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Kim C, Jin H, Kang G, Dusing GJ, Chum A. Patterns of follow-up mental health care after hospitalization for suicide-related behaviors among older adults in South Korea. J Affect Disord 2024; 350:313-318. [PMID: 38237869 DOI: 10.1016/j.jad.2024.01.089] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVE This study aimed to investigate the sociodemographic and clinical factors associated with receiving follow-up mental healthcare within 7 days and 30 days after hospitalization for suicide-related behaviors (SRB) among older adults in South Korea. METHODS Data from the Korean National Health Information Database were used, including information on sociodemographic variables and healthcare utilization. The study cohort consisted of individuals born in 1950 or before with a prior hospitalization record for suicide attempts or probable suicide attempts. Logistic regression analysis was conducted to predict the odds of receiving follow-up care within 7 days and 30 days, adjusting for covariates. RESULTS Among the 37,595 older adults discharged from hospitalization for SRB, 29.13 % and 37.86 % received follow-up care within 7 days and 30 days, respectively. Follow-up care was more common among younger individuals, women, those with higher socio-economic status (SES), urban residents, and individuals with comorbidities. CONCLUSION The provision of mental health follow-up care for older adults after hospitalization for suicide attempts is inadequate in South Korea. Increasing access to follow-up care among those with lower income, residing in rural areas, and older age is crucial. Public awareness campaigns, stigma reduction training for healthcare providers, and system-level changes, such as telemedicine and integrated care pathways, can help bridge the healthcare gap and reduce suicide mortality among older adults.
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Affiliation(s)
- Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Hyunju Jin
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China; Seoul National University Institute of Sport Science, Seoul, South Korea
| | - Goneui Kang
- Department of Economics, Korea University, Seoul, South Korea
| | | | - Antony Chum
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Kim C, Bai Y, O'Campo P, Chum A. Impact of the minimum wage increase on intimate partner violence (IPV): a quasi-experimental study in South Korea. J Epidemiol Community Health 2024; 78:235-240. [PMID: 38262734 DOI: 10.1136/jech-2023-221339] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Poverty is associated with intimate partner violence (IPV), but whether exogenous increases in wage could reduce IPV among low-income women is still unclear. We examined whether the 2018 minimum wage hike led to a reduction in IPV risk among women. METHODS Using the 2015-2019 Korean Welfare Panel Study, we employed a difference-in-differences (DID) approach to assess the effect of the minimum wage hike on IPV. The analysis focused on married women aged 19 or older. We categorised participants into a target group (likely affected by the minimum wage increase) and a comparison group based on their hourly wage. Three IPV outcomes were examined: verbal abuse, physical threat and physical assault. We conducted DID analyses with two-way fixed-effects models. RESULTS The increase in minimum wage was correlated with a 3.2% decrease in the likelihood of experiencing physical threat among low-income female workers (95% CI: -6.2% to -0.1%). However, the policy change did not significantly influence the risk of verbal abuse, physical assault or a combined IPV outcome. The study also highlights a higher incidence of all IPV outcomes in the target group compared with the comparison group. CONCLUSIONS The 2018 minimum wage increase in Korea was associated with a modest reduction in physical threat among low-income female workers. While economic empowerment through minimum wage policies may contribute to IPV prevention, additional measures should be explored. Further research is needed to understand the intricate relationship between minimum wage policies and IPV, and evidence-based prevention strategies are crucial to address IPV risk.
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Affiliation(s)
- Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Yihong Bai
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- University of Western Ontario, London, Ontario, Canada
| | - Patricia O'Campo
- Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Antony Chum
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Kim C, Bai Y, Dusing GJ, Nielsen A, Chum A. The impact of minimum wage increase on suicidal ideation in South Korea: a difference-in-differences analysis using nationally representative panel data. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02646-w. [PMID: 38429540 DOI: 10.1007/s00127-024-02646-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND South Korea had the highest suicide rates in the OECD and one of the largest (16.4%) increases in the minimum wage in 2018. Prior studies have provided evidence that increases in minimum wage reduce suicide rates in the population, but no study examined the effects of the policy change on individual-level suicidal behaviour. METHODS Our study sample was built using the 2015-2019 waves of the Korean Welfare Panel Survey, a population-representative longitudinal survey. The sample consisted of 5146 participants, including those earning above minimum wage (control) and minimum wage earners (treatment) based on their 2018/19 earnings. The outcome of the study was suicidal ideation, which is an important precursor to other suicidal behaviours, and was captured using self-reported measures. We examined the impact of the 2018 minimum wage hike in Korea on suicidal ideation, using a difference-in-differences design. RESULTS The minimum wage increase was associated with a 1.6% points reduction (95% CI: -2.8% to -0.5%) in self-reported suicidal ideation. Stronger policy effects were shown among women and older age groups. CONCLUSIONS Our study demonstrates that public policies employing a population-based approach, such as increasing minimum wages, could serve as an effective intervention to mitigate suicidal ideation among low-income workers.
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Affiliation(s)
- Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Yihong Bai
- Department of Economics, McMaster University, Hamilton, ON, Canada
- Western University Ontario, London, Canada
| | - Gabriel John Dusing
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Andrew Nielsen
- Canadian Institute for Health Information, Ottawa, ON, Canada
| | - Antony Chum
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada.
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Dusing GJ, Kim C, Nielsen A, Chum A. Disparities in alcohol- and substance-related hospitalizations and deaths across sexual orientations in Canada: a longitudinal study. Public Health 2024; 226:32-38. [PMID: 37995410 DOI: 10.1016/j.puhe.2023.10.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES We aim to quantify disparities in substance-related acute events (i.e. hospitalizations and deaths for substances, including alcohol, cannabis, opioids, narcotics, and/or illicit drugs) across sexual orientations based on health administrative data. STUDY DESIGN This was a longitudinal analysis from six waves of the Canadian Community Health Survey (2009-2014) linked to hospitalization/mortality data in Ontario, Canada. METHODS The study sample consisted of survey respondents aged ≥15 (weighted n = 15,406,000) who provided a valid response to the question about sexual orientation. The primary outcome was substance-related acute events, including hospitalizations and deaths due to alcohol, cannabis, opioids, narcotics, and/or illicit drugs. Disparities in substance-related acute events across sexual orientation and gender were examined using flexible parametric survival analysis. RESULTS Bisexual women had hazard ratios of 2.46 (95% confidence interval: 1.46-4.15) for any substance-related acute event and 2.67 (95% confidence interval: 1.42-5.00) for non-alcohol substance acute events compared to heterosexual women. Lesbian women did not exhibit significant differences in acute event risk compared to heterosexual women. Gay and bisexual men demonstrated elevated but not statistically significant risks compared to heterosexual men. CONCLUSIONS Bisexual women face higher risks of substance-related acute events, potentially due to self-medication of unique stressors brought on by discrimination and isolation. Enhanced education and training for healthcare professionals are essential to increase awareness and sensitivity toward the heightened substance use risk among lesbian, gay, and bisexual individuals. Targeted interventions aimed at reducing substance use problems among bisexual individuals warrant increased funding and research.
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Affiliation(s)
- G J Dusing
- York University, School of Kinesiology and Health Sciences, Canada
| | - C Kim
- York University, School of Kinesiology and Health Sciences, Canada
| | - A Nielsen
- Canadian Institute of Health Information, Canada
| | - A Chum
- York University, School of Kinesiology and Health Sciences, Canada; University of Toronto, Dalla Lana School of Public Health, Canada.
