Objectives: A majority of population-based studies suggest prevalence of drug and alcohol risk behaviour increases during late adolescence to early adulthood. The purpose of this systematic literature review is to clarify if socioeconomic status (SES) is a determinant of marijuana and alcohol risk behaviour in adolescents between the ages of 10-15 years. Methods: We performed a meta-analysis to identify published or unpublished papers between January 1, 1980 and February 9, 2007 that reviewed marijuana and alcohol risk behaviour by SES in adolescents aged 10-15 years. Synthesis: We found nine studies that fulfilled our inclusion criteria and passed the methodological quality review. The prevalence of marijuana and alcohol risk behaviour was 22% higher (RR = 1.22; 95% CI 1.14-1.31) in adolescents with low SES in comparison to adolescents with higher SES. Stratification by country of origin revealed that American and New Zealand studies had statistically significant variability in the reported effects as compared to European and UK studies. Discussion: The evidence suggests that low SES has an inverse association with the prevalence of marijuana and alcohol risk behaviour in adolescents between the ages of 10-15 years. Higher rates of marijuana and alcohol risk behaviour among lower SES adolescents may impact emotional development, limit future educational and occupational achievement, and increase the likelihood for adult marijuana and alcohol addiction. Conclusion: Lower SES adolescents have higher rates of marijuana and alcohol risk behaviour than higher SES adolescents.

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Objective: The purpose of this paper was to use a linked dataset to compare health care utilization rates and costs between income groups in Saskatoon, Canada. Methods: The Canadian Community Health Survey was linked to hospital, physician and medication data in Saskatoon. Results: Of 3,688 eligible participants, 3,433 agreed to the health survey and data linkage with health records (83.7% overall response). Low-income residents were 27-33% more likely to be hospitalized and 36-45% more likely to receive a medication than middle-and higher-income residents, but were 5-7% less likely to visit a physician over a one-year period. In comparison to middle-income residents, low-income residents had 56% more high users of hospitals, 166% more high users of physicians and 90% more high users of medications. Low-income residents had 34-35% higher health care costs overall than middle-and high-income residents. After multivariate adjustment for increased disease prevalence, low income had a reduced association with high health care utilization. Conclusions: The results demonstrate that residents with lower income are responsible for disproportionate usage of hospitals, physicians and medications; due mainly (but not entirely) to higher disease prevalence.

Objective: To determine if Aboriginal (in this paper, First Nations and Métis people) cultural status is independently associated with lifetime suicidal ideation in the Saskatoon Health Region after controlling for other covariates, particularly income status. Results: Participants (n = 5948) completed the survey with a response rate of 81.1%. The prevalence of lifetime suicidal ideation was 11.9%. After stratification, it was found that high-income Aboriginal people have similar low levels of suicidal ideation, compared with high-income Caucasian people. The risk-hazard model demonstrated a larger independent effect of income status in explaining the association between Aboriginal cultural status and lifetime suicidal ideation, compared with the independent effect of age. After full multivariate adjustment, Aboriginal cultural status had a substantially reduced association with lifetime suicidal ideation. The odds of lifetime suicidal ideation for Aboriginal people reduced from 3.28 to 1.99 after multivariate adjustment for household income alone. Conclusion:The results of this study suggest reductions in lifetime suicidal ideation can be observed in Aboriginal people in Canada by adjusting levels of household income.Can J Psychiatry. 2009;54(9):589-595. Clinical Implications· The results of this study suggest reductions in lifetime suicidal ideation can be observed in Aboriginal people in Canada by adjusting levels of household income. · Targeted policies to improve the social conditions of Aboriginal people, coupled with generic policies focusing on reducing socioeconomic inequalities, should be provided in combination with individual treatment strategies to prevent suicidal ideation. Limitations· The study is cross-sectional and can therefore only describe associations and not causation. · The CCHS does not ask about mood disorders in each cycle; therefore, no information on variables such as depression is presented. · Data on Aboriginal residents are limited to the off-reserve population.

The recognition that Aboriginal cultural status is not independently associated with moderate or severe depressed mood in youth after full multivariate adjustment allows policy makers to acknowledge that mental health disparity prevention is possible because the determinants of health (ie, education) are modifiable (in comparison with Aboriginal cultural status).