverse persons experiencing mental illness and homelessness. BMC Psychiatry 2014; 14:353. [PMID: 25496296 PMCID: PMC4275956 DOI: 10.1186/s12888-014-0353-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 12/05/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This mixed methods study explored the characteristics of and experiences with perceived discrimination in an ethnically diverse urban sample of adults experiencing homelessness and mental illness. METHODS Data were collected in Toronto, Ontario, as part of a 4-year national randomized field trial of the Housing First treatment model. Rates of perceived discrimination were captured from survey questions regarding perceived discrimination among 231 ethnoracially diverse participants with moderate mental health needs. The qualitative component included thirty six in-depth interviews which explored how individuals who bear these multiple identities of oppression navigate stigma and discrimination, and what affects their capacity to do so. RESULTS Quantitative analysis revealed very high rates of perceived discrimination related to: homelessness/poverty (61.5%), race/ethnicity/skin colour (50.6%) and mental illness/substance use (43.7%). Immigrants and those who had been homeless three or more years reported higher perceived discrimination on all three domains. Analysis of qualitative interviews revealed three common themes related to navigating these experiences of discrimination among participants: 1) social distancing; 2) old and new labels/identities; and, 3) 'homeland' cultures. CONCLUSIONS These study findings underscore poverty and homelessness as major sources of perceived discrimination, and expose underlying complexities in the navigation of multiple identities in responding to stigma and discrimination. TRIAL REGISTRATION Current Controlled Trials ISRCTN42520374 . Registered 18 August 2009.
Collapse
Affiliation(s)
- Suzanne Zerger
- Centre for Research on Inner City Health, Li KaShing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5C 1N8, Canada.
| | - Sarah Bacon
- Centre for Research on Inner City Health, Li KaShing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5C 1N8, Canada.
| | - Simon Corneau
- Université du Québec à Montréal, 405 Rue Sainte-Catherine Est, Montréal, Québec, H2L 2C4, Canada.
| | - Anna Skosireva
- Centre for Research on Inner City Health, Li KaShing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5C 1N8, Canada.
| | - Kwame McKenzie
- Health Services and Health Equity Research, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada.
| | - Susan Gapka
- Centre for Research on Inner City Health, Li KaShing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5C 1N8, Canada.
| | - Patricia O’Campo
- Centre for Research on Inner City Health, Li KaShing Knowledge Institute of St. Michael’s Hospital, 209 Victoria Street, Toronto, Ontario M5C 1N8 Canada ,Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON M5T 3M7 Canada
| | - Aseefa Sarang
- Across Boundaries: An Ethno-racial Mental Health Centre, 51 Clarkson Ave, Toronto (Ontario), M6E 2T5, Canada.
| | - Vicky Stergiopoulos
- Centre for Research on Inner City Health, Li KaShing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, Toronto, Ontario, M5C 1N8, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.
| |
Collapse
|
31
|
Shankardass K, O’Campo P, Dodds L, Fahey J, Joseph KS, Morinis J, Allen VM. Magnitude of income-related disparities in adverse perinatal outcomes. BMC Pregnancy Childbirth 2014; 14:96. [PMID: 24589212 PMCID: PMC3984719 DOI: 10.1186/1471-2393-14-96] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 02/18/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND To assess and compare multiple measurements of socioeconomic position (SEP) in order to determine the relationship with adverse perinatal outcomes across various contexts. METHODS A birth registry, the Nova Scotia Atlee Perinatal Database, was confidentially linked to income tax and related information for the year in which delivery occurred. Multiple logistic regression was used to examine odds ratios between multiple indicators of SEP and multiple adverse perinatal outcomes in 117734 singleton births between 1988 and 2003. Models for after tax family income were also adjusted for neighborhood deprivation to gauge the relative magnitude of effects related to SEP at both levels. Effects of SEP were stratified by single- versus multiple-parent family composition, and by urban versus rural location of residence. RESULTS The risk of small for gestational age and spontaneous preterm birth was higher across all the indicators of lower SEP, while risk for large for gestational age was lower across indicators of lower SEP. Higher risk of postneonatal death was demonstrated for several measures of lower SEP. Higher material deprivation in the neighborhood of residence was associated with increased risk for perinatal death, small for gestational age birth, and iatrogenic and spontaneous preterm birth. Family composition and urbanicity were shown to modify the association between income and some perinatal outcomes. CONCLUSIONS This study highlights the importance of understanding the definitions of SEP and the mechanisms that lead to the association between income and poor perinatal outcomes, and broadening the types of SEP measures used in some cases.
