Neighborhood Violence Research Articles

The Co-evolution of Bullying Perpetration, Homophobic Teasing, and a School Friendship Network.

Bullying and homophobic teasing behaviors affect the lives of many school aged children, often co-occur, and tend to peak in middle school. While bullying and homophobic teasing behaviors are known to be peer group phenomena, studies typically examine the associations at the individual or school levels. An examination of these behaviors at the peer group level can aid in our understanding of the formation and maintenance of peer groups that engage in these forms of aggressive behavior (selection), and the extent to which friends and the peer group impact individual rates of these aggressive behaviors (influence). In this longitudinal study, we assess the co-evolution of friendship networks, bullying perpetration, and homophobic teasing among middle school students (n = 190) using a Stochastic Actor-Based Model (SABM) for longitudinal networks. Data were collected from 6-8th-grade students (Baseline age 12-15; 53% Female; 47% Male) across three waves of data. The sample was diverse with 58% African American, 31% White, and 11% Hispanic. Since bullying and homophobic teasing behaviors are related yet distinct forms of peer aggression, to capture the unique and combined effects of these behaviors we ran models separately and then together in a competing model. Results indicated that on average individuals with higher rates of bullying perpetration and homophobic teasing were associated with becoming increasingly popular as a friend. However, the effects were not linear, and individuals with the highest rates of bullying perpetration and homophobic teasing were less likely to receive friendship nominations. There was no evidence that bullying perpetration or homophobic teasing were associated with the number of friendship nominations made. Further, there was a preference for individuals to form or maintain friendships with peers who engaged in similar rates of homophobic name-calling; however, this effect was not found for bullying perpetration. Additionally, changes in individual rates of bullying perpetration were not found to be predicted by the bullying perpetration of their friends; however, changes in adolescent homophobic teasing were predicted by the homophobic teasing behaviors of their friends. In a competing model that combined bullying perpetration and homophobic teasing, we found no evidence that these behaviors were associated with popularity. These findings are likely due to the high association between bullying perpetration and homophobic teasing combined with the small sample size. However, friendship selection was based on homophobic name-calling, such that, there was a preference to befriend individuals with similar rates of homophobic teasing. We also examined several risk factors (dominance, traditional masculinity, impulsivity, femininity, positive attitudes of bullying, and neighborhood violence), although, impulsivity was the only covariate that was associated with higher levels of bullying perpetration and homophobic teasing. More specifically, youth with higher rates of impulsivity engaged in higher rates of bullying perpetration and homophobic teasing over time. The findings suggest bullying perpetration and homophobic teasing have important influences on friendship formation, and close friendships influence youth's engagement in homophobic teasing. Implications for prevention and intervention efforts are discussed in terms of targeting peer groups and popular peers to help reduce rates of these aggressive behaviors.

Examining relationships between perceptions and objective assessments of neighborhood environment and sedentary time: Data from the Washington, D.C. Cardiovascular Health and Needs Assessment.

Sedentary time (ST) and neighborhood environment (NE) are predictors of cardiovascular (CV) health. However, little is known about ST's relationship with NE. We examined associations of perceived and objective NE with ST in the predominantly African American faith-based population of the Washington, D.C. CV Health and Needs Assessment. After using community-based research principles, participants reported NE perceptions, including sidewalks, recreational areas, and crime presence. Factor analysis was conducted to explore pertinent constructs; factor sums were created and combined as Total Perception Score (TPS) (higher score = more favorable perception). Objective NE was assessed using Google Maps and the Active Neighborhood Checklist (ANC). ST was self-reported. Linear regression determined relationships between TPS and ST, and ANC scores and ST, for 1) overall population, 2) lower median-income D.C. areas, and 3) higher median-income DC and Maryland areas. For the sample (N = 98.9% African-American, 78% female), lower median-income areas had significantly lower mean TPS and ANC scores than higher median-income areas (p < 0.001). Three factors (neighborhood violence, physical/social environment, and social cohesion) were associated with overall NE perception. Among those in lower median-income areas, there was a negative association between TPS and ST that remained after covariate adjustment; this was not observed in higher median-income areas. There was no association between ANC scores and ST. Poorer NE perception is associated with greater ST for those in lower income areas, while objective environment is not related to ST. Multi-level interventions are needed to improve NE perceptions in lower-median income areas, reduce ST, and improve CV health.

