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Abramovich A, Marshall M, Webb C, Elkington N, Stark RK, Pang N, Wood L. Identifying 2SLGBTQ+ individuals experiencing homelessness using Point-in-Time counts: Evidence from the 2021 Toronto Street Needs Assessment survey. PLoS One 2024; 19:e0298252. [PMID: 38598425 PMCID: PMC11006143 DOI: 10.1371/journal.pone.0298252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/20/2023] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION The objective of this study was to utilize the data generated by the City of Toronto, Street Needs Assessment conducted in 2021 to explore the prevalence, causes, experiences, and characteristics of 2-spirit, lesbian, gay, bisexual, transgender, queer, and questioning (2SLGBTQ+) individuals experiencing homelessness in Toronto, Ontario, Canada. METHODS Data was collected by the City of Toronto during its Street Needs Assessment in April 2021. The Street Needs Assessment is a needs assessment survey and Point-in-Time count of people experiencing homelessness across the city of Toronto. Homelessness included any individual who was sleeping outdoors or staying in City-administered emergency/transitional shelters and shelter motels/hotels on the night of data collection. The Street Needs Assessment survey was administered to clients by trained shelter and outreach staff using a computer or mobile device. To ensure that survey questions were 2SLGBTQ+ inclusive, questions on sexual orientation, gender identity, and 2SLGBTQ+ identity were included in the survey. RESULTS Two hundred and eighty-eight 2SLGBTQ+ individuals completed the survey. Compared to non-2SLGBTQ+ individuals experiencing homelessness, 2SLGBTQ+ respondents were younger at the time of survey completion and when they first experienced homelessness, were more likely to have been in foster care or a group home, reported higher rates of conflict with and/or abuse by a parent/guardian as their main pathway into homelessness, and were more likely to experience chronic homelessness. CONCLUSION Our study results demonstrate that Street Needs Assessments and Point-in-Time counts can be used to examine homelessness in marginalized populations, including 2SLGBTQ+ individuals and that sexual orientation and gender identity questions need to be included on future government surveys. The consistency of findings from this study and previous research suggests that 2SLGBTQ+ individuals experience a significant need for population-based housing and social support services aimed at meeting the needs of 2SLGBTQ+ populations.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Max Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Christopher Webb
- Shelter, Support, and Housing Administration, City of Toronto, Toronto, Ontario, Canada
| | - Nicole Elkington
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rowen K. Stark
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nelson Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Linda Wood
- Shelter, Support, and Housing Administration, City of Toronto, Toronto, Ontario, Canada
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Dermody SS, Uhrig A, Wardell JD, Tellez C, Raessi T, Kovacek K, Hart TA, Hendershot CS, Abramovich A. Daily and Momentary Associations Between Gender Minority Stress and Resilience With Alcohol Outcomes. Ann Behav Med 2024:kaae015. [PMID: 38582074 DOI: 10.1093/abm/kaae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND AND PURPOSE Minority stressors have been linked with alcohol use among transgender and gender diverse (TGD); however, no ecological momentary assessment studies have examined daily links between minority stress and alcohol use specifically among TGD. This study examined gender minority stressors and resilience as predictors of same-day or momentary alcohol-related outcomes. Feasibility and acceptability of procedures were evaluated. METHODS Twenty-five TGD adults (mean age = 32.60, SD = 10.82; 88% White) were recruited Canada-wide and participated remotely. They completed 21 days of ecological momentary assessment with daily morning and random surveys (assessing alcohol outcomes, risk processes, gender minority stressors, resilience), and an exit interview eliciting feedback. RESULTS Gender minority stress had significant and positive within-person relationships with same-day alcohol use (incidence risk ratio (IRR) = 1.12, 95% confidence interval [CI] [1.02, 1.23]), alcohol-related harms (IRR = 1.14, 95% CI [1.02, 1.28]), and coping motives (IRR = 1.06, 95% CI [1.03, 1.08]), as well as momentary (past 30-min) alcohol craving (IRR = 1.32, 95% CI [1.18, 1.47]), coping motives (IRR = 1.35, 95% CI [1.21, 1.51]), and negative affect (IRR = 1.28, 95% CI [1.20, 1.36]). Gender minority stress indirectly predicted same-day drinking via coping motives (ab = 0.04, 95% CI [0.02, 0.08]). Resilience was positively associated with same-day alcohol use (IRR = 1.25, 95% CI [1.03, 1.51]) but not harms. CONCLUSIONS TGD adults may use alcohol to cope with gender minority stress, which can increase the risk for alcohol-related harms. Interventions are needed to eliminate gender minority stressors and support adaptive coping strategies.
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Affiliation(s)
- Sarah S Dermody
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Alexandra Uhrig
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Jeffrey D Wardell
- Department of Psychology, York University, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carmina Tellez
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Tara Raessi
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Karla Kovacek
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Trevor A Hart
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Christian S Hendershot
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Bowles Center for Alcohol Studies, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Dharma C, Liu E, Grace D, Logie C, Abramovich A, Mitsakakis N, Baskerville B, Chaiton M. Factors associated with the use of psychedelics, ketamine and MDMA among sexual and gender minority youths in Canada: a machine learning analysis. J Epidemiol Community Health 2024; 78:248-254. [PMID: 38262735 DOI: 10.1136/jech-2023-220748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Substance use is increasing among sexual and gender minority youth (SGMY). This increase may be due to changes in social norms and socialisation, or due to SGMY exploring the potential therapeutic value of drugs such as psychedelics. We identified predictors of psychedelics, MDMA and ketamine use. METHODS Data were obtained from 1414 SGMY participants who completed the ongoing longitudinal 2SLGBTQ+ Tobacco Project in Canada between November 2020 to January 2021. We examined the association between 80 potential features (including sociodemographic factors, mental health-related factors and substance use-related factors) with the use of psychedelics, MDMA and ketamine in the past year. Random forest classifier was used to identify the predictors most associated with reported use of these drugs. RESULTS 18.1% of participants have used psychedelics in the past year; 21.9% used at least one of the three drugs. Cannabis and cocaine use were the predictors most strongly associated with any of these drugs, while cannabis, but not cocaine use, was the one most associated with psychedelic use. Other mental health and 2SLGBTQ+ stigma-related factors were also associated with the use of these drugs. CONCLUSION The use of psychedelics, MDMA and ketamine among 2SLGBTQ+ individuals appeared to be largely driven by those who used them together with other drugs. Depression scores also appeared in the top 10 factors associated with these illicit drugs, suggesting that there were individuals who may benefit from the potential therapeutic value of these drugs. These characteristics should be further investigated in future studies.
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Affiliation(s)
- Christoffer Dharma
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Esther Liu
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Human Biology, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Grace
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Carmen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- United Nations University Institute for Water Environment and Health, Hamilton, Ontario, Canada
| | - Alex Abramovich
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto Department of Psychiatry, Toronto, Ontario, Canada
| | - Nicholas Mitsakakis
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Bruce Baskerville
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Michael Chaiton
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Medical Science, University of Toronto, Toronto, Ontario, Canada
- Ontario Tobacco Research Unit, University of Toronto, Toronto, Ontario, Canada
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Abramovich A, Gould WA, Pang N, de Oliveira C, Iwajomo T, Vigny-Pau M, MacKinnon K, Lam JSH, Kurdyak P. Exploring Mediators of Mental Health Service Use Among Transgender Individuals in Ontario, Canada. Can J Psychiatry 2023; 68:933-948. [PMID: 37165522 PMCID: PMC10657585 DOI: 10.1177/07067437231171541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To determine if and to what degree neighbourhood-level marginalization mediates mental health service use among transgender individuals. METHODS This retrospective cohort study identified 2,085 transgender individuals through data obtained from 4 outpatient community and hospital clinics in 3 large cities in Ontario, which were linked with administrative health data between January 2015 and December 2019. An age-matched 1:5 comparison cohort was created from the general population of Ontario. Outcome measures were analysed from March 2020 to May 2022. The primary outcome was mental health service utilization, which included mental health-related visits to primary care providers, psychiatrists, mental health- and self-harm-related emergency department visits, and mental health hospitalizations. Mediation variables included ethnic concentration, residential instability, dependency, and material deprivation at the neighbourhood level and were derived from the Ontario Marginalization Index. RESULTS This study identified 2,085 transgender individuals from participating outpatient community and hospital clinics, who were matched to the general population (n = 10,425). Overall, neighbourhood-level marginalization did not clinically mediate mental health service use. However, transgender individuals were more likely to be exposed to all forms of neighbourhood-level marginalization, as well as having higher rates of health service use across all outcome measures. CONCLUSIONS In this study, mental health service use among transgender individuals was not clinically mediated by marginalization at the neighbourhood level. This study highlights the need to explore marginalization and mental health service use at the individual level to better understand the mental health disparities experienced by transgender individuals and to ensure that health-care services are inclusive and affirming.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - W. Ariel Gould
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nelson Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Canada
- ICES University of Toronto, Mental Health and Addictions Research Program, Toronto, Canada
- Centre for Health Economics and Hull York Medical School, University of York, York, UK
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- ICES University of Toronto, Mental Health and Addictions Research Program, Toronto, Canada
| | - Myriam Vigny-Pau
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - June Sing Hong Lam
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- ICES University of Toronto, Mental Health and Addictions Research Program, Toronto, Canada
- General and Health Systems Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- ICES University of Toronto, Mental Health and Addictions Research Program, Toronto, Canada
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Kia H, Kenney KA, Abramovich A, Ferlatte O, MacKinnon KR, Knight R. "Nowhere else to be found": Drawing on peer support experiences among transgender and gender-diverse people to substantiate community-driven gender-affirming care. Soc Sci Med 2023; 339:116406. [PMID: 37979491 DOI: 10.1016/j.socscimed.2023.116406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
Increasingly, applied social scientists and clinicians recognize the value of engaging transgender and gender-diverse (TGD) people, particularly TGD individuals with lived experience as care recipients (peers), to inform the provision of gender-affirming care. Despite this trend, few researchers have systematically examined how this group can contribute to and enhance the development and delivery of interventions intended to affirm gender diversity. In this article, we address limitations in the literature by drawing on a secondary analysis of qualitative data - originally collected to examine the peer support experiences of TGD individuals - to explore the potential that TGD peers hold for elevating gender-affirming care. The study was informed methodologically by an abductive approach to grounded theory, and conceptually by critical resilience and intersectional scholarship. Data collection involved virtual, semi-structured interviews with 35 TGD individuals in two Canadian cities who indicated having experiences of seeking, receiving, and/or providing peer support. Data analysis comprised an iterative, abductive process of cross-referencing participant accounts with relevant scholarship to arrive at an account of how TGD peers may contribute to the growth of gender-affirming care. Our findings suggest, broadly, that TGD peers may enhance gender-affirming care by: (1) validating a growing diversity of embodiments and experiences in healthcare decision-making, (2) nurturing and diversifying relevant networks of safety, community support, and advocacy outside formal systems of care, and (3) strengthening possibilities for resisting and transforming existing healthcare systems. After outlining these findings, we briefly consider the implications of our analysis and leverage our inferences to substantiate the notion of community-driven gender-affirming care, meaning care that is intentional in its incorporation of relevant community stakeholders to shape governance and service provision. We conclude with reflections on the promise of community-driven care at a time of heightened volatility across systems serving TGD populations.