Collapse
Affiliation(s)
- Ketan Shankardass
- Department of Psychology, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario, Canada
- Centre for Research on Inner City Health, St. Michael’s Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Patricia O’Campo
- Centre for Research on Inner City Health, St. Michael’s Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Linda Dodds
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Fahey
- Reproductive Care Program of Nova Scotia, Halifax, Nova Scotia, Canada
| | - KS Joseph
- Department of Obstetrics & Gynaecology, School of Population and Public Health, University of British Columbia and the Children’s and Women’s Hospital of British Columbia, Vancouver, British Columbia, Canada
| | - Julia Morinis
- Centre for Research on Inner City Health, St. Michael’s Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Victoria M Allen
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
32
|
Kouyoumdjian FG, Calzavara LM, Bondy SJ, O’Campo P, Serwadda D, Nalugoda F, Kagaayi J, Kigozi G, Wawer M, Gray R. Intimate partner violence is associated with incident HIV infection in women in Uganda. AIDS 2013; 27:1331-8. [PMID: 23925380 DOI: 10.1097/qad.0b013e32835fd851] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To quantify the association between intimate partner violence (IPV) and incident HIV infection in women in the Rakai Community Cohort Study between 2000 and 2009. DESIGN AND METHODS Data were from the Rakai Community Cohort Study annual surveys between 2000 and 2009. Longitudinal data analysis was used to estimate the adjusted incidence rate ratio (IRR) of incident HIV associated with IPV in sexually active women aged 15-49 years, using a multivariable Poisson regression model with random effects. The population attributable fraction was calculated. Putative mediators were assessed using Baron and Kenny's criteria and the Sobel-Goodman test. RESULTS Women who had ever experienced IPV had an adjusted IRR of incident HIV infection of 1.55 (95% CI 1.25-1.94, P = 0.000), compared with women who had never experienced IPV. Risk of HIV infection tended to be greater for longer duration of IPV exposure and for women exposed to more severe and more frequent IPV. The adjusted population attributable fraction of incident HIV attributable to IPV was 22.2% (95% CI 12.5-30.4). There was no evidence that either condom use or number of sex partners in the past year mediated the relationship between IPV and HIV. CONCLUSION IPV is associated with incident HIV infection in a population-based cohort in Uganda, although the adjusted population attributable fraction is modest. The prevention of IPV should be a public health priority, and could contribute to HIV prevention.
Collapse
|
33
|
White HL, O’Campo P, Moineddin R, Matheson FI. Modeling the cumulative effects of social exposures on health: moving beyond disease-specific models. Int J Environ Res Public Health 2013; 10:1186-201. [PMID: 23528813 PMCID: PMC3709312 DOI: 10.3390/ijerph10041186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/13/2013] [Accepted: 03/19/2013] [Indexed: 11/25/2022]
Abstract
The traditional explanatory models used in epidemiology are “disease specific”, identifying risk factors for specific health conditions. Yet social exposures lead to a generalized, cumulative health impact which may not be specific to one illness. Disease-specific models may therefore misestimate social factors’ effects on health. Using data from the Canadian Community Health Survey and Canada 2001 Census we construct and compare “disease-specific” and “generalized health impact” (GHI) models to gauge the negative health effects of one social exposure: socioeconomic position (SEP). We use logistic and multinomial multilevel modeling with neighbourhood-level material deprivation, individual-level education and household income to compare and contrast the two approaches. In disease-specific models, the social determinants under study were each associated with the health conditions of interest. However, larger effect sizes were apparent when outcomes were modeled as compound health problems (0, 1, 2, or 3+ conditions) using the GHI approach. To more accurately estimate social exposures’ impacts on population health, researchers should consider a GHI framework.
Collapse
Affiliation(s)
- Heather L. White
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada; E-Mail:
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada; E-Mails: (R.M.); (F.I.M.)
| | - Patricia O’Campo
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada; E-Mails: (R.M.); (F.I.M.)
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5C 1N8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Population, Reproductive and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Author to whom correspondence should be addressed; E-Mail: co’; Tel.: +1-416-864-5403; Fax: +1-416-864-5485
| | - Rahim Moineddin
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada; E-Mails: (R.M.); (F.I.M.)
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5C 1N8, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Flora I. Matheson
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada; E-Mails: (R.M.); (F.I.M.)
