Jennifer E. Butters

Meeting the Health care needs of female crack users: A Canadian example

ABSTRACT Canada is an egalitarian society committed to accessible and comprehensive health care. Although there has been a tendency to assume that its various social welfare programs have improved health conditions for lower income citizens, Canadas record in ensuring health equality remains poorer than expected (Humphries and van Doorslaer, 2000; Wasylenki, 2001). The Canadian Health Act stipulates that all residents of Canada are to have access to medically necessary hospital and physician services based on need and not the ability to pay. However, for marginalized groups such as drug users and the homeless, structural barriers to better health remain. This paper examines the health care needs and experiences of 30 women who were heavily involved in the street life of crack and prostitution in Toronto. Through their ready access to local drop-in clinics and nearby hospitals, the women reported generally positive experiences with the health care system. The study concludes that the women experienced many of the health problems that typify homeless, poorly housed and economically marginalized groups. Both positive and negative experiences with the health care system, and structural barriers that hamper its full utilization, are identified.

The Impact of Peers and Social Disapproval on High-Risk Cannabis Use: Gender Differences and Implications for Drug Education.

Drug education programs that rely on an abstinence based philosophy neglect, and may even contribute to, the potentially adverse consequences experienced by young people who already engage in this potentially health-compromising behaviour. A predominant focus of drug research during the initial wave of rising cannabis use by young people in the 1960s and 1970s, was centred on identifying the factors that contributed to this trend. Less attention has been devoted to uncovering those factors that may inhibit the progression to high-risk levels of use and particularly whether their impact differs for adolescent males and females. In spite of the questionable effectiveness, formal control mechanisms (i.e., criminal laws) and a reliance on prevention-based drug education remain primary approaches for combating drug use. This paper identifies a sub-group of adolescents already using cannabis and estimates the effects of peers, social disapproval and perceived health effects on inhibiting the escalation of use to problem levels. The results suggest that the risk for problem cannabis use among adolescents may be attenuated by some of these informal control items. The findings also suggest however, that the effects of these factors may be different for males and females. The implications for drug education initiatives are discussed. The impact of peers and social disapproval on high-risk cannabis use: Gender differences and implications for drug education.

Does gender moderate the relationship between driver aggression and its risk factors

AIM The current study assessed gender as a potential moderator of the relationship between self-reported driver aggression and various demographic variables, general and driving-related risk factors. METHODS Using data from a general-population telephone survey conducted from July 2002 through June 2005, two approaches to binary logistic regression were adopted. Based on the full dataset (n=6259), the initial analysis was a hierarchical-entry regression examining self-reported driver aggression in the last 12 months. All demographic variables (i.e., gender, age, income, education, marital status), general risk factors (i.e., psychological distress, binge drinking, cannabis use), and driving-related risk factors (i.e., driving exposure, stressful driving, exposure to busy roads, driving after drinking, driving after cannabis use) were entered in the first block, and all two-way interactions with gender were entered stepwise in the second block. The subsequent analysis involved dividing the sample by gender and conducting logistic regressions with main effects only for males (n=2921) and females (n=3338) separately. RESULTS Although the prevalence of driver aggression in the current sample was slightly higher among males (38.5%) than females (32.9%), the difference was small, and gender did not enter as a significant predictor of driver aggression in the overall logistic regression. In that analysis, difficulty with social functioning and being older were associated with a reduced risk of driver aggression. Marital status and education were unrelated to aggression, and all other variables were associated with an increased risk of aggression. Gender was found to moderate the relationships between driver aggression and only three variables: income, psychological distress, and driving exposure. Separate analyses on the male and female sub-samples also found differences in the predictive value of income and driving exposure; however, the difference for psychological distress could not be detected using this separate regression approach. The secondary analysis also identified slight differences in the predictive value of four of the risk factors, where the odds ratios for both males and females were in the same direction but only one of the two was statistically significant. CONCLUSIONS The results demonstrate the importance of conducting the gender analysis using both regression approaches. With few exceptions, factors that were predictive of driver aggression were generally the same for both male and female drivers.

