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The Paper was Presented by Pierre Tremblay at The 11th Annual Sociological Symposium: "Deconstructing Youth Suicide," San Diego State University - March, 2000 (Cover Page). A part of the present updated paper was presented at the Gay Men's Health Summit in Boulder, Colorado - July, 2000 (Cover Page).
Note 2: Tremblay (1998) summarized the status of bisexuality in the research world by stating that, even though Kinsey's 1948 research indicated significant bisexuality in males, it was only as the result of AIDS-related research that the concept began to surface again in discourses by researchers. "Essentially, sexual orientation has been presented as a homosexual / heterosexual dichotomy, with nothing in between. For too long bisexuality has been perceived as a transition and, by definition, unstable, linked to adolescence, to the absence of a female partner (as in the case of prisoners), or to economic reasons (as with prostitutes)." (Translated by author.) Dorais (1994) noted the same fact which was also reflected in a recent study of papers published in 17 family therapy journals from 1975 to 1995. Clark et al. (1997) reported that only .006% of the articles (n = 77) focused on homosexuality issues, and that "only two [of these] studies included bisexuals, indicating a dearth of knowledge in this area" (p. 248). Also indicated, however, is the complete absence of "bisexuality" from the consciousness of family therapists, as I witnessed in 1994 at a meeting of professionals concerned about homosexually oriented youth. Calgary's leading expert on "homosexual orientation" issues (a family therapist of high stature who headed the list for related referrals by my family doctor) reported that, in his practice, bisexuality was responded to as a nonexistent entity. One's clients were to be either homosexual or heterosexual and 'therapy' would proceed accordingly so that the results, even if some clients were being harmed, would not conflict with the therapist's beliefs about the binary nature of sexual orientation.
In gay and lesbian communities, the general response to bisexual individuals has also been to negate their existence because they were perceived to challenge the belief that only heterosexual and homosexual people existed. Many bisexual individuals have reported on their abuses in gay and lesbian communities. Tisdale (1998) writes: "Many gay activists see any talk of bisexuality as diluting the coherence of the community, particularly damaging in a time of attack... Others simply don't believe in bisexuality, seeing through the lens of their own difficult coming-out experience... Bisexuals hear the same things from straights and gays, friends, lovers and perfect strangers: You can't be both. You can't be neither. You just haven't faced the truth. You're secretly wishing for A or B. Insert gay, insert straight, and it comes out the same - something essential is denied." A similar situation is described by Button (1998): "As a bisexual woman... I have been called a fence-sitter, disease-carrier, AC/DC, confused, etc. by gay and lesbian communities."
In an interview, Kenji Yoshino, the author of "The Epistemic Contract of Bisexual Erasure" published in the Standford Law Review (Yoshino, 2000), summed up the situation for bisexual individuals: "Advocate: It's a conspiracy. Yoshino: Yeah. My theory is that both gays and straights have agreed that, no matter what else they disagree on - they disagree on a lot - they'll both agree about this one thing, which is that bisexuals don't exist. Because they have different but overlapping interests in erasure. If the realm of bisexual possibility exists, it becomes impossible to actually prove that you're straight or you're gay. If you're straight in a world where bisexuality doesn't exist, then you can prove you're straight simply by adducing cross-sex desire: like, "I have a wife, I have a girlfriend" - if you're a man - kind of thing. Right? Whereas, once you introduce a bisexual possibility, the fact that you have cross-sex desire does not [prove] that you don't have same-sex desire. Given that same-sex desire is stigmatized, people who want to identify as straight are going to have a lot invested in making sure that they can prove that they're straight. Because otherwise they'll lose heterosexual privilege... One of the things that both straights and gays, according to their own accounts, feel [is] threatening about bisexuals is that bisexuals are seen to be gender-blind" (Bass, 1999). The elimination of bisexuality began in the professional with individuals such as Sandor Rado (1940) who was quoted in the following way: "..biologically speaking, 'there is no such thing as bisexuality either in man or in any other either vertebrate.' except for developmental disturbances that are clearly recognizable as 'inconsistencies of sex differentiation' (p. 464)" (Quoted by Marmor, 1981, p. 14.) Many in gay communities and professional worlds bought into a generalized view of this ideology (written to invalidate Freud's belief about innate human bisexuality), to the point that bisexuality was widely given a non-existent status by the 1980s and 1990s. As a result, there were great abuses by gay and lesbian identified individual (and professionals with similar beliefs, including therapists) of individuals daring to assert their bisexual orientation.
