Poorly executed transitions between health care settings can lead to poor outcomes and greater use of health care resources for older adults. Older adults with complex needs often receive care from many health care providers in multiple care settings, and face greater risk of experiencing fragmented care. System navigation roles have been suggested as an innovative strategy to address these challenges, yet there is a lack of consensus on the desired characteristics and effectiveness of the role. The goal of this research is to develop a framework for a system navigation role to enhance coordination of formal and community-based services to older persons with chronic disease through health care transitions. This research gathered information from multiple perspectives and a variety of data sources, including a systematic literature review, focus group interviews and in-depth interviews with a variety of health care consumers and providers. A critical analysis of collected data, using a frame derived from content analysis, sought to understand how older adults navigate the health care system, and subsequently to explore the potential of a “system navigator” role to facilitate successful transitions across care settings. Finally, following a grounded theory approach, a model was empirically derived to reflect what role system navigators may have on the experience of older adults navigating the health care system in Waterloo Wellington. This research study aimed to describe optimal care coordination practices across the continuum of care for complex, high-risk individuals, such as those with chronic disease or hip fracture. Ultimately, this study may lead to improved patient care coordination, safety and satisfaction during transitions and in accessing community services, which may assist patients to achieve a higher quality of life.

Introduction: Alzheimer’s disease (AD) and dementias constitute a significant public health burden and it is estimated that one in 85 people may be living with AD by 2050. Dementias are a spectrum of diseases with common traits including amyloid protein growth, neurodegradation, neurofibrillary plaque and tangle formation, and which may be influenced by pro- and anti- inflammatory immune mechanisms. Even a modest delay in onset could result in significant reductions in the social and economic burdens of dementias. An important lifestyle factor identified in risk reduction is physical activity (PA). Although the association between dementia risk and PA has been established, the exact physiological mechanisms through which protection occurs are not known. This research consists of two experiments that were designed to explore the effects of physical activity on pro- and anti-inflammatory cytokines and apoptosis in the mouse hippocampus, a brain region implicated in learning, memory, and cognition. Methods: Study #1: Female C57BL/6 mice, 4-5 months of age, were divided into three groups: sedentary controls (NOTREAD) (n = 22), treadmill exercise with immediate sacrifice (TREAD-Imm) (n = 21), or treadmill exercise with sacrifice after 2 hours (TREAD-2h) (n = 20). TNF-α, IL-6, and IL-1β expression in the hippocampus and intestinal lymphocytes were measured by Western blot analysis. Percentages of hippocampal cells undergoing apoptosis (Annexin+) or necrosis (Propidium Iodide+) were determined through flow cytometry. Plasma levels of 8-isoprostane and corticosterone were measured using commercially available EIA kits. Study # 2: Female C57BL/6 mice, 3-4 weeks of age, were assigned to wheel running (WR; n = 20) or a control condition (No WR; n = 22) and sacrificed after the 16 weeks. Data collected included measures of training status (running volume, body weight, run-to-exhaustion time, and skeletal muscle cytochrome c oxidase activity), flow cytometric analysis of hippocampal cell phenotypes and apoptosis (CD45+, CD11b+, Annexin+, Annexin+/PI+, PI+), and cytokine concentrations (TNF-α, IL-1β, IL-12, IL-6, IL-1ra, and IL-10) in cell lysates. Results: Study #1: Acute treadmill exercise lead to significant decreases in TNF-α (p<0.05) and increases in IL-6 (p<0.05) expression in the hippocampus of healthy mice. No effects of acute exercise on the apoptotic status of hippocampal cells were observed. In intestinal lymphocytes, the exercise bout lead to significant increases in TNF-α (p<0.05), IL-6 (p<0.05), and IL-1β (p<0.05). Acute exercise was associated with a significant increase in both plasma 8-isoprostane (p<0.05) and corticosterone (p<0.05) levels. Study #2: WR mice had measurable training effects and significantly lower TNF-α (p<0.05) and higher IL-6 (p<0.05), IL-1ra (p<0.05) and IL-12 (p<0.05) expression in the hippocampus compared to controls. IL-1β, IL-10, and the percent of apoptotic, dead cells, and cell phenotypes did not change due to training. Conclusion: Exercise chronicity (acute vs. chronic), stress characteristics of the exercise (forced vs. voluntary) and tissue location (systemic vs. central) emerged as important variables with effects on both cytokine concentrations and plasma levels of stress hormones. Physical activity may protect the hippocampus against inflammatory damage caused by TNF-α, and the suppression of this cytokine may be due to increased glucocorticoid secretion during acute exercise. It is also proposed that elevated IL-6 expression (central and systemic) may mediate this protection by creating an anti-apoptotic environment in the hippocampus. Less apoptosis may also contribute to maintenance of cognitive function during acute and long-term physical activity.

