Valérie Émond is an scientific expert at the Quebec Public Health Institute. Over the past 10 years, she has worked at developing chronic disease surveillance for the province of Quebec using administrative data. After developing the model for diabetes surveillance, she is currently working on an integreted chronic disease surveillance model, with a research focus on the elderly and multimorbidity. She has a background degree in actuarial mathematics from Université Laval and a Masters degree in demography from Université de Montréal. She has also worked for the Canadian Institute for Health Information where she acquired an extensive knowledge of health administrative data across Canada.

This paper addresses the needs of disabled off-reserve Aboriginal Canadians. Although approximately 80% of Aboriginal Canadians live off-reserve, most studies have been focused towards on-reserve populations with a comparable proportion of funding thus directed.

A disabled person’s well-being is directly influenced by the degree to which his/her specialized needs are met. Previous investigation of the use of services by disabled Aboriginal people suggests that there is a large degree of unmet need for services, especially at older ages. However, there has been no examination of unmet needs for aids or assistive devices, including hearing and vision aids, mobility devices, as well as modifications to dwellings such as wheelchair ramps or lifts. Like access to and use of services, access to assistive devices may be influenced by education about services and programs, the availability of programs and benefits, the cultural appropriateness of service delivery as well as income characteristics. In Aboriginal populations, access to services is further complicated by differences in the benefit programmes that serve Registered Indians and Inuit, and Métis and Non-Status First Nations.

Using the 2006 Participation and Activity Limitation Survey (PALS) and the 2006 Aboriginal Peoples Survey (APS), this paper examines the age-related patterns of unmet needs for aids and assistive devices and modifications to dwellings among off-reserve Aboriginal people with disabilities, and compares them to the non-Aboriginal population. We find that older Aboriginal women were at somewhat higher risk to disability than older Aboriginal men or non-Aboriginal people, and also that their relative risk of having unmet needs was higher. A majority of these needs were related to mobility, with income the main reason they had not been met. Multivariate logistic regression models of the probability of unmet needs are used to isolate the contribution of education and income, as well as the differences between Status and non-Status First Nations, Inuit, and Métis.

Martin Cooke is an assistant professor jointly appointed in the departments of Sociology and Health Studies and Gerontology at the University of Waterloo, where he teaches in the Master of Public Health programme. Born in Winnipeg, he studied sociology at the University of Winnipeg and sociology and demography the University of Western Ontario. His research areas have been in the social demography and health of Aboriginal peoples and social policy from a life course perspective. Past research topics have included First Nations mobility and migration, women’s experiences with social assistance, and indicators of well-being for Aboriginal populations. He is currently the principal investigator of a SSHRC-funded project examining the life course trajectories of First Nations and Métis people, and an editorial board member of the International Indigenous Policy Journal.

Studies on risk factors show that age, family history of AD, hypertension, high cholesterol/blood level and low education are associated to the onset of AD. Other factors, such as prolonged use of anti-inflammatory drugs, moderate consumption of red wine or having been to school for eight years or more, can be considered factors that protect an individual against AD. Factors that seem to have an influence in developing AD, include sex or having suffered head trauma but these results do vary from study to study (Lindsay et al., 2002; Dartigues et al., 1991; Arcand-Hébert, 2008).

In the present study, the prevalence of AD in individuals 65 and older is examined by using a probit model referred to in an extensive review of the literature by Maddala (1983) and Greene (2003). The data set used for this study is from the master files of the 2005 Canadian Community Health Survey (CCHS) which contain more than 132 000 observations, and approximately 1900 variables. Within this survey, 30 000 observations of individuals over the age of 64 are available of which 330 participants reported having AD. For this study, all estimations are weighted so that they are representative of the population. We used the Bootstrap method developed by Rao, Wu, et Yue, (1992) and Rust, et Rao, (1996) to ensure the consistency of the estimators.

In the course of this study, the influence of individual characteristics (among others; age, gender, education, ethnic background, place of residence, marital status, weight, other health issues, physical exercise and nourishment) and socioeconomic characteristics (i.e.; activities, revenue, etc.) on the likelihood of being affected or not being affected by AD was examined. We also examined the possibility that certain explicative variables are endogenous and therefore could underestimate the probit model.

Preliminary results show that certain variables are significant at the 5% threshold. The chances of developing AD are associated with having lower education, being 50 years of age or older, being obese and residing in an urban area. Our model also includes variables pertaining to physical exercise, eating habits, tobacco and alcohol consumption and chronic illness. In summary, the probit model will help us determine the influence of these variables on AD. In addition, by using the marginal effects of the probit model, we will be able to better understand the changes in the predicted probability according to AD status.