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Kim C, Dusing GJ, Nielsen A, MacMaster FP, Rittenbach K, Allin S, O'Campo P, Penney TL, Hamilton HA, Kirst M, Chum A. Disparities in cannabis-related emergency department visits across depressed and non-depressed individuals and the impact of recreational cannabis policy in Ontario, Canada. Psychol Med 2023; 53:7127-7137. [PMID: 37345465 PMCID: PMC10719623 DOI: 10.1017/s0033291723000569] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/23/2023] [Accepted: 02/16/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Recreational cannabis policies are being considered in many jurisdictions internationally. Given that cannabis use is more prevalent among people with depression, legalisation may lead to more adverse events in this population. Cannabis legalisation in Canada included the legalisation of flower and herbs (phase 1) in October 2018, and the deregulation of cannabis edibles one year later (phase 2). This study investigated disparities in cannabis-related emergency department (ED) visits in depressed and non-depressed individuals in each phase. METHODS Using administrative data, we identified all adults diagnosed with depression 60 months prior to legalisation (n = 929 844). A non-depressed comparison group was identified using propensity score matching. We compared the pre-post policy differences in cannabis-related ED-visits in depressed individuals v. matched (and unmatched) non-depressed individuals. RESULTS In the matched sample (i.e. comparison with non-depressed people similar to the depressed group), people with depression had approximately four times higher risk of cannabis-related ED-visits relative to the non-depressed over the entire period. Phases 1 and 2 were not associated with any changes in the matched depressed and non-depressed groups. In the unmatched sample (i.e. comparison with the non-depressed general population), the disparity between individuals with and without depression is greater. While phase 1 was associated with an immediate increase in ED-visits among the general population, phase 2 was not associated with any changes in the unmatched depressed and non-depressed groups. CONCLUSIONS Depression is a risk factor for cannabis-related ED-visits. Cannabis legalisation did not further elevate the risk among individuals diagnosed with depression.
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Affiliation(s)
- Chungah Kim
- Faculty of Health, York University, School of Kinesiology and Health Science, Toronto, Ontario, Canada
| | - Gabriel John Dusing
- Faculty of Health, York University, School of Kinesiology and Health Science, Toronto, Ontario, Canada
| | - Andrew Nielsen
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Frank P. MacMaster
- University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Katherine Rittenbach
- Faculty of Medicine & Dentistry, Psychiatry Department, University of Alberta, Edmonton, Alberta
| | - Sara Allin
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario
| | - Patricia O'Campo
- St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Tarra L. Penney
- Faculty of Health, York University, School of Kinesiology and Health Science, Toronto, Ontario, Canada
| | | | - Maritt Kirst
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Antony Chum
- Faculty of Health, York University, School of Kinesiology and Health Science, Toronto, Ontario, Canada
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario
- St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Bai Y, Kim C, Chum A. Impact of the minimum wage increase on smoking behaviour: A quasi-experimental study in South Korea. Soc Sci Med 2023; 333:116135. [PMID: 37562244 DOI: 10.1016/j.socscimed.2023.116135] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND While there's a growing body of research studying the health effects of minimum wage increases, evidence of its impact on smoking is inconsistent. Using nationally representative statistics, our quasi-experimental study examines the impacts of South Korea's 2018 minimum wage increase on smoking patterns, offering a distinctive context due to the significant wage growth and the country's permissive smoking culture. METHODS Using the Korean Welfare Panel Study (KOWEPS), we conducted a difference-in-differences analysis using two-way fixed effect (TWFE) and Callaway and Sant'Anna Difference-in-differences (CSDID) methods. The study sample (n = 3494) included individuals aged 19-64 at baseline in 2016, and employed in the entire study period (2016-2019). RESULTS The model results suggest a roughly 2% increase in the probability of current smoking with an insignificant impact on average daily cigarette consumption following the 2018 minimum wage increase in Korea. These effects were most pronounced among men and age groups (45-64). We also found policy effects on those earning up to 150% of the minimum wage. CONCLUSION In a culture with widespread acceptance of smoking, an exogenous increase in disposable income due to elevated minimum wage might enhance vulnerability to societal pressure to smoke. Although TWFE and CSDID both suggest the same overall trend, the latter approach allows a more detailed examination by acknowledging heterogeneous treatment effects. These results could guide policymakers to contemplate the potential for increased smoking resulting from minimum wage hikes in societies where tobacco use is common, and accordingly strategize anti-smoking public health initiatives.
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Affiliation(s)
- Yihong Bai
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Antony Chum
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Chum A, Kim C, Nielsen A, Dusing GJ, O'Campo P, Matheson FI, Barker L, Vigod S, Ling V, Fung K, Kennedy S. Disparities in Suicide-Related Behaviors Across Sexual Orientations by Gender: A Retrospective Cohort Study Using Linked Health Administrative Data. Am J Psychiatry 2023; 180:660-667. [PMID: 37282552 DOI: 10.1176/appi.ajp.20220763] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The authors used a population-representative sample and health administrative data to quantify suicide-related behavior leading to acute care or deaths across self-identified heterosexual, gay/lesbian, and bisexual individuals. METHODS Data from a population-based survey (N=123,995) were linked to health administrative data (2002-2019), and differences in time to suicide-related behavior events across sexual orientations were examined using Cox proportional hazards regression. RESULTS The crude incidence rates of suicide-related behavior events per 100,000 person-years were 224.7 for heterosexuals, 664.7 for gay/lesbian individuals, and 5,911.9 for bisexual individuals. In fully adjusted (gender-combined) models, bisexual individuals were 2.98 times (95% CI=2.08-4.27) more likely to have an event, and gay men and lesbians 2.10 times (95% CI=1.18-3.71) more likely, compared with heterosexual individuals. CONCLUSIONS In a large population-based sample of Ontario residents, using clinically relevant outcomes, the study found gay/lesbian and bisexual individuals to be at elevated risk of suicide-related behavior events. Increased education among psychiatric professionals is needed to improve awareness of and sensitivity to the elevated risk of suicide-related behavior among sexual minority individuals, and further research on interventions is needed to reduce such behaviors.
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Affiliation(s)
- Antony Chum
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Andrew Nielsen
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Gabriel John Dusing
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Patricia O'Campo
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Flora I Matheson
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Lucy Barker
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Simone Vigod
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Vicki Ling
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Kinwah Fung
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
| | - Sidney Kennedy
- School of Kinesiology and Health Science, York University, Toronto (Chum, Kim, Dusing); Dalla Lana School of Public Health, University of Toronto, Toronto (Chum, Matheson); MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto (Chum, Nielsen, O'Campo, Matheson); Department of Psychiatry, Women's College Hospital, Toronto (Barker, Vigod); Department of Psychiatry, University of Toronto, Toronto (Vigod); Institute for Clinical Evaluative Sciences, Toronto (Ling, Fung); Centre for Depression and Suicide Studies, St. Michael's Hospital, Toronto (Kennedy)
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Nielsen A, Azra KK, Kim C, Dusing GJ, Chum A. Is the association between sexual minority status and suicide-related behaviours modified by rurality? A discrete-time survival analysis using longitudinal health administrative data. Soc Sci Med 2023; 325:115896. [PMID: 37084702 DOI: 10.1016/j.socscimed.2023.115896] [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: 09/26/2022] [Revised: 03/08/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND While self-reported data shows that lesbian, gay, and bisexual (LBG) individuals have a greater suicide-related behaviours (SRB) risk, little is known about how rurality may amplify SRB risk associated with sexual minority status. Sexual minority individuals in rural areas may experience unique stressors due to stigma and a lack of LGB-specific social and mental health services. Using a population-representative sample linked to clinical SRB outcomes, we examined whether rurality modifies the association between sexual minority status and SRB risk. METHODS A nationally representative survey linked to administrative health data was used to construct a cohort of individuals (unweighted n = 169,091; weighted n = 8,778,115) in Ontario, Canada, and captured all SRB-related emergency department visits, hospitalizations, and deaths between 2007 and 2017. Sex-stratified discrete-time survival analyses were used to examine interactions between rurality and sexual minority status on SRB risk while controlling for potential confounders. RESULTS Sexual minority men had 2.18 times higher SRB odds compared to their heterosexual counterparts (95%CI 1.21-3.91), while sexual minority women had 2.07 times higher odds (95%CI 1.48-2.89) after adjusting for the confounders. The Rurality Index of Ontario and the Index of Remoteness were associated with the odds of SRB in a dose-response manner. No significant interactions were observed between rural and sexual minority status. CONCLUSIONS Our study provides evidence that rural and sexual minority status both independently contribute to an elevated likelihood of SRB; however, rurality did not appear to modify SRB risk by sexual orientation. Implementation and evaluation of interventions to reduce SRB in both rural and sexual minority populations are required.
