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Resources addressing intimate partner violence (IPV) play a role in shaping how physicians conceptualize and perform their roles in caring for affected patients. This study combines environmental scanning with critical discourse analysis (CDA) to parse how roles of physicians were represented in 28 education materials and policy documents about IPV, taking the Canadian training milieu as an example. We developed a cyclical model of three core physician roles in addressing IPV—learning about IPV, identifying patients experiencing IPV, and responding to patients' disclosures of IPV. The construction of these physician roles is suggestive of an ongoing process of medicalization of IPV. [ABSTRACT FROM AUTHOR]

Maternal exposure to childhood maltreatment (CM) is associated with offspring behavioral problems; however, little work has examined these associations longitudinally across child development. This study examined the effects of maternal history of CM on trajectories of child internalizing and externalizing behavior measured from toddlerhood to preschool, and the role of maternal depressive symptoms and parenting behavior as potential mediators. Participants included 115 mother–child dyads recruited from a hospital maternity ward. Maternal CM was measured at 3-months postpartum. At 18, 36, and 60 months, maternal depressive symptoms and child behavior were assessed via maternal report and parenting behavior was assessed through direct observation. Findings indicated that children of mothers exposed to CM demonstrated poorer trajectories of problem behavior across early childhood. Maternal depressive symptoms mediated the relation between CM and children's internalizing problems. Findings highlight the importance of screening for maternal depressive symptoms and early intervention for maternal and child mental health. [ABSTRACT FROM AUTHOR]

Objective To establish global research priorities for interpersonal violence prevention using a systematic approach. Methods Research priorities were identified in a three-round process involving two surveys. In round 1, 95 global experts in violence prevention proposed research questions to be ranked in round 2. Questions were collated and organized according to the four-step public health approach to violence prevention. In round 2,280 International experts ranked the importance of research in the four steps, and the various substeps, ofthe public health approach. In round 3,131 international experts ranked the importance of detailed research questions on the public health step awarded the highest priority In round 2. Findings In round 2, 'developing, Implementing and evaluating interventions' was the step of the public health approach awarded the highest priority for four of the six types, of violence considered (i.e. child maltreatment, intimate partner violence, armed violence and sexual violence) but not for youth violence or elder abuse. In contrast, 'scaling up interventions and evaluating their cost-effectiveness' was ranked lowest for all types of violence. In round 3, research into' developing, implementing and evaluating interventions' that addressed parenting or laws to regulate the use of firearms was awarded the highest priority. The key limitations of the study were response and attrition rates among survey respondents. However, these rates were in line with similar priority-setting exercises. Conclusion These findings suggest It is premature to scale up violence prevention interventions. Developing and evaluating smaller-scale interventions should be the funding priority. Objectif Definir les priorites mondiales de recherche pour la prevention de la violence Interpersonnelle a l'aide d'une approche systematique. Methodes Les priorites de recherche ont ete etablies au cours d'un processus en trois cycles, comprenant deux questionnaires. Durant le premier cycle, 95 experts mondiaux dans le domaine de la prevention de la violence ont propose des questions de recherche, qui seraient classees au cours du deuxieme cycle. Ces questions ont ete rassemblees et organisees suivant l'approche en quatre etapes de la prevention de la violence axee sur la sante publique. Lors du deuxieme cycle du processus, 280 experts Internationaux ont classe parordre d'importance les recherches concernant les quatre etapes et les differentes sous-etapes de cette approche axee sur la sante publique. Au cours du troisieme cycle, 131 experts internationaux ont classe par ordre d'importance des questions de recherche detaillees sur l'etape consideree comme prioritaire au cycle no. 2. Resultats Lors du deuxieme cycle, <> etait l'etape de l'approche de sante publique jugee prioritaire pour quatre des six types de violence consideres (a savoir maltraitance de l'enfant, violence a l'encontre du partenaire intime, violence armee et violence sexuelle) mais non pour la violence chez les jeunes ou la maltraitance des personnes agees. A l'inverse, <> etait juge comme letape la moins importante pour tous les types de violence. Lors du troisieme cycle, <> relatives au role des parents ou aux lois reglementant l'utilisation des armes a feu etait considere comme le domaine de recherche prioritaire. Les principales limitations de l'etude etaient les taux de reponse et d'abandon de l'etude par les repondants. Ces taux etalent toutefois comparables a ceux d'exercices similaires de definition de priorites. Conclusion Ces resultats laissent entendre qu'il est premature d'etendre les interventions de prevention de la violence. La priorite de financement devrait porter sur l'elaboration et l'evaluation d'interventions de moindre ampleur. Objetivo Establecer prioridades de investigacion globales para la prevencion de la violencia interpersonal mediante el uso de un enfoque sistematico. Metodos Se identificaron las prioridades de investigacion en un proceso de tres etapas que incluia dos encuestas. En la primera etapa, 95 expertos mundiales en la prevencion de la violencia propusieron preguntas de investigacion para su clasificacion en la segunda etapa. Las preguntas se recopilaron y organizaron segun el enfoque de salud publica de cuatro fases sobre la prevencion de la violencia. En la segunda etapa, 280 expertos internacionales clasificaron la importancia de la Investigacion en cuatro fases, y en distintas subfases, del enfoque de salud publica. En la tercera fase, 131 expertos internacionales clasificaron la importancia de las preguntas de investigacion detalladas sobre la fase de salud publica que, en la segunda fase, se consideraron de mayor prioridad. Resultados En la segunda etapa, la fase de'desarrollo, implementacion y evaluacion de Intervenciones' fue la que se considero de mayor prioridad del enfoque de salud publica para cuatro de los seis tipos de violencia considerados (esto es, maltrato infantil, violencia conyugal, violencia armada y violencia sexual), pero no para la violencia juvenil o el abuso de ancianos. Sin embargo, la fase de 'incremento de las intervenciones y evaluacion de su rentabilidad' obtuvo la menor calificacion de todos los tipos de violencia. En la tercera etapa, la Investigacion sobre la fase de'tiesarrollo, Implementacion y evaluacion de intervenciones' que abordo la paternidad o las leyes para regular el uso de las armas de fuego se considero la de mayor prioridad. Las limitaciones fundamentales del estudio fueron las tasas de respuesta y abandono entre los encuestados. No obstante, dichas tasas concordaron con los ejercicios de prioridad similar. Conclusion Los resultados sugieren que aun es pronto para ampliar las intervenciones para prevenir la violencia. La mayor prioridad deberia ser el desarrollo y la evaluacion de intervenciones a menor escala., Introduction Almost half a million people are victims of homicide every year (1) and one in three women has experienced violence from an intimate partner at some point during her [...]