This paper develops and estimates a dynamic model of health using data from the United States Health and Retirement Study (HRS). The HRS is a nationally representative panel of individuals aged 50+ collected biannually over the 1992-2006 period. This data set contains rich data on the health of the elderly population, including self-rated and objective health measures as well as information on the onset of various diseases.

A major challenge of this research is to summarize a large set of disparate health measures and their evolution over time in a parsimonious, yet comprehensive manner. We use a latent factor model to summarize the various health measures provided by the HRS with a single scalar. SES differences in how this scalar is distributed at age 50 reflect the socioeconomic gap in health among those entering old age. We examine how this health-scalar evolves as individuals age and how this evolution differs by SES. Our model distinguishes gradual declines in the health from major adverse health events, such as stroke, heart attacks or the emergence of cancer.

Fabian Lange completed his Ph.D. in economics at the University of Chicago in 2004 and subsequently joined the Department of Economics at Yale University, where he has been since. In 2007/2008, he visited the University of Chicago Booth School of Business. His research interests are in the determinants of life-cycle earnings and in particular in the role of employer learning in generating earnings inequality as individuals age. He received the H. G. Lewis prize 2008 and the IZA Young Labor Economist Award for his work in this area. Fabian also pursues interests in population and health economics. In population economics, he studied the link between schooling and fertility decisions. In health economics, he develops and estimates models of health dynamics as individuals age and uses these to study the socio-economic gradient in health. He also uses these models of aging to study the interaction between health and labor supply decisions among elderly workers.

Yann Décarie is a Ph.D student in Demography at L’Institut National de la Recherche Scientifique (INRS) under the supervision of Alain Bélanger. Yann received a degree in Statistics from the Université de Sherbrooke and an undergraduate degree in Actuarial Science from the Université de Montréal. Since 2006, Yann has been working with Professor Jacques Légaré and Professor Janice Keefe as a research assistant on a project related to the projection of disabled people and home care needs. Yann’s research interests are on ageing, projection methods, microsimulation and population health.

Sean Clouston did his undergraduate work at the University of Victoria, and is working on his PhD at McGill University. Last year, he spent the years as a Fulbright Scholar at the Mailman School of Public Health in New York. His work focuses broadly on social inequalities and health, taking a lifecourse perspective on the ways that individuals proceed through their lives while trying to understand how public policy interacts with everyday life to create unequal circumstances and inequities in health outcomes. Sean is part of the International Research Infrastructure on Social Inequalities in Health (IRIS) at McGill University and the Center for the Study of Social Inequalities and Health at Columbia University.

Amélie Quesnel-Vallée, PhD, is Assistant Professor at McGill University, where she holds an Arts and Medicine cross-faculty appointment in the Departments of Sociology and of Epidemiology. She also heads the International Research Infrastructure on Social inequalities in health (IRIS), funded by the Canada Foundation for Innovation Leaders Opportunity Fund. In 2005, she received the American Sociological Association Dissertation Award for her Fulbright-funded doctoral research. She currently studies the impact of public policies on health inequalities in 21 OECD countries. Her work recently appeared in a book she co-edited, Le privé dans la santé : Les discours et les faits (Presses de l’Université de Montréal, 2008.

Piotr Wilk is the Community Health Researcher/Educator at the Middlesex-London Health Unit, with a research focus on the health and well being of children. Dr. Wilk is currently conducting research on how the socio-economic conditions in which children are born and grow up affect their health and developmental trajectories. Dr. Wilk also focuses his research on health of Aboriginal children by examining the role of contextual predictors related to family characteristics and community/neighborhood characteristics. He is also involved in teaching advanced graduate courses in social statistics and quantitative research methods.

A sample of 848 first years students (64.1% female) at a large university in Southwestern Ontario, Canada, completed an online baseline questionnaire one week after the beginning of classes in September 2006. Subsequently, a subset of 415 respondents participated in the second phase, consisting of 26 consecutive online weekly questionnaires from October 2006 to April 2007. A subset of 358 students participated in the third phase consisting of 24 consecutive months from May 2007 to April 2009. These weekly and monthly online assessments included the Beck Depression Inventory-II (BDI-II).

We describe the BDI-II score trajectories over the three-year period of the weekly and monthly assessments. We also report on the latent growth modelling analyses of the depressive symptom trajectories, including gender-based trajectories. The strongest trend was an initial decrease in reported depressive symptoms in the first part of the first semester. Gender difference analyses revealed similar trajectory shapes for men and women but with women scoring about 2 points higher than men at each time point. Implications of these results are discussed in reference to the empirical literature on depression.

More information about this study can be obtained from the lead author.