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Affiliation(s)
- Andrew Nielsen
- Canadian Institute for Health Information, 4110 Yonge St Suite 300, North York, ON M2P 2B7, Canada
| | - Karanpreet Kaur Azra
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon St, Whitby, Ontario, L1N 5S9, Canada
| | - Chungah Kim
- School of Kinesiology and Health Science, York University, 4700 Keele St, Toronto, Ontario, M3J 1P3, Canada
| | - Gabriel John Dusing
- School of Kinesiology and Health Science, York University, 4700 Keele St, Toronto, Ontario, M3J 1P3, Canada
| | - Antony Chum
- School of Kinesiology and Health Science, York University, 4700 Keele St, Toronto, Ontario, M3J 1P3, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada; Unity Health Toronto, MAP Centre for Urban Health Solutions, 209 Victoria Street, 3rd floor, Toronto, Ontario, M5B 1T8, Canada.
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Kim C, Teo C, Nielsen A, Chum A. Macro-level gender equality and women's depressive symptoms in South Korea: a longitudinal study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:383-393. [PMID: 35931793 DOI: 10.1007/s00127-022-02335-6] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE In 2014, the Korean Government passed the Gender Equality Act, which was accompanied by policies to increase women's participation in the labour force and representation in positions of power in the public and private sectors. While Korea has witnessed modest progress in macro-level gender equality, little is known about the effects of these changes on mental health outcomes. Our study investigated the relationship between regional-level gender equality (as measured by women's economic and political power) and women's depressive symptoms from 2013-18, and whether the effects differed across women from different socioeconomic positions. METHODS To examine how change over time in political and economic power influences the severity of depressive symptoms, we applied a fixed-effect regression, using a nationally representative sample for women aged 19-64 (n = 9,589) from the Korean Longitudinal Survey of Women and Families (2013-2018, wave 4 to 6) residing across the 16 regions of South Korea. RESULTS Our study found that increases in women's political and economic power led to moderate reductions in depressive symptoms (-0.25 and -0.23 points in CESD respectively). Sensitivity analyses indicate that economic power is more consistently associated with subsequent reductions in CESD. The effect of economic and political power on depressive symptoms did not differ by women's socioeconomic positions. CONCLUSIONS Our findings suggest that even modest improvements in gender equality were associated with increases in women's mental health. Further progress to ensure gender equality, such as the anti-discrimination legislation, may lead to greater improvements in public mental health.
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Affiliation(s)
- Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Celine Teo
- Department of Applied Health Sciences, Brock University, St Catharines, ON, Canada
| | - Andrew Nielsen
- Department of Applied Health Sciences, Brock University, St Catharines, ON, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Antony Chum
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Azra KK, Nielsen A, Kim C, Dusing GJ, Chum A. Investigating suicide related behaviours across sexual orientation and neighbourhood deprivation levels: A cohort study using linked health administrative data. PLoS One 2023; 18:e0282910. [PMID: 36989270 PMCID: PMC10058080 DOI: 10.1371/journal.pone.0282910] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/24/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND There have been no studies examining how neighbourhood deprivation modifies the effects of sexual minority status on suicide-related behaviours (SRB). Sexual minority individuals in deprived areas may face unique challenges and stressors that exacerbate their risk of SRB. This study aims to investigate the association between sexual minority status and clinical SRB, and examine whether the effect of neighbourhood deprivation differs across sexual orientation. METHODS A population-representative survey sample (169,090 respondents weighted to represent 8,778,120 individuals; overall participation rate 75%) was linked to administrative health data in Ontario, Canada to measure SRB-related events (emergency department visits, hospitalizations, and deaths) from 2007 to 2017. Neighbourhood-level deprivation was measured using the Ontario Marginalisation index measure of material deprivation at the dissemination area level. Discrete-time survival analysis models, stratified by sex, tested the effects of neighbourhood deprivation and sexual minority status, while controlling for individual-level covariates. RESULTS Sexual minority men had 2.79 times higher odds of SRB compared to their heterosexual counterparts (95% CI 1.66 to 4.71), while sexual minority women had 2.14 times higher odds (95% CI 1.54 to 2.98). Additionally, neighbourhood deprivation was associated with higher odds of SRB: men in the most deprived neighbourhoods (Q5) had 2.01 times higher odds (95% CI 1.38 to 2.92) of SRB compared to those in the least deprived (Q1), while women had 1.75 times higher odds (95% CI 1.28 to 2.40). No significant interactions were observed between sexual minority status and neighbourhood deprivation levels. CONCLUSION In both men and women, sexual minority status and neighbourhood deprivation are independent risk factors for SRB. Despite the lack of effect modification, sexual minorities living in the most deprived neighbourhoods have the highest chances of SRB. Future investigations should evaluate interventions and policies to improve sexual minority mental health and address neighbourhood deprivation.
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Affiliation(s)
- Karanpreet Kaur Azra
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Andrew Nielsen
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Gabriel John Dusing
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Antony Chum
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Kim C, Chum A, Nielsen A, MacMaster F, Rittenbach K, Allin S, O'Campo P, Kirst M, Hamilton H. Cannabis Legalization and cannabis-Related Hospitalizations in Ontario, Canada. Can J Psychiatry 2023; 68:67-70. [PMID: 35892283 PMCID: PMC9720479 DOI: 10.1177/07067437221114785] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chungah Kim
- Department of Applied Health Sciences, 7497Brock University, St. Catharines, Ontario, Canada
| | - Antony Chum
- Department of Applied Health Sciences, 7497Brock University, St. Catharines, Ontario, Canada.,Unity Health Toronto, MAP Centre for Urban Health Solutions, Toronto, Ontario, Canada.,274071University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Andrew Nielsen
- Department of Applied Health Sciences, 7497Brock University, St. Catharines, Ontario, Canada.,Unity Health Toronto, MAP Centre for Urban Health Solutions, Toronto, Ontario, Canada
| | - Frank MacMaster
- Department of Psychiatry, 2129University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, 2129University of Calgary, Calgary, Alberta, Canada
| | - Katherine Rittenbach
- Department of Psychiatry, 2129University of Calgary, Calgary, Alberta, Canada.,3146Alberta Health Services, Strategic Clinical Networks, Edmonton, Alberta, Canada
| | - Sara Allin
- 274071University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Patricia O'Campo
- Unity Health Toronto, MAP Centre for Urban Health Solutions, Toronto, Ontario, Canada.,274071University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Maritt Kirst
- Department of Psychology, 8431Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Hayley Hamilton
- 7978Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada
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12
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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.
