The understanding that Attention Deficit/ Hyperactivity Disorder (ADHD) commonly persists into adulthood has not been widely accepted until recently. Accordingly, less is known about diagnostic and treatment prevalence or health and social outcomes of ADHD in adulthood. The objectives of this study were to: determine lifetime prevalence of ADHD diagnosis and treatment for Manitoba young adults, investigate whether a socioeconomic gradient exists within Manitoba young adults with a lifetime diagnosis of ADHD, and investigate the relationship between ADHD in Manitoba young adults and health service utilization. Using the Manitoba Population Health Research Data Repository, this cross-sectional analysis used 24 years of data (1984/85-2008/09) and included all Manitoba adults aged 18-29 during 2007/08-2008/09 with a lifetime diagnosis of ADHD. Crude prevalence was calculated for ADHD diagnosis and psychostimulant prescriptions, in addition to several demographic variables. The presence of a socioeconomic gradient in lifetime ADHD diagnosis was investigated using Poisson and negative binomial regression. Relationships between young adults with lifetime ADHD diagnosis and health service utilization for several health and social outcome variables were explored using a matched cohort design with two comparison groups and GEE regression models. In relation to previous Manitoba research on childhood ADHD, the socioeconomic gradient for ADHD diagnosis was found to dissipate into young adulthood. However, when region of residence was accounted for, a small inverse gradient in the urban population and a direct gradient in the rural population were evident. Individuals from the highest income quintile were significantly less likely to be diagnosed before age 18 than all other income quintiles. Depression, anxiety, personality disorders, conduct disorder, substance abuse, multiple types of injuries, receipt of income assistance, and reduced high school graduation were significantly correlated with lifetime ADHD diagnosis. Given the high lifetime prevalence of ADHD in Manitoba young adults, significant socioeconomic correlates for diagnosis, and multitude of adverse health and social outcomes in this population, further investigation into the trajectory of this relatively unexplored population is recommended. Furthermore, continued measurement of the provision and success of additional resources will ultimately be necessary for enhancing the health status of all Canadian adults living with ADHD.

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The understanding that Attention Deficit/ Hyperactivity Disorder (ADHD) commonly persists into adulthood has not been widely accepted until recently. Accordingly, less is known about diagnostic and treatment prevalence or health and social outcomes of ADHD in adulthood. The objectives of this study were to: determine lifetime prevalence of ADHD diagnosis and treatment for Manitoba young adults, investigate whether a socioeconomic gradient exists within Manitoba young adults with a lifetime diagnosis of ADHD, and investigate the relationship between ADHD in Manitoba young adults and health service utilization. Using the Manitoba Population Health Research Data Repository, this cross-sectional analysis used 24 years of data (1984/85-2008/09) and included all Manitoba adults aged 18-29 during 2007/08-2008/09 with a lifetime diagnosis of ADHD. Crude prevalence was calculated for ADHD diagnosis and psychostimulant prescriptions, in addition to several demographic variables. The presence of a socioeconomic gradient in lifetime ADHD diagnosis was investigated using Poisson and negative binomial regression. Relationships between young adults with lifetime ADHD diagnosis and health service utilization for several health and social outcome variables were explored using a matched cohort design with two comparison groups and GEE regression models. In relation to previous Manitoba research on childhood ADHD, the socioeconomic gradient for ADHD diagnosis was found to dissipate into young adulthood. However, when region of residence was accounted for, a small inverse gradient in the urban population and a direct gradient in the rural population were evident. Individuals from the highest income quintile were significantly less likely to be diagnosed before age 18 than all other income quintiles. Depression, anxiety, personality disorders, conduct disorder, substance abuse, multiple types of injuries, receipt of income assistance, and reduced high school graduation were significantly correlated with lifetime ADHD diagnosis. Given the high lifetime prevalence of ADHD in Manitoba young adults, significant socioeconomic correlates for diagnosis, and multitude of adverse health and social outcomes in this population, further investigation into the trajectory of this relatively unexplored population is recommended. Furthermore, continued measurement of the provision and success of additional resources will ultimately be necessary for enhancing the health status of all Canadian adults living with ADHD.

