Residential Trajectory and HIV High-Risk Behaviors among Montréal Street Youth—A Reciprocal Relationship

Evidence has linked residential instability and engagement in high-risk behaviors. This paper longitudinally examines the relationship between changes in residential stability and changes in HIV risk behaviors among Montréal street youth (SY). Between April 2006 and May 2007, 419 SY (18–25 years old) were recruited in a cohort study. SY (using Montréal street youth agencies services) were eligible if they had had at least one 24-hour episode of homelessness in the previous 30 days. Baseline and follow-up interviews, carried out every 3 months, included completion of a questionnaire (based on Life History Calendar Technique) assessing daily sleeping arrangements since the last interview, and monthly sexual and drug use behaviors. Using mixed-effects logistic regression method, we examined the association between various risk behaviors and residential stability, reached when a youth resided in any of the following settings for a whole month: own place; friends’/partner’s/parent’s place; any types of housing service (excluding emergency shelters). Analyses were carried out controlling for gender, age, education level, lifetime duration of homelessness, childhood sexual trauma, and lifetime mental health disorders. As of January 2009, 360 SY (79% boys) had completed at least one follow-up interview, representing 4,889 months of follow-up. Residential stability was significantly associated with the following: sex exchange (adjusted odd ratio [AOR], 0.25; 95% confidence interval [CI], 0.14–0.37), drug injection (AOR, 0.55; CI, 0.33–0.76), daily alcohol consumption (AOR, 0.58; CI, 0.42–0.74), polydrug consumption (AOR, 0.61; CI, 0.50–0.73), polydrug consumption excluding marijuana (AOR, 0.55; CI, 0.45–0.65), and multiple sex partners (≥3 partners; AOR, 0.57; CI, 0.40–0.74). Our results suggest a reciprocal relationship between residential instability and HIV risk behaviors. This calls for more integrated services combining both individual and structural-level interventions to improve the health of street youth.     

Regional surveillance of social and geographic inequalities in smoking: the case of Montréal, Canada

Surveillance of social inequalities in health is a platform for action. We examined the trends in smoking behaviours (current and ever smoking, quit ratios) according to education and place of residence and we quantified the observed inequalities. Data were from repeated cross-sectional surveys (2003-2009) of Montreal (Canada) residents ≥15 years (n=12,053). Trends in smoking behaviours according to education were measured with logistic and log-binomial regressions. Spatial distribution of smoking behaviours across local areas was assessed with Morans' Index. Observed inequalities were quantified with prevalence ratio and difference, population attributable risk, and slope index of inequality. Results showed that ever smoking rose among low-educated individuals. Among their high-educated fellow-citizens, current smoking decreased and quit ratios increased. Adverse smoking behaviours (current and ever smoking) were clustered in south-central areas. We conclude that smoking inequalities in Montreal are growing. We thus encourage a closer monitoring of smoking social differentials.     

Trajectories of cognitive decline over 10 years in a Brazilian elderly population: the Bambuí Cohort Study of Aging

Few population-based studies have examined long term cognitive trajectory, and these studies were conducted in high income countries. We investigated the association of age, gender and education with 10-year cognitive trajectory in a well-defined population of elderly using data from the Bambuí Cohort Study of Aging, in Brazil. Cognition was measured using the Mini- Mental State Examination (MMSE). Cohort members underwent annual follow-ups. This analysis was based on 12,206 MMSE measurements from 1,461 (91%) baseline participants. We used mixed effects models to study MMSE as outcome. The key findings from this analysis are that women and people with a higher schooling level at baseline had high scores of MMSE, while older participants started off lower. Regarding cognitive decline, women, older people and those with a higher schooling level declined faster.     

