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Portnoy J, Schwartz JA. Adolescent Violent Delinquency Associated With Increased Emergency Department Usage in Young Adulthood. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023; 67:739-756. [PMID: 34963357 DOI: 10.1177/0306624x211066835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Limited research has examined the extent to which adolescent delinquency predicts healthcare usage in young adulthood, including emergency department (ED) visits. This study used data from 3,310 adolescents (52.05% female; mean age at Wave I = 16.04 years) from the sibling subsample of the National Longitudinal Study of Adolescent to Adult Health (Add Health). We examined whether adolescent delinquency at Wave I predicted ED visits at Wave III using sibling fixed effects models to adjust estimates for within-family unobserved heterogeneity. Increased violent, but not nonviolent, delinquency predicted a higher number of ED visits in early adulthood in the sibling fixed effects models. To our knowledge, this is the first study to examine the relationship between delinquency and ED usage using a sibling fixed effects design. Findings demonstrate that violent adolescent delinquency may increase healthcare usage and suggest the potential role of healthcare providers in improving outcomes for delinquent youth.
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Affiliation(s)
- Jill Portnoy
- University of Massachusetts Lowell, Lowell, MA, USA
| | - Joseph A Schwartz
- Florida State University, Tallahassee, FL, USA
- King Abdulaziz University, Jeddah, Saudi Arabia
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Kontu M, Hakko H, Riala K, Riipinen P. Injuries, Poisonings, and Other External Causes of Morbidity among Drug Crime Offenders: A Follow-Up Study of Former Adolescent Psychiatric Inpatients. Eur Addict Res 2023; 29:194-201. [PMID: 37100043 DOI: 10.1159/000530122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/24/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Criminal offenders have high incidences of injury- and substance-related emergency department visits. Very few studies focus on drug crime offenders or the medical specialties involved in treating these offenders. We aimed to study how drug crime offenders' treatment events in specialized health care due to injuries, poisonings, or other external causes of morbidity differed from treatment of non-criminal controls and which of the medical specialties were involved in their care. METHODS The study population included 508 former adolescent psychiatric inpatients (age 13-17 years), who were followed up through Finnish national registers. A total of 60 had committed a drug crime during the 10-15 years' follow-up. They were matched with 120 non-criminal controls from the study population. Hazard ratios (HRs) with 95% confidence intervals (Cl) for drug crime offending were assessed using a Cox regression model. RESULTS Almost 90% of drug crime offenders had treatment events in specialized health care due to injuries, poisonings, and other external causes of morbidity, compared to 50% of non-criminals. The majority of the drug crime offenders had been treated for accidental injuries (65% vs. 29%; p < 0.001) in comparison to non-criminal controls. More drug crime offenders had been treated for intentional poisonings (42% vs. 11%; p < 0.001) than non-criminal controls. For drug crime offenders, the lifetime probability of a treatment event due to poisoning was almost doubled (HR: 1.89, 95% CI: 1.26-2.84; p = 0.002), and for treatments due to injury, there was a 2.5-fold increase (HR: 2.54, 95% CI: 1.69-3.82; p < 0.001) in comparison to non-criminal controls. CONCLUSION In emergency care, substance use screening and referral for appropriate psychiatric and substance abuse treatment services should be considered for all adolescents and young adults attending hospitals due to injuries or poisonings.
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Affiliation(s)
| | - Helina Hakko
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Kaisa Riala
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Pirkko Riipinen
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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Thomas-Smith S, Klein E, Strelitz B, Jensen J, Parker E, Richardson L, McCarty C, Shafii T. Electronic Screening for Adolescent Risk Behaviors in the Emergency Department: A Randomized Controlled Trial. West J Emerg Med 2022; 23:931-938. [DOI: 10.5811/westjem.2022.7.55755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/19/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: In this study we aimed to assess the impact of an electronic health assessment with individualized feedback for risk behaviors in adolescents seeking care in a pediatric emergency department (ED).