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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
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13
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Kim C, Nielsen A, Teo C, Chum A. Social Movement and Mental Health of South Korean Women Sexual Violence Survivors, 2012-2019. Am J Public Health 2022; 112:1337-1345. [PMID: 35838525 DOI: 10.2105/ajph.2022.306945] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To examine whether the #MeToo movement influenced depressive symptoms among women in South Korea with a history of experiencing sexual violence. Methods. We used data from a nationally representative sample (n = 4429) of women 19 to 50 years of age who participated in the Korean Longitudinal Survey of Women and Families between 2012 and 2019. A difference-in-differences model was used to estimate within-person changes in depressive symptoms attributable to the #MeToo movement across women with and without a history of experiencing sexual violence. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CESD). Results. After adjustment for potential confounders, the #MeToo movement led to a 1.64 decrease in CESD scores among women with a history of experiencing sexual violence relative to women without such a history. Conclusions. Our findings suggest that the #MeToo movement in Korea led to reduced depressive symptoms among women with a history of experiencing sexual violence. Public Health Implications. Despite the progress of the #MeToo movement, there are still judicial and institutional problems that can revictimize sexual violence survivors. Further policy changes will likely improve the mental health of survivors. (Am J Public Health. Published online ahead of print July 14, 2022:e1-e9. https://doi.org/10.2105/AJPH.2022.306945).
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Affiliation(s)
- Chungah Kim
- Chungah Kim and Antony Chum are with the School of Kinesiology and Health Science, York University, Toronto, Ontario. Antony Chum, Andrew Nielsen, and Celine Teo are with MAP Centre for Urban Health Solutions, Unity Health Toronto, Ontario. Andrew Nielsen and Celine Teo are also with the Department of Applied Health Sciences, Brock University, St. Catharines, Ontario. Antony Chum is also with the Dalla Lana School of Public Health, University of Toronto, Ontario
| | - Andrew Nielsen
- Chungah Kim and Antony Chum are with the School of Kinesiology and Health Science, York University, Toronto, Ontario. Antony Chum, Andrew Nielsen, and Celine Teo are with MAP Centre for Urban Health Solutions, Unity Health Toronto, Ontario. Andrew Nielsen and Celine Teo are also with the Department of Applied Health Sciences, Brock University, St. Catharines, Ontario. Antony Chum is also with the Dalla Lana School of Public Health, University of Toronto, Ontario
| | - Celine Teo
- Chungah Kim and Antony Chum are with the School of Kinesiology and Health Science, York University, Toronto, Ontario. Antony Chum, Andrew Nielsen, and Celine Teo are with MAP Centre for Urban Health Solutions, Unity Health Toronto, Ontario. Andrew Nielsen and Celine Teo are also with the Department of Applied Health Sciences, Brock University, St. Catharines, Ontario. Antony Chum is also with the Dalla Lana School of Public Health, University of Toronto, Ontario
| | - Antony Chum
- Chungah Kim and Antony Chum are with the School of Kinesiology and Health Science, York University, Toronto, Ontario. Antony Chum, Andrew Nielsen, and Celine Teo are with MAP Centre for Urban Health Solutions, Unity Health Toronto, Ontario. Andrew Nielsen and Celine Teo are also with the Department of Applied Health Sciences, Brock University, St. Catharines, Ontario. Antony Chum is also with the Dalla Lana School of Public Health, University of Toronto, Ontario
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14
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Kim C, Teo C, Nielsen A, Chum A. What are the mental health consequences of austerity measures in public housing? A quasi-experimental study. J Epidemiol Community Health 2022; 76:jech-2021-218324. [PMID: 35705363 DOI: 10.1136/jech-2021-218324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/28/2021] [Accepted: 05/26/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND As governments around the world implement austerity measures to reduce national deficits, there is an urgent need to investigate potential health impacts of specific measures to avoid unintended consequences. In 2013, the UK government implemented the underoccupancy penalty (ie, the bedroom tax) to reduce the national housing benefits bill, by cutting social housing subsidies for households deemed to have excess rooms. We investigated the impact of the bedroom tax on self-reported psychological distress. METHODS Using data from the UK Household Longitudinal Study (2010-2014), the sample included those who received housing subsidies, aged 16-60, living in England. Control and treatment groupings were identified on their household composition and housing situation. We used matching methods to create an exchangeable set of observations. Difference-in-differences analysis was performed to examine changes across the prereform and postreform psychological distress of the treatment and control groups, using the 12-item General Health Questionnaire. RESULTS The implementation of the reform was associated with a moderate increase in psychological distress (0.88, 95% CI 0.06 to 1.71) among the treatment group, relative to the control group. However, the announcement was not associated with change in psychological distress (0.53, 95% CI 0.21 to 1.27). CONCLUSION Our study provides evidence that the implementation of housing austerity measures can increase psychological distress among social housing tenants. As the use of austerity measures become more widespread, policy-makers should consider supplementary interventions to ameliorate potential negative health consequences.
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Affiliation(s)
- Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Celine Teo
- Department of Applied Health Sciences, Brock University, St Catharines, Ontario, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Andrew Nielsen
- Department of Applied Health Sciences, Brock University, St Catharines, Ontario, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Antony Chum
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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15
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Kim C, Azra K, Teo C, Nielsen A, Bellows Z, Young T, Chum A. Do social protection programmes have a causal effect on suicide mortality? A protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e054677. [PMID: 35459667 PMCID: PMC9036465 DOI: 10.1136/bmjopen-2021-054677] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Recent international and national strategies to reduce suicide mortality have suggested that social protection programmes may be an effective multisectoral response given the link between material deprivation and suicides in observational studies. However, there is a lack of evidence on the causal relationship between social protection programmes and suicide, which may hinder substantial national budget reallocations necessary to implement these policies. Social protection programmes are government interventions that ensure adequate income now and in the future, through changes to earned income (eg, minimum wage increase) or social security (via cash transfers or cash equivalents). Our review aims to evaluate the existing evidence on a causal relationship between social protection programmes and suicide mortality by examining all relevant experimental and quasi-experimental studies between January 1980 and November 2021. METHODS AND ANALYSIS The review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We will search references published between 1 January 1980 and 30 November 2021 in 10 electronic databases, including MEDLINE (PubMed), PsycINFO, EMBASE and Applied Social Sciences Index Abstracts. Seven reviewers will independently participate in screening studies from titles, abstracts and full texts across all the stages. Experimental (ie, randomised controlled trials) and quasi-experimental studies (ie, non-randomised interventional studies) written in English, French, Spanish, German, Chinese, Korean and Japanese examining the impact of income security programmes on suicide mortality were included. Meta-analyses will be conducted if there are at least three studies with similar income security programmes. ETHICS AND DISSEMINATION Our proposed review does not require ethical approval. In collaboration with our community partners, we will develop a policy brief for stakeholders to support efforts to implement social protection programmes to help prevent suicides. Our findings will be presented at conferences, published in a peer-reviewer journal and promoted on social media platforms. PROSPERO REGISTRATION NUMBER CRD42021252235.