Neighbourhood influences on health in Montréal, Canada

This paper examines neighbourhood effects on health within a large Canadian city--Montréal. Our approach is to consider that individual health outcomes are determined both by individual and neighbourhood characteristics and we consciously take on the problem of neighbourhood definition by developing 'natural' neighbourhoods. Our data come from the Montréal health region sample of the 2000/1 Canadian Community Health Survey, a comprehensive national survey that contains information on health outcomes as well as behavioural and socio-demographic information. Respondents were placed into 'naturally' defined neighbourhoods as opposed to arbitrary geostatistical units, responding to calls in the literature to develop more meaningful units of analysis. We also compare the 'natural' neighbourhood approach with the use of standard census tracts as the unit of analysis. Results show significant between-neighbourhood variation in health status with about 3% of the variance in the Health Utilities Index captured at the neighbourhood level, even after controlling for a variety of socio-demographic and behavioural variables at the individual level. Models using census tracts as the unit of analysis had remarkably similar results to the 'natural' neighbourhood models, suggesting that census tracts are good proxies for natural neighbourhood boundaries in studies of neighbourhood effects on health.     

Iterative Factors Favoring Collaboration for Interorganizational Resilience: The Case of the Greater Montréal Transportation Infrastructure

Between members of a network, interorganizational resilience is favored by effective collaboration and coordination during a crisis. The quality of that collaboration depends on various iterative factors present between these organizations before the occurrence of a crisis.We find that these factors are iterative since collaboration factors follow a mutually reinforcing cycle: collaboration within a crisis management network is conditioned by a general agreement, which is in turn conditioned by the extent to which the institutions coordinate themselves prior to crisis. We evaluated the factors that promote collaboration between public and private organizations that manage the Greater Montréal transportation infrastructure.These factors are based on adaptive management processes such as mutual agreements, common organizational culture, knowledge and financial resources, levers of power,regulations, and pressure. Crisis management coordination represents the ability to build and assess the effectiveness of common response plans to risks to which they are exposed. We show how these processes vary depending on the links between private and public organizations.     

The challenge of teaching occupational medicine to medical students: the Université de Montréal experience

Nonrecognition and mismanagement of work-related diseases is often linked to inadequate medical training. However, undergraduate training in occupational medicine faces many challenges, including lack of student interest and limited curriculum time. The purpose of this article is to present an undergraduate training program developed in one medical school to ensure that all medical students acquire the basic knowledge to recognize work-related health conditions and understand the fundamental principles of workers' comprehensive care. The program involves various learning methods including case studies, small-group learning, interactive large-group teaching, field activities, and e-learning. It has resulted in improving students' attitudes and competencies in occupational medicine and requires little curriculum time.     

Installation of a Bridge Barrier as a Suicide Prevention Strategy in Montréal,Québec,Canada