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Affiliation(s)
- Hannah Kia
- School of Social Work, The University of British Columbia, Canada.
| | - K A Kenney
- School of Social Work, The University of British Columbia, Canada
| | - Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | | | | | - Rod Knight
- École de Santé Publique, Université de Montréal, Canada
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MacKinnon KR, Gould WA, Enxuga G, Kia H, Abramovich A, Lam JSH, Ross LE. Exploring the gender care experiences and perspectives of individuals who discontinued their transition or detransitioned in Canada. PLoS One 2023; 18:e0293868. [PMID: 38019738 PMCID: PMC10686467 DOI: 10.1371/journal.pone.0293868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Those who detransition have received increased public and scholarly attention and their narratives are often presented as evidence of limitations with contemporary gender-affirming care practices. However, there are scant empirical studies about how this population experienced their own process of gaining access to gender-affirming medical/surgical interventions, or their recommendations for care practice. AIMS To qualitatively explore the care experiences and perspectives of individuals who discontinued or reversed their gender transitions (referred to as detransition). METHODS Between October 2021-January 2022, Canadian residents aged 18 and older with experience of stopping, shifting, or reversing a gender transition were invited to participate in semi-structured, one-on-one, virtual interviews. A purposive sample of 28 was recruited by circulating study adverts over social media, to clinicians in six urban centres, and within participants' social networks. Interviews ranged between 50-90 minutes, were audio-recorded, and transcribed verbatim. Following constructivist grounded theory methodology, interview data were analyzed inductively and thematically following a two-phase coding process to interpret participants' experiences of, and recommendations for, gender care. RESULTS Participants were between the ages of 20-53 (71% were between 20-29). All participants identified along the LGBTQ2S+ spectrum. Twenty-seven out of 28 of the participants received medical/surgical interventions (60% were ages 24 and younger). A majority (57%) reported three or more past gender identities, with 60% shifting from a binary transgender identity at the time of initiating transition to a nonbinary identity later in their transition journey. To access medical/surgical interventions, most participants were assessed via the gender-affirming care model pathway and also engaged in talk therapy with a mental healthcare provider such as a psychologist or psychiatrist. Some participants experienced their care as lacking the opportunity to clarify their individual treatment needs prior to undergoing medical/surgical transition. Decisional regret emerged as a theme alongside dissatisfaction with providers' "informed consent" procedures, such that participants felt they would have benefitted from a more robust discussion of risks/benefits of interventions prior to treatment decision-making. Overall, participants recommended an individualized approach to care that is inclusive of mental healthcare supports. CONCLUSIONS To optimize the experiences of people seeking and receiving gender care, a thorough informed consent process inclusive of individualized care options is recommended, as outlined by the World Professional Association of Transgender Health, standards of care, version 8.
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Affiliation(s)
- Kinnon R. MacKinnon
- School of Social Work, York University, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Wren Ariel Gould
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel Enxuga
- School of Social Work, York University, Toronto, Ontario, Canada
| | - Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - June S. H. Lam
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Adult Gender Identity Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lori E. Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Salway T, Kinitz DJ, Kia H, Ashley F, Giustini D, Tiwana A, Archibald R, Mallakzadeh A, Dromer E, Ferlatte O, Goodyear T, Abramovich A. A systematic review of the prevalence of lifetime experience with 'conversion' practices among sexual and gender minority populations. PLoS One 2023; 18:e0291768. [PMID: 37792717 PMCID: PMC10550144 DOI: 10.1371/journal.pone.0291768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023] Open
Abstract
RATIONALE Conversion practices (CPs) refer to organized attempts to deter people from adopting or expressing non-heterosexual identities or gender identities that differ from their gender/sex assigned at birth. Numerous jurisdictions have contemplated or enacted legislative CP bans in recent years. Syntheses of CP prevalence are needed to inform further public health policy and action. OBJECTIVES To conduct a systematic review describing CP prevalence estimates internationally and exploring heterogeneity across country and socially relevant subgroups. METHODS We performed literature searches in eight databases (Medline, Embase, PsycInfo, Social Work Abstracts, CINAHL, Web of Science, LGBTQ+ Source, and Proquest Dissertations) and included studies from all jurisdictions, globally, conducted after 2000 with a sampling frame of sexual and gender minority (SGM) people, as well as studies of practitioners seeing SGM patients. We used the Hoy et al. risk of bias tool for prevalence studies and summarized distribution of estimates using median and range. RESULTS We identified fourteen articles that reported prevalence estimates among SGM populations, and two articles that reported prevalence estimates from studies of mental health practitioners. Prevalence estimates among SGM samples ranged 2%-34% (median: 8.5). Prevalence estimates were greater in studies conducted in the US (median: 13%), compared to Canada (median: 7%), and greater among transgender (median: 12%), compared to cisgender (median: 4%) subsamples. Prevalence estimates were greatest among people assigned male at birth, whether transgender (median: 10%) or cisgender (median: 8%), as compared to people assigned female at birth (medians: 5% among transgender participants, 3% among cisgender participants). Further differences were observed by race (medians: 8% among Indigenous and other racial minorities, 5% among white groups) but not by sexual orientation. CONCLUSIONS CPs remain prevalent, despite denouncements from professional bodies. Social inequities in CP prevalence signal the need for targeted efforts to protect transgender, Indigenous and racial minority, and assigned-male-at-birth subgroups.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - David J. Kinitz
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hannah Kia
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada
| | - Florence Ashley
- Faculty of Law & Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Dean Giustini
- Biomedical Branch Library, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amrit Tiwana
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Reilla Archibald
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Amirali Mallakzadeh
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Elisabeth Dromer
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Olivier Ferlatte
- École de santé publique, Université de Montréal, Montréal, Quebec, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Quebec, Canada
| | - Trevor Goodyear
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Gould WA, MacKinnon KR, Lam JSH, Enxuga G, Abramovich A, Ross LE. Detransition Narratives Trouble the Simple Attribution of Madness in Transantagonistic Contexts: A Qualitative Analysis of 16 Canadians' Experiences. Cult Med Psychiatry 2023:10.1007/s11013-023-09838-0. [PMID: 37737532 DOI: 10.1007/s11013-023-09838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Abstract
Emerging evidence suggests that transgender individuals are more likely than cisgender peers to receive a diagnosis with a primary mental disorder. Attributions of madness, though, may serve the social function of dismissing and discrediting transgender individual's self-perceptions. The narratives of individuals who stop or reverse an initial gender transition who also identify as living with mental health conditions can sometimes amplify these socio-political discourses about transgender people. Through a critical mental health lens, this article presents a qualitative analysis of 16 individuals who stopped or reversed a gender transition and who also reported a primary mental health condition. Semi-structured, virtual interviews were conducted with people living in Canada. Applying constructivist grounded theory methodology, and following an iterative, inductive approach to analysis, we used the constant comparative method to analyse these 16 in-depth interviews. Results show rich complexity such that participants narrated madness in nuanced and complex ways while disrupting biased attitudes that madness discredited their thoughts and feelings, including prior gender dysphoria. Instead, participants incorporated madness into expanding self-awareness and narrated their thoughts and feelings as valid and worthy. Future research must consider provider's perspectives, though, in treating mad individuals who detransitioned, since alternate gender-affirming care models may better support the identification and wellness of care-seeking individuals who may be identified (in the past, present, or future) as mad.
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Affiliation(s)
- Wren Ariel Gould
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- School of Social Work, York University, Toronto, ON, Canada
| | - Kinnon R MacKinnon
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- School of Social Work, York University, Toronto, ON, Canada.
| | - June Sing Hong Lam
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Evaluative Clinical Sciences (ICES), Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, General and Health Systems Psychiatry Division, Toronto, ON, Canada
| | - Gabriel Enxuga
- School of Social Work, York University, Toronto, ON, Canada
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Health Systems & Health Equity Research Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Kerman N, Kidd SA, Voronov J, Marshall CA, O'Shaughnessy B, Abramovich A, Stergiopoulos V. Victimization, safety, and overdose in homeless shelters: A systematic review and narrative synthesis. Health Place 2023; 83:103092. [PMID: 37515964 DOI: 10.1016/j.healthplace.2023.103092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
The objective of this prospectively registered systematic review was to identify the factors that contribute to sense of safety, victimization, and overdose risk in homeless shelters, as well as groups that are at greater risk of shelter-based victimization. Fifty-five articles were included in the review. Findings demonstrated that fears of violence and other forms of harm were prominent concerns for people experiencing homelessness when accessing shelters. Service users' perceptions of shelter dangerousness were shaped by the service model and environment, interpersonal relationships and interactions in shelter, availability of drugs, and previous living arrangements. 2SLGBTQ+ individuals were identified as being at heightened risk of victimization in shelters. No studies examined rates of shelter-based victimization or tested interventions to improve safety, with the exception of overdose risk. These knowledge gaps hinder the establishment of evidence-based practices for promoting safety and preventing violence in shelter settings.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Voronov
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | | | - Alex Abramovich
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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10
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Dermody SS, Uhrig A, Moore A, Raessi T, Abramovich A. A narrative systematic review of the gender inclusivity of measures of harmful drinking and their psychometric properties among transgender adults. Addiction 2023; 118:1649-1660. [PMID: 37070479 DOI: 10.1111/add.16212] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/28/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND AND AIMS Experiencing higher rates of stigma, marginalization and discrimination puts transgender individuals at risk for alcohol use and associated harms. Measures of harmful drinking were designed with cisgender people in mind, and some rely on sex- and gender-based cut-offs. The applicability of these measures for gender diverse samples remains unknown. The present study had two aims: (i) identify gender-non-inclusive language and cut-offs in measures of harmful drinking, and (ii) systematically review research reporting psychometric properties of these measures in transgender individuals. METHODS We reviewed 22 measures of harmful drinking for gendered language and sex- and gender-based cut-off values and provided suggestions for revision when warranted. We also conducted a systematic narrative review, including eight eligible studies, summarizing the psychometric properties of measures of harmful drinking in transgender populations. RESULTS Six of 22 measures of harmful drinking were not gender inclusive, because of gendered language in the measure itself or use of sex- or gender-based cut-off scores. Only eight published studies reported psychometric data for these measures in transgender people. Apart from in one study, the Alcohol Use Disorders Identification Test (AUDIT) and Alcohol Use Disorders Identification Test Consumption (AUDIT-C) appear reliable for transgender adults (Cronbach's α: AUDIT [0.81-0.87] and AUDIT [0.72-0.8)]). There is initial support for using uniform cut-offs for transgender people for the AUDIT-C (≥3) and binge drinking (≥5 drinks in a sitting). CONCLUSIONS Most existing measures of harmful drinking appear to be gender inclusive (containing gender neutral language and uniform cut-off scores across sex and gender groups) and some that are not easily adapted to be gender inclusive.