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5C 1N8, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| |
Collapse
|
34
|
Stergiopoulos V, O’Campo P, Gozdzik A, Jeyaratnam J, Corneau S, Sarang A, Hwang SW. Moving from rhetoric to reality: adapting Housing First for homeless individuals with mental illness from ethno-racial groups. BMC Health Serv Res 2012; 12:345. [PMID: 23031406 PMCID: PMC3532422 DOI: 10.1186/1472-6963-12-345] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 09/20/2012] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The literature on interventions addressing the intersection of homelessness, mental illness and race is scant. The At Home/Chez Soi research demonstration project is a pragmatic field trial investigating a Housing First intervention for homeless individuals with mental illness in five cities across Canada. A unique focus at the Toronto site has been the development and implementation of a Housing First Ethno-Racial Intensive Case Management (HF ER-ICM) arm of the trial serving 100 homeless individuals with mental illness from ethno-racial groups. The HF ER-ICM program combines the Housing First approach with an anti-racism/anti-oppression framework of practice. This paper presents the findings of an early implementation and fidelity evaluation of the HF ER-ICM program, supplemented by participant narrative interviews to inform our understanding of the HF ER-ICM program theory. METHODS Descriptive statistics are used to describe HF ER-ICM participant characteristics. Focus group interviews, key informant interviews and fidelity assessments were conducted between November 2010 and January 2011, as part of the program implementation evaluation. In-depth qualitative interviews with HF ER-ICM participants and control group members were conducted between March 2010 and June 2011. All qualitative data were analysed using grounded theory methodology. RESULTS The target population had complex health and social service needs. The HF ER-ICM program enjoyed a high degree of fidelity to principles of both anti-racism/anti-oppression practice and Housing First and comprehensively addressed the housing, health and sociocultural needs of participants. Program providers reported congruence of these philosophies of practice, and program participants valued the program and its components. CONCLUSIONS Adapting Housing First with anti-racism/anti-oppression principles offers a promising approach to serving the diverse needs of homeless people from ethno-racial groups and strengthening the service systems developed to support them. The use of fidelity and implementation evaluations can be helpful in supporting successful adaptations of programs and services.
Collapse
Affiliation(s)
- Vicky Stergiopoulos
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1 W8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada
| | - Patricia O’Campo
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1 W8, Canada
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 6th floor, 155 College Street, Toronto, Ontario, M5T 3 M7, Canada
| | - Agnes Gozdzik
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1 W8, Canada
| | - Jeyagobi Jeyaratnam
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1 W8, Canada
| | - Simon Corneau
- Sexology Department, Université du Québec à Montréal, Case postale 8888, succursale Centre-Ville, Montréal, Québec, H3C 3P8, Canada
| | - Aseefa Sarang
- Across Boundaries: An Ethno-racial Mental Health Centre, 51 Clarkson Avenue, Toronto, Ontario, M6E 2 T5, Canada
| | - Stephen W Hwang
- Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1 W8, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
35
|
Kingston D, Heaman M, Chalmers B, Kaczorowski J, O’Brien B, Lee L, Dzakpasu S, O’Campo P. Comparison of Maternity Experiences of Canadian-Born and Recent and Non-Recent Immigrant Women: Findings From the Canadian Maternity Experiences Survey. Journal of Obstetrics and Gynaecology Canada 2011; 33:1105-1115. [DOI: 10.1016/s1701-2163(16)35078-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
36
|
Shankardass K, Solar O, Murphy K, Greaves L, O’Campo P. A scoping review of intersectoral action for health equity involving governments. Int J Public Health 2011; 57:25-33. [DOI: 10.1007/s00038-011-0302-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 09/01/2011] [Accepted: 09/04/2011] [Indexed: 11/28/2022] Open
|
37
|
Ulibarri MD, Strathdee SA, Ulloa EC, Lozada R, Fraga MA, Magis-Rodríguez C, De La Torre A, Amaro H, O’Campo P, Patterson TL. Injection drug use as a mediator between client-perpetrated abuse and HIV status among female sex workers in two Mexico-US border cities. AIDS Behav 2011; 15:179-85. [PMID: 19636697 PMCID: PMC2889005 DOI: 10.1007/s10461-009-9595-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 07/12/2009] [Indexed: 11/23/2022]
Abstract
We examined relationships between client-perpetrated emotional, physical, and sexual abuse, injection drug use, and HIV-serostatus among 924 female sex workers (FSWs) in Tijuana and Ciudad Juarez, two large Mexico-US border cities. We hypothesized that FSWs’ injection drug use would mediate the relationship between client-perpetrated abuse and HIV-seropositivity. The prevalence of client-perpetrated emotional, physical, and sexual abuse in the past 6 months was 26, 18, and 10% respectively; prevalence of current injection drug use and HIV was 12 and 6%, respectively. Logistic regression analyses revealed that client-perpetrated sexual abuse was significantly associated with HIV-seropositivity and injection drug use, and that injection drug use was positively associated with HIV-seropositivity. Injection drug use partially mediated the relationship between client-perpetrated sexual abuse and HIV-seropositivity. Results suggest the need to address client-perpetrated violence and injection drug use when assessing HIV risk among FSWs.