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Affiliation(s)
- Chungah Kim
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Karanpreet Azra
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Celine Teo
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Andrew Nielsen
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Zachary Bellows
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Thomas Young
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Antony Chum
- Department of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Epidemiology Divison, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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16
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Chum A, Teo C, Azra KK. Does the longitudinal association between neighbourhood cohesion and mental health differ by ethnicity? Results from the UK Household Longitudinal Survey. Soc Psychiatry Psychiatr Epidemiol 2022; 57:859-872. [PMID: 34241637 DOI: 10.1007/s00127-021-02125-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 06/22/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE While the association between neighbourhood cohesion and mental health has been widely studied in the general population, the effects of neighbourhood cohesion across ethnic groups are not well understood. Ethnicity is often left out of study design, many studies do not consider effect modification by ethnicity, or they rely on overly simplistic ethnic categories. METHODS Data from the UK household longitudinal study were used to investigate whether changes in neighbourhood cohesion are independently associated with changes in mental health (measured using the GHQ) over 9 years (2009-2018), and whether the association differed across 17 ethnic groups. The study used a fixed-effect modeling approach that includes within-person estimators that allow each participant to act as their own control. RESULTS Compared to British White, the following ethnic groups all saw a similar improvement in GHQ (- 0.76, 95% CI - 0.83 to - 0.70) for each point increase in neighbourhood cohesion: Irish, any other White, White and Asian mixed, Chinese, Caribbean, African, any other Black, Arab, and others. Some ethnic groups saw stronger improvements in mental for each point increase in neighbourhood cohesion, including White and Black Caribbean mixed, any other mixed, Indian, Pakistani, any other Asian, with the strongest effect seen in Bangladeshi participants (- 2.52. 95% CI - 3.48 to - 1.56). CONCLUSION Our study highlights the importance of ethnocultural data in research examining neighbourhood effects on mental health. Future research should evaluate policies to improve neighbourhood cohesion for ethnic minorities to address ethnic mental health disparities.
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Affiliation(s)
- Antony Chum
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 4A, Canada. .,MAP Center for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, M5V 1W8, Canada.
| | - Celine Teo
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 4A, Canada
| | - Karanpreet Kaur Azra
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 4A, Canada
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Chum A, Kaur S, Teo C, Nielsen A, Muntaner C, O'Campo P. The impact of changes in job security on mental health across gender and family responsibility: evidence from the UK Household Longitudinal Study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:25-36. [PMID: 34767035 DOI: 10.1007/s00127-021-02187-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE While there is strong evidence that job insecurity leads to mental distress, little is known about how gender and parental responsibilities may exacerbate this relationship. Examining their contribution as potential effect modifiers may provide insights into gender inequalities in mental health and inform gender-sensitive labour policies to ameliorate the negative effects of job insecurity. Our study addresses this gap by examining the longitudinal association between job insecurity and mental health across different configurations of gender and parental responsibilities. METHODS Our sample includes 34,772 employed participants over the period of 2010-2018. A gender-stratified fixed-effect regression was used to model the within-person change over time in mental health associated with loss of job security, and effect modification by parent-partner status (e.g. childfree men, partnered father, etc.). RESULTS Loss of job security was associated with a moderate decrease in mental health functioning for partnered fathers, partnered mothers, and childfree men and women ranging between a reduction in MCS-12 by 1.00 to 2.27 points (p < 0.05). Lone fathers who lose their job security experienced a higher decrease in mental health functioning at - 7.69 (95% CI - 12.69 to - 2.70), while lone mothers did not experience any change. CONCLUSION The effects of job insecurity on mental health is consistent across gender and parent-partner status with the exception of lone fathers and lone mothers. Future studies should investigate the effects of policies that may reduce mental distress in the face of the threat of job loss such as reducing wait time for payment of unemployment benefits.
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Affiliation(s)
- Antony Chum
- Department of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 4A1, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.
| | - Sukhdeep Kaur
- Department of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 4A1, Canada
| | - Celine Teo
- Department of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 4A1, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Andrew Nielsen
- Department of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 4A1, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Carles Muntaner
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Patricia O'Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
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18
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Chum A, Nielsen A, Teo C. Sleep problems among sexual minorities: a longitudinal study on the influence of the family of origin and chosen family. BMC Public Health 2021; 21:2267. [PMID: 34930188 PMCID: PMC8690990 DOI: 10.1186/s12889-021-12308-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/24/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is growing evidence that lesbian, gay, and bisexual (LGB) adults experience more sleep problems than the general population. As LGB individuals experience a significantly greater risk of family rejection and low family support, our study investigates the role of family support as a potential determinant of LGB sleep problems over a prolonged period, and whether friend support (i.e. chosen family) can mitigate the effect of low family support. Given the importance of sleep on mental and physical health, study results may help shed light on persistent health disparities across sexual orientations. METHODS Our sample included 1703 LGB individuals from the UK Household Longitudinal Study (UKHLS). Mixed-effect logistic regressions were used to estimate the effect of family and friend support on the development of sleep problems after 24 months while controlling for potential confounders. A modified Pittsburgh Sleep Quality Index was used to measure 1) presence of any sleep problems, 2) short sleep duration, and 3) poor sleep quality. RESULTS Family support at baseline was independently associated with all sleep problems in our study after 24-months: 1 SD increase in family support was associated with a 0.94 times lower risk of sleep problems (95% C.I = 0.90-0.98), a 0.88 times lower risk of short sleep duration (95% C.I = 0.81-0.95), and a 0.92 times lower risk of sleep quality (95% C.I = 0.93-0.98). Support from one's chosen family (proxied by friend support) did not mitigate the effects of low family support on sleep problems. CONCLUSIONS Our study found a consistent effect of family support across all sleep outcomes along with evidence of a persistent effect after 24 months. Our findings point to the importance of targeting family support in designing interventions aimed at reducing LGB sleep problems.
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Affiliation(s)
- Antony Chum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Department of Applied Health Sciences, Brock University, St. Catharines, Canada. .,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.
| | - Andrew Nielsen
- Department of Applied Health Sciences, Brock University, St. Catharines, Canada.,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Celine Teo
- Department of Applied Health Sciences, Brock University, St. Catharines, Canada.,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
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Teo C, Metheny N, Chum A. Family support modifies the effect of changes to same-sex marriage legislation on LGB mental health: evidence from a UK cohort study. Eur J Public Health 2021; 32:35-40. [PMID: 34448847 PMCID: PMC9090167 DOI: 10.1093/eurpub/ckab139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Many lesbian, gay and bisexual (LGB) individuals continue to experience unique challenges, such as the lack of family support and access to same-sex marriage. This study examines the effect of the introduction of same-sex marriage in the UK (2013–14) on mental health functioning among sexual minorities, and investigates whether low family support may hamper the positive effects of marriage equality legislation among LGB individuals. Methods This analysis included LGB participants (n = 2172) from the UK household longitudinal study waves 3–7, comprising two waves before and two waves after marriage equality legislation passed in England, Wales and Scotland. Individual-level mental health functioning was measured using the mental component score (MCS-12) of the Short Form-12 survey. Fixed-effect panel linear models examined the effect of marriage equality on MCS-12 across varying family support levels. Analyses included adjustment for covariates and survey weights. Results Legalization of same-sex marriage was independently associated with an increase of 1.17 [95% confidence interval (CI): 0.28–2.05] MCS-12 in men and 1.13 (95% CI: 0.47–2.27) MCS-12 in women. For men, each additional standard deviation of family support modified the effect of legalization on mental health functioning by +0.70 (95% CI: 0.22–1.18) MCS-12 score. No interaction was found in women. Conclusions Our findings provide evidence that same-sex marriage will likely improve LGB mental health functioning, and these effects may be generalizable to other European countries. Since male sexual minorities with low family support benefited the least, additional interventions aimed at improving family support and acceptance of this group is required to help reduce mental health disparities.