Background: The demand for hospice palliative care (HPC) services is expected to grow due to the increasing number of seniors living into advanced old age, the changing nature of death, and the changing family structure. HPC is a philosophy of care that aims to relieve suffering and improve the quality of life for clients with life-threatening illnesses or end of life issues. The goals of HPC are not only to ameliorate clients’ symptoms but also to reduce unneeded or unwanted medical interventions such as emergency room visits or hospitalizations (ERVH). Hospitals are considered a setting ill-prepared for end of life issues. Therefore, use of such acute care services has to be considered an indicator of poor quality end of life care. It is important to understand the factors that contribute to ERVH in order to determine how to minimize the number of avoidable hospital visits. Objectives: The objectives of this study were to report the proportion of palliative home care clients with ERVH, describe the characteristics of clients with ERVH, and identify the predisposing, enabling, and need-for-care variables associated with ERVH. Methods: Analysis of secondary data was performed on a palliative home care dataset from the Hamilton Community Care Access Centre (CCAC). All palliative home care clients receiving services from the Hamilton branch were assessed using the interRAI Palliative Care (interRAI PC), which is a comprehensive, standardized instrument. One assessment for each client assessed between April 2008 and July 2010 was used, for a final sample size of 764. Results: Half of the palliative home care clients had one or more ERVH. Visits to the emergency department by time of the day and day of the week were relatively stable. Logistic regression and Cox regression analyses showed that wish to die at home and advance care directives are protective against ERVH. Unstable health, identified by a Changes in Health End stage disease and Signs and Symptoms scale (CHESS) score of 3 or higher, was associated with reduced odds of ERVH, while infections such as prior pneumonia and prior urinary tract infections increased odds of ERVH. Conclusions: Predisposing characteristics (i.e., wish to die at home and advance care directives) are nearly as important as need variables (i.e., CHESS and prior urinary tract infection) in determining ERVH among palliative home care clients, which challenges the assumption that need variables are the most important determinants of ERVH. There was a lack of significant association between many assessed needs and ERVH, perhaps due to the fluctuating health status among such clients and the stability of measurements. Ongoing assessment of palliative home care clients is essential in reducing ERVH, as reassessments at specified intervals will allow care and service plans to be adjusted with clients’ changing health needs and end of life preferences.

Background: Depression is a worldwide problem but studies have shown that after patients with depressive symptoms are in remission, difficulties in social relationships may persist. There is a need for future research on the relationship between social function and depressive symptoms in order to facilitate development of new clinical interventions. Objectives: This study aimed to identify what factors contribute to the relationship between depressive symptoms and social relationships and what factors predict improvement in depressive symptoms during psychiatric hospitalization. Methods: This longitudinal cohort study was based on a secondary analysis of RAI-MH data from the Ontario Mental Health Reporting System (OMHRS). Depressive symptoms were measured with the Depressive Symptoms Rating Scale (DRS) and social relationships difficulties were evaluated with the interRAI Social Relationships CAP. The sample comprised of 125,120 patients from acute, long stay, addiction, psychiatric crisis units and forensic units. Sub-sample of patients with depressive symptoms and mood disorder was created (N = 38,823). Results presented in a descriptive analysis for both samples and bivariate and multivariate analysis for the sub-sample. Logistic regression analysis was performed to predict rates of improvement of depressive symptoms. Results: The study revealed that many factors predict outcome of depressive symptoms. Difficulties in social relationships, older age, multi-morbidity, functional impairments, trauma, and poor physical health predict decreased odds of improvements but longer hospital stay, individual therapy and family/couples therapy predict increased odds of improvements. Conclusions: The interRAI Social Relationships CAP provides a valuable tool to address social issues in patient care, assist clinical staff in care planning and provide mental health authorities information for policy making.