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Affiliation(s)
- Sarah S Dermody
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Alexandra Uhrig
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Annabelle Moore
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Tara Raessi
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Alex Abramovich
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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11
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Fahey KML, Kovacek K, Abramovich A, Dermody SS. Substance use prevalence, patterns, and correlates in transgender and gender diverse youth: A scoping review. Drug Alcohol Depend 2023; 250:110880. [PMID: 37480799 DOI: 10.1016/j.drugalcdep.2023.110880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 07/24/2023]
Abstract
Transgender and gender diverse (TGD) adults are at elevated risk of problematic substance use. While understanding substance use disparities in TGD youth is crucial for informing early preventions, there is no known synthesis of prevalence and correlates of substance use in TGD youth. The objectives of this study were to: 1) describe the prevalence and patterns of substance use in TGD youth, 2) identify and evaluate potential correlates of substance use, and 3) report the strengths and limitations of the current literature in recommendation of future steps. A PRISMA-guided systematic search was conducted to identify 55 studies that reported prevalence, patterns, or correlates of substance use in TGD youth aged 10-24 years; were published in the English language; and followed a quantitative design. Fifty-four (98.18%) studies examined prevalence and patterns, 23 (41.82%) examined correlates, and 12 (21.82%) examined moderators and mediators of substance use in TGD youth. Findings suggest TGD youth exhibit a moderate-to-high prevalence of recent substance use, including alcohol (23-31%), binge drinking (11-59%), cigarettes (10-59%), e-cigarettes (17-27%), and marijuana (17-46%). Additionally, results supported that greater victimization experiences, including those related and unrelated to being a gender minority, were associated with increased substance use risk. Few studies examined polysubstance use, resilience, and protective factors, or considered TGD subgroup differences, which we recommend in future research. Further, we recommend improving population-based surveys to better capture gender identity and related experiences.
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Affiliation(s)
| | | | - Alex Abramovich
- University of Toronto, Canada; Centre for Addiction and Mental Health, Canada
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12
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Abramovich A, Pang N, Kim KV, Stark RK, Lange S, Chaiton M, Logie CH, Hamilton HA, Kidd SA. A longitudinal investigation of the effects of the COVID-19 pandemic on 2SLGBTQ+ youth experiencing homelessness. PLoS One 2023; 18:e0288591. [PMID: 37459299 PMCID: PMC10351701 DOI: 10.1371/journal.pone.0288591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The objective of this study was to examine the impacts of the coronavirus 2019 (COVID-19) pandemic on various dimensions of wellbeing among 2SLGBTQ+ youth experiencing homelessness over a 12-month period during the COVID-19 pandemic. METHODS 2SLGBTQ+ youth (recruited using a convenience sampling method) participated in three online surveys to assess mental health (depression, anxiety, suicidality), substance and alcohol use, health care access, and violence for 12-months between 2021-2022. Quantitative data analysis included non-parametric one-sample proportion tests, paired t-test and McNemar's test. Longitudinal data collected across all three timepoints were treated as paired data and compared to baseline data using non-parametric exact multinomial tests, and if significant, followed by pairwise post-hoc exact binomial tests. For the purposes of analysis, participants were grouped according to their baseline survey based on pandemic waves and public health restrictions. RESULTS 2SLGBTQ+ youth experiencing homelessness (n = 87) reported high rates of mental health challenges, including anxiety and depression, over 12-months during the pandemic. Youth participants reported experiencing poor mental health during the early waves of the pandemic, with improvements to their mental health throughout the pandemic; however, results were not statistically significant. Likewise, participants experienced reduced access to mental health care during the early waves of the pandemic but mental health care access increased for youth throughout the pandemic. CONCLUSION Study results showed high rates of mental health issues among 2SLGBTQ+ youth, but reduced access to mental health care, due to the COVID-19 pandemic. Findings highlight the need for 2SLGBTQ+ inclusive and affirming mental health care and services to address social and mental health issues that have been exacerbated by the pandemic.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nelson Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Kawon Victoria Kim
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rowen K. Stark
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michael Chaiton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Hayley A. Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sean A. Kidd
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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13
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Kundu A, Fu R, Grace D, Logie CH, Abramovich A, Baskerville B, Yager C, Schwartz R, Mitsakakis N, Planinac L, Chaiton M. Correlates of wanting to seek help for mental health and substance use concerns by sexual and gender minority young adults during the COVID-19 pandemic: A machine learning analysis. PLoS One 2022; 17:e0277438. [PMID: 36383536 PMCID: PMC9668172 DOI: 10.1371/journal.pone.0277438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 pandemic has worsened the mental health and substance use challenges among many people who are Two Spirit, lesbian, gay, bisexual, transgender, queer, questioning, and intersex (2SLGBTQI+). We aimed to identify the important correlates and their effects on the predicted likelihood of wanting to seek help among 2SLGBTQI+ young adults for mental health or substance use concerns during the pandemic. A cross-sectional survey was conducted in 2020-2021 among 2SLGBTQI+ young adults aged 16-29 living in two Canadian provinces (Ontario and Quebec). Among 1414 participants, 77% (n = 1089) wanted to seek help for their mental health or substance use concerns during the pandemic, out of these, 69.8% (n = 760) reported delay in accessing care. We built a random forest (RF) model to predict the status of wanting to seek help, which achieved moderately high performance with an area under the receiver operating characteristic curve (AUC) of 0.85. The top 10 correlates of wanting to seek help were worsening mental health, age, stigma and discrimination, and adverse childhood experiences. The interactions of adequate housing with certain sexual orientations, gender identities and mental health challenges were found to increase the likelihood of wanting to seek help. We built another RF model for predicting risk of delay in accessing care among participants who wanted to seek help (n = 1089). The model identified a similar set of top 10 correlates of delay in accessing care but lacked adequate performance (AUC 0.61). These findings can direct future research and targeted prevention measures to reduce health disparities for 2SLGBTQI+ young adults.
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Affiliation(s)
- Anasua Kundu
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Ontario Tobacco Research Unit, University of Toronto, Toronto, Canada
| | - Rui Fu
- Department of Otolaryngology—Head and Neck Surgery, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- United Nations University Institute for Water, Environment & Health, Hamilton, Canada
| | - Alex Abramovich
- Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Bruce Baskerville
- Canadian Institutes of Health Research, Ottawa, Canada
- School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, Canada
| | | | - Robert Schwartz
- Centre for Addiction and Mental Health, Toronto, Canada
- Ontario Tobacco Research Unit, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nicholas Mitsakakis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Lynn Planinac
- Ontario Tobacco Research Unit, University of Toronto, Toronto, Canada
| | - Michael Chaiton
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
- Ontario Tobacco Research Unit, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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14
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MacEntee K, Lee EOJ, Oudshoorn A, Abramovich A, Kiptui R, Ayuku D, Van Berkum A, Saarela O, Tang TS, Apondi E, Wachira J, MacDonald SA, Braitstein P. Using scenario videos with Theatre Testing method to adapt a peer navigation model to improve street-connected youth's access to HIV care in Kenya and Canada. Front Public Health 2022; 10:975117. [PMID: 36408034 PMCID: PMC9669244 DOI: 10.3389/fpubh.2022.975117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Theatre testing (TT) method demonstrates whole or portions of an evidence-based intervention to stakeholders to elicit feedback on context-specific adaptations and future implementation. The Peer Navigator Project (PNP) studied the adaptation and implementation of Peer Navigators in five urban sites to increase street-connected youth (SCY) access to HIV prevention, testing, and treatment in Canada and Kenya. TT was used with SCY, healthcare providers, and community stakeholders to collect feedback on the optimal characteristics of the PNs (e.g., social identities) and their professional activities and responsibilities in each site. Sites scripted unique scenarios of PNs supporting SCY and interacting with social service providers. Local actors were employed, and the scenarios were filmed and edited into videos alongside audience discussion questions. Videos were screened to separate audiences of SCY (n = 40), healthcare providers (n = 12), and community stakeholders (n = 59). Facilitated discussion about the scenarios were recorded as data, and transcripts were analyzed thematically by the research team. The scenario videos are presented as a unique adaptation to the TT method. The adaptations were time-consuming and limited the ability to present responsive changes while presenting the method to different audiences. They were also effective at maintaining presentation fidelity and eliciting diverse and meaningful responses from different stakeholder groups. One site successfully adapted the method for use in a physically distanced manner that complied with COVID-19 public health regulations. TT using video scenarios is an engaging approach that garners rich responses from diverse stakeholder groups about the adaptation of evidence-based interventions preparing for implementation in international settings.
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Affiliation(s)
- Katie MacEntee
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada,*Correspondence: Katie MacEntee
| | - Edward Ou Jin Lee
- École de Travail Social, Université de Montréal, Montréal, QC, Canada
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Reuben Kiptui
- Academic Model Providing Access to Healthcare in Eldoret, Eldoret, Kenya
| | - David Ayuku
- Academic Model Providing Access to Healthcare in Eldoret, Eldoret, Kenya,Department of Mental Health and Behavioral Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Amy Van Berkum
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Thai-Son Tang
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Edith Apondi
- Academic Model Providing Access to Healthcare in Eldoret, Eldoret, Kenya,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare in Eldoret, Eldoret, Kenya,Department of Mental Health and Behavioral Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Sue-Ann MacDonald
- École de Travail Social, Université de Montréal, Montréal, QC, Canada
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Department of Epidemiology and Biostatistics, School of Public Health, Moi University, Eldoret, Kenya
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15
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Khan M, MacEntee K, Kiptui R, Van Berkum A, Oudshoorn A, Ayuku DO, Apondi E, Lee EOJ, Abramovich A, MacDonald SA, Braitstein P. Barriers to and facilitators of accessing HIV services for street-involved youth in Canada and Kenya. BMC Public Health 2022; 22:1901. [PMID: 36224566 PMCID: PMC9555255 DOI: 10.1186/s12889-022-14290-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction UNICEF estimates that there are as many as 100 million street-involved youth (SIY) globally. Marginalized conditions put SIY at higher risk of HIV and adverse outcomes once HIV-positive. The objective of this analysis was to describe barriers and facilitators of accessing HIV prevention, testing, and treatment services as Phase I of an implementation study evaluating the use of peer navigators to increase access to HIV services. Methods Semi-structured interviews, focus group discussions (FGD), and theatre testing were conducted with individuals who identify as SIY, health care providers, and community stakeholders living in Canada (Toronto, Montreal, London) and Kenya (Eldoret, Huruma, Kitale). Data were analyzed using a directed content approach, guided by the socio-ecological model (SEM). Results Across the six sites were 195 participants: 64 SIY, 42 healthcare providers, and 97 community-based stakeholders. Barriers were identified at the societal (e.g. intersectional stigma and discrimination), public policy (e.g., inadequate access to basic needs, legal documentation, lack of health insurance, and limited community-based funding), institutional (e.g. lack of inclusive education and training, inadequate HIV educational outreach, and restrictive service provision), interpersonal (e.g., ineffective communication from healthcare providers), and intrapersonal levels (e.g. lack of trust and associated fear, low perception for healthcare, and lack of self-esteem). These contributed to limited HIV services utilization among SIY. Conversely, numerous facilitators were also identified at the public policy (e.g. affordable HIV services and treatment), institutional (e.g. available and accessible HIV prevention tools, HIV education and awareness programs, and holistic models of care), interpersonal level (e.g., systems navigation support, peer support, and personal relationships), and intrapersonal levels (e.g. self-efficacy) as positively supporting SIY access to HIV services. Conclusion Intersectional stigma was a critical barrier in all sites, and policies and programs that foster welcoming environments for youth from diverse backgrounds and living circumstances may be better able to respond to the HIV service needs of this high risk population. Social support and navigation services were reported to facilitate access to HIV services in all sites. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14290-7.
