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Weitzman ER. Social complexity of a fentanyl vaccine to prevent opioid overdose conference proceedings: Radcliffe institute for advanced study conference proceedings. Vaccine 2024:126324. [PMID: 39317618 DOI: 10.1016/j.vaccine.2024.126324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 09/04/2024] [Indexed: 09/26/2024]
Abstract
Despite significant public health attention and investment, hundreds of thousands of individuals have suffered fatal opioid overdose since the onset of the opioid crisis. Risk of opioid overdose has been exacerbated by the influx of fentanyl, a powerful synthetic opioid, into the drug supply. The National Institutes of Health Helping End Addiction Long-term (HEAL) Initiative is supporting the development of vaccines targeting fentanyl to protect against overdose. If successful, a vaccine would induce anti-fentanyl antibodies to sequester fentanyl (but not other opioids) in the blood, preventing fentanyl from crossing into the brain and reaching the central nervous system where it can cause overdose. Introduction of an overdose preventing strategy that relies on a vaccine to confer passive protection may be impactful. However, vaccines are poorly understood by the public and politicized. Moreover, the overdose ecosystem is complex and extends across numerous social, economic, medical, and cultural systems. As such, optimal use of a vaccine strategy to address overdose may benefit from multidisciplinary consideration of the social, ethical, and systemic factors that influence substance use and overdose that may also impact the acceptability of a fentanyl vaccine and related implementation strategies. In March 2022, Dr. Elissa Weitzman convened a two-day conference at the Harvard Radcliffe Institute for Advanced Study on the Social Complexity of a Fentanyl Vaccine to Prevent Opioid Overdose. In all, 19 professionals from diverse disciplines (medicine, psychology, history, ethics, immunology, vaccinology, communications, policy) attended the conference and led discussions that centered on population health and epidemiology, history of medicine and frameworks for understanding substance use, ethics, decision-making and attitudes, and operational issues to the question of a novel immunotherapy targeting fentanyl overdose. Participants also debated the risks and benefits of vaccine administration in response to fictional clinical case vignettes. A summary of the conference presentations and discussions follows.
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Affiliation(s)
- Elissa R Weitzman
- Division of Addiction Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA; Computational Health Informatics Program, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
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Lynch V, Clemans-Cope L. Initiation and Receipt of Medication for Opioid Use Disorder Among Adolescents and Young Adults in 4 State Medicaid Programs in 2018: Improving Medicaid Quality Metrics. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:434-445. [PMID: 38294428 DOI: 10.1177/29767342241227791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Medications for opioid use disorder (MOUD) in youth can reduce harms but many youths do not receive MOUD. Improving quality metrics of MOUD among youth can advance interventions for youth with opioid use disorder (OUD). METHODS We relied on 2018 Medicaid claims data from California, Colorado, Massachusetts, and New Mexico. We calculated the percentage of youth with OUD included in the quality metric for initiation, and the percentage who initiated by state. We also calculated the percentage excluded from the quality metric for initiation because they have an existing episode of OUD care and their MOUD receipt. We compared the characteristics of those who initiated/received MOUD to those who did not and compared state estimates after adjusting for age and health conditions. RESULTS Estimates of initiation exclude about half of the youth with OUD because they were in an existing episode of OUD care and could not be observed initiating. Among youth in a new episode of OUD care, only about 1 in 4 initiated and state estimates varied from 18.9% to 40.1%. Among youth with an existing episode of OUD care, more than half received MOUD and state estimates ranged from 35.2% to 71.3%. Youth who initiated MOUD or received MOUD with an existing OUD had more severe OUD but fewer co-occurring substance use disorders or mental or physical health diagnoses. After adjusting for age and health conditions, MOUD still varied substantially across states. CONCLUSIONS Most youth with a new OUD diagnosis do not initiate MOUD but more than half of the youth in an existing OUD diagnosis receive MOUD. MOUD quality metrics that are disaggregated, adjusted, and inclusive of youth in an existing episode of care provide additional insight into opportunities to better support youth who might choose MOUD. State differences should be further studied for insight into policies that may affect MOUD.