Paul F. Tremblay, PhD, received his doctorate in psychology (measurement) from the University of Western Ontario, Canada, in 1998. He is a scientist in the Social, Prevention, and Health Policy Research Department at the Centre for Addiction and Mental Health, an adjunct research professor in the Psychology Department at the University of Western Ontario, and an academic research associate at the Centre for Research and Education on Violence Against Women and Children in London, Ontario. He conducts research on the experiences of conflict and aggression and their relations to drinking patterns, depressive symptoms, and personality dimensions.

Objectives: To establish if girls matched with an adult mentor in Big Brothers Big Sisters (BBBS) community match programs fair better (or worse) than matched boys in terms of improved behavioral, mental health, and psychosocial outcomes.

Method: Structural equation and latent growth curve analyses will be conducted on a sample of approximately 500 matched and unmatched children enrolled in 20 BBBS programs across Canada followed longitudinally for 18 months. The sample is a subset of an ongoing study involving 950 families (children and parents) enrolled in BBBS programs followed for 30 months. Child and parent reports of child outcomes are obtained at 6 month intervals through a combination of face to face interviews and self-administered assessments.

Results: Adjusting for baseline scores (prior to match exposure), preliminary SEM results at the 12 month follow-up suggest that matched girls experience more favorable outcomes than matched boys in terms of fewer conduct, emotional, and in-school behavioral problems, and less frequent verbal and physical abuse by bullies. In contrast, boys are more likely than girls to report positive attitudes toward school.

Future Directions: Future work will seek to replicate these findings as greater numbers of children are paired with a mentor and mature in their match relationships. Particular attention will focus on the extent to which length of time in the match relationship deflects various trajectories of child developmental outcomes and the potential moderating role of child gender.

David De Wit, Ph.D., is Senior Research Scientist with the Centre for Addiction and Mental Health located in London, Ontario and an Associate Professor in the Department of Epidemiology and Biostatistics at the University of Western Ontario. He is also an Associate Scientist with the Lawson Health Research Institute (also in London). His primary research interests include the evaluation of community interventions for vulnerable populations, environmental influences on child health and well-being, and risk and protective factors for child and youth mental health problems and substance addiction. He has led or co-led a number of grant-funded projects including a five year study funded by the National Institutes of Health to evaluate the effectiveness of a family skills-based intervention for children of parents struggling with alcohol problems. He recently received funding from the Canadian Institutes of Health Research (De Wit, P.I., $1.7 million) to study the impact of Big Brother Big Sister community match relationships across Canada on the health and well-being of children in need of an adult mentor. Throughout his career he has published in several scientific journals and delivered numerous presentations to the scientific and lay communities. He recently completed a five year term on the Editorial Board for the Journal of Marriage and the Family and currently serves as a grant reviewer for the Child Health Committee, Canadian Institutes of Health Research. He has given a number of guest lectures to students in both undergraduate and graduate level courses primarily dealing with statistical techniques for handling missing values and techniques for analyzing longitudinal data. He currently supervises one Masters level student and one Ph.D. student.

Using data from the Canadian National Longitudinal Survey of Children and Youth (NLSCY), this study examines how and why health outcomes exhibit persistence during the period from childhood to adolescence. We examine the distribution of health outcomes and health transitions using descriptive analysis and explore the determinants of these distributions by estimating the contributions of family SES, unobserved heterogeneity and state dependence and also allowing for heterogeneity of state dependence parameters across categories of neighborhood status. Our analysis indicates that children living in poorer neighborhoods and in neighborhoods with lower education level tend to experience poor health status for longer after a transition to it, while children tend to experience multiple health drops living in poorer neighborhoods, in neighborhoods with less educated people, in neighborhoods with more families headed by lone-parents and in neighborhoods with more families living in rental accommodations.

Junhu Li is a Ph.D. candidate in the Department of Economics at McMaster University. Her research fields are health economics and applied econometrics. She is interested in the analysis of dynamics and determinants of child health outcomes, and policy analysis of health care financing and funding reforms. Her recent research is on two topics. The first topic is on the evolution of health outcomes from childhood to adolescence using Canadian survey data NLSCY. The second topic is on the empirical identification of physician response to pay-for-performance incentives by exploiting the quasi-natural-experiment in the primary care reform models in Ontario, Canada.

J. Melissa Scarpate is a doctoral candidate at Auburn University in the Department of Human Development and Family Studies. She is currently working on her dissertation entitled, The development of self-regulation during adolescence: Understanding the effects by pubertal changes and parenting which utilizes the National Longitudinal Study of Children and Youth (NLSCY). Her research interests include parenting, adolescent internalizing and externalizing behaviors, and adolescent self-regulation.