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Affiliation(s)
- Momina Khan
- Division of Social and Behavioral Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Katie MacEntee
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Reuben Kiptui
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Amy Van Berkum
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | - David O Ayuku
- Department of Mental Health and Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Alex Abramovich
- Division of Social and Behavioral Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Division of Child and Youth Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Paula Braitstein
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, M5T 3M7, Toronto, ON, Canada. .,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. .,Department of Epidemiology and Medical Statistics, School of Public Health, College of Health Sciences, Eldoret, Kenya.
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16
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Kundu A, Fu R, Grace D, Logie C, Abramovich A, Baskerville B, Yager C, Schwartz R, Mitsakakis N, Planinac L, Chaiton M. Correlates of past year suicidal thoughts among sexual and gender minority young adults: A machine learning analysis. J Psychiatr Res 2022; 152:269-277. [PMID: 35759979 DOI: 10.1016/j.jpsychires.2022.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/27/2022] [Accepted: 06/07/2022] [Indexed: 01/14/2023]
Abstract
Sexual and gender minority populations are at elevated risk of experiencing suicidal thoughts and attempting suicide. The COVID-19 pandemic exacerbated mental health and substance use challenges among this population. We aimed to examine the relative importance and effects of intersectional factors and strong interactions associated with the risk of suicidal thoughts among Canadian lesbian, gay, bisexual, transgender, queer, questioning, intersex and Two Spirit (LGBTQI2S+) young adults. A cross-sectional online survey was conducted among LGBTQI2S + participants aged 16-29 years living in two Canadian provinces (Ontario, Quebec). Among 1414 participants (mean age 21.90 years), 61% (n = 857) participants reported suicidal thoughts in last 12 months. We built a random forest model to predict the risk of having past year suicidal thoughts, which achieved high performance with an area under the receiver operating characteristic curve (AUC) of 0.84. The top 10 correlates identified were: seeking help from health professionals for mental health or substance use issues since the start of the pandemic, current self-rated mental health status, insulted by parents or adults in childhood, ever heard that being identifying as LGBTQI2S+ is not normal, age in years, past week feeling depressed, lifetime diagnosis of mental illness, lifetime diagnosis of depressive disorder, past week feeling sad, ever pretended to be straight or cisgender to be accepted. The increase in the risk of suicidal thoughts for those having mental health challenges or facing minority stressors is more pronounced in those living in urban areas or being unemployed than those living in rural areas or being employed.
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Affiliation(s)
- Anasua Kundu
- Institute of Medical Science, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada; Ontario Tobacco Research Unit, University of Toronto, Toronto, Canada.
| | - Rui Fu
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Research Institute, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - Carmen Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada; United Nations University Institute for Water, Environment & Health, Hamilton, Canada
| | - Alex Abramovich
- Centre for Addiction and Mental Health, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Bruce Baskerville
- Canadian Institutes of Health Research, Ottawa, Canada; School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, Canada
| | | | - Robert Schwartz
- Centre for Addiction and Mental Health, Toronto, Canada; Ontario Tobacco Research Unit, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Nicholas Mitsakakis
- Dalla Lana School of Public Health, University of Toronto, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Lynn Planinac
- Ontario Tobacco Research Unit, University of Toronto, Toronto, Canada
| | - Michael Chaiton
- Centre for Addiction and Mental Health, Toronto, Canada; Ontario Tobacco Research Unit, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
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17
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Lam JSH, Abramovich A, Victor JC, Zaheer J, Kurdyak P. Characteristics of Transgender Individuals With Emergency Department Visits and Hospitalizations for Mental Health. Psychiatr Serv 2022; 73:722-729. [PMID: 34875849 DOI: 10.1176/appi.ps.202100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Transgender individuals experience significant oppression resulting in mental health disparities. Factors associated with their need for acute mental health care are unknown. This study compared characteristics of transgender individuals who presented for acute mental health care with population-based comparison samples. METHODS This cross-sectional study examined transgender individuals who had a mental health-related emergency department (ED) visit (N=728) or hospitalization (N=454). Transgender individuals were identified, and their data were linked with health administrative data. The transgender ED and hospitalization samples were each compared with two samples: all individuals in Ontario who had an ED visit or hospitalization (unmatched) and individuals matched on age, region of residence, and mental health care utilization history. Individuals' sociodemographic and clinical factors were compared. RESULTS After matching, transgender individuals in the ED sample were more likely than those in the comparison group to be in the lowest neighborhood income quintile (37% versus 27%) and the highest residential instability quintile (47% versus 38%) and to be diagnosed as having a mood (26% versus 19%) or personality disorder (4% versus 1%). Transgender individuals in the hospitalization sample were more likely to be in the lowest neighborhood income quintile (36% versus 27%) and the highest residential instability quintile (45% versus 35%) and to be diagnosed as having a mood (40% versus 35%) or personality disorder (5% versus 2%). CONCLUSIONS Transgender individuals who accessed acute mental health care had unique sociodemographic and clinical factors associated with their presentation that persisted after matching. More research into the factors associated with their acute care presentation is warranted, including how experiences of marginalization play a role.
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Affiliation(s)
- June Sing Hong Lam
- Centre for Addiction and Mental Health, Toronto (Lam, Abramovich, Zaheer, Kurdyak); Department of Psychiatry (Lam, Abramovich Zaheer, Kurdyak), Dalla Lana School of Public Health (Abramovich), and Institute of Health Policy, Management and Evaluation (Lam, Victor, Kurdyak), University of Toronto, Toronto;ICES, Toronto (Victor, Kurdyak)
| | - Alex Abramovich
- Centre for Addiction and Mental Health, Toronto (Lam, Abramovich, Zaheer, Kurdyak); Department of Psychiatry (Lam, Abramovich Zaheer, Kurdyak), Dalla Lana School of Public Health (Abramovich), and Institute of Health Policy, Management and Evaluation (Lam, Victor, Kurdyak), University of Toronto, Toronto;ICES, Toronto (Victor, Kurdyak)
| | - J Charles Victor
- Centre for Addiction and Mental Health, Toronto (Lam, Abramovich, Zaheer, Kurdyak); Department of Psychiatry (Lam, Abramovich Zaheer, Kurdyak), Dalla Lana School of Public Health (Abramovich), and Institute of Health Policy, Management and Evaluation (Lam, Victor, Kurdyak), University of Toronto, Toronto;ICES, Toronto (Victor, Kurdyak)
| | - Juveria Zaheer
- Centre for Addiction and Mental Health, Toronto (Lam, Abramovich, Zaheer, Kurdyak); Department of Psychiatry (Lam, Abramovich Zaheer, Kurdyak), Dalla Lana School of Public Health (Abramovich), and Institute of Health Policy, Management and Evaluation (Lam, Victor, Kurdyak), University of Toronto, Toronto;ICES, Toronto (Victor, Kurdyak)
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto (Lam, Abramovich, Zaheer, Kurdyak); Department of Psychiatry (Lam, Abramovich Zaheer, Kurdyak), Dalla Lana School of Public Health (Abramovich), and Institute of Health Policy, Management and Evaluation (Lam, Victor, Kurdyak), University of Toronto, Toronto;ICES, Toronto (Victor, Kurdyak)
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18
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MacKinnon KR, Kia H, Salway T, Ashley F, Lacombe-Duncan A, Abramovich A, Enxuga G, Ross LE. Health Care Experiences of Patients Discontinuing or Reversing Prior Gender-Affirming Treatments. JAMA Netw Open 2022; 5:e2224717. [PMID: 35877120 PMCID: PMC9315415 DOI: 10.1001/jamanetworkopen.2022.24717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as detransition. OBJECTIVE To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice. DESIGN, SETTING, AND PARTICIPANTS Using constructivist grounded theory as a qualitative approach, data were collected in the form of in-depth interviews. Data were analyzed using an inductive 2-stage coding process to categorize and interpret detransition-related health care experiences to inform clinical practice. Between October 2021 and January 2022, individuals living in Canada who were aged 18 years and older with experience of stopping, shifting, or reversing a gender transition were invited to partake in semistructured virtual interviews. Study advertisements were circulated over social media, to clinicians, and within participants' social networks. A purposive sample of 28 participants who discontinued, shifted, or reversed a gender transition were interviewed. MAIN OUTCOMES AND MEASURES In-depth, narrative descriptions of the physical and mental health experiences of people who discontinued or sought to reverse prior gender-affirming medical and/or surgical interventions. RESULTS Among the 28 participants, 18 (64%) were assigned female at birth and 10 (36%) were assigned male at birth; 2 (7%) identified as Jewish and White, 5 (18%) identified as having mixed race and ethnicity (which included Arab, Black, Indigenous, Latinx, and South Asian), and 21 (75%) identified as White. Participants initially sought gender-affirmation at a wide range of ages (15 [56%] were between ages 18 and 24 years). Detransition occurred for various reasons, such as an evolving understanding of gender identity or health concerns. Participants reported divergent perspectives about their past gender-affirming medical or surgical treatments. Some participants felt regrets, but a majority were pleased with the results of gender-affirming medical or surgical treatments. Medical detransition was often experienced as physically and psychologically challenging, yet health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs. CONCLUSIONS AND RELEVANCE This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions.
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Affiliation(s)
| | - Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Florence Ashley
- Faculty of Law & Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | | | - Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel Enxuga
- School of Social Work, McGill University, Montreal, Québec, Canada
| | - Lori E. Ross
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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19
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Abramovich A, Pang N, Moss A. Experiences of family violence among 2SLGBTQ + youth at risk of, and experiencing, homelessness before and during the COVID-19 pandemic. Journal of Gay & Lesbian Mental Health 2022. [DOI: 10.1080/19359705.2022.2076759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nelson Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Amanda Moss
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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20
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Chaiton M, Billington R, Copeland I, Grey L, Abramovich A. Mental Health and Addiction Services Exclusive to LGBTQ2S+ during COVID-19: An Environmental Scan. Int J Environ Res Public Health 2022; 19:ijerph19105919. [PMID: 35627456 PMCID: PMC9140765 DOI: 10.3390/ijerph19105919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Youth who are lesbian, gay, bisexual, trans, queer, 2-spirit, and of other identities (LGBTQ2S+) experience mental health disparities and higher rates of substance use when compared to their cisgender and heterosexual peers and yet also experience more barriers to access to services. The purpose of this paper is to determine the types of mental health and substance use programs and services exclusive to LGBTQ2S+ youth in Ontario during the pandemic. METHODS An environmental scan was conducted to identify existing programs and services in Ontario, Canada that offered exclusive mental health and addiction services to LGBTQ2S+ individuals aged 16-29, either by offering services to all or subgroups within the population. Organizations, services and programs were classified by the geographical distribution of services, populations served, types of programming or services, methods of service delivery, and program criteria. RESULTS In total, 113 organizations and 240 programs and services were identified as providing mental health and substance use services exclusively to LGBTQ2S+ youth. Identified adaptations for the COVID-19 pandemic included cancelling in-person services, increasing online and telephone services, and expansion to province wide from local availability. CONCLUSIONS The findings highlight the importance of offering services that provide culturally inclusive care for LGBTQ2S+ youth, and these results can also be used by policy makers to inform policies. In particular, there was a lack of culturally relevant clinical services for youth requiring a greater intensity of treatment.