Child trauma exposure (CTE) is an important public health concern in the U.S.; more than two-thirds of children report experiencing a traumatic event by the age of 16. CTE may have important acute and long-term physiological, developmental, behavioral, and psychological implications if not addressed. Trauma-focused cognitive behavioral therapy (TF-CBT) is the gold standard for treatment of child trauma and is well-supported for resulting in significant decreases in negative mental health outcomes associated with CTE. Despite the efficacy of evidence-based interventions such as TF-CBT, many children do not receive treatment due to a variety of contextual, logistical, and interpersonal barriers. This mixed-methods exploratory study examines possible predictors of enrollment and completion of TF-CBT, specifically parental trauma exposure, at a community organization that serves abused and traumatized children in the metro Atlanta area. Data were collected during individual assessments consisting of a computer survey and semi-structured interview (n=41). Data analysis focused on parental trauma exposure, and qualitative interviews were examined for common themes regarding intentions for their child’s enrollment and completion of services. Results indicated that caregivers of children referred to services had relatively high (56.1%) rates of trauma exposure. Results from logistical regression indicate that parents with a trauma history were 10.5 times more likely to have a child enroll in therapy. These results indicate that parents with personal trauma histories may be more committed to their child receiving services, therefore public health efforts aimed towards educating parents without trauma histories may be beneficial.

Epidemiological studies have shown that disparities in mental health service utilization still exist among ethnic minority groups in the United States. This study looks specifically at the lay referral system and what factors influence the likelihood of an individual referring a friend to mental health services. Since college student populations have fewer barriers than most to seeking treatment, 60 Asian American and 49 White American college students were sampled for the purposes of this study. They evaluated one of four vignettes in which cultural competency of the potential therapist and type of symptoms being presented were manipulated. Though there was no significant interaction found, implications of the current findings and corrections to the methodology for future research are discussed.

Researchers examining clinically-relevant trends for sexual minority women have found evidence of psychological distress and greater utilization of mental health services compared to heterosexually-identified women. However, the results of many research studies with this population have methodological limitations surrounding recruitment of participants, cross-sectional methods, and participant report of clinical services utilized. Few researchers have sought to analyze actual clinical presentation, service utilization, or clinical outcome of sexual minority women in a treatment-setting. This study is an in-depth clinical analysis of 215 sexual minority woman who sought services at a large Midwestern university counseling center over a period of two years and nine months. The analyses conducted allowed for the initial clinical presentation, service utilization, and clinical outcome of sexual minority women to be described and compared to comparative samples of service-seeking female college students. Sexual minority women were found to have a greater incidence of prior suicidality and prior counseling compared to heterosexual women at the same agency. Sexual minority women also reported greater symptoms of social anxiety, eating concerns, and family distress than heterosexual women at the same agency. Of seven examined predictors of service utilization, sexual minority identity label, age, and academic term of service initiation differentiated brief and extended service utilization from moderate service utilization. Prior use of counseling, psychological distress, racial-ethnic minority status, and time in the semester of initiation of services were not significant predictors of service utilization. Implications and limitations of these findings are presented, and future directions for research and intervention are discussed.