Objectives. We investigated whether the installation of a suicide prevention barrier on Jacques-Cartier Bridge led to displacement of suicides to other jumping sites on Montréal Island and Montérégie, Québec, the 2 regions it connects.Methods. Suicides on Montréal Island and Montérégie were extracted from chief coroners’ records. We used Poisson regression to assess changes in annual suicide rates by jumping from Jacques-Cartier Bridge and from other bridges and other sites and by other methods before (1990–June 2004) and after (2005–2009) installation of the barrier.Results. Suicide rates by jumping from Jacques-Cartier Bridge decreased after installation of the barrier (incidence rate ratio [IRR] = 0.24; 95% confidence interval [CI] = 0.13, 0.43), which persisted when all bridges (IRR = 0.39; 95% CI = 0.27, 0.55) and all jumping sites (IRR = 0.66; 95% CI = 0.54, 0.80) in the regions were considered.Conclusions. Little or no displacement to other jumping sites may occur after installation of a barrier at an iconic site such as Jacques-Cartier Bridge. A barrier’s design is important to its effectiveness and should be considered for new bridges with the potential to become symbolic suicide sites.Physical availability and sociocultural acceptability are important considerations in the choice of method of suicide.1 Restricting access to commonly used methods of suicide is widely recognized as a suicide prevention strategy. Several studies have indicated that detoxification of domestic gas; mandatory use of catalytic converters in motor vehicles; restrictions on pesticides, barbiturates, and analgesics; use of lower toxicity antidepressants; firearm control legislation; and construction of barriers at jumping sites have been effective in reducing suicides by those methods.1 However, evidence for the success of some of these strategies remains equivocal (e.g., use of catalytic converters in Australia,2 reduction of paracetamol pack size in the United Kingdom3,4). Furthermore, restricting one method can result in substitution with another, although substitution may depend on the popularity of the method and the availability of alternative methods that are acceptable to the individual.5–7 A change in overall suicide rates may be obscured if method substitution occurs or if the restricted suicide method accounts for a relatively small proportion of all suicides.1,8For suicide by jumping, displacement to other jumping sites is probably more likely than a change in method. Two studies found no shift to other jumping sites after installation of barriers, but they did not examine the effect on overall suicide rates.9,10 By contrast, other studies have shown evidence of displacement, with overall suicide rates remaining unchanged.11–13 In 1 of these latter studies, jumping suicides from other bridges and buildings in Toronto increased after the construction of a suicide barrier at Bloor Street Viaduct.13 The researchers suggested that the viaduct was not a uniquely attractive location for suicide and was therefore interchangeable with other sites. By contrast, some jumping sites are reportedly the only site a suicidal individual would consider (e.g., Golden Gate Bridge, Eiffel Tower, Empire State Building); their status as suicide magnets is enhanced by the ease of access, perceived lethality of the jump, notoriety as a popular suicide site, romantic view of death they encourage, media attention, and unique features such as being over water.10,13–16All of these factors existed for Jacques-Cartier Bridge, which spans the St. Lawrence River between Montréal Island and Montérégie, Québec, with an average of 10 suicides annually before the construction of a barrier in 2004 (P-A Perron, unpublished data, 2002). To create the barrier, the existing 1.1-meter steel palisade fencing was extended a further 1.4 meters and curved inwardly at the top, making it high and difficult to climb (see image available as a supplement to the online version of this article at http://www.ajph.org). An initiative to have a barrier installed was unsuccessful in 1996 and almost halted in 2002 because of the argument that a barrier would not decrease suicides but merely displace them to other sites. To test the validity of this argument, we assessed whether displacement to other jumping sites on Montréal Island and Montérégie occurred.     

Stability and Change of Adolescents’ Aggressive Behavior in Residential Youth Care

Background

Aggression in residential youth care institutions is a frequent problem.

Objective

The present short-term longitudinal study examined individual and institutional predictors of aggression in a group of 198 adolescents placed in open, semi-secure and secure residential institutions from the perspective of the importation and deprivation model.

Methods

A total of 198 adolescents in residential youth care filled in questionnaires regarding group climate and aggression with a 3 month interval. Hierarchical multiple regression analyses were performed to test the degree to which individual and contextual factors predict aggression.

Results

Very limited support was found for the effect of contextual factors; only repression showed a trend, predicting direct aggression, while gender composition of the living groups yielded a small effect. Girls placed in same-gender groups showed lower levels of indirect (relational) aggression compared to adolescents placed in mixed-gender or boys-only groups, even when controlled for gender and initial levels of aggression. Type of institution (i.e., level of security) did not predict differences in aggression. In particular individual characteristics of the adolescents were associated with later aggression, including initial levels of aggression, showing substantial 3 months stability, age and gender of the adolescents.

Conclusions

These findings are in line with research showing that aggression is relatively stable. Very limited support for environmental effects was found.

     

Assessing the evolution of primary healthcare organizations and their performance (2005-2010) in two regions of Québec province: Montréal and Montérégie

Background

Chronic Kidney Disease is a major cause of morbidity and interventions now exist which can reduce risk. We sought to develop and validate two new risk algorithms (the QKidney^® Scores) for estimating (a) the individual 5 year risk of moderate-severe CKD and (b) the individual 5 year risk of developing End Stage Kidney Failure in a primary care population.