Background. Inuit experience some of the highest rates of tobacco use and of tobacco-related diseases in Canada. Communication strategies, such as health warnings on tobacco products, are seen as a necessary means of informing the public of tobacco-related health risk and motivating smokers to want to quit smoking. However, there is little evidence to suggest how such strategies might be working among Inuit nor is there evidence to suggest how best to communicate tobacco-related health risk to and promote smoking cessation among Inuit smokers. Objectives. (1) To systematically examine the effects of textual message frame (i.e., loss- vs. gain-framed), graphic type (i.e., gruesome vs. personal suffering), and narrative style (i.e., testimonial vs. didactic) on measures of message acceptance (i.e., personal relevance and perceived credibility), affective response, and potential message effectiveness. (2) To examine fear as a potential mediator of the relation between textual message frame and measures of potential message effectiveness, as well as of the relation between graphic type and measures of potential message effectiveness. (3) To examine the potential impact of the message spokesperson (i.e., Caucasian, middle-aged male/female vs. Inuit middle-aged male/female vs. Inuit Elder male/female) on measures of message acceptance and potential message effectiveness. Experimental design. A repeated measures (i.e., within-subject) 2 x 2 x 2 factorial design was used to examine the effects of textual message frame, graphic type and narrative style. A separate ranking task assessed the potential impact of the message spokesperson. Methods. Eligible participants (Inuit, aged 18 years of age or older, having smoked at least one cigarette in the previous 30 days and smoked over 100 cigarettes in their lifetime) were recruited in October 2012 from two communities in Nunavut (Iqaluit and Rankin Inlet). Participants completed a survey, an experimental procedure (i.e., a health warning rating task) and a health warning ranking task on a hand-held electronic device with a trained research assistant. With data from the health warning rating task, a series of multinomial regression models using the Generalized Estimating Equation (GEE) method were fitted to examine the effects of three message characteristics on each of the outcome measures, controlling for known covariates. Outcome measures were categorized into 3-levels: (1) extremely, (2) somewhat, and (3) not really. The “not really” category was used as the comparison category for multinomial regression models. Multinomial regression was also used to examine the potential mediating effects of fear as it related to each of the measures of potential message effectiveness. With data from the health warning ranking task, frequencies of participant choices as related to the message spokesperson were examined. 129 participants were included in the analyses. Results. Participants were, on average, 37.3 years of age (STD = 12.7) and smoked 13.0 cigarettes per day (STD = 8.9). Just over half were female (56.6%) and most had less than a high school education (72.7%). Messages with gruesome images were more likely than those with images of personal suffering to be rated as extremely relevant (OR = 2.23, CI: 1.56-3.20), credible (OR = 2.46, CI: 1.67-3.62), emotionally arousing (OR = 3.40, CI: 2.27-5.08), and potentially effective (OR = 2.56, CI: 1.69-3.86). Loss-framed messages were more likely than gain-framed messages to be rated as extremely emotionally arousing (OR = 1.71, CI: 1.23-2.37), but no more likely to be rated as extremely relevant (OR = 1.03, CI: 0.61-1.74), credible (OR = 1.06, CI: 