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Affiliation(s)
- Celine Teo
- Department of Applied Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, Coral Gables, Florida, USA
| | - Antony Chum
- Department of Applied Health Sciences, Brock University, St Catharines, Ontario, Canada.,Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
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Chum A, Nielsen A, Bellows Z, Farrell E, Durette PN, Banda JM, Cupchik G. Changes in Public Response Associated With Various COVID-19 Restrictions in Ontario, Canada: Observational Infoveillance Study Using Social Media Time Series Data. J Med Internet Res 2021; 23:e28716. [PMID: 34227996 PMCID: PMC8396548 DOI: 10.2196/28716] [Citation(s) in RCA: 7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/09/2021] [Accepted: 04/26/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND News media coverage of antimask protests, COVID-19 conspiracies, and pandemic politicization has overemphasized extreme views but has done little to represent views of the general public. Investigating the public's response to various pandemic restrictions can provide a more balanced assessment of current views, allowing policy makers to craft better public health messages in anticipation of poor reactions to controversial restrictions. OBJECTIVE Using data from social media, this infoveillance study aims to understand the changes in public opinion associated with the implementation of COVID-19 restrictions (eg, business and school closures, regional lockdown differences, and additional public health restrictions, such as social distancing and masking). METHODS COVID-19-related tweets in Ontario (n=1,150,362) were collected based on keywords between March 12 and October 31, 2020. Sentiment scores were calculated using the VADER (Valence Aware Dictionary and Sentiment Reasoner) algorithm for each tweet to represent its negative to positive emotion. Public health restrictions were identified using government and news media websites. Dynamic regression models with autoregressive integrated moving average errors were used to examine the association between public health restrictions and changes in public opinion over time (ie, collective attention, aggregate positive sentiment, and level of disagreement), controlling for the effects of confounders (ie, daily COVID-19 case counts, holidays, and COVID-19-related official updates). RESULTS In addition to expected direct effects (eg, business closures led to decreased positive sentiment and increased disagreements), the impact of restrictions on public opinion was contextually driven. For example, the negative sentiment associated with business closures was reduced with higher COVID-19 case counts. While school closures and other restrictions (eg, masking, social distancing, and travel restrictions) generated increased collective attention, they did not have an effect on aggregate sentiment or the level of disagreement (ie, sentiment polarization). Partial (ie, region-targeted) lockdowns were associated with better public response (ie, higher number of tweets with net positive sentiment and lower levels of disagreement) compared to province-wide lockdowns. CONCLUSIONS Our study demonstrates the feasibility of a rapid and flexible method of evaluating the public response to pandemic restrictions using near real-time social media data. This information can help public health practitioners and policy makers anticipate public response to future pandemic restrictions and ensure adequate resources are dedicated to addressing increases in negative sentiment and levels of disagreement in the face of scientifically informed, but controversial, restrictions.
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Affiliation(s)
- Antony Chum
- Department of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew Nielsen
- Department of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Zachary Bellows
- Department of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Eddie Farrell
- Department of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | | | - Juan M Banda
- Department of Computer Science, College of Arts and Sciences, Georgia State University, Atlanta, GA, United States
| | - Gerald Cupchik
- Department of Psychology, University of Toronto, Toronto, ON, Canada
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Teo C, Kim C, Nielsen A, Young T, O'Campo P, Chum A. Did the UK COVID-19 Lockdown Modify the Influence of Neighbourhood Disorder on Psychological Distress? Evidence From a Prospective Cohort Study. Front Psychiatry 2021; 12:702807. [PMID: 34234704 PMCID: PMC8255607 DOI: 10.3389/fpsyt.2021.702807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background: National lockdown in the UK during the COVID-19 pandemic severely restricted the mobility of residents and increased time spent in their residential neighbourhoods. This is a unique opportunity to understand how an exogenous factor that reduces mobility may influence the association between neighbourhood social environment and mental health. This study investigates whether the COVID-19 lockdown may modify the effect of neighbourhood disorder on psychological distress. Methods: We tracked changes in psychological distress, using the UK household longitudinal survey across the pre-COVID and lockdown periods in 16,535 adults. Neighbourhood disorder was measured along two subscales: social stressors and property crime. Fixed-effects regression was used to evaluate whether the widespread reduction in mobility modifies the association between the subscales of neighbourhood disorder and psychological distress. Results: The effect of neighbourhood social stressors on psychological distress was stronger in the lockdown period compared to the pre-COVID period. Compared to the pre-COVID period, the effect of being in neighbourhoods with the highest social stressors (compared to the lowest) on psychological distress increased by 20% during the lockdown. Meanwhile, the effect of neighbourhood property crime on mental health did not change during the lockdown. Conclusion: The sudden loss of mobility as a result of COVID-19 lockdown is a unique opportunity to address the endogeneity problem as it relates to mobility and locational preferences in the study of neighbourhood effects on health. Vulnerable groups who have limited mobility are likely more sensitive to neighbourhood social stressors compared to the general population.
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Affiliation(s)
- Celine Teo
- Department of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Chungah Kim
- Department of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Andrew Nielsen
- Department of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Thomas Young
- Department of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Patricia O'Campo
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Antony Chum
- Department of Applied Health Sciences, Brock University, St. Catharines, ON, Canada.,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
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Teo C, Chum A. The effect of neighbourhood cohesion on mental health across sexual orientations: A longitudinal study. Soc Sci Med 2020; 265:113499. [PMID: 33213945 DOI: 10.1016/j.socscimed.2020.113499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022]
Abstract
Given the persistent mental health disparities between sexual minorities and the general population, social epidemiological research should address this disparity by investigating the differential impact of neighbourhood social environments across sexual orientations. There is growing evidence that neighbourhood cohesion, conceptualized as a sense of belonging and social connection, is an important social determinant of mental health in the general population, but little is known about its impact across sexual orientations. Using data from the UK household longitudinal study (2009-2018) including waves 1, 3, 6, and 9 ( n = 52,903), this paper examined the longitudinal relationship between neighbourhood cohesion and mental health (using GHQ-12) across sexual orientations. A fixed-effect regression approach was taken to model the within-person change over time in GHQ predicted by neighbourhood cohesion with disaggregated analyses by gender and sexual orientation. Across all sexual orientations and genders, individuals who experienced an increase in neighbourhood cohesion also saw an improvement in their mental health over time. Moreover, the effect of neighbourhood cohesion on mental health over time differed by sexual orientation. Each 1-point increase in neighbourhood cohesion (on a 5-point scale) lead to mental health improvements of -0.8 GHQ score (95%CI -0.89 to -0.71) for heterosexual males at the lowest end, and up to -1.71 GHQ score (95%CI -2.31 to - 1.11) for homosexual men at the highest end. Given that the study demonstrates notable differences in the effects of neighbourhood social environment across gender and sexual orientations, this points to the need to consider sexual orientation (along with gender) as a key modifier in research involving neighbourhood effects. Future studies should evaluate the effectiveness of specific policies aimed at improving neighbourhood social environment for sexual minorities to help close mental health disparities.