Individuals who are well versed on issues related to sexual orientation rendered by the Kinsey (1948) 7-point "homosexual to heterosexual" scales for behavior and fantasy, Klein's sexual orientation scale or grid (Weinrich et al., 1993; Keppel and Hamilton, 1998), and especially contemporary and historical cross-cultural anthropological knowledge of human sexualities (Carrier, 1981; Murray et al., 1992; Werner, 1998; Murray and Roscoe, 1998; Halperin, 2000), may reach the conclusion arrived at by Peter Voeller (1997) as the result of attending comprehensive lectures on sexual orientation given by Lois McDermott, Department of Psychology, University of Washington. "General thoughts taken away from the lectures: The idea of sexualities and the fluidity of human sexual experience, shown by her figure of a total of as many as 400 homosexualities, heterosexualities, and bisexualities. This theory has unfolded in order to capture not only the well-established and clear-cut distinctions like gay and straight, but also newer distinctions, like transsexuality and transvestism, in order to distinguish more of the variety within the broader rubric of sexual orientation."
Note 3: Kinsey et al. (1948) reported that 37 percent of males had experienced at least one orgasm while relating sexually with another male between the onset of adolescence and old age. Given that Kinsey's sample also included young males, and that some of these individuals reporting no homosexual experiences when interviewed may have experienced same-gender sexual experiences later, the life time incidence would be higher than that reported for the sample. In addition, another 13 percent of males with no homosexual experience did report having related desires, probably not being incidental. Given the modern idea that "sexual orientation" is apparently not to be based on "behavior," but on desire (which may not be acted on), these males would certainly not be in the exclusive homosexuality category. Twenty-five percent (25%) of males were reported to "have more than incidental experiences or reactions (i.e., rates 2-6) for at least three years between the ages of 16 and 55 (pp. 650-1)".
Kinsey et al. (1948) also reported that "there is much more homosexual activity among males of lower educational level [forming the working classes] than there is of males of the college level [generally forming the middle classes]," the differences being in the order of "200 to 500 per cent." A lesser difference - "not more than 50 to 150 per cent, and sometimes they are not even 10% - occurred between religiously active and religiously inactive groups" (pp. 482-3). Interestingly, the highest reported incidence of homosexual outlet for any group (59.4%, age: 16 to 20) was for single males with an educational level of grades 9-12 (the predominant education level of males in the neighborhood in which I grew up), who were also inactive Catholics as many males in my community were by that age, or soon became.
Given the above stated incidence of 37% for homosexual male activity to orgasm, and 13% for reporting related desires not yet acted upon at the time of interview, the fact that some would have eventually acted on their desires, and the significant class effect (200% to 500% difference) with respect to males having engaged in homosexual activity to orgasm, it could be concluded that more than 50 percent of the working-class males who formed the majority male population in the first half of the 20th century in the United States were manifesting either homosexual desires or the ability to have orgasms when relating sexually with another male. My own experience (Bagley, 1997) indicates that almost all males throughout adolescence may also manifest their potential to enjoy relating sexually with other males, and also seek out such encounters, to a degree reaching the 80 to 90 percent level, much like the situation which had existed in Ancient Greece. However, age difference, or sex role difference (i.e., being dominant or passive in accordance to socially prescribed sex roles), did not apply in my community Therefore significant behavioral variation may be expected in populations of males where high rates of homosexual activity has been reported.
An example of a form of male homosexuality quite alien to my adolescent male collective was given in the Dowsett (1994) study. He reported that in the Australian working-class city of Nullangardie where male homosexuality was exceptionally common, "men in the study reported that their school friends told each other of the places to get sex with other boys and older men." This indicates that male homosexuality is related to sex roles, such as only being dominant and passive, and an important question came to mind as I read this. Discourses by adolescent males may not reflect, in some significant ways, what actually occurs in more private spaces. Therefore, in an environment where adolescent males casually and positively discuss the places where one can have sex with other males, it is possible that some or many of these boys may be also relating sexually with each other, and sexual activity may not be in the apparently prescribed active-passive male-female heteronormative manner. Dowsett (1994) does not seem to have explored this possible reality for male adolescents in Nullangardie.