Methods

We conducted a prospective open cohort study using data from 368 QResearch^® general practices to develop the scores. We validated the scores using two separate sets of practices - 188 separate QResearch^® practices and 364 practices contributing to the THIN database. We studied 775,091 women and 799,658 men aged 35-74 years in the QResearch^® derivation cohort, who contributed 4,068,643 and 4,121,926 person-years of observation respectively. We had two main outcomes (a) moderate-severe CKD (defined as the first evidence of CKD based on the earliest of any of the following: kidney transplant; kidney dialysis; diagnosis of nephropathy; persistent proteinuria; or glomerular filtration rate of < 45 mL/min) and (b) End Stage Kidney Failure. We derived separate risk equations for men and women. We calculated measures of calibration and discrimination using the two separate validation cohorts.

Results

Our final model for moderate-severe CKD included: age, ethnicity, deprivation, smoking, BMI, systolic blood pressure, diabetes, rheumatoid arthritis, cardiovascular disease, treated hypertension, congestive cardiac failure; peripheral vascular disease, NSAID use and family history of kidney disease. In addition, it included SLE and kidney stones in women. The final model for End Stage Kidney Failure was similar except it did not include NSAID use. Each risk prediction algorithms performed well across all measures in both validation cohorts. For the THIN cohort, the model to predict moderate-severe CKD explained 56.38% of the total variation in women and 57.49% for men. The D statistic values were high with values of 2.33 for women and 2.38 for men. The ROC statistic was 0.875 for women and 0.876 for men.

Conclusions

These new algorithms have the potential to identify high risk patients who might benefit from more detailed assessment, closer monitoring or interventions to reduce their risk.     

Study of the protein profile of the Adélé tribe of Togo

Plasma proteins provide precise information about the physiological status of an individual. In this study, we compared the plasma protein profiles of 168 individuals from the Adélé ethnic group, from an isolated rural area of Togo, with those of 159 individuals from an urban population from the capital, Lomé. The Adélé villages are located in the Atakora mountains. The subjects were volunteers, all apparently healthy and aged between 18 and 65 years. We separated serum proteins by electrophoresis and identified proteins specific for nutritional, inflammatory and immune status. The Adélé significantly higher total serum protein concentrations than the urban individuals, with higher concentrations of a1 globulins (2.35 +/- 0.57 g/L versus 1.94 +/- 0.52 g/L) and g globulins (22.19 +/- 5.67 g/L versus 16.98 +/- 5.23 g/L) and lower concentrations of b globulins (6.83 +/- 1.56 g/L versus 7.34 +/- 1. 52 g/L). The Adélé also had lower plasma concentrations of albumin (41.91 +/- 5.74 g/L versus 44.56 +/- 6.32 g/L), tranferrin (2.5 +/- 0.52 g/L versus 3.03 +/- 0.6 g/L), haptoglobin (0.57 +/- 0.59 g/L versus 1.32 +/- 0.89 g/L) and IgA (2.3 +/- 0.89 g/L versus 2.88 +/- 1.12 g/L) and higher plasma concentrations of orosomucoid (0.85 +/- 0.26 g/L versus 0.69 +/- 0.27 g/L); IgG (25.3 +/- 7.11 g/L versus 21. 79 +/- 6.5 g/L) and IgM (4.25 +/- 2.83 g/L versus 2.25 +/- 1.0 g/L). The data obtained for the Adélé and urban populations were similar to those obtained for European populations except for IgM (higher in the Adélé than in the urban and European populations), IgG and CRP (higher for the Adélé and urban populations than for European populations). Nutritional status, as estimated by albumin and transferrin concentrations, was higher in the urban population of Lomé than in the Adélé population but the Adélé population suffered no malnutrition problems. These results are consistent with those of a previous study, using apo A-I concentrations as an index of nutritional status. Apo A-I has also been shown to be a reliable indicator of nutritional status, as prealbumin concentration alone is sufficient for the early diagnosis of protein malnutrition. The very high concentrations of plasma CRP obtained indicate the presence of an inflammatory syndrome in the Adélé and urban populations, as this protein is the first acute phase protein to be detected. However, the orosomucoid concentrations obtain-ed provide no evidence of significant inflammation. The high affinity of haptoglobin (Hp) for hemoglobin (Hb) results in the formation of soluble Hp-Hb complexes, reducing the value of Hp as a marker of the acute phase of inflammation. The frequency os sickle cell disease was higher in the Adélé population than in the urban population (10-25% versus 2-6%). Hemoglobinopathies are correlated with haptoglobin concentration and thus plasma haptoglobin concentration was lower in the Adélé population than in the urban population. The plasma concentrations of a1-antitrypsin in this study were similar to those reported for Europeans. The plasma concentration of protease inhibitors, such as a1-antitrypsin, increased as protease levels increased. These data confirm that the Adélé and urban populations suffer no disease due to high levels of protease release into the bloodstream. They also show that a1-antitrypsin is of some value as an acute phase marker protein. The acute nature of the inflammatory syndrome (as assessed by CRP concentration) in the Adélé and urban populations was confirmed by the hyperglobulinemia (high levels of production of IgM and IgG antibodies) observed in these populations. The Adélé and Lomé urban populations live in a tropical environment in which they are continuously in contact with infectious agents. This results in repeated stimulation of the immune system in both these populations. This study of plasma proteins in the Adélé provides insight into the physiological conditions of this ethnic group, w     