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Affiliation(s)
- Celine Teo
- Brock University, 1812 Sir Isaac Brock Way, St. Catharines, Ontario, L2S 3A1, Canada.
| | - Antony Chum
- Brock University, 1812 Sir Isaac Brock Way, St. Catharines, Ontario, L2S 3A1, Canada; Unity Health Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
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23
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Chum A, Wang R, Nisenbaum R, O'Campo P, Stergiopoulos V, Hwang S. Effect of a Housing Intervention on Selected Cardiovascular Risk Factors Among Homeless Adults With Mental Illness: 24-Month Follow-Up of a Randomized Controlled Trial. J Am Heart Assoc 2020; 9:e016896. [PMID: 32975159 PMCID: PMC7792403 DOI: 10.1161/jaha.119.016896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/16/2022]
Abstract
Background Cardiovascular disease is a leading cause of mortality among people experiencing homelessness. This study investigated whether housing intervention affects cardiovascular disease risk factors among homeless adults with mental illnesses over a 24-month period. Methods and Results We conducted a randomized controlled trial of a Housing First intervention that provided community-based scattered-site housing and support services. Five hundred seventy-five participants were randomized to the intervention (n=301) or treatment as usual (TAU) (n=274). Analyses were performed according to the intention-to-treat principle using generalized estimating equations. There were no differences in change over 24 months between the 2 groups for blood pressure, tobacco, and cocaine/crack use. However, the intervention had an impact on reducing the number of days of alcohol intoxication by 1.58 days compared with TAU (95% CI, -2.88 to -0.27, P=0.0018). Over the 24-month period, both the intervention and TAU groups had significant reductions in tobacco and cocaine use. Conclusions The intervention, compared with TAU, did not result in greater improvements in many of the selected cardiovascular risk factors. Since the study took place in a service-rich city with a range of pre-existing supportive services and universal health insurance, the high level of usual services available to the TAU group may have contributed to reductions in their cardiovascular disease risk factors. Further research is needed to develop interventions to reduce risk factors of cardiovascular disease among people experiencing homelessness and mental illness beyond existing treatments. REGISTRATION www.isrctn.comURL: www.isrctn.com. Unique Identifier: ISRCTN42520374.
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Affiliation(s)
- Antony Chum
- Brock University St. Catharines ON Canada.,Unity Health Toronto Toronto ON Canada
| | - Ri Wang
- Unity Health Toronto Toronto ON Canada
| | | | | | - Vicky Stergiopoulos
- Unity Health Toronto Toronto ON Canada.,Centre for Addiction and Mental Health Toronto ON Canada
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Chum A, O'Campo P, Lachaud J, Fink N, Kirst M, Nisenbaum R. Evaluating same-source bias in the association between neighbourhood characteristics and depression in a community sample from Toronto, Canada. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1177-1187. [PMID: 31054019 DOI: 10.1007/s00127-019-01718-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/25/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE It is common in prior studies of the influence of neighbourhood characteristics on mental health to use participant-assessed neighbourhood exposures, which can lead to same-source bias since an individual's mental health status may influence their judgement of their neighbourhood. To avoid this potential bias, we evaluated the use of individually assessed neighbourhood exposures to understand how they compare to collectively assessed measures (by aggregating multiple responses within the same neighbourhood). This would increase the validity of the measure by decoupling the neighbourhood measure from an individual's mental health status. METHODS We conducted a stratified-randomised survey of 2411 adults across 87 census tracts in Toronto, Canada (mean of 28 per census tract) to investigate how self-reported (individually assessed) social environmental neighbourhood measures compared to aggregated, collectively assessed, measures for neighbourhood problems/disorder, safety, service quality, and linking, bonding and bridging social capital. The outcome, experience of major depression in the past 12 months, was measured using the Composite International Diagnostic Studies Depression Scale Short Form. RESULTS (1) Individually assessed neighbourhood problems, (2) low (individually assessed) neighbourhood safety, (3) low (individually assessed) neighbourhood service quality, and (4) low (individually assessed) linking social capital were independently associated with depression (all at least p < 0.05). However, when the individually assessed exposures were aggregated over residents in the same neighbourhood, none of them were significantly associated with depression. CONCLUSIONS Our study provides evidence for same-source bias in studies of social environmental determinants of depression that relies on individually assessed neighbourhood measures. We caution future studies from solely relying on individually assessed neighbourhood exposures especially in the study of social environmental influences on mental health outcomes.
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Affiliation(s)
- Antony Chum
- Department of Applied Health Sciences, Brock University, St. Catharines, Canada. .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
| | - Patricia O'Campo
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - James Lachaud
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Nicolas Fink
- Department of Psychology, York University, Toronto, Canada
| | - Maritt Kirst
- Community Psychology, Wilfrid Laurier University, Waterloo, Canada
| | - Rosane Nisenbaum
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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Gee S, Chum A, Lim B. Moving Metaphors: Shifting Institutional Responsibilities and Evidentiary Boundaries in the Commissioning of Pre-Exposure Prophylaxis for HIV. Qual Health Res 2019; 29:1408-1418. [PMID: 30845886 DOI: 10.1177/1049732319831040] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this article, we investigate how speakers in the U.K.'s House of Commons cited the same legislative context and medical research to arrive at contradictory conclusions regarding the Government's responsibility to fund pre-exposure prophylaxis (PrEP) as an HIV intervention. Because the Government had expressed that it would not comment on institutional responsibilities directly, given the likelihood of a legal challenge in response to the National Health Service withdrawing PrEP from the drug commissioning process, the Government's support of this decision could not be explicitly detailed. Our discourse analytic approach reveals how members of parliament adopted positions in the debate by using distinct metaphorical frames and lexical choices to linguistically encode assumptions that imply contrary interpretations of mutually agreed upon facts. This suggests that the concrete discursive practices used to cite evidence in policy-making discussions, regardless of the quality of the evidence, may have material consequences for evidence-based policy.
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Affiliation(s)
- Seran Gee
- 1 York University, Toronto, Ontario, Canada
| | - Antony Chum
- 2 Brock University, St. Catharines, Ontario, Canada
- 3 St Michael's Hospital, Toronto, Ontario, Canada
| | - Bryan Lim
- 4 University of London, London, United Kingdom
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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.
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Affiliation(s)
- Antony Chum
- Department of Health Sciences, Brock University, Saint Catharines, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
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O'Campo P, Stergiopoulos V, Nir P, Levy M, Misir V, Chum A, Arbach B, Nisenbaum R, To MJ, Hwang SW. How did a Housing First intervention improve health and social outcomes among homeless adults with mental illness in Toronto? Two-year outcomes from a randomised trial. BMJ Open 2016; 6:e010581. [PMID: 27619826 PMCID: PMC5030577 DOI: 10.1136/bmjopen-2015-010581] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES We studied the impact of a Housing First (HF) intervention on housing, contact with the justice system, healthcare usage and health outcomes among At Home/Chez Soi randomised trial participants in Toronto, a city with an extensive service network for social and health services for individuals who are experiencing homelessness and mental illness. METHODS Participants identified as high needs were randomised to receive either the intervention which provided them with housing and supports by an assertive community treatment team (HF+ACT) or treatment as usual (TAU). Participants (N=197) had in-person interviews every 3 months for 2 years. RESULTS The HF+ACT group spent more time stably housed compared to the TAU group with the mean difference between the groups of 45.8% (95% CI 37.1% to 54.4%, p<0.0001). Accounting for baseline differences, HF+ACT group showed significant improvements over TAU group for community functioning, selected quality-of-life subscales and arrests at some time points during follow-up. No differences between HF+ACT and TAU groups over the follow-up were observed for health service usage, community integration and substance use. CONCLUSIONS HF for individuals with high levels of need increased housing stability and selected health and justice outcomes over 2 years in a city with many social and health services. TRIAL REGISTRATION NUMBER ISRCTN42520374.