Emotional responses to unintentional and intentional traumatic injuries among urban black men: A qualitative study

PurposeThe burden of injuries is disproportionately concentrated among Black men in the United States. Previous studies suggest that the mental health effects of trauma may vary by the intentionality of the injury (intentional vs. unintentional), yet little is known about this experience among Black men. We explored the emotional responses to traumatic injuries in the context of injury intentionality among Black men in an urban area. MethodsWe conducted semi-structured, qualitative interviews with 74 Black men who were traumatically injured. The interviews took place three months after discharge from the hospital and they were audiotaped, transcribed, and de-identified. We used systematic thematic analysis to identify themes about post-trauma emotional responses to intentional and unintentional injuries. ResultsThe narratives of intentionally injured men revealed persistent exposure to neighborhood violence and their distrust of others including the people they knew and to whom they felt close. Survivors of unintentional injuries did not express a similar distrust of others. Our findings suggest that survivors of intentional injuries experience loss of social support following their injuries. ConclusionsEmotional responses can differ by intentionality of traumatic injury among urban Black men. Intentional injuries may be a marker for chronic exposure to violence and limited social support for recovery. Additional resources should be targeted to survivors of intentional injury who return to disadvantaged communities after medical treatment to decrease risk of re-traumatization and adverse emotional responses.

Perceived neighborhood characteristics predict severity and emotional response to daily stressors

RationaleNeighborhood characteristics may influence health and well-being outcomes through stressors in daily life. ObjectivesThis study tested whether a varied set of perceived characteristics of neighborhood (i.e., social cohesion, safety, aesthetic quality, violence) predicted stressor frequency and severity as well as negative emotional responses to stressors. We predicted greater reported cohesion and safety and less violence would be associated with less frequent stressor exposure and severity and less intense negative affect following stressors; we conducted subsequent tests of neighborhood aesthetic quality as a predictor. MethodsParticipants (n = 233, age 25–65 years) were residents in a socio-economically, racially, and ethnically diverse zip code in Bronx, New York, most who participated in the Effects of Stress on Cognitive Aging, Physiology and Emotion study between 2012 and 2013. They provided demographic information and neighborhood ratings, then participated in the EMA protocol in which they completed brief smartphone surveys of current negative affect and stressor exposure, severity, and recency, five times daily for 14 days. ResultsNo coded neighborhood characteristic was related to the frequency of stressors. Individuals who reported greater neighborhood violence, however, rated their stressors as more severe. Individuals rating their neighborhood lower in safety or aesthetic quality, or higher in violence, had greater negative affect following stressors. ConclusionEven among people living within the same zip code, individual differences in perceptions of neighborhood predict how stressful they appraised stressors in daily life to be and how much negative affect they reported following stressors.

Community Violence Exposure and Conduct Problems in Children and Adolescents with Conduct Disorder and Healthy Controls.

Exposure to community violence through witnessing or being directly victimized has been associated with conduct problems in a range of studies. However, the relationship between community violence exposure (CVE) and conduct problems has never been studied separately in healthy individuals and individuals with conduct disorder (CD). Therefore, it is not clear whether the association between CVE and conduct problems is due to confounding factors, because those with high conduct problems also tend to live in more violent neighborhoods, i.e., an ecological fallacy. Hence, the aim of the present study was: (1) to investigate whether the association between recent CVE and current conduct problems holds true for healthy controls as well as adolescents with a diagnosis of CD; (2) to examine whether the association is stable in both groups when including effects of aggression subtypes (proactive/reactive aggression), age, gender, site and socioeconomic status (SES); and (3) to test whether proactive or reactive aggression mediate the link between CVE and conduct problems. Data from 1178 children and adolescents (62% female; 44% CD) aged between 9 years and 18 years from seven European countries were analyzed. Conduct problems were assessed using the Kiddie-Schedule of Affective Disorders and Schizophrenia diagnostic interview. Information about CVE and aggression subtypes was obtained using self-report questionnaires (Social and Health Assessment and Reactive-Proactive aggression Questionnaire (RPQ), respectively). The association between witnessing community violence and conduct problems was significant in both groups (adolescents with CD and healthy controls). The association was also stable after examining the mediating effects of aggression subtypes while including moderating effects of age, gender and SES and controlling for effects of site in both groups. There were no clear differences between the groups in the strength of the association between witnessing violence and conduct problems. However, we found evidence for a ceiling effect, i.e., individuals with very high levels of conduct problems could not show a further increase if exposed to CVE and vice versa. Results indicate that there was no evidence for an ecological fallacy being the primary cause of the association, i.e., CVE must be considered a valid risk factor in the etiology of CD.