Collapse
|
38
|
Joseph K, Fahey J, Dendukuri N, Allen VM, O’Campo P, Dodds L, Liston RM, Allen AC. Recent Changes in Maternal Characteristics by Socioeconomic Status. Journal of Obstetrics and Gynaecology Canada 2009; 31:422-33. [DOI: 10.1016/s1701-2163(16)34173-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
39
|
Elo I, Culhane J, Kohler I, O’Campo P, Burke J, Messer L, Kaufman J, Laraia B, Eyster J, Holzman C. Neighbourhood deprivation and small-for-gestational-age term births in the United States. Paediatr Perinat Epidemiol 2009; 23:87-96. [PMID: 19228318 PMCID: PMC2963199 DOI: 10.1111/j.1365-3016.2008.00991.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Residential context has received increased attention as a possible contributing factor to race/ethnic and socio-economic disparities in birth outcomes in the United States. Utilising vital statistics birth record data, this study examined the association between neighbourhood deprivation and the risk of a term small-for-gestational-age (SGA) birth among non-Hispanic whites and non-Hispanic blacks in eight geographical areas. An SGA birth was defined as a newborn weighing <10th percentile of the sex- and parity-specific birthweight distribution for a given gestational week. Multi-level random intercept logistic regression models were employed and statistical tests were performed to examine whether the association between neighbourhood deprivation and SGA varied by race/ethnicity and study site. The risk of term SGA was higher among non-Hispanic blacks (range 10.8-17.5%) than non-Hispanic whites (range 5.1-9.2%) in all areas and it was higher in cities than in suburban locations. In all areas, non-Hispanic blacks lived in more deprived neighbourhoods than non-Hispanic whites. However, the adjusted associations between neighbourhood deprivation and term SGA did not vary significantly by race/ethnicity or study site. The summary fully adjusted pooled odds ratios, indicating the effect of one standard deviation increase in the deprivation score, were 1.15 [95% CI 1.08, 1.22] for non-Hispanic whites and 1.09 [95% CI 1.05, 1.14] for non-Hispanic blacks. Thus, neighbourhood deprivation was weakly associated with term SGA among both non-Hispanic whites and non-Hispanic blacks.
Collapse
Affiliation(s)
- Irma Elo
- Department of Sociology, University of Pennsylvania, Philadelphia, PA, Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Jennifer Culhane
- Department of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia, PA
| | - Iliana Kohler
- Population Studies Center, University of Pennsylvania, Philadelphia, PA
| | - Patricia O’Campo
- Center for Research on Inner City Health, St. Michael’s Hospital, Toronto, ONT, Department of Public Health Sciences, Faculty of Medicine, University of Toronto, Toronto, ONT, Canada
| | - Jessica Burke
- Department of Behavioral and Community Health Services, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Lynne Messer
- Health Inequalities Program, Center for Health Policy, Duke Global Health Institute, Durham, NC
| | - Jay Kaufman
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC
| | - Barbara Laraia
- Center for Health and Community, Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Janet Eyster
- Department of Epidemiology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Claudia Holzman
- Department of Epidemiology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| |
Collapse
|
40
|
Rajaratnam JK, O’Campo P, Caughy MO, Muntaner C. The Effect of Social Isolation on Depressive Symptoms Varies by Neighborhood Characteristics: A Study of an Urban Sample of Women with Pre-School Aged Children. Int J Ment Health Addict 2007. [DOI: 10.1007/s11469-007-9115-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
41
|
Menéndez M, Benach J, Muntaner C, Amable M, O’Campo P. Is precarious employment more damaging to women's health than men's? Soc Sci Med 2007; 64:776-81. [DOI: 10.1016/j.socscimed.2006.10.035] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Indexed: 11/26/2022]
|
42
|
Abstract
Census data are widely used for assessing neighborhood socioeconomic context. Research using census data has been inconsistent in variable choice and usually limited to single geographic areas. This paper seeks to a) outline a process for developing a neighborhood deprivation index using principal components analysis and b) demonstrate an example of its utility for identifying contextual variables that are associated with perinatal health outcomes across diverse geographic areas. Year 2000 U.S. Census and vital records birth data (1998-2001) were merged at the census tract level for 19 cities (located in three states) and five suburban counties (located in three states), which were used to create eight study areas within four states. Census variables representing five socio-demographic domains previously associated with health outcomes, including income/poverty, education, employment, housing, and occupation, were empirically summarized using principal components analysis. The resulting first principal component, hereafter referred to as neighborhood deprivation, accounted for 51 to 73% of the total variability across eight study areas. Component loadings were consistent both within and across study areas (0.2-0.4), suggesting that each variable contributes approximately equally to "deprivation" across diverse geographies. The deprivation index was associated with the unadjusted prevalence of preterm birth and low birth weight for white non-Hispanic and to a lesser extent for black non-Hispanic women across the eight sites. The high correlations between census variables, the inherent multidimensionality of constructs like neighborhood deprivation, and the observed associations with birth outcomes suggest the utility of using a deprivation, index for research into neighborhood effects on adverse birth outcomes.