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Affiliation(s)
- Michael Chaiton
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3S7, Canada;
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada; (R.B.); (I.C.); (L.G.)
- Correspondence: ; Tel.: +416-978-7096; Fax: +416-595-6068
| | - Rebecca Billington
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada; (R.B.); (I.C.); (L.G.)
| | - Ilana Copeland
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada; (R.B.); (I.C.); (L.G.)
| | - Luc Grey
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada; (R.B.); (I.C.); (L.G.)
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3S7, Canada;
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada; (R.B.); (I.C.); (L.G.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 3S7, Canada
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21
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Somé NH, Shokoohi M, Shield KD, Wells S, Hamilton HA, Elton-Marshall T, Abramovich A. Alcohol and cannabis use during the COVID-19 pandemic among transgender, gender-diverse, and cisgender adults in Canada. BMC Public Health 2022; 22:452. [PMID: 35255847 PMCID: PMC8899793 DOI: 10.1186/s12889-022-12779-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study examined whether heavy episodic drinking (HED), cannabis use, and subjective changes in alcohol and cannabis use during the COVID-19 pandemic differ between transgender and gender-diverse (TGD) and cisgender adults. METHODS Successive waves of web-based cross-sectional surveys. SETTING Canada, May 2020 to March 2021. PARTICIPANTS 6,016 adults (39 TGD, 2,980 cisgender men, 2,984 cisgender women, and 13 preferred not to answer), aged ≥18 years. MEASUREMENTS Measures included self-reported HED (≥5 drinks on one or more occasions in the previous week for TGD and cisgender men and ≥4 for cisgender women) and any cannabis use in the previous week. Subjective changes in alcohol and cannabis use in the past week compared to before the pandemic were measured on a five-point Likert scale (1: much less to 5: much more). Binary and ordinal logistic regressions quantified differences between TGD and cisgender participants in alcohol and cannabis use, controlling for age, ethnoracial background, marital status, education, geographic location, and living arrangement. RESULTS Compared to cisgender participants, TGD participants were more likely to use cannabis (adjusted odds ratio (aOR)=3.78, 95%CI: 1.89, 7.53) and to have reported subjective increases in alcohol (adjusted proportional odds ratios (aPOR)= 2.00, 95%CI: 1.01, 3.95) and cannabis use (aPOR=4.56, 95%CI: 2.13, 9.78) relative to before the pandemic. Compared to cisgender women, TGD participants were more likely to use cannabis (aOR=4.43, 95%CI: 2.21, 8.87) and increase their consumption of alcohol (aPOR=2.05, 95%CI: 1.03, 4.05) and cannabis (aPOR=4.71, 95%CI: 2.18, 10.13). Compared to cisgender men, TGD participants were more likely to use cannabis (aOR=3.20, 95%CI: 1.60, 6.41) and increase their use of cannabis (aPOR=4.40, 95%CI: 2.04, 9.49). There were no significant differences in HED between TGD and cisgender participants and in subjective change in alcohol between TGD and cisgender men; however, the odds ratios were greater than one as expected. CONCLUSIONS Increased alcohol and cannabis use among TGD populations compared to before the pandemic may lead to increased health disparities. Accordingly, programs targeting the specific needs of TGD individuals should be prioritized.
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Affiliation(s)
- Nibene H Somé
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada. .,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. .,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Mostafa Shokoohi
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kevin D Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,World Health Organization/Pan American Health Organization Collaborating Centre in Addiction and Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Samantha Wells
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Hayley A Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
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22
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Kirubarajan A, Barker LC, Leung S, Ross LE, Zaheer J, Park B, Abramovich A, Yudin MH, Lam JSH. LGBTQ2S+ childbearing individuals and perinatal mental health: A systematic review. BJOG 2022; 129:1630-1643. [PMID: 35048502 DOI: 10.1111/1471-0528.17103] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND The perinatal period may uniquely impact the mental health and wellbeing of lesbian, gay, bisexual, transgender, queer, and Two-Spirit (LGBTQ2S+) childbearing individuals. OBJECTIVES To characterise and synthesise the experiences of LGBTQ2S+ childbearing individuals regarding perinatal mental health, including symptomatology, access to care and care-seeking. SEARCH STRATEGY We conducted and reported a systematic review following PRISMA guidelines of eight databases (EMBASE, MEDLINE-OVID, CINAHL, Scopus, Web of Science: Core Collection, Sociological Abstracts, Social Work Abstract, and PsycINFO) from inception to 1 March 2021. SELECTION CRITERIA Original, peer-reviewed research related to LGBTQ2S+ mental health was eligible for inclusion if the study was specific to the perinatal period (defined as pregnancy planning, conception, pregnancy, childbirth, and first year postpartum; includes miscarriages, fertility treatments and surrogacy). DATA COLLECTION AND ANALYSIS Findings were synthesised qualitatively via meta-aggregation using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI), and the ConQual approach. MAIN RESULTS Our systematic search included 26 eligible studies encompassing 1199 LGBTQ2S+ childbearing participants. Using the JBI SUMARI approach, we reported 65 results, which we synthesised as six key findings. The studies described unique considerations for LGBTQ2S+ individuals' perinatal mental health, including heteronormativity, cisnormativity, isolation, exclusion from traditional pregnancy care, stigma, and distressing situations from the gendered nature of pregnancy. Many participants described a lack of knowledge from healthcare providers related to care for LGBTQ2S+ individuals. In addition, LGBTQ2S+ individuals described barriers to accessing mental healthcare and gaps in health systems. Strategies to improve care include provider education, avoidance of gendered language, documentation of correct pronouns, trauma-informed practices, cultural humility training and tailored care for LGBTQ2S+ people. CONCLUSIONS Pregnancy, postpartum, and the perinatal period uniquely impacts the mental health and wellbeing of LGBTQ2S+individuals, largely due to systems-level inequities and exclusion from perinatal care. Healthcare providers should implement the identified strategies to improve perinatal care and address inequities.
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Affiliation(s)
- Abirami Kirubarajan
- University of Toronto Faculty of Medicine, Toronto, ON, Canada.,University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada
| | - Lucy C Barker
- University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada.,University of Toronto Department of Psychiatry, Toronto, ON, Canada.,Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada
| | - Shannon Leung
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Lori E Ross
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Juveria Zaheer
- University of Toronto Department of Psychiatry, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Bomi Park
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Alex Abramovich
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Mark H Yudin
- University of Toronto Department of Obstetrics and Gynaecology, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, Unity Health, St Michael's Hospital, Toronto, ON, Canada
| | - June Sing Hong Lam
- University of Toronto Institute of Health Policy, Management, and Evaluation, Toronto, ON, Canada.,University of Toronto Department of Psychiatry, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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23
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Abramovich A, Pang N, Kunasekaran S, Moss A, Kiran T, Pinto AD. Examining COVID-19 vaccine uptake and attitudes among 2SLGBTQ+ youth experiencing homelessness. BMC Public Health 2022; 22:122. [PMID: 35042491 PMCID: PMC8764500 DOI: 10.1186/s12889-022-12537-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/06/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has disproportionately impacted 2SLGBTQ+ youth experiencing homelessness. Little is known about vaccine attitudes and uptake among this population. To address this, the objectives of this study were to explore this group's COVID-19 vaccine attitudes, and facilitators and barriers impacting vaccine uptake. METHODS 2SLGBTQ+ youth experiencing homelessness in the Greater Toronto Area were recruited to participate in online surveys assessing demographic characteristics, mental health, health service use, and COVID-19 vaccine attitudes. Descriptive statistics and statistical tests were used to analyze survey data to explore variables associated with vaccine confidence. Additionally, a select group of youth and frontline workers from youth serving organizations were invited to participate in online one-on-one interviews. An iterative thematic content approach was used to analyze interview data. Quantitative and qualitative data were merged for interpretation by use of a convergent parallel analytical design. RESULTS Ninety-two youth completed surveys and 32 youth and 15 key informants participated in one-on-one interviews. Quantitative and qualitative data showed that the majority of 2SLGBTQ+ youth experiencing homelessness were confident in the COVID-19 vaccine; however, numerous youth were non-vaccine confident due to mistrust in the healthcare system, lack of targeted vaccine-related public health information, concerns about safety and side effects, and accessibility issues. Solutions to increase vaccine confidence were provided, including fostering trust, targeted public health messaging, and addressing accessibility needs. CONCLUSION Our study highlights the need for the vaccine strategy and rollouts to prioritize 2SLGBTQ+ youth experiencing homelessness and to address the pervasive health disparities that have been exacerbated by the pandemic.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
| | - Nelson Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
| | - Sharumathy Kunasekaran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
| | - Amanda Moss
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada
| | - Tara Kiran
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
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24
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Vigny-Pau M, Pang N, Alkhenaini H, Abramovich A. Suicidality and non-suicidal self-injury among transgender populations: A systematic review. Journal of Gay & Lesbian Mental Health 2021. [DOI: 10.1080/19359705.2021.1955195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Myriam Vigny-Pau
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Nelson Pang
- Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hamad Alkhenaini
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Alex Abramovich
- Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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25
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Abramovich A, Pang N, Moss A, Logie CH, Chaiton M, Kidd SA, Hamilton HA. Investigating the impacts of COVID-19 among LGBTQ2S youth experiencing homelessness. PLoS One 2021; 16:e0257693. [PMID: 34547037 PMCID: PMC8454954 DOI: 10.1371/journal.pone.0257693] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/07/2021] [Indexed: 01/11/2023] Open
Abstract
Background LGBTQ2S youth are overrepresented among youth experiencing homelessness and experience significantly higher rates of mental health issues compared to heterosexual and cisgender youth. COVID-19 related challenges for LGBTQ2S youth experiencing homelessness remain unknown. To address this gap, this study aimed to understand the impacts of the COVID-19 pandemic on LGBTQ2S youth at risk of, and experiencing, homelessness in the Greater Toronto Area, Ontario, Canada and surrounding areas. Methods Utilizing a mixed-methods convergent parallel design, LGBTQ2S youth experiencing homelessness were recruited to participate in virtual surveys and in-depth one-on-one interviews. Surveys included standardized measures and were administered to measure mental health outcomes and collect information on demographic characteristics, and health service use. Survey data were analyzed with descriptive statistics and statistical tests for difference of proportions. Interviews were analyzed using an iterative thematic content approach. Results Sixty-one youth completed surveys and 20 youth participated in one-on-one interviews. Quantitative and qualitative data showed that youth have been significantly impacted by the COVID-19 pandemic in various ways, including experiencing poor mental health, such as suicidality, depression, anxiety, and increased substance use, and lack of access to health and social support services. Conclusion Our study highlights the need for LGBTQ2S inclusive and affirming health care and support services for precariously housed adolescents to address the pre-existing social and health issues that have been exacerbated by the pandemic.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Nelson Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Amanda Moss
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Michael Chaiton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sean A. Kidd
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Hayley A. Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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26
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Abstract
This article offers descriptive and evaluative data for the first cohort of youth who lived in Canada's first transitional housing program for LGBTQ2S youth, operated by the YMCA of Greater Toronto. The purpose of this mixed-methods study was to report on how youth experienced living in an LGBTQ2S population-based housing program in relation to mental health, self-esteem, community participation and family connectedness, and how access to culturally competent services impact experiences of homelessness. The outcomes of this study are important for service providers, program managers, and policymakers to review in order to better understand how LGBTQ2S youth experience population-based housing programs and whether or not they positively impact their transition to adulthood. Although this study took place in Toronto, Canada, it has broader relevance nationally and internationally, and can be used to build the evidence base to guide the improvement, development, and evaluation of future LGBTQ2S housing services for youth.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Kimura
- Canadian Observatory on Homelessness, York University, Toronto, Ontario, Canada
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27
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Kia H, MacKinnon KR, Abramovich A, Bonato S. Peer support as a protective factor against suicide in trans populations: A scoping review. Soc Sci Med 2021; 279:114026. [PMID: 34010778 DOI: 10.1016/j.socscimed.2021.114026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/19/2021] [Accepted: 05/07/2021] [Indexed: 11/19/2022]
Abstract
RATIONALE There is a growing body of research involving transgender (trans) individuals that foregrounds elevated rates of suicidality in trans populations. Although peer support is increasingly studied as a protective factor against suicide among trans persons, the scholarship in this area continues to be limited and has yet to be synthesized and appraised. OBJECTIVE In this paper, we address this existing gap in the literature by presenting the results of a scoping review of the literature examining the significance and function of peer support in mitigating suicide risk in trans populations. METHODS This scoping review is based on an analysis of 34 studies that were included following the execution of a methodical search and selection process. Drawing on scoping review methodology, along with PRISMA-P guidelines, we selected peer-reviewed empirical works, published between 2000 and 2020, which examined relationships between providing, seeking, and/or receiving peer support and suicide risk in trans populations. RESULTS Our findings, which are conceptualized using the minority stress model as a guiding theoretical framework, reveal that while the literature generally substantiates the protective significance of peer support for trans persons, a small body of work also uncovers novel and unanticipated sources of peer support, including social support offered by trans peers online, which are infrequently and inconsistently examined in this body of scholarship. CONCLUSIONS Using our appraisal of the literature, we outline the need for future research to further elucidate the significance and function of peer support in protecting against suicide among trans persons. In particular, we discuss the need for exploratory inquiry to inform a conceptualization and operationalization of peer support that more fully and consistently accounts for how such support (including online and community-based support) is sought, received, and experienced among trans persons in the context of suicide.