Parents and peers as protective factors among adolescents exposed to neighborhood risk

The purpose of this study was to examine the link between neighborhood risk and adolescent antisocial behavior and whether this association was moderated by parent and peer relationships and characteristics. We also explored whether the moderating effects varied by age. The sample consisted of 206 adolescents (ages 10–18years) from predominantly low-income, ethnic minority families. Results indicated that high levels of neighborhood violence and neighborhood danger were significantly related to high levels of antisocial behavior. The findings also showed that high levels of peer (but not parent) prosocial behavior and emotion regulation attenuated the links between neighborhood violence and antisocial behavior. Moreover, parent-adolescent (but not peer-adolescent) relationship quality served as a protective factor in the face of neighborhood violence and danger. In addition, little evidence of age differences in the moderating effects of parents and peers was found. Implications regarding the role of interpersonal relationships in the context of risk are discussed.

Associations of neighborhood disorganization and maternal spanking with children’s aggression: A fixed-effects regression analysis

This study employed fixed effects regression that controls for selection bias, omitted variables bias, and all time-invariant aspects of parent and child characteristics to examine the simultaneous associations between neighborhood disorganization, maternal spanking, and aggressive behavior in early childhood using data from the Fragile Families and Child Wellbeing Study (FFCWS). Analysis was based on 2,472 children and their mothers who participated in Wave 3 (2001–2003; child age 3) and Wave 4 (2003–2006; child age 5) of the FFCWS. Results indicated that higher rates of neighborhood crime and violence predicted higher levels of child aggression. Maternal spanking in the past year, whether frequent or infrequent, was also associated with increases in aggressive behavior. This study contributes statistically rigorous evidence that exposure to violence in the neighborhood as well as the family context are predictors of child aggression. We conclude with a discussion for the need for multilevel prevention and intervention approaches that target both community and parenting factors.

Neighbors but Not Classmates: Neighborhood Disadvantage, Local Violent Crime, and the Heterogeneity of Educational Experiences in Chicago

Large urban school districts are increasingly offering their students options that break the link between residential location and school attendance. Individual decisions are likely to aggregate in different ways across communities, leaving students in some neighborhoods with more varied educational experiences. In this paper, I explore these patterns using a complete cohort of Chicago Public School high school freshmen in 2009 (N = 24,019) and explore the characteristics of different schools that students living in the same neighborhood attend. Students in poor and violent neighborhoods attend schools that are more heterogeneous in terms of type, achievement, safety, and student demographics. Students from these neighborhoods also scatter geographically to schools across the city, many traveling quite long distances. In contrast, students from safe and affluent neighborhoods attend many fewer schools, are less likely to make long distance trips, and are more likely to attend school with a large proportion of their neighbors.

Learning in Harm’s Way: Neighborhood Violence, Inequality, and American Schools

Is a school’s geographic proximity to violent crime related to characteristics of its student body and to students’ academic performance? Our understanding of the educational impacts of students’ exposure to violence has been constrained because of various technical and financial limitations that have made research in this area problematic. The work presented here leverages advances in the availability of geo-coded data on incidents of crime to overcome the limitations of prior research in this area, showing that a school’s proximity to violent crime is associated with common measures of educational inequality and also with school performance. We discuss the implications of our findings for future research and public policy.

Violent Injury and Neighborhood Racial/Ethnic Diversity in Oakland, California.

