Kevin M. Gorey

The prevalence of child sexual abuse: integrative review adjustment for potential response and measurement biases

This integrative review synthesizes the finding of 16 cross-sectional surveys (25 hypotheses) on the prevalence of child abuse among nonclinical, North American samples. It is essentially a research literature on sexual abuse; only one of the studies assessed physical abuse, and there has not yet been a single study of prevalent child emotional abuse nor neglect. The following summative inferences were made: (1) response rates diminished significantly over time, M = 68% prior to 1985 and M = 49% for more recent surveys, p < .05; (2) unadjusted estimates of the prevalent experience among women and men of childhood sexual abuse was 22.3% and 8.5%, respectively; (3) study response rates and child abuse operational definitions together accounted for half of the observed variability in their abuse prevalence estimates, R2 = .500, p < .05; (4) female and male child sexual abuse prevalence estimates adjusted for response rates (60% or more) were respectively, 16.8% and 7.9%, and adjusted for operational definitions (excluding the broadest, noncontact category) they were 14.5% and 7.2%; (5) after adjustment for response rates and definitions, the prevalence of child sexual abuse was not found to vary significantly over the three decades reviewed. Given the large human costs, both personal and social, of child abuse, and the identified gap in the requisite knowledge needed to steer effective preventive and treatment interventions, it is time to invest in a large, methodologically rigorous, population-based study of child abuse which, if it does nothing else, spares no expense in ensuring very high participation.

An international comparison of cancer survival: Toronto, Ontario, and Detroit, Michigan, metropolitan areas

OBJECTIVES This study examined whether socioeconomic status has a differential effect on the survival of adults diagnosed with cancer in Canada and the United States. METHODS The Ontario Cancer Registry and the National Cancer Institutes Surveillance, Epidemiology, and End Results (SEER) program provided a total of 58,202 and 76,055 population-based primary malignant cancer cases for Toronto, Ontario, and Detroit, Mich, respectively. Socioeconomic data for each persons residence at time of diagnosis were taken from population censuses. RESULTS In the US cohort, there was a significant association between socioeconomic status and survival for 12 of the 15 most common cancer sites; in the Canadian cohort, there was no such association for 12 of the 15 sites. Among residents of low-income areas, persons in Toronto experienced a survival advantage for 13 of 15 cancer sites at 1- and 5-year follow-up. No such between-country differentials were observed in the middle- or high-income groups. CONCLUSIONS The consistent pattern of a survival advantage in Canada observed across various cancer sites and follow-up periods suggests that Canadas more equitable access to preventive and therapeutic health care services is responsible for the difference.

Secular trends in the incidence of anorexia nervosa : Integrative review of population-based studies

OBJECTIVE AND METHOD Aggregating across retrospective cohort samples, this integrative review synthesizes the findings of 12 cumulative incidence studies (45 hypotheses) on anorexia nervosa secular trends. RESULTS (1) The female/male anorexia incidence rate ratio was estimated to be 8.20, 18.46 versus 2.25 cases per 100,000 per year, p < .05; (2) female teenagers experienced anorexia at a rate fivefold greater than other women, 50.82 versus 10.37 incident cases per 100,000 per year, p < .001; (3) no secular trend or change in the incidence of anorexia was observed among teenagers, while a near threefold increase was observed over the past 40 years among women in their 20s and 30s, 6.28 (1950-1964) versus 17.70 (1980-1992) cases per 100,000 per year, p < .05; and (4) the two cohort characteristics of age, and the age by year interaction accounted for nearly two thirds of the variability among anorexia incidence estimates, R2 = .614, F(2,27) = 21.49, p < .001. After the two factors of age and the Age x Year interaction were accounted for, none of the other study characteristics, including study year(s), were found to be significantly associated with anorexia incidence, that is, a main effect of time was not observed. DISCUSSION The integrative evidence across the population-based epidemiologic studies covering 40 years in this field suggests strongly that, overall, the incidence of anorexia nervosa, particularly among those very young women at greatest risk of experiencing it, has not increased significantly. However, the risk does seem to have increased significantly among women in their 20s and 30s.

Association of Ambient Air Pollution with Respiratory Hospitalization in a Government-Designated “Area of Concern”: The Case of Windsor, Ontario

This study is part of a larger research program to examine the relationship between ambient air quality and health in Windsor, Ontario, Canada. We assessed the association between air pollution and daily respiratory hospitalization for different age and sex groups from 1995 to 2000. The pollutants included were nitrogen dioxide, sulfur dioxide, carbon monoxide, ozone, particulate matter ≤10 μm in diameter (PM10), coefficient of haze (COH), and total reduced sulfur (TRS). We calculated relative risk (RR) estimates using both time-series and case-crossover methods after controlling for appropriate confounders (temperature, humidity, and change in barometric pressure). The results of both analyses were consistent. We found associations between NO2, SO2, CO, COH, or PM10 and daily hospital admission of respiratory diseases especially among females. For females 0–14 years of age, there was 1-day delayed effect of NO2 (RR = 1.19, case-crossover method), a current-day SO2 (RR = 1.11, time series), and current-day and 1- and 2-day delayed effects for CO by case crossover (RR = 1.15, 1.19, 1.22, respectively). Time-series analysis showed that 1-day delayed effect of PM10 on respiratory admissions of adult males (15–64 years of age), with an RR of 1.18. COH had significant effects on female respiratory hospitalization, especially for 2-day delayed effects on adult females, with RRs of 1.15 and 1.29 using time-series and case-crossover analysis, respectively. There were no significant associations between O3 and TRS with respiratory admissions. These findings provide policy makers with current risks estimates of respiratory hospitalization as a result of poor ambient air quality in a government designated “area of concern.”