Alexander T. Vazsonyi is Professor of Human Development and Family Studies at Auburn University. His varied research interests include the etiology of adolescent problem behaviors, health compromising behaviors, and deviance, with interests in individual characteristics (self-control, self regulation), in socialization effects (parenting), and in contextual (school, neighborhoods, and culture/society) effects on development; much of his work employs a cross-cultural or cross-national comparative approach to the study of human development and behaviors. He currently serves as the Editor-In-Chief of The Journal of Early Adolescence and is an editor of The Cambridge Handbook of Violent Behavior and Aggression (2007).

Piotr Wilk is the Community Health Researcher/Educator at the Middlesex-London Health Unit, with a research focus on the health and well being of children. Dr. Wilk is currently conducting research on how the socio-economic conditions in which children are born and grow up affect their health and developmental trajectories. Dr. Wilk also focuses his research on health of Aboriginal children by examining the role of contextual predictors related to family characteristics and community/neighborhood characteristics. He is also involved in teaching advanced graduate courses in social statistics and quantitative research methods.

Data Source: This study used data from The Residential Care Facilities Survey (RCFS), for the province of Ontario, collected between 1996 and 2006. The RCFS is a longitudinal census survey administered annually by Statistics Canada, to all LTC facilities operating in Canada that receive public funding. The RCFS contains information about the: 1) facility’s type, location, chain ownership and profit status; 2) quantity and cost of inputs employed (i.e. nursing staff, other medical staff, administrative staff, equipment, number of beds, etc.); 3) age, sex and morbidity distribution of residents; 4) number of patient days; and 5) number of deaths and discharges.

Methods: Using the stochastic frontier analysis (SFA) of panel data, this study assesses the determinants of operational efficiency in LTC facilities in Ontario, while controlling for quality of care. In keeping with the literature, output was measured in total resident days; capital inputs were estimated based on prescription drug and medical supplies expenditure, as well as total number of beds; and labour inputs were measured in cumulated paid hours of direct care and other staff (including RNs, physiotherapists/occupational therapists, other direct care staff, administration, dietary services staff, other general services staff, recreational staff, and etc.) in each LTC facility.

Conclusions: Our analysis revealed significant differences in performance by facility size, despite the fact that facilities are compensated at the same per diem rates, with larger LTC facilities operating more efficiently than smaller LTC facilities. We also found significant differences in performance by profit status and urban/rural location. The results also underline the importance of considering an array of quality indicators and controlling for endogeneity of quality.

Amy Hsu is a MSc candidate in the Department of Health Policy, Management and Evaluation under the supervision of Dr. Peter C. Coyte and Dr. Audrey Laporte. Her research interest is in performance measurement, especially pertaining to geriatrics and long-term care. Amy received her Honours BSc in Human Biology from the University of Toronto in 2008, and has a background in human genetics, sociology and religion.

Objective: The purpose of the present study was to identify the association between depression and leisure-time physical activity among community-dwelling, Canadian adults aged 65 and older, using a modified version of the International Classification of Functioning, Disability and Health (ICF) framework.

Method: This study included a weighted sample of 3,785,145 community- dwelling, seniors aged 65 years or older who participated in the Canadian Community Health Survey (Cycle 2.1). Univariate and multiple logistic regressions were used to examine the cross-sectional association between depression-related disorders and leisure-time physical activity in the context of chronic physical conditions, personal characteristics and environmental factors (e.g., gender, rural versus urban residence, immigration status, etc.).

Results: Older adults reporting depression-related disorders were less likely to participate in leisure-time physical activity after adjusting for relevant personal and environmental factors (odds ratios (ORs) ranged from 0.76 to 0.79, p < 0.001). This association was partially mediated by activity limitations associated with depression- related disorders. Similar results were observed between chronic physical conditions and participation in leisure-time physical activity (ORs ranged from 0.65 to 0.81, p <0.001). There was no evidence of a statistical interaction between depression-related and chronic physical conditions.

Conclusion: Although the present study was unable to identify the temporal relationships among study variables, the results provide clinicians who care for older adults with depression and/or chronic physical diseases with potentially useful information on the benefits of physical activity. They also provide evidence in support of community-based exercise or leisure-time physical activity program for seniors who are physically inactive to prevent chronic mental or physical illnesses and reduced quality of life.

Geum Ju Song was born in South Korea and holds a Bachelor of Science (1997) and a Masters of Science (2003) in Physical Education from Seoul Women’s University, Korea and a Masters of Science in Health Studies and Gerontology from University of Waterloo (2009). The title of my Master’s thesis from the University of Waterloo is “The Association between Depression-related Disorders, Chronic Physical Conditions and Leisure-time Physical activity among Canadians in Late Life: Results from the Canadian Community Health Survey (Cycle 2.1)”. Current research area in the Ph.D. program, University of Waterloo is the effect of physical activity on mental health among the elderly population.