Methods: We conducted a randomized control trial using a tablet-based screening program with a study population of adolescents in a busy pediatric ED. The intervention group received the screening program with individualized feedback. The control group received the screening program without feedback. All participants received one-day and three-month follow-up surveys to assess behaviors and attitudes toward health behaviors.
Results: A total of 296 subjects were enrolled and randomized. There was no difference in changes in risky behaviors between the control and experimental groups. A higher proportion of participants in the intervention groups reported that the screener changed the way they thought about their health at one-day follow-up (27.0%, 36/133) compared to the control group (15.5%, 20/129, P = .02).
Conclusion: This study successfully tested a multivariable electronic health screener in a real-world setting of a busy pediatric ED. The tool did not significantly change risky health behaviors in the adolescent population screened. However, our finding that the intervention changed adolescents’ perceptions of their health opens a door to the continued development of electronic interventions to screen for and target risk behaviors in adolescents in the ED setting.
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Affiliation(s)
- Siobhan Thomas-Smith
- University of Washington, Seattle Children’s Hospital, Department of Pediatrics, Division of Emergency Medicine, Seattle, Washington
| | - Eileen Klein
- University of Washington, Seattle Children’s Hospital, Department of Pediatrics, Division of Emergency Medicine, Seattle, Washington
| | - Bonnie Strelitz
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Jennifer Jensen
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Elizabeth Parker
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Laura Richardson
- University of Washington School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Seattle, Washington
| | - Carolyn McCarty
- University of Washington School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Seattle, Washington
| | - Taraneh Shafii
- University of Washington School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Seattle, Washington
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Dubey VP, Randell KA, Masonbrink AR, Pickett ML, Sherman AK, Ramaswamy M, Miller MK. Justice System Involvement Among Adolescents in the Emergency Department. J Pediatr 2021; 236:284-290. [PMID: 33811870 PMCID: PMC8403109 DOI: 10.1016/j.jpeds.2021.03.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 03/04/2021] [Accepted: 03/25/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess justice system involvement among adolescents in the pediatric emergency department and identify associations with risk and protective factors. STUDY DESIGN We conducted a cross-sectional, computerized survey of adolescents to assess for personal, justice system involvement, and nonhousehold justice system involvement (ie, important people outside of household). We assessed sexual behaviors, violent behaviors, substance use, school suspension/expulsion, parental supportiveness, and participant mood (score <70 indicates psychological distress). We compared differences between groups using the χ2 tests, Fisher exact tests, t tests, and performed multivariable logistic regression analyses. RESULTS We enrolled 191 adolescents (mean age 16.1 years, 61% female). Most (68%) reported justice system involvement: personal (13%), household (42%), and nonhousehold (40%). Nearly one-half (47%) were sexually active and 50% reported school suspension/expulsion. The mean score for mood was 70.1 (SD 18); adolescents with justice system involvement had had lower mood scores (68 vs 74, P = .03) compared with those without justice system involvement. In a multivariable model, school expulsion/suspension was significantly associated with reporting any justice system involvement (OR 10.4; 95% CI 4.8-22.4). CONCLUSIONS We identified the pediatric emergency department as a novel location to reach adolescents at risk for poor health outcomes associated with justice system involvement. Future work should assess which health promotion interventions and supports are desired among these adolescents and families.
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Affiliation(s)
- Vivek P Dubey
- Pediatric Emergency Medicine, Children's Mercy Hospital, Kansas City, MO; The University of Missouri Kansas City, Kansas City, MO; The University of Kansas, School of Medicine, Kansas City, KS.