0.81-1.39), or potentially effective (OR = 1.24, CI: 0.98-1.58). Testimonial messages were no more likely than didactic messages to be rated as extremely relevant (OR = 0.90, CI: 0.60-1.35), credible (OR = 0.97, CI: 0.70-1.34), emotionally arousing (OR = 1.22, CI: 0.90-1.67), or potentially effective (OR = 1.08, CI: 0.85-1.37). Fear appeared to partially mediate the relation between textual message frame and all three indicators of potential message effectiveness suggesting loss-framed messages elicited greater feelings of fear, thereby enhancing the potential effectiveness of the message. There was also some evidence that fear partially mediated the relation between graphic type and some indicators of potential message effectiveness suggesting messages with gruesome images elicited greater feelings of fear, thereby enhancing the potential effectiveness of the messages. Finally, greater proportions of participants indicated health warnings with an Inuit Elder were most personally relevant (44.2%) and most credible (35.9%) compared to health warnings with middle-aged Inuit or Caucasian spokespersons. However, participants’ choice of which health warning was potentially most effective was split relatively evenly between all options. Conclusions. Findings from this study suggest health warnings accompanied by gruesome images are potentially more effective at communicating tobacco-related health risk and motivating cessation among Inuit compared to those with images of personal suffering. This provides some initial evidence that current communication strategies that use gruesome imagery, like some tobacco product health warnings in Canada, may be effective among Inuit populations. However, when a spokesperson is used in a communication campaign, Inuit Elders tend to be preferred. Together these findings suggest that an integrated communication strategy that includes complementary, targeted materials working synergistically alongside population-level approaches (like tobacco product warning labels) may work best among Inuit.

Youth represent a substantial portion of smokeless tobacco (ST) users in Canada compared to the general population. Highest prevalence of use is typically seen in males, in current smokers, and in the Western provinces. ST use has also been associated with youth who participate in sports teams. Furthermore, ST has been marketed to youth through the use of flavours and sweeteners to make ST more attractive and appealing. The goal of this study was to determine the prevalence of ST use among Canadian youth and examine factors associated with its use. The study used self-report data from 29,007 grade 9-12 youth who participated in the 2010-2011 Canadian Youth Smoking Survey (YSS). Logistic regression analyses were used to determine factors associated with ST ever and current use among Canadian youth as well as among the sub-population of youth smokers. A mediation analysis was also used to understand if (a) sports team participation or (b) physical activity mediate an association between attempting to quit smoking and ST use among youth smokers. In 2010-2011, 5.3% of Canadian youth had ever used ST and 1.9% were current ST users. Odds of ST use were highest among males, grade 12 students, youth with more than $100 of weekly spending money and current smoking youth. This study was the first to identify associations between both physical activity and sports team participation and ST use among grade 9-12 Canadian youth. Continued monitoring of ST use among youth is recommended. Additionally, further research is needed to explore beyond individual-level factors and understand broader influences of ST use among youth.