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Affiliation(s)
- Patricia O'Campo
- Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Pam Nir
- Cota, Toronto, Ontario, Canada
| | - Matthew Levy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Vachan Misir
- Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada
| | - Antony Chum
- Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rosane Nisenbaum
- Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Matthew J To
- Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Centre for Research on Inner City Health, St Michael's Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Chum A, Skosireva A, Tobon J, Hwang S. Construct Validity of the SF-12v2 for the Homeless Population with Mental Illness: An Instrument to Measure Self-Reported Mental and Physical Health. PLoS One 2016; 11:e0148856. [PMID: 26938990 PMCID: PMC4777288 DOI: 10.1371/journal.pone.0148856] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/25/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Self-reported health measures are important indicators used by clinicians and researchers for the evaluation of health interventions, outcome assessment of clinical studies, and identification of health needs to improve resource allocation. However, the application of self-reported health measures relies on developing reliable and valid instruments that are suitable across diverse populations. The main objective of this study is to evaluate the construct validity of the SF-12v.2, an instrument for measuring self-rated physical and mental health, for homeless adults with mental illness. Various interventions have been aimed at improving the health of homeless people with mental illness, and the development of valid instruments to evaluate these interventions is imperative. STUDY DESIGN We measured self-rated mental and physical health from a quota sample of 575 homeless people with mental illness using the SF-12v2, EQ-5D, Colorado Symptoms Index, and physical/mental health visual analogue scales. We examined the construct validity of the SF-12v2 through confirmatory factor analyses (CFA), and using ANOVA/correlation analyses to compare the SF-12v2 to the other instruments to ascertain discriminant/convergent validity. RESULTS Our CFA showed that the measurement properties of the original SF-12v2 model had a mediocre fit with our empirical data (χ2 = 193.6, df = 43, p < .0001, CFI = 0.85, NFI = 0.83, RMSEA = 0.08). We demonstrate that changes based on theoretical rationale and previous studies can significantly improve the model, achieving an excellent fit in our final model (χ2 = 160.6, df = 48, p < .0001, CFI = 0.95, NFI = 0.95, RMSEA = 0.06). Our CFA results suggest that an alternative scoring method based on the new model may optimize health status measurement of a homeless population. Despite these issues, convergent and discriminant validity of the SF-12v2 (scored based on the original model) was supported through multiple comparisons with other instruments. CONCLUSION Our study demonstrates for the first time that the SF-12v2 is generally appropriate as a measure of physical and mental health status for a homeless population with mental illness.
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Affiliation(s)
- Antony Chum
- School of Geography, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
| | - Anna Skosireva
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Juliana Tobon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University and Offord Center for Child Studies, Hamilton, Ontario, Canada
| | - Stephen Hwang
- St. Michael’s Hospital, Centre for Research on Inner City Health, Toronto, Ontario, Canada
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Chum A, Farrell E, Vaivada T, Labetski A, Bohnert A, Selvaratnam I, Larsen K, Pinter T, O'Campo P. The effect of food environments on fruit and vegetable intake as modified by time spent at home: a cross-sectional study. BMJ Open 2015; 5:e006200. [PMID: 26044756 PMCID: PMC4458641 DOI: 10.1136/bmjopen-2014-006200] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE There is a growing body of research that investigates how the residential neighbourhood context relates to individual diet. However, previous studies ignore participants' time spent in the residential environment and this may be a problem because time-use studies show that adults' time-use pattern can significantly vary. To better understand the role of exposure duration, we designed a study to examine 'time spent at home' as a moderator to the residential food environment-diet association. DESIGN Cross-sectional observational study. SETTINGS City of Toronto, Ontario, Canada. PARTICIPANTS 2411 adults aged 25-65. PRIMARY OUTCOME MEASURE Frequency of vegetable and fruit intake (VFI) per day. RESULTS To examine how time spent at home may moderate the relationship between residential food environment and VFI, the full sample was split into three equal subgroups--short, medium and long duration spent at home. We detected significant associations between density of food stores in the residential food environment and VFI for subgroups that spend medium and long durations at home (ie, spending a mean of 8.0 and 12.3 h at home, respectively--not including sleep time), but no associations exist for people who spend the lowest amount of time at home (mean=4.7 h). Also, no associations were detected in analyses using the full sample. CONCLUSIONS Our study is the first to demonstrate that time spent at home may be an important variable to identify hidden population patterns regarding VFI. Time spent at home can impact the association between the residential food environment and individual VFI.
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Affiliation(s)
- Antony Chum
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Social and Environmental Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Eddie Farrell
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tyler Vaivada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Anna Labetski
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Arianne Bohnert
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Inthuja Selvaratnam
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kristian Larsen
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Patricia O'Campo
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada
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Chum A, O'Campo P. Cross-sectional associations between residential environmental exposures and cardiovascular diseases. BMC Public Health 2015; 15:438. [PMID: 25924669 PMCID: PMC4438471 DOI: 10.1186/s12889-015-1788-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 04/22/2015] [Indexed: 11/24/2022] Open
Abstract
Background Prior research examining neighbourhood effects on cardiovascular diseases (CVDs) has focused on the impact of neighbourhood socio-economic status or a few selected environmental variables. No studies of cardiovascular disease outcomes have investigated a broad range of urban planning related environmental factors. This is the first study to combine multiple neighbourhood influences in an integrated approach to understanding the association between the built and social environment and CVDs. By modeling multiple neighbourhood level social and environmental variables simultaneously, the study improved the estimation of effects by accounting for potential contextual confounders. Methods Data were collected using a cross-sectional survey (n = 2411) across 87 census tracts (CT) in Toronto, Canada, and commercial and census data were accessed to characterize the residential environment. Multilevel regressions were used to estimate the associations of neighbourhood factors on the risk of CVD. Results Exposure to violent crimes, environmental noise, and proximity to a major road were independently associated with increased odds of CVDs (p < 0.05) in the fully adjusted model. While reduced access to food stores, parks/recreation, and increased access to fast food restaurants were associated with increased odds of CVDs in partially adjusted models (p < 0.05), these associations were fully attenuated after adjusting for BMI and physical activity. Housing disrepair was not associated with CVD risk. Conclusions These findings illustrate the importance of measuring and modeling a broad range of neighborhood factors— exposure to violent crimes, environmental noise, and traffic, and access to food stores, fast food, parks/recreation areas— to identify specific stressors in relation to adverse health outcomes. Further research to investigate the temporal order of events is needed to better understand the direction of causation for the observed associations.
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Affiliation(s)
- Antony Chum
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK. .,Centre for Research on Inner City Health, St. Michael's Hospital, 209 Victoria, 3rd floor, Toronto, ON, M5B 1C6, Canada.
| | - Patricia O'Campo
- Centre for Research on Inner City Health, St. Michael's Hospital, 209 Victoria, 3rd floor, Toronto, ON, M5B 1C6, Canada.
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Chum A. Policy implications of neighbourhood effects on health research: Towards an alternative to poverty deconcentration. Health Place 2011; 17:1098-104. [DOI: 10.1016/j.healthplace.2011.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 05/24/2011] [Indexed: 10/18/2022]
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