Note 4: At the age of 11 or 12, a best friend and I were discussing whether or not what we were doing sexually was a sin, the thought being that our sexual activities were most natural even if it was to be private in nature. By then, we had been told that sex with females was sinful (adultery, if one is not married), but no one talked about sex between males. Our first conclusion was that a male having sex with a female was sinful because the two individuals were different. In our situation, however, because we were the same, it was probably not a sin. I nonetheless decided to check this out with priests in confession, without directly asking, but by incorporating my homosexual activities in the list of sins. Reflecting on this, I still find it most amazing that not one priest, out of many to whom I confessed my sins, ever mentioned anything specific to me about this sin, and the penance I received after I began adding the homosexual sins to the list were the same as it had been before. The conclusion was therefore that this was a sin, but nothing special. Maybe something not worse than telling a lie.
Note 5: In the past few years I have encountered two reports, both from England, of adolescent males who had joined navies only to then become the property of a male who sold their sexual services to others on the ship. One individual had joined the Royal Navy at the age of 16 in the early 1960s, and the other had become part of the merchant marine in the 1940s, both eventually obtaining their PhDs and becoming researchers. Given that the availability of these boys was widely known on the ship and that they were used extensively both by their 'owners' and others, these cases indicate that navies were very much in need of the infamous "cabin boy" so often spoken of "sexually' in legends. This phenomenon is also remarkably similar to one aspect of the male homosexuality reported to have been the rule in 19th century male prisons (Ellis, 1906) and also by individuals reporting on the North American prison situation in the 1960s and 1970s (Scacco, 1982; Donaldson, 1993; Caron 1979). There are some indications, however, that the extent of homosexuality in North American prisons has lessened in the last 20 years, but the situation seems to have continued in Australia given that a recent study reported that about 25% of male youth entering prisons are raped by other males apparently in need of male sexual services, with or without the consent of the targeted desired male (Murphey, 1998). The Reiss (1961) study reports that about 60 percent of American "career delinquents" were also involved in "trade" situation with homosexual-identified males when they were not in prison, most often for money, but that they also participated in such activity for free, the motive being the enjoyment of such activities. The title of the study, The social integration of peers and queers, implies a social construction remarkably similar to the situation reported in the Nilsson (1998) study which could have been titled "The social integration of real men and men who were so."
Note 6: Garofalo et al. (1999) reported that GBN males (gay/bisexual identified, and the ones not sure of their sexual orientation) were 6.5 times more likely than heterosexual males to report a suicide attempt in the past 12 months, but it was apparently not deemed important to report the percentage of suicide attempters in each category. Given, however, that males had a suicide attempt incidence (for a 12-month period) of 6.4% and using an estimate of about 4.7% for GBN males (3.8% GB males + 0.9% "not sure") in calculations, the relative incidence of suicide attempters would be 33% versus 5.1% for GBN males compared to heterosexual males. On the basis of this estimate, another estimate is also possible. About one quarter - 24.3% - of male suicide attempters are in the GBN category. Therefore, 4.7% of the students in the GBN category account for about 25% of the male suicide attempt problem.
Note 7: The suicidality data intake methodology used by Bagley and Tremblay (1997) is known in the field of American suicidology. In fact, Moscicki (1989) deemed Bagley & Ramsay's 1985 distinction between "self-harm" and "suicide attempt" to be "very important," and she reported on the methodology. "Respondents were asked in a semi structured interview about sociodemographic characteristics, childhood history, social ties, religiosity, stress, health, 'suicidal behaviors,' and 'suicidal actions': 1. Have you ever felt that life was not worth living? 2. Have you wished that you were dead - for instance, that you could go to sleep and not wake up? 3. Have you ever thought of taking your life, even if you would not really do it? 4. Have you ever reached the point where you seriously considered taking your own life and perhaps made plans how you would go about doing it? 5. Have you ever deliberately harmed yourself, but in a way that stopped short of a real intent to take your life? 6. Have you ever made an intentional attempt to take your life?" The six items are cited from the Appendix in Ramsay and Bagley (1985, p. 165), and the correlates of suicidal behavior were published in the same year by Bagley and Ramsay (1985).