Cigarette packaging is the most prominent form of tobacco promotion in Canada. Tobacco companies are increasingly selling cigarettes in innovative packaging, including the use of slim and super-slim “lipstick” sizes that are primarily marketed towards females. Australia is currently the only country that regulates the shape and size of cigarette packaging. The current study examined the relative importance of five cigarette packaging attributes—pack shape (e.g., “slims”) , brand, plain packaging, warning label size, and price—on perceptions of product taste, harm, and interest in trying, among young women in Canada. A discrete choice experiment was conducted online with smoking (n=211) and non-smoking (n=292) females, aged 16 to 24, recruited from a commercial sample. Respondents were shown 8 choice sets, each containing four packs displaying different combinations of the attributes: pack structure (slim, lipstick, booklet, standard); brand ( ‘Vogue’, ‘du Maurier’); branding (branded, plain); warning label size (50%, 75%); and price ($8.45, $10.45). For each choice set, respondents chose the brand that they: 1) would rather try, 2) would taste better, 3) would be less harmful, or “none”. For each outcome, the attributes’ impact on choices was analyzed using a multinomial logit model, and the relative importance (RI) of each attribute was calculated. The results showed that pack structure significantly influenced interest in trying (RI = 16%) and perceptions of taste (RI = 8%), whereas perceptions of harm were driven by pack structure (RI = 46%). Branding was the most important contributor to trial intent decisions (RI = 39%) and perceptions of taste (RI = 48%). Interest in trying among females significantly increased for booklet (p < 0.0001) packs compared to the traditional design. As well, females were significantly more interested in trying branded packs, female oriented ‘Vogue’ brand, and a 75% warning label size (p < 0.0001, for all). In terms of taste related perceptions, females believed that slim (p=0.02) and booklet packs (p=0.006) were significantly better tasting than traditional designs. Similarly, branded packs (p < 0.0001), ‘Vogue’ brand (p < 0.0001), 75% warning (p < 0.0001), and higher priced packs (p=0.04) significantly increased perceptions of taste among females. Among young females, booklet (p=0.03), lipstick (p < 0.0001) and slim (p < 0.0001) pack sizes were perceived as significantly less harmful compared to traditional designs. As well, women believed branded packs, ‘Vogue’ brand, and more expensive brands would be significantly less harmful (p < 0.0001, for all). Given that the discrete choice design did not include all pack profiles that could be generated with attribute-level combinations of branding, brand, and warning labels, and in particular, due to the absence of “branded Vogue packs with smaller warnings”, the findings on warning label size should be interpreted with caution. Overall, the findings suggest that “plain” packaging and prohibiting variations in pack shape and size may decrease interest in trying and reduce false perceptions of reduced product harm among young females.

Background: Police officers are often the first to respond when persons experience a mental health crisis in the community. They must de-escalate volatile situations involving persons with serious mental disorder (PSMD) and bring the person to the attention of either the criminal justice or mental health care system. It is argued that issues such as repeated police contact, excessive emergency department (ED) wait times, and the criminalization of the mentally ill are evidence that the current system lacks the ability to meet the needs of PSMD. Critics have argued the source of the problem is inadequate police training, and insufficient and poorly organized community mental health services. Others claim that the underlying issue is that the current system for responding to PSMD is dysfunctional. The model is based on the concept that the best way to meet the needs of PSMD is through the integration of systems and services which to date, has remained an impossible goal. Given the current system will not be replaced anytime soon, efforts should be directed toward developing innovative ways to make it easier for the systems to work more effectively together. Objectives: The major objective of this dissertation was to develop and pilot a new mental health screening form, the interRAI Brief Mental Health Screener (BMHS)* to enhance the ability of police officers to identify PSMD, and to support their decision-making. A second objective was to develop a model that best predicts which persons are most likely to be taken to hospital by police officers and which persons most likely to be admitted. A final objective was to analyze the impact that interacting with PSMD has on police resources in terms of the amount of time police officers spend on mental health related calls for service. Methodology: Logistic regression analysis was used to identify 14 predictors of serious mental health disorders from 41,019 cases obtained from the main Resident Assessment Instrument for Mental Health (RAI-MH) database. The RAI-MH is a comprehensive mental health assessment system that is currently used for all persons admitted into a psychiatric hospital in Ontario. Additional clinical, demographic and contextual items were added after consultation with an advisory committee composed of representatives from hospitals and police services resulting in a pilot version of the interRAI BMHS. The County of Wellington and the city of Guelph were selected as the setting for the pilot that included 4 general hospitals, 1 psychiatric facility and the participation of the Ontario Provincial