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Affiliation(s)
- Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, Canada.
| | | | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Sarah Bonato
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
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MacKinnon KR, Kia H, Rai N, Abramovich A, Cheung JJH. Integrating trans health knowledge through instructional design: preparing learners for a continent - not an island - of primary care with trans people. Educ Prim Care 2021; 32:198-201. [PMID: 33568022 DOI: 10.1080/14739879.2021.1882885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In recent years the need to teach primary care providers to better care for transgender and non-binary (trans) patients has garnered significant scholarly and public attention. The alarming why motivating this surge in trans health primary care education has already been firmly established and needs no further comment. Instead, we offer new perspectives on how to do trans health primary care education. From treasured 'trans 101' educational interventions to trans health 'clinical pearls', the prevailing model used to teach primary care learners represents time-limited cultural competency-based education, which we argue creates an isolated education 'island'. In rethinking this approach, we present an introduction to the concepts of knowledge integration and the transfer of learning and apply them to show how trans health knowledge and skills should be structured within existing curricula to support effective learning and application. These instructional design considerations have yet to be extensively explored when teaching primary care learners trans health content and may be critical to building pedagogy that ultimately improves healthcare delivery. We conclude that trans health - and trans patients themselves - must not be treated as an isolated education island of knowledge and practice. Rather, it is the responsibility of educators to design instruction that encourages learners to integrate this knowledge with foundational principles of primary care; building bridges across a continent of primary care practice landscapes in turn.
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Affiliation(s)
| | - Hannah Kia
- School of Social Work, The University of British Columbia
| | - Nanky Rai
- Parkdale Queen West Community Health Centre & Temerty Faculty of Medicine, University of Toronto
| | - Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health & Dalla Lana School of Public Health, University of Toronto
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Kinitz DJ, Salway T, Dromer E, Giustini D, Ashley F, Goodyear T, Ferlatte O, Kia H, Abramovich A. The scope and nature of sexual orientation and gender identity and expression change efforts: a systematic review protocol. Syst Rev 2021; 10:14. [PMID: 33419475 PMCID: PMC7796537 DOI: 10.1186/s13643-020-01563-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/17/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sexual orientation and gender identity and expression change efforts (SOGIECE) are a set of scientifically discredited practices that aim to deny and suppress the sexual orientations, gender identities, and/or gender expressions of sexual and gender minorities (SGM). SOGIECE are associated with significant adverse health and social outcomes. SOGIECE continue to be practiced around the world, despite denouncements from professional bodies and survivors, as well as calls for legislative advocacy to prohibit SOGIECE and protect SGM. There are substantial gaps in the availability of consolidated international research to support and refine legislative proposals related to SOGIECE, including those currently underway to enforce bans in Canada and elsewhere. We therefore propose the first systematic review of international data on SOGIECE that will outline the scope and nature of these practices worldwide. Specifically, we aim to estimate how many SGM have been exposed to SOGIECE, which sub-groups of SGM experience higher rates of SOGIECE, and how estimates of SOGIECE vary over time and place. In addition, we aim to describe when, where, how, and under what circumstances SGM are exposed to SOGIECE. METHODS To locate an interdisciplinary swath of papers, nine (9) bibliographic databases will be searched: Medline (OVID), Embase (OVID), PsycInfo and Social Work Abstracts via EBSCO, CINAHL, Web of Science Core Collection, LGBTQ+ Source, and Proquest Dissertations & Theses Global and Sociology Collection (ProQuest). A gold standard search will be developed for Medline and adapted to the other databases. Grey literature will be searched at relevant websites, and reference harvesting will be performed in relevant SOGIECE scientific consensus statements. Two authors will independently screen abstracts/titles, screen full texts, abstract data, and apply risk of bias assessments. A narrative synthesis will be implemented to summarize findings. DISCUSSION This review will address the gap in synthesized data regarding the prevalence of SOGIECE, social correlates of SOGIECE, variations of SOGIECE over time and place, and the circumstances, settings, and time-points of SOGIECE exposure. Findings from this review will directly inform ongoing and new legislative efforts to ban SOGIECE and other interventions that aim to stem SOGIECE practices and support SOGIECE survivors. SYSTEMATIC REVIEW REGISTRATION Registration with PROSPERO can be found under the registration number: CRD42020196393 .
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Affiliation(s)
- David J Kinitz
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall 10506; 8888 University Dr., Burnaby, B.C., V5A 1S6, Canada. .,British Columbia Centre for Disease Control, Vancouver, Canada. .,Centre for Gender and Sexual Health Equity, Vancouver, Canada.
| | - Elisabeth Dromer
- Université de Montréal, Montréal, Canada.,Centre de recherche en santé publique, Montreal, Canada
| | - Dean Giustini
- University of British Columbia Biomedical Branch Library, Vancouver, Canada
| | | | - Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Olivier Ferlatte
- Université de Montréal, Montréal, Canada.,Centre de recherche en santé publique, Montreal, Canada
| | - Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, Canada
| | - Alex Abramovich
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
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Abstract
IMPORTANCE Transgender individuals experience stigma, discrimination, and socioeconomic disadvantages, leading to a myriad of poor health outcomes and high rates of disease burden; however, transgender health continues to be an understudied area. OBJECTIVE To examine sociodemographic characteristics, health conditions, and health service utilization patterns among transgender individuals compared with the general population. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of 2085 transgender individuals from 3 large cities in Ontario, Canada, compared characteristics and health service use among transgender individuals with the general population in the province. Transgender individuals were identified through data obtained from 4 outpatient community and hospital clinics, which were linked with health administrative data between January 2012 and December 2016. Data were analyzed between October 2018 and May 2020. Individuals were age-matched 1:5 to a random 5% sample of the general Ontario population (10 425 individuals). MAIN OUTCOMES AND MEASURES Sociodemographic variables, health service use, and chronic conditions among transgender individuals and the general population were compared. RESULTS This study included a sample of 2085 transgender individuals with a mean (SD) age of 30.40 (12.81) years; 771 (37.0%) identified as transgender women. Compared with 10 425 cisgender controls, trangender individuals were more likely to live in lower-income neighborhoods (lowest-income quintile: 625 [30.0%] vs 2197 [21.1%]; P < .001) and experience chronic physical and mental health conditions, including higher rates of asthma (489 [23.5%] vs 2034 [19.5%]; P < .001), diabetes (115 [5.5%] vs 352 [3.4%]; P < .001), chronic obstructive pulmonary disease (51 [2.4%] vs 156 [1.5%]; P < .001), and HIV (34 [1.6%] vs 12 [0.1%]; P < .001). Comorbid chronic health conditions were higher among the transgender population compared with the cisgender population (702 [33.7%] vs 2941 [28.2%]; P < .001). Transgender individuals also had higher health service use compared with the general population, particularly for mental health and self-harm, including mean (SD) number of psychiatrist visits between January 2012 and December 2016 (8.25 [23.13] vs 0.93 [9.57]; standardized difference, 5.84). CONCLUSIONS AND RELEVANCE This study found higher rates of mental and physical comorbidities and higher health service use among transgender individuals compared with cisgender individuals. Further research should explore reasons for these findings. Clinicians caring for transgender individuals should be aware of the high potential for mental health issues and self-harm.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York, United Kingdom
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tara Kiran
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Quality Business Unit, Ontario Health, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Lori E. Ross
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abramovich A, Lam JSH, Chowdhury M. A transgender refugee woman experiencing posttraumatic stress disorder symptoms and homelessness. CMAJ 2020; 192:E9-E11. [PMID: 31907229 DOI: 10.1503/cmaj.190974] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Alex Abramovich
- Dalla Lana School of Public Health (Abramovich); Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health; Centre for Addiction and Mental Health (Lam); Department of Psychiatry (Lam), University of Toronto; Parkdale Queen West Community Health Centre (Chowdhury), Toronto, Ont.
| | - June Sing Hong Lam
- Dalla Lana School of Public Health (Abramovich); Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health; Centre for Addiction and Mental Health (Lam); Department of Psychiatry (Lam), University of Toronto; Parkdale Queen West Community Health Centre (Chowdhury), Toronto, Ont
| | - Muna Chowdhury
- Dalla Lana School of Public Health (Abramovich); Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health; Centre for Addiction and Mental Health (Lam); Department of Psychiatry (Lam), University of Toronto; Parkdale Queen West Community Health Centre (Chowdhury), Toronto, Ont
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Affiliation(s)
- June Sing Hong Lam
- Department of Psychiatry (Lam); Dalla Lana School of Public Health (Abramovich), University of Toronto; Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health, Toronto, Ont
| | - Alex Abramovich
- Department of Psychiatry (Lam); Dalla Lana School of Public Health (Abramovich), University of Toronto; Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health, Toronto, Ont.