Objectives: Exposure to child maltreatment is associated with physical, emotional, and social impairment, yet in Canada there is a paucity of community-based information about the extent of this problem and its determinants. We examined the prevalence of child physical and sexual abuse and the associations of child abuse with early contextual, family, and individual factors using a community-based sample in Ontario. Methods: The Ontario Child Health Study is a province-wide health survey of children aged 4 through 16 years. Conducted in 1983, a second wave was undertaken in 1987 and a third in 2000-2001. The third wave (N = 1,928) included questions about exposure to physical and sexual abuse in childhood. Results: Males reported significantly more child physical abuse (33.7%), but not severe physical abuse (21.5%), than females (28.2% and 18.3%, respectively). Females reported significantly more child sexual abuse (22.1%) than males (8.3%). Growing up in an urban area, young maternal age at the time of the first child's birth, and living in poverty, predicted child physical abuse (and the severe category), and sexual abuse. Childhood psychiatric disorder was associated with child physical abuse (and the severe category), while parental adversity was associated with child sexual abuse and severe physical abuse. Siblings of those who experienced either physical abuse or sexual abuse in childhood were at increased risk for the same abuse exposure; the risk was highest for physical abuse. Conclusions: These findings highlight important similarities and differences in risk factors for physical and sexual abuse in childhood. Such information is useful in considering approaches to prevention and early detection of child maltreatment. Clinicians who identify physical abuse or sexual abuse in children should be alert to the need to assess whether siblings have experienced similar exposures. This has important implications for assessment of other children in the home at the time of identification with the overall goal of reducing further occurrence of abuse. (Contains 4 tables and 1 figure.)