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Persaud N, Sabir A, Woods H, Sayani A, Agarwal A, Chowdhury M, de Leon-Demare K, Ibezi S, Jan SH, Katz A, LaFortune FD, Lewis M, McFarlane T, Oberai A, Oladele Y, Onyekwelu O, Peters L, Wong P, Lofters A. Recommandations pour des soins préventifs pour promouvoir l’équité en matière de santé. CMAJ 2023; 195:E1674-E1701. [PMID: 38081626 PMCID: PMC10718275 DOI: 10.1503/cmaj.230237-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Contexte: Malgré des investissements importants dans un système de soins de santé public qui comprend des services préventifs, on continue d’observer des disparités évitables en matière de santé au Canada. L’équipe avait pour objectif de formuler des recommandations pour des soins de santé préventifs qui puissent améliorer l’équité en matière de santé par la priorisation des interventions efficaces à l’intention des groupes défavorisés. Méthodes: La ligne directrice a été élaborée par un comité composé de spécialistes en soins primaires et de membres de la patientèle, avec la contribution d’un groupe de patientes-et patientspartenaires ayant vécu diverses expériences. Après avoir sélectionné les sujets à prioriser, nous avons recensé les revues systématiques, les essais randomisés et contrôlés récents sur les méthodes de dépistage et d’autres études pertinentes sur l’efficacité du dépistage et de la prise en charge. Nous avons utilisé l’approche GRADE (Grading of Recommendations, Assessment, Development and Evaluation) pour formuler les recommandations et avons suivi le guide AGREE II (Appraisal of Guidelines for Research and Evaluation) pour rédiger le rapport. Il en a été de même avec les principes du Guidelines International Network pour la gestion des intérêts concurrents. Les recommandations ont été passées en revue par un comité externe d’experts en contenu avant d’être distribuées à des intervenants à l’échelle nationale pour approbation. Recommandations: Nous avons formulé 15 recommandations concernant le dépistage et d’autres soins préventifs et 1 recommandation de nature politique visant à améliorer l’accès aux soins primaires. Ainsi, nous recommandons de prioriser une stratégie de communication pour le dépistage du cancer colorectal à partir de l’âge de 45 ans et pour l’évaluation du risque de maladie cardiovasculaire pour lutter contre les iniquités en matière de santé et promouvoir la santé. Les interventions particulières qui devraient être déployées pour lutter contre les iniquités comprennent l’autodépistage du virus du papillome humain (VPH) et du VIH, et le test de libération de l’interféron γ pour l’infection tuberculeuse. Le dépistage de la dépression, de la toxicomanie, de la violence conjugale et de la pauvreté devrait également permettre aux personnes touchées d’accéder plus facilement à des interventions éprouvées. Nous recommandons une prise de contact systématique avec des professionnels de la santé en soins primaires pour les personnes défavorisées. Interprétation: Les interventions préventives éprouvées peuvent aider à combattre les iniquités en matière de santé si la priorité est accordée aux personnes défavorisées. Les médecins, les organisations de santé et les gouvernements devraient adopter des mesures fondées sur des données probantes et en faire le suivi s’ils veulent promouvoir l’équité en matière de santé partout au Canada.
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Affiliation(s)
- Nav Persaud
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont.
| | - Areesha Sabir
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Hannah Woods
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Ambreen Sayani
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Arnav Agarwal
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Muna Chowdhury
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Kathleen de Leon-Demare
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Somtochukwu Ibezi
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Saadia Hameed Jan
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Alan Katz
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Frantz-Daniel LaFortune
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Melanie Lewis
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Trudy McFarlane
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Anjali Oberai
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Yinka Oladele
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Onyema Onyekwelu
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Lisa Peters
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Patrick Wong
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Aisha Lofters
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
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Choi S, Lim S, Kwon SC, Trinh-Shevrin C, Neighbors CJ, Yi SS. Urgent need for substance use disorder research among understudied populations: examining the Asian-American experience. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad058. [PMID: 38756976 PMCID: PMC10986273 DOI: 10.1093/haschl/qxad058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/21/2023] [Accepted: 10/24/2023] [Indexed: 05/18/2024]
Abstract
Substance use disorder (SUD) among Asian Americans is understudied. Our review of National Institutes of Health-funded projects reveals a striking underrepresentation of research focused on SUD in this population, possibly perpetuated by the pervasive societal myth that Asian Americans are a healthy community. Moreover, the limited availability and disaggregation of data on SUD among Asian Americans further hinder our understanding of prevalence rates, treatment utilization, and associated disparities-thereby limiting opportunities for prevention and intervention. In light of these findings, our review serves as a crucial call to action, emphasizing the urgent need for increased research efforts and resources to address the significant gaps in knowledge and inform effective interventions for addressing SUD among Asian Americans.