| | - Kimberly A Randell
- Pediatric Emergency Medicine, Children's Mercy Hospital, Kansas City, MO; The University of Missouri Kansas City, Kansas City, MO; The University of Kansas, School of Medicine, Kansas City, KS
| | - Abbey R Masonbrink
- Hospital Medicine, Children's Mercy Hospital, Kansas City, MO; The University of Missouri Kansas City, Kansas City, MO; The University of Kansas, School of Medicine, Kansas City, KS
| | - Michelle L Pickett
- Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | | | - Megha Ramaswamy
- Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Melissa K Miller
- Pediatric Emergency Medicine, Children's Mercy Hospital, Kansas City, MO; The University of Missouri Kansas City, Kansas City, MO; The University of Kansas, School of Medicine, Kansas City, KS
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Abstract
OBJECTIVES The aims of this study were to describe emergency department (ED) utilization by people in provincial prison and on release, and to compare with ED utilization for the general population. METHODS We linked correctional and health administrative data for people released from provincial prison in Ontario in 2010. We matched each person by age and sex with four people in the general population. We compared ED utilization rates using generalized estimating equations, by sex and for high urgency and ambulatory care sensitive conditions. RESULTS People who experienced imprisonment (N = 48,861) had higher ED utilization rates compared with the general population (N = 195,444), with rate ratios of 3.2 (95% CI 3.0-4.4) for men and 6.5 (95% CI 5.6-7.5) for women in prison and a range of rate ratios between 3.1 and 7.7 for men and 4.2 and 8.8 for women over the 2 years after release. Most ED visits were high urgency, and between 1.0% and 5.1% of visits were for ambulatory care sensitive conditions. ED utilization rates increased on release from prison. CONCLUSIONS People experiencing imprisonment in Ontario have higher ED utilization compared with matched people in the general population, primarily for urgent issues, and particularly in women and in the week after release. Providing high-quality ED care and implementing prison- and ED-based interventions could improve health for this population and prevent the need for ED use.
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Blackburn J, Norwood C, Rusyniak D, Gilbert AL, Sullivan J, Menachemi N. Indiana's Section 1115 Medicaid Waiver And Interagency Coordination Improve Enrollment For Justice-Involved Adults. Health Aff (Millwood) 2020; 39:1891-1899. [PMID: 33136497 DOI: 10.1377/hlthaff.2019.01823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Timely access to Medicaid coverage offers many potential benefits to justice-involved adults reentering the community. In 2015 Indiana's Section 1115 Medicaid waiver (the Healthy Indiana Plan [HIP]) expanded eligibility for low-income adults. To expedite coverage for justice-involved adults, Indiana subsequently improved interagency coordination in two ways. First, the Indiana Department of Correction began initiating Medicaid applications for those in custody. Second, Medicaid began temporarily suspending coverage for people while they were incarcerated instead of discontinuing it. Prison release data from the Indiana Department of Correction linked to Medicaid enrollment data indicate that before HIP was implemented, approximately 9 percent of justice-involved adults received Medicaid coverage within 120 days of release. After HIP implementation, coverage rates increased by 9 percentage points. After both interagency coordination policies were implemented, an additional 29-percentage-point increase in coverage occurred. Furthermore, coverage effective within seven days of release increased by 14 percentage points after the interagency coordination policies went into effect. These findings support the notion that policies and procedures encouraging interagency coordination are beneficial in increasing timely access to Medicaid coverage for justice-involved people.