To date, most American suicidality research has ignored the last two distinctions noted by Moscicki (1989) to be very important, and a study that Moscicki's research team published in the same year had also ignored this distinction (Moscicki et al. 1989). Under the heading of "limitations" for their study, the following caveat was written. "'Suicide attempt' could thus have been interpreted by the respondent as an act of deliberate self-harm without the intention of dying, a genuine (and failed) attempt to end one's life, or as something else (perhaps an 'accident' had been explained to them by a physician that had seen it as an unconscious suicide attempt). Suicide ideation, similarly, may mean different things to different people (p. 122)." This serious nomenclature problem was noted by O'Carroll et. al. (1996), with recommendation being made. After reviewing these recommendations, Bagley and Ramsay (1997) stated: "Our definition of suicidality generally accord with those proposed by O'Carroll et al. (1996)" (p. 7).
Note 8: Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm and the following data from the Bagley and Tremblay (1997) study - 5 attempters and 77 GB non-attempters (homosexual or bisexual) versus 3 attempters and 665 heterosexual non-attempters, - produces an OR (Odds Ratio for attempting suicide) = 14.4 (95% CI, 3.4-61.4). The OR for "Self-Harm" (13 GB males reporting self-harm, 69 not reporting self-harm / 37 heterosexual males reporting self-harm and 631 not reporting self harm; - produces an OR (Odds Ratio for self-harm) = 3.2 (95% CI, 1.6 - 6.3). The related Chi Square significance is 22.1, p < .0000 and 12.5, p = .0004, respectively.
The "suicide attempt" OR for the Bagley and Tremblay (1997) study of homosexual and bisexual males versus heterosexual males ranging in age from 18 to 27 years (Mean = 22.7 years) - is similar to the OR calculated for the Bell and Weinberg (1978) data for male to the age of 21: 14.9 (95% CI, 3.6-61.6) - Predominantly homosexual males versus predominantly heterosexual males: 55 suicide-attempters / 520 nonattempters versus 2 suicide attempters / 282 nonattempters. These ORs are also similar to the estimated ORs calculated from the data given by Cochran and Mays (2000) for males (age range = 17 to 29 years) reporting having only female sex partner(s), reporting having only female sex partner(s), or males reporting not having had any male sex partners, versus males reporting having had a least one lifetime same-sex partner. Respectively, the ORs are 12.5 (95% CI, 6.4-24.2) and 13.8 (95% CI, 7.1-26.8). The Odds Ratios were calculated using the 2 X 2 Table located at -- http://home.clara.net/sisa/twoby2.htm and the following estimated data:
Odds Ratio Calculation for males reporting lifetime male sex partner(s) compared to males reporting only female sex partner(s): 15 / 32 (attempters / nonattempters) versus 60 / 1595 (attempters / nonattempters), - 95% CI, Odds Ratio: 6.41<12.46<24.24.
Odds Ratio Calculation for males reporting lifetime male sex partner(s) and males reporting only female sex partner(s) plus males reporting a celibate status: 15 / 32 (attempters / nonattempters) versus 61 [60 + 1] / 1796 [1595 + 201] - 95% CI, OR: 7.10<13.8<26.82.
Information related to all above estimated OR values is available at - http://www.youth-suicide.com/gay-bisexual/gbsuicide1.htm .
Note 9: For a sample of 28 male and 20 female homosexual (88%) and bisexual (12%) individuals, Hammelman (1993) reported that 64% of the suicide attempters had identified their homosexuality to have been a part (35%) or most (29%) of the problem linked to their suicide attempt. Information was not solicited, however, to permit a reporting on the possible relationship of some suicide attempts to homosexual relationship problems.
Note 10: Drug use and abuse by homosexually oriented adolescents in school compared to heterosexually oriented adolescents.
Garofalo et al. (1998): Results for grades 9 to 12 Massachusetts' students (1995 sample), comparing 2.5 percent of gay, lesbian, and bisexual identified students with heterosexually identified students in grades 9 to 12:
1. Cocaine use before the age of 13 (17.3% vs 1.2%: 14.4 times).
2. Cocaine use in last 30 days (25.3% vs 2.7%: 9.4 times).
3. Cocaine use in lifetime (33% vs 6.9%; 4.8 times).
4. Crack or freebase use in lifetime (35.3% vs 3.5%: 8.9 times).
5. Shared needles for illicit drug use in lifetime (15.5% vs 1.1%: 14.1 times).
6. Anabolic steroids use in lifetime (25% vs 3.9%: 8.4 times).
7. Injected illegal drugs in lifetime (22.2% vs 2.3%: 9.6 times).
Levine and Beeler (1997) [Related published paper: Faulkner et al. (1998)]: Results for grades 9 to 12 Massachusetts' students (1993 sample), comparing 3.7 percent of students who reported having been homosexually active to students who had been only heterosexually active:
1. Involved in episodic heavy drinking (15.0%% vs. 3.8%: 4 times).Smith et al (1999): Six percent of a sample of 3,387 Australian students in grades 10 to 12 reported same-gender sexual attraction. "Being attracted to members of the same-sex was associated with more frequent binge drinking among boys and girls, and a three- to four-fold increase in the likelihood of reporting injecting drug use both over the lifetime and within the previous 12 months" (p. 643).
2. Currently consuming alcohol every day (10.9% vs 1.2%: 8.7 times).
3. Used cocaine at least once (19.2% vs 3.2%: 6.0 times).
4. Used cocaine 10 or more times (13.3 vs .7%: 19 times).
5. Used illegal drugs other than alcohol, marijuana, or cocaine (17.8% vs 3.5%: 5.1 times).
6. Injected illegal drug (20.8% vs 3.1%; 6.7 times).
Note 11: Using the 2 X 2 Table located at - http://home.clara.net/sisa/twoby2.htm - and the following data from the Remafedi et al. (1991) study 38 gay and bisexual male suicide attempters classified as feminine, androgynous, and undifferentiated, and 71 nonattempters in the same categories versus 3 "masculine" attempters and 25 "masculine" gay and bisexual male non-attempters - produces an OR (Odds Ratio for attempting suicide) = 4.5 (95% CI, 1.3 - 15.7). Chi Square: 6.2, p = .013. The Risk Ratio = 3.2 (95% CI, 1.1 - 9.8).
Note 12: French texts by de Luze (1990) translated by author:
La vérité est souvent rebutante. La plupart des homosexuels que j'ai rencontrés ne tiennent pas à la connaître (malgré leurs professions de foi contraire)... L'usage si fréquent du mensonge chez les dragueurs homosexuels pose parfois des problèmes. Par exemple dans les cas où, succédant au simple plaisir, s'installe la passion. Peut-on envisager une liaison? Sur quelle base? Où va-t-on ainsi à l'aveuglette? En fait, quand on a affaire à un menteur enraciné, il n'y a guère de moyen rationnel pour détecter où finit le mensonge et où commence la vérité (de Luze, 1990: Conclusion).
Les muscles de Guy sont un effort désespéré pour faire croire qu'il est un mec sûr de lui, résolu, moralement solide, alors qu'en fait c'est un garçon timide, complexé, maladivement nerveux, perpétuellement anxieux comme je m'en rends compte au fur et à mesure que la soirée s'avance et que, l'alcool lui donnant un peu d'assurance, un maniement plus aisée de la parole, il finit par se confier et nous révéler qu'il est constamment dépressif et a déjà fait trois tentatives de suicide (de Luze, 1990: Mensonge du Paraître: Muscles).
Note 13: A response to "gay stereotype" issues mentioned in the Final Report of the 'Here for Life" Youth Sexuality Project was sent to Graham Brown, the contact person for the Final Report. The exchange of information resulted in a revised section addressing a number of related issues. Permission was requested to quote from the emails by sending a draft of the section for approval and related comments. A final version was then sent, and permission to quote was granted. A related comment by Graham Brown: "While I may not totally agree with all your conclusions, I agree with the general thrust, and anyway it is not for me to necessarily agree or not, but for you to put forward your thoughts and arguments, and I am happy to contribute to that." He also volunteered to have his email given - email@example.com - should anyone reading this section of the paper wish to have someone with whom some important multi-dimensional issues relating to the organization of sexual minority youth groups may be discussed, including the development of potential problems, gay stereotypes, etc.. Graham Brown's Address: WA AIDS Council, PO Box 1510, West Perth, WA 6872, Australia.