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Abramovich A. Features of molecular light scattering and structure of the chlorobenzene–o-dichlorobenzene solutions. Struct Chem 2019. [DOI: 10.1007/s11224-019-01293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pinto AD, Aratangy T, Abramovich A, Devotta K, Nisenbaum R, Wang R, Kiran T. Routine collection of sexual orientation and gender identity data: a mixed-methods study. CMAJ 2019; 191:E63-E68. [PMID: 30665975 PMCID: PMC6336479 DOI: 10.1503/cmaj.180839] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sexual orientation and gender identity are key social determinants of health, but data on these characteristics are rarely routinely collected. We examined patients' reactions to being asked routinely about their sexual orientation and gender identity, and compared answers to the gender identity question against other data in the medical chart on gender identity. METHODS We analyzed data on any patient who answered at least 1 question on a routinely administered sociodemographic survey between Dec. 1, 2013, and Mar. 31, 2016. We also conducted semistructured interviews with 27 patients after survey completion. RESULTS The survey was offered to 15 221 patients and 14 247 (93.6%) responded to at least 1 of the sociodemographic survey questions. Most respondents answered the sexual orientation (90.6%) and gender identity (96.1%) questions. Many patients who had been classified as transgender or gender diverse in their medical chart did not self-identify as transgender, but rather selected female (22.9%) or male (15.4%). In the semistructured interviews, many patients expressed appreciation at the variety of options available, although some did not see their identities reflected in the options and some felt uncomfortable answering the questions. INTERPRETATION We found a high response rate to questions about sexual orientation and gender identity. Fitting with other research, we suggest using a 2-part question to explore gender identity. Future research should evaluate the acceptability and feasibility of administering these questions in a variety of care settings. These data can help organizations identify health inequities related to sexual orientation and gender identity.
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Affiliation(s)
- Andrew D Pinto
- The Upstream Lab (Pinto), Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Kiran), Faculty of Medicine and Dalla Lana School of Public Health (Pinto, Abramovich, Nisenbaum), University of Toronto; Centre for Urban Health Solutions (Aratangy, Devotta, Nisenbaum, Wang, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health; Health Quality Ontario (Kiran), Toronto, Ont.
| | - Tatiana Aratangy
- The Upstream Lab (Pinto), Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Kiran), Faculty of Medicine and Dalla Lana School of Public Health (Pinto, Abramovich, Nisenbaum), University of Toronto; Centre for Urban Health Solutions (Aratangy, Devotta, Nisenbaum, Wang, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health; Health Quality Ontario (Kiran), Toronto, Ont
| | - Alex Abramovich
- The Upstream Lab (Pinto), Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Kiran), Faculty of Medicine and Dalla Lana School of Public Health (Pinto, Abramovich, Nisenbaum), University of Toronto; Centre for Urban Health Solutions (Aratangy, Devotta, Nisenbaum, Wang, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health; Health Quality Ontario (Kiran), Toronto, Ont
| | - Kim Devotta
- The Upstream Lab (Pinto), Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Kiran), Faculty of Medicine and Dalla Lana School of Public Health (Pinto, Abramovich, Nisenbaum), University of Toronto; Centre for Urban Health Solutions (Aratangy, Devotta, Nisenbaum, Wang, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health; Health Quality Ontario (Kiran), Toronto, Ont
| | - Rosane Nisenbaum
- The Upstream Lab (Pinto), Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Kiran), Faculty of Medicine and Dalla Lana School of Public Health (Pinto, Abramovich, Nisenbaum), University of Toronto; Centre for Urban Health Solutions (Aratangy, Devotta, Nisenbaum, Wang, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health; Health Quality Ontario (Kiran), Toronto, Ont
| | - Ri Wang
- The Upstream Lab (Pinto), Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Kiran), Faculty of Medicine and Dalla Lana School of Public Health (Pinto, Abramovich, Nisenbaum), University of Toronto; Centre for Urban Health Solutions (Aratangy, Devotta, Nisenbaum, Wang, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health; Health Quality Ontario (Kiran), Toronto, Ont
| | - Tara Kiran
- The Upstream Lab (Pinto), Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Department of Family and Community Medicine (Pinto, Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Pinto, Kiran), Faculty of Medicine and Dalla Lana School of Public Health (Pinto, Abramovich, Nisenbaum), University of Toronto; Centre for Urban Health Solutions (Aratangy, Devotta, Nisenbaum, Wang, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; Institute for Mental Health Policy Research (Abramovich), Centre for Addiction and Mental Health; Health Quality Ontario (Kiran), Toronto, Ont
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Kiran T, Davie S, Singh D, Hranilovic S, Pinto AD, Abramovich A, Lofters A. Cancer screening rates among transgender adults: Cross-sectional analysis of primary care data. Can Fam Physician 2019; 65:e30-e37. [PMID: 30674526 PMCID: PMC6347308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare rates of cervical, breast, and colorectal cancer screening between patients who are transgender and those who are cisgender (ie, nontransgender). DESIGN Cross-sectional study. SETTING A multisite academic family health team in Toronto, Ont, serving more than 45 000 enrolled patients. PARTICIPANTS All patients enrolled in the family health team who were eligible for cervical, breast, or colorectal cancer screening. Patients were identified as transgender using an automated search of the practice electronic medical record followed by manual audit. MAIN OUTCOME MEASURES Screening rates for cervical, breast, and colorectal cancer calculated using data from the electronic medical record and provincial cancer screening registry. Screening rates among the transgender and cisgender populations were compared using 2 tests, and logistic regression modeling was used to understand differences in screening after adjustment for age, neighbourhood income quintile, and number of primary care visits. RESULTS A total of 120 transgender patients were identified as eligible for cancer screening. More than 85% of transgender patients eligible for breast cancer screening were assigned male at birth. Transgender patients were less likely than cisgender patients (n = 20 514) were to be screened for cervical (56% vs 72%, P = .001; adjusted odds ratio [OR] of 0.39; 95% CI 0.25 to 0.62), breast (33% vs 65%, P < .001; adjusted OR = 0.27; 95% CI 0.12 to 0.59), and colorectal cancer (55% vs 70%, P = .046; adjusted OR = 0.50; 95% CI 0.26 to 0.99). CONCLUSION In this setting, transgender patients were less likely to receive recommended cancer screening compared with the cisgender population. Future research and quality improvement activities should aim to understand and address potential patient, provider, and system factors.
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Affiliation(s)
- Tara Kiran
- Staff physician and clinician investigator in the Department of Family and Community Medicine at St Michael's Hospital and the University of Toronto in Ontario, Fidani Chair in Improvement and Innovation and Vice-Chair of Quality and Innovation in the Department of Family and Community Medicine at the University of Toronto, and Associate Scientist in the Centre for Urban Health Solutions.
| | - Sam Davie
- Quality Improvement and Decision Support Specialist in the Department of Family and Community Medicine at St Michael's Hospital at the time of writing
| | - Dhanveer Singh
- Medical student in the School of Medicine at the Royal College of Surgeons in Ireland in Dublin
| | - Sue Hranilovic
- Primary health care nurse practitioner in the Department of Family and Community Medicine at St Michael's Hospital
| | - Andrew D Pinto
- Founder and director of the Upstream Lab at the Centre for Urban Health Solutions in the Li Ka Shing Knowledge Institute at St Michael's Hospital, a family physician and public health and preventive medicine specialist in the Department of Family and Community Medicine at St Michael's Hospital, and Assistant Professor in the Department of Family and Community Medicine and Assistant Professor (status only) in the Dalla Lana School of Public Health at the University of Toronto
| | - Alex Abramovich
- Independent scientist at the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health and Assistant Professor at the Dalla Lana School of Public Health at the University of Toronto
| | - Aisha Lofters
- Scientist at the Centre for Urban Health Solutions in the Li Ka Shing Knowledge Institute at St Michael's Hospital, a staff physician in the Department of Family and Community Medicine at St Michael's Hospital, Assistant Professor and Clinician Scientist in the Department of Family and Community Medicine at the University of Toronto, Adjunct Scientist at ICES, and Assistant Professor in the Dalla Lana School of Public Health
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Logie CH, Abramovich A, Schott N, Levermore K, Jones N. Navigating stigma, survival, and sex in contexts of social inequity among young transgender women and sexually diverse men in Kingston, Jamaica. Reprod Health Matters 2018; 26:72-83. [PMID: 30475167 DOI: 10.1080/09688080.2018.1538760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Social inequities, including stigma, criminalisation of same-sex practices, and poverty, elevate HIV exposure among young transgender women and sexually diverse men in Jamaica. Yet the ways transgender women and sexually diverse men in Jamaica navigate sex and HIV in contexts of social inequity are underexplored. The study objective was to explore experiences and perceptions of sexual decision-making and HIV risk among young (aged 18-30) sexually diverse men and transgender women in Kingston, Jamaica. We conducted a community-based qualitative study in Kingston that involved in-depth individual interviews (transgender women: n = 20; sexually diverse men: n = 20), 2 focus groups (transgender women: n = 8; sexually diverse men: n = 10) and 13 key informant interviews. Focus groups and interviews were digitally recorded, transcribed verbatim, and analysed with a thematic approach. Findings suggest that transgender women and sexually diverse men in Kingston are aware of, and managing survival challenges and HIV risks in contexts of social inequity. Daily survival challenges include stigma and a lack of human rights protections that contributed to barriers to employment, housing, healthcare, education, and exposure to violence. Challenges maintaining sexual relationships included the need to hide for safety, often resulting in difficulties forming lasting relationships. These survival and relationship challenges converged to lower self-esteem and self-acceptance. In the face of these challenges, participants navigated sexual risk and pleasure. Findings provide insight into agency and sexual decision-making processes in contexts of social inequities. Findings can inform multi-level strategies to promote social equity, sexual health, and HIV prevention with young transgender women and sexually diverse men in Jamaica.
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Affiliation(s)
- Carmen H Logie
- a Associate Professor, Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada.,b Adjunct Scientist, Women's College Research Institute , Women's College Hospital , Toronto , ON , Canada
| | - Alex Abramovich
- c Independent Scientist , Centre for Addiction and Mental Health , Toronto , ON , Canada
| | - Nicole Schott
- d Doctoral Candidate, Ontario Institute for Studies in Education (OISE) , University of Toronto , Toronto , ON , Canada
| | - Kandasi Levermore
- e Executive Director , Jamaica AIDS Support for Life , Kingston , Jamaica
| | - Nicolette Jones
- f Research Coordinator , Jamaica AIDS Support for Life , Kingston , Jamaica
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Logie CH, Abramovich A, Schott N, Levermore K, Jones N. Navigating stigma, survival, and sex in contexts of social inequity among young transgender women and sexually diverse men in Kingston, Jamaica. Reprod Health Matters 2018; 26:72-83. [PMID: 30475167 DOI: 10.1080/09688080.09682018.01538760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Social inequities, including stigma, criminalisation of same-sex practices, and poverty, elevate HIV exposure among young transgender women and sexually diverse men in Jamaica. Yet the ways transgender women and sexually diverse men in Jamaica navigate sex and HIV in contexts of social inequity are underexplored. The study objective was to explore experiences and perceptions of sexual decision-making and HIV risk among young (aged 18-30) sexually diverse men and transgender women in Kingston, Jamaica. We conducted a community-based qualitative study in Kingston that involved in-depth individual interviews (transgender women: n = 20; sexually diverse men: n = 20), 2 focus groups (transgender women: n = 8; sexually diverse men: n = 10) and 13 key informant interviews. Focus groups and interviews were digitally recorded, transcribed verbatim, and analysed with a thematic approach. Findings suggest that transgender women and sexually diverse men in Kingston are aware of, and managing survival challenges and HIV risks in contexts of social inequity. Daily survival challenges include stigma and a lack of human rights protections that contributed to barriers to employment, housing, healthcare, education, and exposure to violence. Challenges maintaining sexual relationships included the need to hide for safety, often resulting in difficulties forming lasting relationships. These survival and relationship challenges converged to lower self-esteem and self-acceptance. In the face of these challenges, participants navigated sexual risk and pleasure. Findings provide insight into agency and sexual decision-making processes in contexts of social inequities. Findings can inform multi-level strategies to promote social equity, sexual health, and HIV prevention with young transgender women and sexually diverse men in Jamaica.