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Affiliation(s)
- Justin Blackburn
- Justin Blackburn is an associate professor in the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health, in Indianapolis, Indiana
| | - Connor Norwood
- Connor Norwood is the chief data officer in the Indiana Family and Social Services Administration, in Indianapolis, Indiana
| | - Dan Rusyniak
- Dan Rusyniak is the chief medical officer in the Indiana Family and Social Services Administration
| | - Amy Lewis Gilbert
- Amy Lewis Gilbert is the chief science officer in the Indiana Family and Social Services Administration
| | - Jennifer Sullivan
- Jennifer Sullivan is the secretary of the Indiana Family and Social Services Administration
| | - Nir Menachemi
- Nir Menachemi is the Fairbanks Endowed Chair, a professor, and head of the Department of Health Policy and Management at the Indiana University Richard M. Fairbanks School of Public Health and a scientist at the Regenstrief Institute, in Indianapolis, Indiana
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Abstract
Children and adolescents who become involved with the justice system often do so with complex medical, mental health, developmental, social, and legal needs. Most have been exposed to childhood trauma or adversity, which both contribute to their involvement with the justice system and negatively impact their health and well-being. Whether youth are held in confinement or in their home communities, pediatricians play a critical role in promoting the health and well-being of justice-involved youth. Having a working knowledge of the juvenile justice system and common issues facing justice-involved youth may help pediatricians enhance their clinical care and advocacy efforts. This policy statement is a revision of the 2011 policy "Health Care for Youth in the Juvenile Justice System." It provides an overview of the juvenile justice system, describes racial bias and overrepresentation of youth of color in the justice system, reviews the health and mental health status of justice-involved youth, and identifies advocacy opportunities for juvenile justice reform.
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Affiliation(s)
- Mikah C Owen
- Department of Pediatrics, School of Medicine, University of California, Davis, Sacramento, California; and
| | - Stephenie B Wallace
- Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
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Wang EA, Macmadu A, Rich JD. Examining the Impact of Criminal Justice Involvement on Health Through Federally Funded, National Population-Based Surveys in the United States. Public Health Rep 2019; 134:22S-33S. [PMID: 31059413 DOI: 10.1177/0033354918824324] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Emily A Wang
- 1 Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Alexandria Macmadu
- 2 Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA.,3 Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Josiah D Rich
- 2 Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA.,3 Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,4 Department of Medicine, Brown University, Providence, RI, USA
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Baggio S, Tran NT, Barnert ES, Gétaz L, Heller P, Wolff H. Lack of health insurance among juvenile offenders: a predictor of inappropriate healthcare use and reincarceration? Public Health 2018; 166:25-33. [PMID: 30439553 DOI: 10.1016/j.puhe.2018.09.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/15/2018] [Accepted: 09/30/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Relationships between the health insurance status and healthcare use among justice-involved youths transitioning into adulthood is an underexplored topic, even if transition to adulthood is a crucial time period for healthcare outcomes. To fill in these knowledge gaps, this study had two aims: (1) to examine trajectories of health insurance coverage and healthcare use among serious juvenile offenders transitioning into adulthood; and (2) to explore associations between the lack of health insurance, healthcare use and reincarceration. STUDY DESIGN We conducted a secondary analysis on the data of the US longitudinal Pathways to Desistance study between ages 20 and 23 years (2000-2010). METHODS Participant data on health insurance coverage, healthcare use, reincarceration and sociodemographic variables (n = 1215) were extracted and analysed using descriptive statistics, generalized linear regressions and cross-lagged panel models. RESULTS About half of the young offenders had no health insurance coverage or intermittent coverage between the age of 20 and 23 years. Emergency services were used (≥17.4%), notably more by insured participants and were increasingly used over time. Being uninsured at the age of 20 years was associated with reincarceration at the age of 23 years (b = -0.052, p = 0.014, odd-ratio = 0.95), but incarceration at the age of 20 years did not predict the insurance status at the age of 23 years (b = 0.009, p = 0.792). CONCLUSIONS Serious juvenile offenders, especially if uninsured, faced major barriers to accessing health care and often reported an inappropriate healthcare use. This likely led to reincarceration. The lack of continuity of care and of access to health care may, therefore, increase health disparities, and efforts are needed to mitigate detrimental outcomes, by effective in and out of detention coordination of health insurance coverage and among health services.