Racial and ethnic segregation has been linked to a number of deleterious health outcomes, including violence. Previous studies of segregation and violence have focused on segregation between African Americans and Whites, used homicide as a measure of violence, and employed segregation measures that fail to take into account neighborhood level processes. We examined the relationship between neighborhood diversity and violent injury in Oakland, California. Violent injuries from the Alameda County Medical Center Trauma Registry that occurred between 1998 and 2002 were geocoded. A local measure of diversity among African American, White, Hispanic, and Asian populations that captured interactions across census block group boundaries was calculated from 2000 U.S. Census data and a Geographic Information System. The relationship between violent injuries and neighborhood level of diversity, adjusted for covariates, was analyzed with zero-inflated negative binomial regression. There was a significant and inverse association between level of racial and ethnic diversity and rate of violent injury (IRR 0.30; 95% CI: 0.13-0.69). There was a similar relationship between diversity and violent injury for predominantly African American block groups (IRR 0.23; 95% CI: 0.08-0.62) and predominantly Hispanic block groups (IRR 0.08; 95% CI: 0.01-0.76). Diversity was not significantly associated with violent injury in predominantly White or Asian block groups. Block group racial and ethnic diversity is associated with lower rates of violent injury, particularly for predominantly African American and Hispanic block groups.

Neighborhood sexual violence moderates women's perceived safety in urban neighborhoods.

Perceptions of neighborhood safety are positively associated with perceptions of neighborhood violence. However, research has yet to examine whether this relationship is moderated by specific types of violence, such as sexual violence, that are more salient for women. Using street-intercept interviews with 343 adults in 9 neighborhoods of a U.S. city with high rates of poverty, unemployment, and crime, we examine the relationship of perceived neighborhood violence to perceived safety in the context of gender while controlling for neighborhood assets that moderate perceptions of neighborhood safety and violence. We hypothesized that gender would moderate the relationship between perceived neighborhood violence and safety, and that women's perceptions of neighborhood safety would be significantly influenced by neighborhood sexual violence, but not other types of violence. Although women and men in these high crime, urban neighborhoods did not differ in their perceptions of neighborhood safety or violence, perceived sexual violence did significantly moderate safety by gender; women's perceptions of neighborhood sexual violence predicted perceived safety in their neighborhood. Importantly, gender did not moderate perceived safety for other types of violence. These results illustrate the importance of taking gender and perceived sexual violence into account to understand neighborhood safety in adults, particularly women.

Racial and Ethnic Health Disparities and Trauma-Informed Care for Children Exposed to Community Violence.

Racial and ethnic disparities in health outcomes and access have been consistently documented for a wide variety of physical and behavioral health conditions. Health inequities are most pronounced in areas with high levels of racial and ethnic segregation, where children and adolescents are also more likely to face economic inequality, which places them at high risk for exposure to neighborhood violence and traumatic loss. Community violence exposure (CVE) has been increasingly recognized as a prominent contributor to negative physical and mental health outcomes. CVE has been linked to children's risk for negative psychological outcomes, such as posttraumatic stress disorder, externalizing behavior, and internalizing symptoms, as well as obesity, asthma, and health-risk behaviors. Providers of pediatric care have opportunities to address CVE and related health disparities by developing trauma-informed systems that routinely screen for CVE, provide basic support for affected families, and link those in need to trauma-focused intervention. [Pediatr Ann. 2017;46(10):e377-e381.].

Chronic School Absenteeism and the Role of Adverse Childhood Experiences

ObjectiveTo examine the association between chronic school absenteeism and adverse childhood experiences (ACEs) among school-age children. MethodsWe conducted a secondary analysis of data from the 2011–2012 National Survey of Children's Health including children 6 to 17 years old. The primary outcome variable was chronic school absenteeism (≥15 days absent in the past year). We examined the association between chronic school absenteeism and ACEs by logistic regression with weighting for individual ACEs, summed ACE score, and latent class analysis of ACEs. ResultsAmong the 58,765 school-age children in the study sample, 2416 (4.1%) experienced chronic school absenteeism. Witnessing or experiencing neighborhood violence was the only individual ACE significantly associated with chronic absenteeism (adjusted odds ratio [aOR] 1.55, 95% confidence interval [CI] 1.20–2.01). Having 1 or more ACE was significantly associated with chronic absenteeism: 1 ACE (aOR 1.35, 95% CI 1.02–1.79), 2 to 3 ACEs (aOR 1.81, 95% CI 1.39–2.36), and ≥4 ACEs (aOR 1.79, 95% CI 1.32–2.43). Three of the latent classes were also associated with chronic absenteeism, and children in these classes had a high probability of endorsing neighborhood violence, family substance use, or having multiple ACEs. ConclusionsACE exposure was associated with chronic school absenteeism in school-age children. To improve school attendance, along with future graduation rates and long-term health, these findings highlight the need for an interdisciplinary approach to address child adversity that involves pediatricians, mental health providers, schools, and public health partners.