Are You What Your Mother Weighs? Evaluating the Impact of Maternal Weight Trajectories on Youth Overweight

In this study, we investigate how three alternative measures of maternal body mass index (BMI) relate to youth overweight. We contrast the typical cross-sectional measure of maternal BMI with a longitudinal mean and a standard deviation in maternal BMI. Using National Longitudinal Survey of Youth data, we estimate logistic regressions that relate maternal BMI to the risk of a youth being overweight while controlling for other familial characteristics. Participants in this study are 918 males and 841 females who were age 16–21 and either healthy weight or overweight in 2006. To be eligible for inclusion, teens were 15 years old by December 2006. After comparing several measures of maternal weight, we find that higher mean maternal BMI measured over the life of the adolescent has the strongest relationship with the odds of youth overweight for both male and female adolescents. For boys, a one unit increase in mother’s mean BMI increases the odds of being overweight by 16% (OR = 1.16, 95% CI 1.11–1.20) while for girls the increase in the odds of being overweight is 13% (OR = 1.13, 95% CI 1.09–1.18). Our findings suggest that researchers should move beyond static measures of maternal weight when examining the correlates of youth BMI. Maternal weight histories offer additional insights about the youth’s home environment that are associated with the risk of a youth being overweight.     

Prospective Study of Ambient Particulate Matter Exposure and Risk of Pulmonary Embolism in the Nurses’ Health Study Cohort

Background

Pulmonary embolism (PE) is the most serious manifestation of venous thromboembolism and a leading cause of sudden death. Several studies have suggested associations of venous thromboembolism with short-term particulate matter (PM) exposure; evidence on long-term PM and traffic exposure is mixed.

Objectives

We examined the association of long-term exposure to PM_2.5, PM_2.5–10, and PM₁₀ (PM with diameter of ≤ 2.5, 2.5–10, and ≤ 10 μm) and distance to roadways with overall incident PE and with PE subtypes in a cohort of U.S. women.

Methods

The study included 115,745 women from the Nurses’ Health Study, followed from 1992 through 2008. Incident PE cases were self-reported biennially. Nonidiopathic PE were cases for which the medical record revealed an underlying health condition related to PE (i.e., surgery, trauma, or malignancy); idiopathic PE were cases with no such history. We used spatiotemporal models combining spatial smoothing and geographic covariates to quantify exposure at residential addresses, and Cox proportional hazards models to calculate hazard ratios (HR) and 95% confidence intervals (CIs).