Collapse
Affiliation(s)
- Lynne C. Messer
- Department of Environmental Sciences and Engineering, University of North Carolina, Chapel Hill, NC USA
- Human Studies Division, U.S. EPA/National Health and Environmental Effects Research Laboratory (NHEERL), MD 58A, Research Triangle Park, NC 27711 USA
| | - Barbara A. Laraia
- Department of Nutrition, School of Public Health, University of North Carolina, Campus Box #8120, Chapel Hill, NC 27599-8120 USA
| | - Jay S. Kaufman
- Department of Epidemiology, School of Public Health, University of North Carolina, Campus Box #7435, Chapel Hill, NC 27599-7435 USA
| | - Janet Eyster
- College of Human Medicine, Michigan State University, 4660 South Hagadon RD, Suite 600, East Lansing, MI 48823 USA
| | - Claudia Holzman
- Department of Epidemiology, Michigan State University, 4660 South Hagadon RD, Suite 600, East Lansing, MI 48823 USA
| | - Jennifer Culhane
- Department of Obstetrics and Gynecology, Drexel College of Medicine, 245 N 15th ST, MS 495, Philadelphia, PA 19102-1101 USA
| | - Irma Elo
- Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104 USA
| | - Jessica G. Burke
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, 218 Parran Hall, Pittsburgh, PA 15261 USA
| | - Patricia O’Campo
- Public Health Sciences, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada
- Inner City Health Research Unit, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| |
Collapse
|
43
|
O’Campo P. 148: Space, Geography, Neighborhoods and Social Epidemiology: New Methods and Concepts. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s37c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P O’Campo
- University of Toronto, Toronto, ONT Canada
| |
Collapse
|
44
|
McDonnell KA, Gielen AC, O’Campo P. Does HIV status make a difference in the experience of lifetime abuse? Descriptions of lifetime abuse and its context among low-income urban women. J Urban Health 2003; 80:494-509. [PMID: 12930886 PMCID: PMC3455975 DOI: 10.1093/jurban/jtg047] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Women living in poor urban communities are doubly disadvantaged with regard to increased risk for two major public health crises in the United States today--HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) and violence. This study moves beyond the comparison of rates of lifetime abuse among women to incorporate contextual information of the abusive situation and experiences of HIV-positive women and a sample of sociodemographically similar HIV-negative women. A total of 611 women, 310 of whom were diagnosed as HIV positive, provided interviews integrating quantitative data and qualitative text on their lifetime experience of abuse. Quantitative results yielded few statistically significant differences between the lifetime experiences of violence between HIV-positive women and their HIV-negative counterparts. Of the women, 62% reported intimate partner violence, and 38% reported experiencing nonpartner abuse as an adult. A majority of the abused women reported that their alcohol or drug use or their partner's alcohol or drug use was associated with the abuse experienced. Significant differences were found between HIV-positive women and HIV-negative women in the pattern of abuse experienced as a child, the frequency of abuse as an adult, and the involvement of women's drinking before or during a violent episode. Qualitative excerpts from the interviews were found to differ thematically and were integrated with the quantitative data to provide a more comprehensive understanding of the women's contextual situation in understanding interpersonal violence experienced by both HIV-positive and HIV-negative women.
Collapse
Affiliation(s)
- Karen A. McDonnell
- Maternal and Child Health Program, George Washington University SPHHS, 2175 K Street NW Suite 700, 20037 Washington, DC
| | | | | |
Collapse
|