Aims: To identify factors that influenced: (1) integration of an intimate partner violence intervention into the Nurse‐Family Partnership programme and (2) utilization of the intervention with fidelity to the clinical pathway by nurses in their home visits. Design: A qualitative descriptive study embedded in the intervention arm (n = 7 sites) of a 15‐site cluster randomized clinical trial to evaluate the intimate partner violence intervention. Methods: Semi‐structured interviews (n = 13) were conducted with supervisors. Nurses at the seven sites shared their experiences in focus groups conducted at two time points (n = 14 focus groups, 12 months after baseline and following collection of client trial data). Qualitative data were generated between May 2012 and September 2016, with this post hoc analysis completed in 2021. Focus group data were analysed using a rapid qualitative analysis technique. Conventional content analysis was used to categorize data from the supervisor interviews. Results: Integration was negatively impacted by: (1) a lack of centralized programme support and (2) competing programme demands. At the practice level, multiple factors related to supervisor capacity, preservation of the nurse–client relationship and nurse, client and intervention attributes influenced nurses' capacity to address intimate partner violence with fidelity to the clinical pathway. A lack of privacy in home visits was the most common barrier to addressing clients' experiences of violence. The need for increased time for nurses to develop clinical expertise prior to the evaluation of the intervention was also identified. Conclusion: Before implementing an intimate partner violence intervention, home visitation programmes need to attend to site readiness, provide support to supervisors to facilitate implementation, and provide nurses with time to develop the expertise and clinical judgement required to use a complex intervention whilst also respecting clients' agency to determine when and how they will respond to the violence in their relationships.ImpactWhat problem did the study address?Given the positive impacts that participating in the Nurse‐Family Partnership intimate partner violence education had on nurse home visitors' attitudes and confidence to address this type of violence experienced by first‐time mothers, it was important to understand what factors contributed to the low fidelity of intervention implementation in practice, a factor that may help to explain the lack of client‐level impacts on maternal outcomes.What were the main findings?Implementation of an intimate partner violence intervention in a nurse home visiting programme was influenced by contextual factors at both programme and practice levels. At the practice level, a lack of privacy in the home limited nurses' capacity to use the intervention. Supervisors were identified as having an important role to support nurses develop the expertise to use the intervention. Nurses also consistently balanced the intervention requirements to address intimate partner violence with an understanding of the complexity of this type of violence in young women's lives and respect for clients' agency to determine when and how they will respond to the violence in their relationships.Where and on whom will the research have an impact?These findings will be of interest to: (1) researchers developing and evaluating complex nursing interventions to address intimate partner violence in home visitation programmes and (2) stakeholders leading the implementation of novel innovations in the Nurse‐Family Partnership programme. [ABSTRACT FROM AUTHOR]

Background: Adverse childhood experiences (ACEs) are associated with multimorbidity in adulthood. This link may be mediated by psychosocial and biological factors, but evidence is lacking. The current study evaluates this mediation model. Method: We analyzed data from the Canadian Longitudinal Study of Aging (N = 27 170 community participants). Participants were 45–85 years at recruitment, when allostatic load and social engagement data were collected, and 3 years older at follow-up, when ACEs and multimorbidity data were collected. Structural equation modeling was used to test for mediation in the overall sample, and in sex- and age-stratified subsamples, all analyses adjusted for concurrent lifestyle confounds. Results: In the overall sample, ACEs were associated with multimorbidity, directly, β = 0.12 (95% confidence interval 0.11–0.13) and indirectly. Regarding indirect associations, ACEs were related to social engagement, β = −0.14 (−0.16 to −0.12) and social engagement was related to multimorbidity, β = −0.10 (−0.12 to −0.08). ACEs were related to allostatic load, β = 0.04 (0.03–0.05) and allostatic load was related to multimorbidity, β = 0.16 (0.15–0.17). The model was significant for males and females and across age cohorts, with qualifications in the oldest stratum (age 75–85). Conclusions: ACEs are related to multimorbidity, directly and via social engagement and allostatic load. This is the first study to show mediated pathways between early adversity and multimorbidity in adulthood. It provides a platform for understanding multimorbidity as a lifespan dynamic informing the co-occurrence of the varied disease processes represented in multimorbidity. [ABSTRACT FROM AUTHOR]

Despite advances in child maltreatment research, accurate measurement of exposure remains a key issue. In this study, we evaluated a short form (CEVQ-SF) of the Childhood Experiences of Violence Questionnaire (CEVQ) in a sample of adolescents involved with child protection services in an urban city in Ontario, Canada. Focusing on the two most readily defined maltreatment types, physical and sexual abuse, we evaluated the short form's comparability with the full version of the CEVQ. Both versions had good internal consistency and moderate-to-good 2-week test-retest reliability. The criterion validity of the two CEVQ versions in comparison with the Childhood Trauma Questionnaire was satisfactory. Construct validity for both versions was demonstrated: physically and sexually abused youth had higher odds of reporting clinical traumatic symptoms compared with either type alone. The CEVQ-SF is as reliable and valid as its full version. Implications for its use in large population-based surveys are discussed. (Contains 1 table.)