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Affiliation(s)
- S Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Chemin du Petit Bel Air 2, 1226 Thônex, Switzerland; Life Course and Social Inequality Research Centre, University of Lausanne, Bâtiment Géopolis, 1015 Lausanne, Switzerland.
| | - N T Tran
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Chemin du Petit Bel Air 2, 1226 Thônex, Switzerland; Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, PO Box 123, Broadway, NSW 2007, Australia.
| | - E S Barnert
- Department of Pediatrics, David Geffen School of Medicine at UCLA, University of California, 10833 Le Conte Ave, Los Angeles, CA, USA.
| | - L Gétaz
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Chemin du Petit Bel Air 2, 1226 Thônex, Switzerland.
| | - P Heller
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Chemin du Petit Bel Air 2, 1226 Thônex, Switzerland.
| | - H Wolff
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Chemin du Petit Bel Air 2, 1226 Thônex, Switzerland.
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Kouyoumdjian FG, Cheng SY, Fung K, Orkin AM, McIsaac KE, Kendall C, Kiefer L, Matheson FI, Green SE, Hwang SW. The health care utilization of people in prison and after prison release: A population-based cohort study in Ontario, Canada. PLoS One 2018; 13:e0201592. [PMID: 30075019 PMCID: PMC6075755 DOI: 10.1371/journal.pone.0201592] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/18/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many people experience imprisonment each year, and this population bears a disproportionate burden of morbidity and mortality. States have an obligation to provide equitable health care in prison and to attend to care on release. Our objective was to describe health care utilization in prison and post-release for persons released from provincial prison in Ontario, Canada in 2010, and to compare health care utilization with the general population. METHODS We conducted a population-based retrospective cohort study. We included all persons released from provincial prison to the community in 2010, and age- and sex-matched general population controls. We linked identities for persons released from prison to administrative health data. We matched each person by age and sex with four general population controls. We examined ambulatory care and emergency department utilization and medical-surgical and psychiatric hospitalization, both in prison and in the three months after release to the community. We compared rates with those of the general population. RESULTS The rates of all types of health care utilization were significantly higher in prison and on release for people released from prison (N = 48,861) compared to general population controls (N = 195,444). Comparing those released from prison to general population controls in prison and in the 3 months after release, respectively, utilization rates were 5.3 (95% CI 5.2, 5.4) and 2.4 (95% CI 2.4, 2.5) for ambulatory care, 3.5 (95% CI 3.3, 3.7) and 5.0 (95% CI 4.9, 5.3) for emergency department utilization, 2.3 (95% CI 2.0, 2.7) and 3.2 (95% CI 2.9, 3.5) for medical-surgical hospitalization, and 21.5 (95% CI 16.7, 27.7) and 17.5 (14.4, 21.2) for psychiatric hospitalization. Comparing the time in prison to the week after release, ambulatory care use decreased from 16.0 (95% CI 15.9,16.1) to 10.7 (95% CI 10.5, 10.9) visits/person-year, emergency department use increased from 0.7 (95% CI 0.6, 0.7) to 2.6 (95% CI 2.5, 2.7) visits/person-year, and hospitalization increased from 5.4 (95% CI 4.8, 5.9) to 12.3 (95% CI 10.1, 14.6) admissions/100 person-years for medical-surgical reasons and from 8.6 (95% CI 7.9, 9.3) to 17.3 (95% CI 14.6, 20.0) admissions/100 person-years for psychiatric reasons. CONCLUSIONS Across care types, health care utilization in prison and on release is elevated for people who experience imprisonment in Ontario, Canada. This may reflect high morbidity and suboptimal access to quality health care. Future research should identify reasons for increased use and interventions to improve care.
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Affiliation(s)
- Fiona G. Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Canada
- St. Michael’s Hospital, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- * E-mail:
| | | | - Kinwah Fung
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Aaron M. Orkin
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Claire Kendall
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- C.T. Lamont Primary Health Care Research Group, Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Lori Kiefer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Ontario Ministry of Community Safety and Correctional Services, Toronto, Canada
| | - Flora I. Matheson
- St. Michael’s Hospital, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Centre for Criminology and Sociolegal Studies, University of Toronto, Toronto, Canada
| | - Samantha E. Green
- St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Stephen W. Hwang
- St. Michael’s Hospital, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
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