Police (OPP) and the Guelph Police Service. After training police officers to use the new form, the interRAI BMHS was pilot tested over a seven month period commencing May 2011. Hospital records were also accessed to determine patient disposition. Logistic regression was used to develop an algorithm to identify the persons with the highest probability of being taken to hospital by police officers, and those persons who were most likely to be admitted. Results: Police officers from the two jurisdictions in Ontario completed a total of 235 interRAI BMHS forms. Chi square analysis revealed the most common reasons why police officers take persons to hospital included the person considering performing a self-injurious act in the past 30 days, and family, and others were concerned the person was at risk for self-injury. Intoxication by drugs or alcohol and having symptoms of psychosis were not significant reasons for police officers to take a person to hospital. The variables most associated with being admitted after being taken to hospital, included indicators of disordered, such as lack of insight into their mental health problems, abnormal thought process, delusions and hallucinations. Overall, although the terminology differed, the same patterns emerged in the pilot study that previous research reported. Police officers tend to focus on dangerousness and public safety, while clinicians are concerned with indicators of disordered thought. Logistic regression analysis revealed that the 14 variable algorithm used to construct the interRAI BMHS was a good predictor of who was most likely to be taken to hospital by police officers, and who was most likely to be admitted. Another important finding was that the reasons why police officers take persons to hospital were not the same as the reasons why persons are subsequently admitted. This suggests the criminal justice, health and mental health systems are not synchronized. The research also revealed that police officers spend a mean time of over three hours overall devoted to calls for service involving PSMD, and a mean time of just over three hours waiting in the ED. Conclusion: The interRAI BMHS provides useful information for both police officers and ED staff regarding the variables significantly associated with serious mental disorder. It will help support police officer and ED decision-making, and it will contribute to enhancing the training provided to police officers and mental health service providers. Additional research and larger sample sizes will help to further refine the instrument. The interRAI BMHS is based on health system data and written in the language of the health system. As such, it has the potential to both enhance the ability of police officers and other mental health service providers to identify indicators of serious mental disorder, and to help synchronize the criminal justice and mental health care systems. *interRAI stands for the international resident assessment instrument, in international collaborative to improve the quality of life of vulverable persons through a seamless comprehensive assessment system.

Background: Police officers are often the first to respond when persons experience a mental health crisis in the community. They must de-escalate volatile situations involving persons with serious mental disorder (PSMD) and bring the person to the attention of either the criminal justice or mental health care system. It is argued that issues such as repeated police contact, excessive emergency department (ED) wait times, and the criminalization of the mentally ill are evidence that the current system lacks the ability to meet the needs of PSMD. Critics have argued the source of the problem is inadequate police training, and insufficient and poorly organized community mental health services. Others claim that the underlying issue is that the current system for responding to PSMD is dysfunctional. The model is based on the concept that the best way to meet the needs of PSMD is through the integration of systems and services which to date, has remained an impossible goal. Given the current system will not be replaced anytime soon, efforts should be directed toward developing innovative ways to make it easier for the systems to work more effectively together. Objectives: The major objective of this dissertation was to develop and pilot a new mental health screening form, the interRAI Brief Mental Health Screener (BMHS)* to enhance the ability of police officers to identify PSMD, and to support their decision-making. A second objective was to develop a model that best predicts which persons are most likely to be taken to hospital by police officers and which persons most likely to be admitted. A final objective was to analyze the impact that interacting with PSMD has on police resources in terms of the amount of time police officers spend on mental health related calls for service. Methodology: Logistic regression analysis was used to identify 14 predictors of serious mental health disorders from 41,019 cases obtained from the main Resident Assessment Instrument for Mental Health (RAI-MH) database. The RAI-MH is a comprehensive mental health assessment system that is currently used for all persons admitted into a psychiatric hospital in Ontario. Additional clinical, demographic and contextual items were added after consultation with an advisory committee composed of representatives from hospitals and police services resulting in a pilot version of the interRAI BMHS. The County of Wellington and the city of Guelph were selected as the setting for the pilot that included 4 general hospitals, 1 psychiatric facility and the participation of the Ontario Provincial Police (OPP) and the Guelph