This study examined factors associated with decisions in favour of out-of-home placement following investigations involving infants at risk of maltreatment. We used data from a sample of children less than 1 year of age (n = 763) investigated by child welfare services across Canada in 2003. We tested unadjusted relationships with placement using Pearson's chi-square statistic. Multivariate logistic regression analyses identified parental substance abuse, mental health problems and few social supports as being associated with an increased likelihood of placement. Child's toxicology at birth, abandonment, physical harm and number of previous family openings also increased the likelihood of placement. Several variables that have been associated with increased placement in previous studies, such as single motherhood and young maternal age, did not show a statistically significant association in our analysis. Among those infants that were placed, there was insufficient power to compare kinship and non-kinship care. This analysis demonstrates the need for the implementation of established prevention programs, such as the Nurse-Family Partnership and substance abuse programs for caregivers.

It is important to understand the epidemiology of intimate partner violence (IPV) experienced by both males and females. Data were drawn from the U.S. National Comorbidity Survey Replication. The relationships between physical IPV and child abuse, mental disorders, and suicidal ideation and attempts among males and females were examined. The results indicate that child sexual abuse was associated with IPV among males, whereas child physical and sexual abuse was associated with IPV among females. IPV was associated with poor mental health outcomes for males and females, although sex differences are noted. The sex differences indicate that females experience a wider range of poor mental health outcomes compared to males. Knowledge about correlates of IPV can be useful in identifying individuals exposed to violence. Further research is required to identify effective methods to reduce exposure to IPV and to adequately address the specific needs of male and female victims of IPV. (Contains 4 tables.)

Objective: This study presents evaluative data on the Childhood Experiences of Violence Questionnaire (CEVQ), a brief, self-report measure of youth victimization. Methods: Literature reviews, expert consultations and qualitative interviews informed the development of the CEVQ. Test-retest reliability of the preliminary and final versions of the CEVQ was examined. Child welfare workers (n = 11) assessed content validity. Construct validity was assessed by comparing levels of emotional and behavioral problems of youth with self-reports (n = 177) of victimization. Criterion validity was tested by comparing clinicians' judgment of child physical abuse (PA) and child sexual abuse (SA) with youths' self-reports (n = 93). Results: In general, test-retest intra-class correlations (ICCs) for the preliminary version of the questionnaire were good to excellent. Reliability estimates for the stem questions in the final version of the CEVQ were excellent, except for peer violence items which showed fair to good agreement. ICCs for PA, severe PA, SA, and severe SA of the CEVQ were 0.85, 0.77, 0.92, and 0.87, respectively. Youth with self-reported victimization had significantly higher scores for most categories of emotional and behavioral disorders. Experts classified victimization items as relevant. Kappa coefficients comparing clinician's judgments and youth's self-reports for PA, severe PA, SA, and severe SA were 0.67, 0.64, 0.70, and 0.50, respectively. Conclusions: The present findings provide preliminary evidence that the CEVQ is a brief, reliable, valid and informative instrument for assessing exposure to victimization and maltreatment among youth. Practice implications: Although this instrument is not appropriate for clinical use at this time, its psychometric properties will make it useful in conducting further epidemiological research and studies evaluating interventions aimed at reducing victimization. (Contains 1 figure and 5 tables.)

This study examined the relationship between a self-reported history of child physical and sexual abuse and chronic pain among women (N = 3381) in a provincewide community sample. Chronic pain was significantly associated with physical abuse, education, and age of the respondents and was unrelated to child sexual abuse alone or in combination with physical abuse, mental disorder (anxiety, depression, or substance abuse), or low income. Number of health problems and mental health disorders did not mediate the relationship between physical abuse and chronic pain. Despite considerable evidence from the clinical literature linking exposure to child maltreatment and chronic pain in adulthood, this may well be the first population-based study to investigate this relationship for child physical and sexual abuse independently. The significant association between childhood history of physical abuse and pain in adulthood calls for a greater awareness of the potential for chronic pain problems associated with this type of maltreatment. Further research is needed to understand the mechanism for this complex relationship. (Contains 2 tables.) [This research was supported by the Wyeth Canada Inc. Canadian Institutes of Health Research (CIHR) Clinical Research Chair in Women's Mental Health and the CIHR Institutes of Gender and Health; Aging; Human Development, Child and Youth Health; Neurosciences, Mental Health and Addiction; and Population and Public Health.]