Methods to Assess Adverse Childhood Experiences of Children and Families: Toward Approaches to Promote Child Well-being in Policy and Practice

BackgroundAdvances in human development sciences point to tremendous possibilities to promote healthy child development and well-being across life by proactively supporting safe, stable and nurturing family relationships (SSNRs), teaching resilience, and intervening early to promote healing the trauma and stress associated with disruptions in SSNRs. Assessing potential disruptions in SSNRs, such as adverse childhood experiences (ACEs), can contribute to assessing risk for trauma and chronic and toxic stress. Asking about ACEs can help with efforts to prevent and attenuate negative impacts on child development and both child and family well-being. Many methods to assess ACEs exist but have not been compared. The National Survey of Children's Health (NSCH) now measures ACEs for children, but requires further assessment and validation. MethodsWe identified and compared methods to assess ACEs among children and families, evaluated the acceptability and validity of the new NSCH-ACEs measure, and identified implications for assessing ACEs in research and practice. ResultsOf 14 ACEs assessment methods identified, 5 have been used in clinical settings (vs public health assessment or research) and all but 1 require self or parent report (3 allow child report). Across methods, 6 to 20 constructs are assessed, 4 of which are common to all: parental incarceration, domestic violence, household mental illness/suicide, household alcohol or substance abuse. Common additional content includes assessing exposure to neighborhood violence, bullying, discrimination, or parental death. All methods use a numeric, cumulative risk scoring methodology. The NSCH-ACEs measure was acceptable to respondents as evidenced by few missing values and no reduction in response rate attributable to asking about children's ACEs. The 9 ACEs assessed in the NSCH co-occur, with most children with 1 ACE having additional ACEs. This measure showed efficiency and confirmatory factor analysis as well as latent class analysis supported a cumulative risk scoring method. Formative as well as reflective measurement models further support cumulative risk scoring and provide evidence of predictive validity of the NSCH-ACEs. Common effects of ACEs across household income groups confirm information distinct from economic status is provided and suggest use of population-wide versus high-risk approaches to assessing ACEs. ConclusionsAlthough important variations exist, available ACEs measurement methods are similar and show consistent associations with poorer health outcomes in absence of protective factors and resilience. All methods reviewed appear to coincide with broader goals to facilitate health education, promote health and, where needed, to mitigate the trauma, chronic stress, and behavioral and emotional sequelae that can arise with exposure to ACEs. Assessing ACEs appears acceptable to individuals and families when conducted in population-based and clinical research contexts. Although research to date and neurobiological findings compel early identification and health education about ACEs in clinical settings, further research to guide use in pediatric practice is required, especially as it relates to distinguishing ACEs assessment from identifying current family psychosocial risks and child abuse. The reflective as well as formative psychometric analyses conducted in this study confirm use of cumulative risk scoring for the NSCH-ACEs measure. Even if children have not been exposed to ACEs, assessing ACEs has value as an educational tool for engaging and educating families and children about the importance of SSNRs and how to recognize and manage stress and learn resilience.

Exposure to Violence Accelerates Epigenetic Aging in Children

Epigenetic processes, including DNA methylation, change reliably with age across the lifespan, such that DNA methylation can be used as an “epigenetic clock”. This epigenetic clock can be used to predict age and age acceleration, which occurs when methylation-based prediction of age exceeds chronological age and has been associated with increased mortality. In the current study we examined epigenetic age acceleration using saliva samples collected from children between ages 6–13 (N = 101). Children’s exposure to neighborhood violence and heart rate during a stressful task were assessed. Age acceleration was associated with children’s direct experience of violence (p = 0.004) and with decreased heart rate (p = 0.002). Children who were predicted to be older than their chronological age had twice as much violence exposure as other children and their heart rate was similar to that of adults. The results remained significant after controlling for demographic variables, such as sex, income and education. This is the first study to show the effects of direct violence exposure on epigenetic aging in children using salivary DNA. Although longitudinal studies are needed to determine whether accelerated epigenetic aging leads to adverse health outcomes later in life, these data point to DNA methylation during childhood as a putative biological mechanism.

Breastfeeding and Exposure to Past, Current, and Neighborhood Violence.