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Affiliation(s)
- Sugy Choi
- Department of Population Health, NewYork University Grossman School of Medicine, New York, NY 10016, United States
| | - Sahnah Lim
- Department of Population Health, NewYork University Grossman School of Medicine, New York, NY 10016, United States
| | - Simona C Kwon
- Department of Population Health, NewYork University Grossman School of Medicine, New York, NY 10016, United States
| | - Chau Trinh-Shevrin
- Department of Population Health, NewYork University Grossman School of Medicine, New York, NY 10016, United States
| | - Charles J Neighbors
- Department of Population Health, NewYork University Grossman School of Medicine, New York, NY 10016, United States
| | - Stella S Yi
- Department of Population Health, NewYork University Grossman School of Medicine, New York, NY 10016, United States
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5
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Ly SM, Fitzpatrick AM, Canfield J, Powis A, So-Armah K, Hurstak EE. Improving DEIB in Addiction Medicine Training Through Interdisciplinary Collaboration and Program Evaluation. Subst Abus 2023; 44:277-281. [PMID: 37830542 DOI: 10.1177/08897077231199552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Developing a diverse Addiction Medicine (AM) workforce will improve medical and public health responses to the increasing health risks created by substance use disorders (SUDs). A workforce that embraces diversity, equity, inclusion, and belonging (DEIB) principles may foster novel responses to address the disparities in treatment and outcomes experienced by Black, Indigenous, and People of Color (BIPOC) who are impacted by SUDs. However, experiences of bias and discrimination in the workplace and a lack of exposure to addiction-related content in educational settings limit opportunities to develop and retain a diverse workforce. In this commentary, we describe the creation of the Inclusion, Diversity, and Equity in Addiction medicine, Addiction research, and Addiction health professions (IDEAAA) initiative, a strategy to foster diversity in the field of addiction through efforts targeting learners at different stages of the biomedical education pipeline. Now in its second year, the IDEAAA Program is focused on programmatic evaluation through a qualitative interview study of AM training programs to improve the understanding of experiences of participants who are self-identified members of underrepresented groups (URGs). Interdisciplinary programs with multi-faceted approaches are a strategy to improve DEIB in the AM workforce; IDEAAA's design and methods can inform other AM programs who have the desire to improve DEIB through novel approaches.
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Affiliation(s)
- Sophia M Ly
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amanda M Fitzpatrick
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Jules Canfield
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Amaya Powis
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Kaku So-Armah
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Emily E Hurstak
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
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6
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Persaud N, Sabir A, Woods H, Sayani A, Agarwal A, Chowdhury M, de Leon-Demare K, Ibezi S, Jan SH, Katz A, LaFortune FD, Lewis M, McFarlane T, Oberai A, Oladele Y, Onyekwelu O, Peters L, Wong P, Lofters A. Preventive care recommendations to promote health equity. CMAJ 2023; 195:E1250-E1273. [PMID: 37748784 PMCID: PMC10519166 DOI: 10.1503/cmaj.230237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Avoidable disparities in health outcomes persist in Canada despite substantial investments in a publicly funded health care system that includes preventive services. Our objective was to provide preventive care recommendations that promote health equity by prioritizing effective interventions for people experiencing disadvantages. METHODS The guideline was developed by a primary care provider-patient panel, with input from a patient-partner panel with diverse lived experiences. After selecting priority topics, we searched for systematic reviews and recent randomized controlled trials of screening and other relevant studies of screening accuracy and management efficacy. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to develop recommendations and followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) reporting guidance. We managed competing interests using the Guideline International Network principles. The recommendations were externally reviewed by content experts and circulated for endorsement by national stakeholders. RECOMMENDATIONS We developed 15 screening and other preventive care recommendations and 1 policy recommendation on improving access to primary care. We recommend prioritized outreach for colorectal cancer screening starting at age 45 years and for cardiovascular disease risk assessment, to help address inequities and promote health. Specific interventions that should be rolled out in ways that address inequities include human papillomavirus (HPV) self-testing, HIV self-testing and interferon-γ release assays for tuberculosis infection. Screening for depression, substance use, intimate partner violence and poverty should help connect people experiencing specific disadvantages with proven interventions. We recommend automatic connection to primary care for people experiencing disadvantages. INTERPRETATION Proven preventive care interventions can address health inequities if people experiencing disadvantages are prioritized. Clinicians, health care organizations and governments should take evidence-based actions and track progress in promoting health equity across Canada.
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Affiliation(s)
- Nav Persaud
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont.
| | - Areesha Sabir
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Hannah Woods
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Ambreen Sayani
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Arnav Agarwal
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Muna Chowdhury
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Kathleen de Leon-Demare
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Somtochukwu Ibezi
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Saadia Hameed Jan
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Alan Katz
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Frantz-Daniel LaFortune
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Melanie Lewis
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Trudy McFarlane
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Anjali Oberai
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Yinka Oladele
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Onyema Onyekwelu
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Lisa Peters
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Patrick Wong
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Aisha Lofters
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
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