Historical, Developmental, and Behavioral Factors Associated with Foster Care Challenges

Three agency-based studies explored the associations of traumatic child histories, as well as their developmental, health and behavioral problems with foster care challenges such as placement instability. The findings represent the convergent perspectives of child welfare workers and foster parents in small cities in Ontario. Alone and in aggregate, child and familial traumas and problems were very strong predictors of various foster care challenges. Foster parent training and other support needs are discussed.

Effectiveness of case management with severely and persistently mentally ill people

This meta-analytic review synthesizes thefindings of 24 published studies dealing with theeffectiveness of case management with the severely andpersistently mentally ill. Summative findings were: (1) Overall, case management interventions areeffective -- 75% of the clients who participate in themdo better than the average client who does not; (2) Theestimated preventive fraction (e.g., prevention of re-hospitalization) among clients whoexperience relatively intense case management service(case loads of 15 or less, 89%) is nearly 30% greaterthan that estimated among similar clients receiving less intensive service; and (3) Various casemanagement practice models did not differ significantlyon estimated effectiveness. Important questionsconcerning the differential effectiveness of casemanagement by specific program, worker, client, andclient-worker relationship characteristics remain to beanswered.

The prevalence of elder care responsibilities among the work force population: Response bias among a group of cross-sectional surveys

This review synthesizes the findings of 17 independent studies dealing with the prevalence of elder care responsibilities among the work force population. Across-study, summative findings were: (a) approximately one fifth (M = 21.1%) to one quarter (Md = 23.1%) of employees provide care for an elderly dependent; primary study findings varied by a factor of nearly 25, ranging from a high estimate of 46.0% to a low of 1.9%; (b) the average response rate was fairly low (M = 45.0% and Md = 41. 1%), indicating that the studies captured only slightly more than one third, but less than half of all eligible in-sample assignments; (c) the correlation of prevalence and response rates was found to be r = -.69, p < .01; (d) the partial correlation of prevalence with response rate, adjusted for the breadth of the elder care operational definition, remained significant, r = -.50,p < .05; and (e) these two methodological characteristics together accounted for half (R2 = .505) of the variability in reported prevalence, response rate accounting for nearly all (95.4%) of this explained criterion variation. Bias due to nonresponse thus represents a potent threat to the validity of the mean prevalence estimate found in this body of research (21.1%). The implementation of statistical controls for nonresponse and definitional inconsistencies resulted in an estimated prevalence of 7.4% to 11.8%; however, this review outcome is tentative at best and must be tested with future, better controlled primary studies.

The association of near poverty status with cancer incidence among black and white adults

This cumulative incidence study was accomplished among adults in Upstate New York metropolitan areas (Buffalo, Rochester, Syracuse and Albany—1979–1986). It used a new ecological socioeconomic status measure—near poverty status (i.e., below 200% of the federally established poverty criterion, including the poor and near poor)-and observed its association with site-specific cancer incidence (lung, stomach, cervix uteri, prostate, colon, rectum and breast). Findings were: 1) near poverty status is directly associated with each cancer sites incidence and the strength of the associations are similar among blacks and whites for each one and 2) the prevalence of exposure, of living in high near impoverishment areas, is nearly seven-fold greater among blacks; prevalence ratio [PR]=6.74 (95% confidence interval [CI]:5.07,8.99).

An international comparison of cancer survival: metropolitan Toronto, Ontario, and Honolulu, Hawaii.

OBJECTIVES Comparisons of cancer survival in Canadian and US metropolitan areas have shown consistent Canadian advantages. This study tests a health insurance hypothesis by comparing cancer survival in Toronto, Ontario, and Honolulu, Hawaii. METHODS Ontario and Hawaii registries provided a total of 9190 and 2895 cancer cases (breast and prostate, 1986-1990, followed until 1996). Socioeconomic data for each persons residence at the time of diagnosis were taken from population censuses. RESULTS Socioeconomic status and cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Honolulu, residents of low-income areas in Toronto experienced 5-year survival advantages for breast and prostate cancer. In support of the health insurance hypothesis, between-country differences were smaller than those observed with other state samples and the Canadian advantage was larger among younger women. CONCLUSIONS Hawaii seems to provide better cancer care than many other states, but patients in Toronto still enjoy a significant survival advantage. Although Hawaiis employer-mandated health insurance coverage seems an effective step toward providing equitable health care, even better care could be expected with a universally accessible, single-payer system.

Breast cancer survival in Canada and the USA: meta-analytic evidence of a Canadian advantage in low-income areas

BACKGROUND This study tested the hypothesis that relatively poor Canadian women with breast cancer have a survival advantage over their counterparts in the USA. METHODS Seventy-eight independent retrospective cohort (incidence between 1984 and 2000, followed until 2006) outcomes were synthesized. Fixed effects meta-regression models compared women with breast cancer in low-income areas of Canada and the USA. RESULTS Low-income Canadian women were advantaged on survival [rate ratio (RR) = 1.14; 95% confidence interval (CI) 1.13-1.15] and their advantage was even larger among women <65 years of age who are not yet eligible for Medicare coverage in the USA (RR = 1.21, 95% CI 1.18-1.24). Canadian advantages were also larger for node positive breast cancer, which may present with greater clinical and managerial discretion (RR = 1.40, 95% CI 1.30-1.50), and smaller when Hawaii, the state providing the most Canadian-like access, was the US comparator (RR = 1.12, 95% CI 1.01-1.20). CONCLUSIONS More inclusive health care insurance coverage in Canada vs the USA, particularly among each countrys relatively poor people, seems the most plausible explanation for such Canadian advantages. Provision of health care for all Americans would likely prevent countless early deaths, particularly among the relatively poor.