Note 14: The issue of adolescent and young adult males being raped after they have become integrated in gay communities is generally ignored. Often enough sexual assaults occur after meeting gay or bisexual individuals in a club or a community group, and then finding themselves in a more private location such as a home or an apartment. In such a situation they may discover their loss of right to not have sex with the individual, and a sexual assault results. As a rule, the raped individuals I have interviewed were more "feminine" in nature, and physically not imposing, although this was not always the case. One 17-year-old Calgary male youth of decent physical stature reported that his size became irrelevant mostly because the two gay males (about 40 years of age) he had met at a gay club participated in the rape after he had accepted an invitation to their home. All raped individuals had also not reported the rape to authorities mostly because they did not want their "homosexuality" to be public knowledge, and this fact essentially gives gay and bisexual rapists an open license to rape. The raped individuals had also not sought counseling related to the rape.
Some raped gay and bisexual males, however, do seek help, and a group of these males in Toronto was reported on by Lana Stermac et al. (1996). They noted: "...that the majority of [mostly young adult male] victims [of sexual assault or rape] are gay or bisexual and are at least acquainted with their assailants [who are also mostly homosexual or bisexual] - have been supported by other recent investigations of sexual assault of males and studies of sexual coercion in dating relationships of adult males" (p. 61). The mental health and suicidality effects of gay community based sexual assault and rape on homosexually oriented male youth, especially adolescents, remain to be studied. A contributing factor to this problem may be related to an observation made about many gay males, one of these being the responses of about 10 gay males present at Calgary Gay Lines one evening. They were most opposed to the idea of meeting a gay male, ending up in a private space, and then having the desired male not want to relate sexually with them. My response to such attitudes was to highlight the fact that many heterosexual males have used the same ideology to justify their date raping activities with females.
Remafedi et al. (1991) reported high rates of sexual abuse for gay and bisexual male youth (39%), but also noted that the reported sexual abuse generally postdated sexual identification as gay or bisexual. The unspoken implication is that the sexual abuse likely occurred after they made themselves available for sexual experiences often occurring via making contact with some gay community attribute such as the "public sex" arena, as most of the first sexual experiences occurred for the teenage gay males studied by Uribe and Harbeck (1992). Sexual assault and rape after adolescent males have made contact with gay communities, however, remain hidden in all studies reporting such experiences, often assumed to be "child sexual abuse" having occurred before the individual made contact with gay communities. This assumption may be incorrect. In a 1989 study of 46 male youth prostitutes (average age of 16.2 years, 70% GB males), 72% of the gay and bisexual males had been sexual abused compared to 43% of heterosexual males, 43% of gay and bisexual males had been raped compared to 21% of heterosexual males, and 85% of the rapes had not been related to their street life (Boyer, 1989).
By the year 2000, the research silence on sexual abuse and rapes of young gay and bisexual males in gay communities had been broken. From a qualitative study of 30 gay-identified male youth ranging in age from 18 to 24, Mutchler (2000) reported that "more than half (18 out of 30) of the young men in this study told of feeling pressured or forced into having sex that they did not completely want. Nine of these individuals were raped by boyfriends, family members, or other men" (p. 31), and four of the nine "were raped by men other than their boyfriends" some at a very young age, with the majority (5/9) being rapes by boyfriends (p. 32). Mutchler noted, however, that "the line between being used and being raped is fussy under [some] situation" (p. 32). For example, he reported on a youth meeting an older man (previously unknown to the youth) and ending up in a situation where the sex (including being subjected to unwanted unprotected anal sex) was experienced. The youth reported his feelings:
I was afraid he would get mad at me or something. I don't know. It was pretty stupid. I don't feel good about it; it's a pretty bad way of treating a person, but it's pretty common in the gay world. When I went to [the gay bar], it sort of felt like the people were circling me like hawks (p. 31).Mutchler noted that "stories like [the one above], with slight variations, [were] repeated by 11 of my 30 respondents" (p. 31).
Note 15: "A New Zealand study being conducted by researchers at the Dunedin School of Medicine (for information please contact Shyamala Nada-Raja - Email: firstname.lastname@example.org) will determine the association between sexual orientation (based on a measure of sexual attraction) and a range of behaviours indicative of deliberate self-harm (suicidal, non-suicidal intent). The study is based on the Dunedin Multidisciplinary Health and Development Study (DMHDS). The findings are expected to complement those reported by Fergusson and colleagues (1999) in the Archives of General Psychiatry." (Cited from a March 21, 2000 email from Shyamala Nada-Raja written in response to a request made by Pierre Tremblay for information to be included in this note.)
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