Women disproportionately account for a majority of all completed and attempted rape victimizations each year in the U.S. relative to men. Female college students, in particular, have been noted as a group with the highest risk for rape. Rape among women not only has a substantial public health impact, but has been linked to a number of individual mental health and substance use problems. Despite the fact that service utilization (formal help-seeking with a counselor, mental health professional, rape crisis center, and police reporting) has been shown to deter negative sequelae of rape, few victims of rape receive assistance from a victim service agency or report the incident to police; and among college student victims, this rate is even lower. Instead, rape victims are more likely to disclose the event and seek help from an informal source, such as a family member, spouse/romantic partner, friend, or acquaintance. Traditionally seen to have a positive impact on victim's mental health, informal social support may play a different role in rape victims with high levels of alcohol involvement or among those who have experienced an alcohol-involved rape. Current measures of social support fail to examine the factors that prompt victims to utilize their social support system and the role that alcohol use may play in victim's disclosure and recovery process. The current study explored the idea that social support may act as a barrier to help-seeking behavior, particularly formal treatment, among victims with alcohol involvement. This study had three primary aims: (a) to identify constructs related to the decision-making process to disclose a rape to an informal social support, (b) to understand victim and victim supporters' perceptions of social support and the impact of these perceptions on rape victims' post-rape mental health, and (c) to determine the role that alcohol plays in the disclosure process. To achieve these aims, the study used a mixed method approach (utilizing data from in-depth, semi-structured (face-to-face) qualitative interviews correlated with quantitative survey data) with a sample of college students (N=46) who were categorized into two groups: female college students who had experienced a rape in their lifetime (Victims; N=16) and college students who had had a rape disclosed to them (Supporters; N=30). The use of thick description provided Victims and Supporters a voice that could not be heard through existing quantitative measures. Qualitative data unveiled the fact that the perceptions surrounding social support during disclosure of a rape are often very different between Supporters and Victims. Victims themselves more often report feeling uncomfortable or guilty because of their own acceptance of rape myths, which appears to hinder them from further help-seeking. However, Victims appear to be prompted to disclose to an informal social support when they feel they are ready to talk and are provided a comfortable environment, but both Victims and Supporters feel that Supporters are unprepared to provide sufficient aid and the support provided during the disclosure may be inadequate. Despite the feelings that professional help would be beneficial, Victims are often stalled by complicating factors during the assault or their individual characteristics, such as alcohol involvement. Recent efforts on educating the general public on rape myths were evident during the interviews, but these beliefs still remain in students' feelings surrounding rape and utilizing mental health services.

Background: Oral health is crucial for overall health. Oral health care need is the most prevalent unmet health care need among children and adolescents in the United States. Youth characteristics and socio-demographic factors are known to influence dental health service utilization. While there have been studies listing the factors contributing to the oral health disparities in the Appalachian region, very few studies have inspected the risk behaviours of the youth and their association with dental health care utilization. Methods: A structured questionnaire was administered to high school students in five counties of South-Central Appalachia. The survey included a question on a recent dental visit. The students provided information on socio-demographic characteristics and risk behaviours. Descriptive analysis was performed and the association between recent dental visit as the outcome variable and sociodemographic factors and health risk behaviours as independent variables were analyzed using logistic regression analysis. The analysis was performed using SAS 9.4. Results:80.1% (N= 129) of the adolescents who had admitted to using tobacco products or electronic vapour products reported having visited the dentist in the past 12 months. 87.5% (N= 168) of the females and 80.3% (N=127) of the males reported having visited the dentist in the past 12 months and 81.43% (N=114) of the adolescents who received free or reduced lunch reported having visited the dentist in the past 12 months. Use of tobacco products was the only health risk behaviour significantly associated with dental visit in the past 12 months (p=0.04) after adjusting for covariates with OR=0.5 (95% C I:0.312 -1.01). Conclusion: The findings suggest that health risk behaviours such as using tobacco products may be associated with dental health care utilization and future research should focus on adolescents with health-risk behaviours with the goal of identifying interventions for at-risk populations. Keywords: Oral health, health disparities, youth, health risk behaviours

Many individuals experience barriers to accessing medical care, especially in rural areas. Some barriers are attitudinal and represent perceptions of quality care. Patient satisfaction and perceived need for medical care are two such attitudinal barriers related to health care utilization, yet the relationship between these variables has not been explored. Using data from an online survey, the current study examined the association between these variables, and further, whether rurality status moderated this association. Results indicated a significant correlation between patient satisfaction and perception of need. Although the overall moderation model was significant, perception of need was not significantly associated with patient satisfaction, and rurality status did not significantly moderate the relationship. However, the covariates of sexual orientation and income did significantly predict patient satisfaction. This study highlights the complex associations of patient satisfaction, as well as the importance of social determinants of health in patients’ perceptions of quality of care.

Master of Public Health - MPH / Non-communicable diseases (NCDs) are the leading cause of death globally, affecting a significant proportion of the economically active population, the majority of these occurring in low- and middle-income countries (LMICs). In South Africa, over 40% of deaths are attributable to NCDs. The use of healthcare services by individuals who have NCDs is putatively high but has yet, not been adequately quantified. Furthermore, there is a paucity of research data on factors that influence healthcare services use among those experiencing NCDs in South Africa.