Police Service. After training police officers to use the new form, the interRAI BMHS was pilot tested over a seven month period commencing May 2011. Hospital records were also accessed to determine patient disposition. Logistic regression was used to develop an algorithm to identify the persons with the highest probability of being taken to hospital by police officers, and those persons who were most likely to be admitted. Results: Police officers from the two jurisdictions in Ontario completed a total of 235 interRAI BMHS forms. Chi square analysis revealed the most common reasons why police officers take persons to hospital included the person considering performing a self-injurious act in the past 30 days, and family, and others were concerned the person was at risk for self-injury. Intoxication by drugs or alcohol and having symptoms of psychosis were not significant reasons for police officers to take a person to hospital. The variables most associated with being admitted after being taken to hospital, included indicators of disordered, such as lack of insight into their mental health problems, abnormal thought process, delusions and hallucinations. Overall, although the terminology differed, the same patterns emerged in the pilot study that previous research reported. Police officers tend to focus on dangerousness and public safety, while clinicians are concerned with indicators of disordered thought. Logistic regression analysis revealed that the 14 variable algorithm used to construct the interRAI BMHS was a good predictor of who was most likely to be taken to hospital by police officers, and who was most likely to be admitted. Another important finding was that the reasons why police officers take persons to hospital were not the same as the reasons why persons are subsequently admitted. This suggests the criminal justice, health and mental health systems are not synchronized. The research also revealed that police officers spend a mean time of over three hours overall devoted to calls for service involving PSMD, and a mean time of just over three hours waiting in the ED. Conclusion: The interRAI BMHS provides useful information for both police officers and ED staff regarding the variables significantly associated with serious mental disorder. It will help support police officer and ED decision-making, and it will contribute to enhancing the training provided to police officers and mental health service providers. Additional research and larger sample sizes will help to further refine the instrument. The interRAI BMHS is based on health system data and written in the language of the health system. As such, it has the potential to both enhance the ability of police officers and other mental health service providers to identify indicators of serious mental disorder, and to help synchronize the criminal justice and mental health care systems. *interRAI stands for the international resident assessment instrument, in international collaborative to improve the quality of life of vulverable persons through a seamless comprehensive assessment system.

INTRODUCTION: Canada’s Aboriginal population is growing at a faster rate than the rest of Canada. While Aboriginal health has improved in the last few decades, life expectancy of First Nations, Inuit and Métis continues to be lower compared to the rest of the Canadian population. Furthermore, current Aboriginal health research tends to focus on those living onreserves while more than half of the Aboriginal population currently resides in urban areas. Despite the importance of neighbourhood factors for understanding health in urban areas, the importance of neighbourhood characteristic for urban Aboriginal health has yet to be examined. OBJECTIVE: The objective of the research was, to determine both individual-level predictors and neighbourhood-level predictors of self-rated health and diagnosis of chronic conditions, amongst Aboriginal populations living in the City of Toronto; and to determine whether and how neighbourhood-level predictors influence individual-level predictors of self-rated health and diagnosis of a chronic conditions in Toronto neighbourhoods with Aboriginal populations living in them. METHODS: This study was a secondary analysis of two samples from the 2006 Aboriginal people Survey, consisting of 1080 and 500 Aboriginal individuals in the Toronto Census Metropolitan Area. A series of logistic regressions models were created to identify individual and neighbourhood predictors of “poor” self-rated health and having one or more diagnosed chronic condition(s). RESULTS: A best fitting model was derived from the individual-level variables to include the demographic variables age, gender and Aboriginal status; and the socio-economic variables average household income, education level and employment status. While neighbourhood-level variables had no significant influence in predicting either health outcome, there was some evidence to suggest influence over individual-level predictors. To further examine this relation, neighbourhoods were stratified based on income inequality, average household income and availability of Aboriginal specific services. This analysis yielded some different effects of individual-level variables for different neighbourhood types, suggesting that some effects of neighbourhood characteristics may interact with individual characteristics to influence health. CONCLUSION: While contextual factors have some effect on self-rated health, individual factors serve as stronger predictors of individual health. However, more neighbourhood level studies should be considered in order to better understand the growing urban Aboriginal population and potential ecological effects on health.