Objectives Breastfeeding has short- and long-term health benefits for children and mothers, but US breastfeeding rates are suboptimal. Exposure to violence may contribute to these low rates, which vary by race/ethnicity. We studied: (1) whether patterns of violence exposure differ by race/ethnicity and (2) whether these patterns are associated with breastfeeding outcomes. Methods We conducted a secondary analysis of data drawn from self-report surveys completed by a convenience sample of low-income postpartum women (n = 760) in upstate New York. Latent class analysis was used to identify groups of women with similar responses to seven violence measures, including childhood physical and/or sexual violence, experience of partner violence during or just after pregnancy (physical, emotional, verbal), and neighborhood violence (perceived or by ZIP code). Logistic regression and survival analysis were utilized to determine if classes were associated with breastfeeding initiation, duration, and exclusivity, controlling for demographics. Results Exposure to at least one form of violence was high in this sample (87%). We identified 4 classes defined by violence exposure (combining current and historical exposures). Violence exposure patterns differed between racial/ethnic groups, but patterns were inconsistently associated with breastfeeding plans or outcomes. For White women, history of violence exposure increased the likelihood of earlier breastfeeding cessation. By contrast, among Black women, history of violence exposure increased the likelihood of having a breastfeeding plan and initiating breastfeeding. Conclusions for Practice Some differences between violence exposure classes are likely due to the correlation between race/ethnicity and socioeconomic status in the community studied. Additional studies are warranted to better understand how exposure to violence is related to breastfeeding and how best to support women making decisions about intention, initiation, and duration of breastfeeding.

An Examination of Correlates for Adolescent Engagement in Nonsuicidal Self‐Injury, Suicidal Self‐Injury, and Substance Use

Little research has examined potential risk factors for direct versus indirect self-injury among adolescents. To address this limitation, 541 clinically referred adolescents were assessed using the interRAI Child and Youth Mental Health Assessment. Logistic regression analyses revealed that older females who experienced heightened depressive symptoms and neighborhood violence were at increased risk for direct self-injury, specifically nonsuicidal and suicidal self-injury. Additionally, adolescents who experienced higher levels of caregiver distress were at greater risk of suicidal self-injury. In contrast, older adolescents who experienced heightened aggressive behavior were at increased risk for one form of indirect self-injury, substance use. Findings suggest that nonsuicidal self-injury, suicidal self-injury, and substance use are associated with differential risk factors. Implications for targeted prevention strategies are discussed.

Advocacy unit probation officers reporting risk factors for young offenders with intellectual or developmental disabilities

ABSTRACTYoung people with intellectual or developmental disabilities are over-represented in the juvenile justice system. Unlike young people without disabilities, young offenders with intellectual or developmental disabilities may have assigned probation officers (i.e., advocacy unit probation officers) who understand the contextual risk factors among these young offenders. For this study, we conducted interviews with eight advocacy unit probation officers about the risk factors for young offenders with intellectual or developmental disabilities as well as ways to reduce court involvement. Risk factors for being involved with the juvenile justice system included peer victimisation, inability of the court to explain its procedures, inappropriate school discipline, experiences of living in poverty, and neighbourhood violence. Suggested strategies to reduce the risk for offending included: improving family–school partnerships, increasing special education knowledge among juvenile justice officials, and having schools appropriately address behaviours of students. Implications are discussed.

What’s a Threat on Social Media? How Black and Latino Chicago Young Men Define and Navigate Threats Online

Youth living in violent urban neighborhoods increasingly post messages online from urban street corners. The decline of the digital divide and the proliferation of social media platforms connect youth to peer communities who may share experiences with neighborhood stress and trauma. Social media can also be used for targeted retribution when threats and insults are directed at individuals or groups. Recent research suggests that gang-involved youth may use social media to brag, post fight videos, insult, and threaten—a phenomenon termed Internet banging. In this article, we leverage “code of the digital street” to understand how and in what ways social media facilitates urban-based youth violence. We utilize qualitative interviews from 33 Black and Latino young men who frequent violence prevention programs and live in violent neighborhoods in Chicago. Emerging themes describe how and why online threats are conceptualized on social media. Implications for violence prevention and criminal investigations are discussed.

Protecting study participants in emergency research: is community consultation before trial commencement enough?

BackgroundThis article presents the results of a community consultation (CC) process completed in Toronto, Ontario, using a random digit dialling technique, on the attitudes and perceptions of the public toward...