Results

PM_2.5 averaged over 1 month (HR = 1.22; 95% CI: 1.04, 1.44) or 12 months (HR = 1.17; 95% CI: 0.93, 1.48) was associated with incident PE, after adjusting for known risk factors and PM_2.5–10. Equivalent analyses restricted to PE subtypes showed a positive association for PM_2.5 with nonidiopathic PE, but not with idiopathic PE. We did not find evidence of an association between distance to roadways and PE risk.

Conclusions

We provide evidence that PM in the prior 1 and 12 months is associated with PE risk. Our results also suggest that women with underlying health conditions may be more susceptible to PE after PM exposure.

Citation

Pun VC, Hart JE, Kabrhel C, Camargo CA Jr, Baccarelli AA, Laden F. 2015. Prospective study of ambient particulate matter exposure and risk of pulmonary embolism in the Nurses’ Health Study cohort. Environ Health Perspect 123:1265–1270; http://dx.doi.org/10.1289/ehp.1408927     

Education Secured? The School Performance of Adolescents in Secure Residential Youth Care

Background

Despite poor school performance by adolescents in secure residential care and the potential importance of education during care, little is known about how to achieve academic success with these adolescents.

Objective

Therefore, the aim of the present study is to assess adolescents’ academic achievement during secure residential care and to identify factors that are associated with adolescents’ achievement.

Methods

In the present study, we have included a sample of 53 adolescents in secure residential care using information from the individual care plans, the adolescents themselves, and their teachers.

Results

Contrary to our expectations, teachers report an average-to-good school performance for a majority of the adolescents (53.8 %). Partly consistent with our expectations, students with an average intelligence level, good academic motivation, and/or relatively few externalizing behavioral problems show significantly better academic achievement than students with a low intelligence level, poor academic motivation, and/or many externalizing problems. The results also suggest that low intelligence and poor motivation predict academic achievement, both directly and indirectly, through an increased risk for externalizing problems. Unexpectedly, we did not find significant associations between teachers’ interaction skills, student–teacher relationship quality, and adolescents’ academic achievement.

Conclusions

Considering our findings, future research should aim at interventions that focus on improving teachers’ ability to handle poor academic motivation and externalizing behavioral problems.     

Adolescence Sleep Disturbances as Predictors of Adulthood Sleep Disturbances—A Cohort Study

PurposeThe present study aimed to estimate whether sleep disturbances in adolescence predicted sleep disturbances in later years.MethodOur sample included 7,781 cohort members from the United Kingdom's National Child Development Study. Sleep disturbances at ages 16, 23, 33, and 42 were measured by asking whether cohort members had difficulties in falling/maintaining sleep or waking unnecessarily early in the morning.ResultsMultivariate regression analyses indicated that sleep disturbance at age 16 was a significant predictor of sleep disturbances at ages 23, 33, and 42. Continuity of a number of risk factors, especially depression, accounted for some of the persistence of sleep disturbances over time but did not explain a significant part of ongoing sleep disturbance.ConclusionsOur findings suggest that many sleep disturbances start in adolescence and continue into later years.     