Gender Differences and Demographic influences in Perceived Concern for Driver Safety and Support for Impaired Driving Countermeasures

INTRODUCTION Driving safety, impaired driving, and legislation to address these concerns remain important issues. It is imperative countermeasures be targeted toward the most appropriate groups. This paper explores the potential relationship between gender and driving attitudes toward safety issues and impaired-driving countermeasures. METHOD The data are from the 2007 Impaired Driving Survey commissioned by Transport Canada and Mothers Against Drunk Driving (MADD) Canada. The survey is a, stratified by region, telephone survey of 1,514 Canadian drivers 18years of age and older with a valid drivers license who had driven within the past 30days. RESULTS The findings illustrate a consistent impact of gender on these issues. Other variables were also identified as relevant factors although less consistently. Current findings suggest that strategies for building support for interventions, or for changing risk perception/concern for risky driving behaviors should be tailored by gender to maximize the potential for behavior change. IMPACT This information may assist program and policy developers through the identification of more or less receptive target groups. Future research directions are also presented.

How does the Canadian juvenile justice system respond to detained youth with substance use associated problems? Gaps, challenges, and emerging issues.

Despite a juvenile justice system that, since its inception in 1908, has been predicated on meeting the rehabilitative needs of youth, Canada has few specialized programs for substance misusing young offenders, preferring more holistic approaches. This is in keeping with an addictions treatment system that has evolved recently in the direction of more integrated services within the general health care and social services delivery systems. In addition, Canada has tended to emphasize community-based over institutional treatment programs. Nevertheless, for youth in conflict with the law, “substance abuse” is recognized as a significant risk factor for recidivism. The approximately 9000 young persons held in custodial facilities on any given day across the country are exposed to a variety of programs aimed at reducing antisocial behavior and hence, re-offending. Some of these have a substance use component. Programs for Aboriginal youth offer some of the most innovative approaches for particular drug use problems. This article provides an overview of the Canadian response and elaborates features of some programs, particularly Multisystemic Therapy, mainly in the province of Ontario. Few programs have received adequate evaluation, however, and the need for systematic assessment is crucial for the development of future effective interventions for youth with multiple drug and other problems.

Age group differences in collision risk

INTRODUCTION The purpose of the current study was to examine differences in factors associated with self-reported collision involvement of three age groups of drivers based on a large representative sample of Ontario adults. METHOD This study was based on data from the CAMH Monitor, an ongoing cross-sectional telephone survey of Ontario adults 18 years and older from 2002 to 2005. Three age groups were examined: 18-34 (n=1,294), 35-54 (n=2,428), and 55+ (n=1,576). For each age group sample, a logistic regression analysis was conducted of self-reported collision involvement in the last 12 months by risk factor measures of driving exposure (kilometers driven in a typical week, driving is stressful, and driving on busy roads), consuming five or more drinks of alcohol on one occasion (past 12 months), cannabis use (lifetime, and past 12 months), and driving after drinking among drinkers (past 12 months), controlling for demographics (gender, region, income, and marital status). RESULTS The study identified differences in factors associated with self-reported collision involvement of the three age groups of adult drivers. The logistic regression model for the youngest group revealed that drivers who reported that driving was stressful at least some of the time, drank five or more drinks on an occasion, and drove after drinking had an increased risk of collision involvement. For the middle age group, those who reported using cannabis in the last 12 months had significantly increased odds of reporting collision involvement. None of the risk factor measures showed significant associations with collision risk for older drivers (aged 55+). IMPACT The results suggest potential areas for intervention and new directions for future research.

Missed Conceptions: A Gendered Extension of Early Conception Among Street Youth

The moral sentiment concerning teenage pregnancy among unmarried youth is that it is an act of deviance or non-conformity. Using data from a multidisciplinary study of high-risk youth, this article explores the notion that early conception among street youth is an opportunity for youth to conform to the conventional societal role of becoming a parent, not an act of deviance. The article further highlights the importance of including young men in discussions about early conception. Drawing on general strain theory and social bonding theory, experiences of strain in the family of origin as well as current social bonds are explored. Findings indicate that both general strain and social bonding contribute to a gendered understanding of early conception among street youth.

Methodological Notes on Conducting Transdisciplinary Research

Substance use and related problems are an important topic of transdisciplinary (TD) urban health research. This chapter reviews various multiple and responsive methods that were utilized with hard to reach adolescent populations such as delinquents, dropouts and street involved youth. Stories and example of practical applications contrasting a unidisciplinary with the TD approach are drawn from two recent Toronto studies. The Drugs, Alcohol and Violence International (DAVI) study is compared to the more TD Youth Pathways Project (YPP) to illustate 3 main issues. These include the impact on formulation of the research questions, methods of data collection, and stakeholder involvement. The importantance of conveying findings to a broad audience including policy makers is also considered. Although the advantages of a transdisciplinary over a unitary disciplinary approach are primarily considered, some cautionary comments will also be raised.