Risk factors for cytomegalovirus seropositivity in a population of day care educators in Montréal, Canada

BACKGROUND: Horizontal transmission of cytomegalovirus (CMV) is common in the day care setting. Day care educators appear to be at a high risk of infection; however, studies are limited. AIMS: To determine the proportion of CMV-seropositive female educators in the day care setting and to identify associated risk factors. METHODS: Educator- and day care-level risk factors for CMV seropositivity were obtained by questionnaires from day care educators and directors, respectively. Sera were collected from educators and analyzed by enzyme-linked immunosorbent assay. Significant independent risk factors for CMV seropositivity were determined using a multivariable logistic regression model which was fitted using the generalized estimating equation method. RESULTS: CMV seroprevalence in 473 female educators from 81 day care centers in Montréal, Canada, was 57%. Significant risk factors for CMV seropositivity were (i) increasing age (OR5-yr = 1.19; 95% CI = 1.05-1.35), (ii) low-income country of birth (OR = 10.23; 95% CI = 2.64-39.50) or middle-income country of birth (OR = 4.99; 95% CI = 2.39-10.40), (iii) having > or =2 children of their own (OR = 1.98; 95% CI = 1.19-3.31) and (iv) child-to-educator ratio >6 (18-35 months old) in a day care center (OR = 1.87; 95% CI = 1.25-2.81). CONCLUSIONS: Day care educators have risks for CMV infection related to their work in the day care setting, as well as personal risk factors. A review of current guidelines for the prevention of CMV infection in day care is needed to ensure that recommendations are evidence based.     

Opportunities for video lottery terminal gambling in Montréal: an environmental analysis

BACKGROUND: In the province of Québec, video lottery terminal (VLT) gambling has proliferated under government control since 1993. The aims of this study were to describe the spatial distribution of video lottery terminals (VLTs) in the municipalities of Montréal and Laval and to identify neighbourhood socio-economic conditions associated with their distribution. METHOD: Locations of all establishments holding VLT licences in Montréal and Laval (n = 834) were geocoded by their street address. Boroughs (n = 49) were characterized by socio-economic indicators (unemployment, educational attainment, lone parenthood), a neighbourhood distress index, and measures of VLT prevalence, VLT adoption and VLT density. RESULTS: VLT prevalence, adoption and density were strongly correlated (p < 0.01) with lower borough socio-economic conditions. Although liquor establishments were also more likely to be located in poorer neighbourhoods, the adoption rate of VLT licences by bars in poorer neighbourhoods was systematically higher than in more affluent ones. CONCLUSIONS: The spatial distribution of VLTs in Montréal and Laval closely reflects local geographies of socio-economic disadvantage. Any public health effort to reduce the burden of gambling-related health and social problems must recognize the spatial distortion of gambling opportunities in the urban environment.     

Video lottery terminal access and gambling among high school students in Montréal

BACKGROUND: Gambling is a risky behaviour that involves uncertain financial outcomes, can be addictive, and has been associated with strongly adverse social and public health outcomes. We wanted to assess whether socio-economic and gambling-related-opportunity environments of neighbourhoods affected the uptake of video lottery terminal (VLT) gambling among Montréal youth. METHODS: Spatial and statistical analyses were conducted to examine geographical patterns of neighbourhood socio-economic conditions, VLT sites (n=407), and high school locations (n=305) within the Montréal Census Metropolitan Area (CMA). VLT concentration within high school neighbourhoods was measured to examine how the number of VLT opportunities varies according to socio-economic status of the school neighbourhood. A student survey was analyzed using logistic regression analysis to explore the role of individual (student) characteristics and environmental (neighbourhood) characteristics in predicting the VLT gambling behaviours reported among a sample (n=1206) of high school students. RESULTS: Video lottery gambling opportunities are more prevalent near schools located in socio-economically deprived neighbourhoods compared with schools located in more affluent neighbourhoods. The principal individual risk factors for VLT gambling were shown to be male sex, peer VLT-use, substance use, as well as the after-school routines of youth. INTERPRETATION: The spatial distribution of VLTs reflects local geographies of socio-economic disadvantage and may have a pronounced impact on students attending schools in lower income neighbourhoods, especially those with individual risk factors. Efforts to reduce gambling-related public health costs may want to take into account the socio-spatial distribution of gambling opportunities, particularly in the local environments that youth frequent.     

Different equations for determining height among the elderly: the Bambuí Cohort Study of Aging

The aim of this study was to compare measured height with estimates of height derived from equations using half arm-span measurements and assess how this affects the calculation of the body mass index (BMI) among elderly individuals. Direct height measurements of a subsample of elderly individuals from the baseline sample of the Bambuí Project were compared with estimates of height derived from equations proposed by Bassey and the WHO. The data was analyzed using the McNemar test, Lin concordance correlation coefficient (CCC) and Bland-Altman method (p < 0.05). Estimates of height using the WHO method showed a low CCC in relation to measured height. For BMI, the concordance was greater. However, with this method height was found to be underestimated so leading to the overestimation of BMI. The Bassey equation showed high concordance with measured height in elderly people over 80 years of age. With respect to BMI, the WHO method resulted in a much greater prevalence of overweight, whereas the estimates derived from the Bassey method did not differ from the results obtained from direct height measurement. Height estimates using the Bassey equation were similar to the results obtained from direct measurements, suggesting that this method is applicable.     

Long-Term Ambient Residential Traffic–Related Exposures and Measurement Error–Adjusted Risk of Incident Lung Cancer in the Netherlands Cohort Study on Diet and Cancer

Background

The International Agency for Research on Cancer (IARC) recently declared air pollution carcinogenic to humans. However, no study of air pollution and lung cancer to date has incorporated adjustment for exposure measurement error, and few have examined specific histological subtypes.

Objectives

Our aim was to assess the association of air pollution and incident lung cancer in the Netherlands Cohort Study on Diet and Cancer and the impact of measurement error on these associations.

Methods

The cohort was followed from 1986 through 2003, and 3,355 incident cases were identified. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals, for long-term exposures to nitrogen dioxide (NO₂), black smoke (BS), PM_2.5 (particulate matter with diameter ≤ 2.5 μm), and measures of roadway proximity and traffic volume, adjusted for potential confounders. Information from a previous validation study was used to correct the effect estimates for measurement error.

Results

We observed elevated risks of incident lung cancer with exposure to BS [hazard ratio (HR) = 1.16; 95% CI: 1.02, 1.32, per 10 μg/m³], NO₂ (HR = 1.29; 95% CI: 1.08, 1.54, per 30 μg/m³), PM_2.5 (HR = 1.17; 95% CI: 0.93, 1.47, per 10 μg/m³), and with measures of traffic at the baseline address. The exposures were positively associated with all lung cancer subtypes. After adjustment for measurement error, the HRs increased and the 95% CIs widened [HR = 1.19 (95% CI: 1.02, 1.39) for BS and HR = 1.37 (95% CI: 0.86, 2.17) for PM_2.5].

Conclusions

These findings add support to a growing body of literature on the effects of air pollution on lung cancer. In addition, they highlight variation in measurement error by pollutant and support the implementation of measurement error corrections when possible.

Citation

Hart JE, Spiegelman D, Beelen R, Hoek G, Brunekreef B, Schouten LJ, van den Brandt P. 2015. Long-term ambient residential traffic–related exposures and measurement error–adjusted risk of incident lung cancer in the Netherlands Cohort Study on Diet and Cancer. Environ Health Perspect 123:860–866; http://dx.doi.org/10.1289/ehp.1408762     

Why men experiencing deep poverty in Montréal avoid using health and social services in times of crisis

This article describes the experiences of men living in deep poverty regarding their decision not to seek out health and social services in moments of crisis, even when they recognized needing help. It presents results from a qualitative research project done in collaboration with a community center in a disadvantaged neighborhood of Montreal, Canada. It was designed to increase understanding of men's experiences of poverty and the role played by health and social services in their lives. Data were collected through 80 days of participant observation, 22 semi-directed interviews, and six group discussions with men living in poverty. The results show that these men are reluctant to use health and social services for three main reasons: 1) the nature of their problems; 2) their difficulty in seeking help; 3) the nature of services offered. The paper concludes with implications of the findings for future research and interventions.