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Affiliation(s)
- Carmen H Logie
- a Associate Professor, Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
- b Adjunct Scientist, Women's College Research Institute , Women's College Hospital , Toronto , ON , Canada
| | - Alex Abramovich
- c Independent Scientist , Centre for Addiction and Mental Health , Toronto , ON , Canada
| | - Nicole Schott
- d Doctoral Candidate, Ontario Institute for Studies in Education (OISE) , University of Toronto , Toronto , ON , Canada
| | - Kandasi Levermore
- e Executive Director , Jamaica AIDS Support for Life , Kingston , Jamaica
| | - Nicolette Jones
- f Research Coordinator , Jamaica AIDS Support for Life , Kingston , Jamaica
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Affiliation(s)
- Alex Abramovich
- 1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario.,2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Kristin Cleverley
- 3 Lawrence S. Bloomberg Faculty of Nursing and Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Ontario.,4 Centre for Addiction and Mental Health, Toronto, Ontario
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Shelton J, Wagaman MA, Small L, Abramovich A. I'm more driven now: Resilience and resistance among transgender and gender expansive youth and young adults experiencing homelessness. Int J Transgend 2017. [DOI: 10.1080/15532739.2017.1374226] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Jama Shelton
- Silberman School of Social Work, Hunter College, New York, NY, USA
| | - M. Alex Wagaman
- School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
| | - Latoya Small
- Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Abstract
This study examined the experiences that lesbian, gay, bisexual, transgender, queer, questioning, and two-spirit (LGBTQ2S) homeless youth have in shelters and the disjunctures that occur for this population in Toronto's shelter system. The attitudes and behaviors of shelter workers and management toward LGBTQ2S youth were also explored. A critical action research approach, informed by critical ethnography and institutional ethnography was employed. Thirty-three people participated in this study in the Greater Toronto Area. The study triangulated data from interviews, focus groups, observations, and document analysis. The systemic enactment of homophobia, transphobia, and hegemonic masculinity are often normalized in shelters and create significant barriers to safe, accessible, and supportive services for LGBTQ2S youth. Excessive bureaucratic regulation and the lack of necessary bureaucratic regulation in highly significant areas play a key role in creating the disjunctures that occur for LGBTQ2S youth in shelters.
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Affiliation(s)
- Alex Abramovich
- a Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research , Toronto , Ontario , Canada
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Domachevsky L, Rachmany L, Barak Y, Rubovitch V, Abramovich A, Pick CG. Hyperbaric oxygen-induced seizures cause a transient decrement in cognitive function. Neuroscience 2013; 247:328-34. [PMID: 23732232 DOI: 10.1016/j.neuroscience.2013.05.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 05/10/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
Hyperbaric oxygen-induced seizures are classified as brief, generalized tonic-clonic seizures. They are believed to cause no residual cognitive damage, although this has not been investigated in depth. In the present study, we examined whether hyperbaric oxygen-induced seizures cause impairment of behavioral and cognitive abilities. Cognitive status was assessed using four behavioral tests: Y-maze, novel object recognition, the elevated plus maze, and a passive avoidance task. Three time intervals were examined: 24h, and 7 and 30 days after the seizures. We found transient impairment of performance in the compressed group on three tests (the novel object recognition paradigm, the Y-maze paradigm, and the passive avoidance task). On the elevated plus maze test, the impairment persisted. The time interval to the appearance of deficits and to eventual recovery was not the same for the different tests. We conclude that hyperbaric oxygen-induced seizures result in transient impairment of performance on behavioral tests in a mouse model. Further investigation is required to establish the mechanism and location of injury, and to determine whether the performance decrement on the elevated plus maze test represents permanent damage or transient damage with slow resolution. These new findings should be taken into account when planning hyperbaric oxygen treatments, to ensure that the chosen protocol is therapeutic yet minimizes the risk of CNS oxygen toxicity.
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Affiliation(s)
- L Domachevsky
- Israel Naval Medical Institute, IDF Medical Corps, Box 89, Rambam Health Care Campus, PO Box 9602, 3109601 Haifa, Israel.
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Katsenelson K, Arieli R, Arieli Y, Abramovich A, Feinsod M, Tal D. Hyperbaric oxygen pretreatment according to the gas micronuclei denucleation hypothesis reduces neurologic deficit in decompression sickness in rats. J Appl Physiol (1985) 2009; 107:558-63. [DOI: 10.1152/japplphysiol.91557.2008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
During sudden or too rapid decompression, gas is released within supersaturated tissues in the form of bubbles, the cause of decompression sickness. It is widely accepted that these bubbles originate in the tissue from preexisting gas micronuclei. Pretreatment with hyperbaric oxygen (HBO) has been hypothesized to shrink the gas micronuclei, thus reducing the number of emerging bubbles. The effectiveness of a new HBO pretreatment protocol on neurologic outcome was studied in rats. This protocol was found to carry the least danger of oxygen toxicity. Somatosensory evoked potentials (SSEPs) were chosen to serve as a measure of neurologic damage. SSEPs in rats given HBO pretreatment before a dive were compared with SSEPs from rats not given HBO pretreatment and SSEPs from non-dived rats. The incidence of abnormal SSEPs in the animals subjected to decompression without pretreatment (1,013 kPa for 32 min followed by decompression) was 78%. In the pretreatment group (HBO at 304 kPa for 20 min followed by exposure to 1,013 kPa for 33 min and decompression) this was significantly reduced to 44%. These results call for further study of the pretreatment protocol in higher animals.
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Arieli R, Boaron E, Abramovich A. Combined effect of denucleation and denitrogenation on the risk of decompression sickness in rats. J Appl Physiol (1985) 2009; 106:1453-8. [PMID: 19228988 DOI: 10.1152/japplphysiol.91146.2008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We previously hypothesized that the number of bubbles emerging on decompression from a dive, and the resultant risk of decompression sickness (DCS), may be reduced by a process whereby effective gas micronuclei that might otherwise have formed bubbles on decompression are shrunk and eliminated. In a procedure defined by us as denucleation, exposure to hyperbaric oxygen (HBO) would result in oxygen replacing the resident gas in the micronuclei, to be subsequently consumed by the mitochondria when the oxygen pressure is reduced. Support for the validity of our hypothesis may be found in our previous studies on the transparent prawn and the reduction of DCS in the rat. In all of these studies, HBO pretreatment was given before supersaturation with inert gas at high pressure. The purpose of the present study was to compare DCS outcome in rats that underwent nitrogen washout (denitrogenation) alone (9 min O2 at 507 kPa) after exposure to air at high pressure (33 min at 1,266 kPa), and rats treated by both procedures (denitrogenation + denucleation; 8 min of O2 breathing followed by 5 min air breathing, both at 507 kPa) after high-pressure air exposure. This was done with the same nitrogen load in both groups before the final decompression (a nitrogen pressure of 467 kPa in fatty and 488 kPa in aqueous tissue). Six of 20 rats in the denitrogenation + denucleation group died, compared with 13 in the denitrogenation group ( P < 0.03). Three rats in the denitrogenation + denucleation group suffered mild DCS, recovering completely within 2 h of decompression. The present study indicates an advantage in considering both denitrogenation and denucleation before decompression. This may have practical application before escape from a disabled submarine, when aborting a technical dive, or in the preparation of aviators for high altitude.
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Kundel Y, Brenner R, Abramovich A, Purim O, Peled N, Idelevich E, Nisenbaum B, Fenig E, Sulkes A, Brenner B. Prognostic factors for tumor histological response to preoperative chemoradiation in rectal cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Glow discharge plasma, derived from direct-current gas breakdown, is investigated in order to realize an inexpensive terahertz (THz) room-temperature detector. Preliminary results for THz radiation show that glow discharge indicator lamps as room-temperature detectors yield good responsivity and noise-equivalent power. Development of a focal plane array (FPA) using such devices as detectors is advantageous since the cost of a glow discharge detector is approximately $0.2-$0.5 per lamp, and the FPA images will be diffraction limited. The detection mechanism of the glow discharge detector is found to be the enhanced diffusion current, which causes the glow discharge detector bias current to decrease when exposed to THz radiation.
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Affiliation(s)
- A Abramovich
- Department of Electrical and Electronic Engineering, Ariel University Center of Samaria, Ariel, Israel.
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Arieli R, Svidovsky P, Abramovich A. Decompression sickness in the rat following a dive on trimix: recompression therapy with oxygen vs. heliox and oxygen. J Appl Physiol (1985) 2006; 102:1324-8. [PMID: 17194730 DOI: 10.1152/japplphysiol.01195.2006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Trimix (a mixture of helium, nitrogen, and oxygen) has been used in deep diving to reduce the risk of high-pressure nervous syndrome during compression and the time required for decompression at the end of the dive. There is no specific recompression treatment for decompression sickness (DCS) resulting from trimix diving. Our purpose was to validate a rat model of DCS on decompression from a trimix dive and to compare recompression treatment with oxygen and heliox (helium-oxygen). Rats were exposed to trimix in a hyperbaric chamber and tested for DCS while walking in a rotating wheel. We first established the experimental model, and then studied the effect of hyperbaric treatment on DCS: either hyperbaric oxygen (HBO) (1 h, 280 kPa oxygen) or heliox-HBO (0.5 h, 405 kPa heliox 50%-50% followed by 0.5 h, 280 kPa oxygen). Exposure to trimix was conducted at 1,110 kPa for 30 min, with a decompression rate of 100 kPa/min. Death and most DCS symptoms occurred during the 30-min period of walking. In contrast to humans, no permanent disability was found in the rats. Rats with a body mass of 100-150 g suffered no DCS. The risk of DCS in rats weighing 200-350 g increased linearly with body mass. Twenty-four hours after decompression, death rate was 40% in the control animals and zero in those treated immediately with HBO. When treatment was delayed by 5 min, death rate was 25 and 20% with HBO and heliox, respectively.
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Affiliation(s)
- R Arieli
- Israel Naval Medical Institute, POB 8040, Haifa 31080, Israel.
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Arieli R, Arieli Y, Daskalovic Y, Eynan M, Abramovich A. CNS oxygen toxicity in closed-circuit diving: signs and symptoms before loss of consciousness. Aviat Space Environ Med 2006; 77:1153-7. [PMID: 17086769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION There is a dearth of information regarding CNS oxygen toxicity accidents in closed-circuit oxygen diving. The aims of the present study were to report the sensations and symptoms that accompany CNS oxygen toxicity accidents, and to evaluate whether loss of consciousness can occur without any warning signs. METHODS We documented 36 CNS oxygen toxicity accidents in closed-circuit oxygen diving. The full accident inquiry included the first report from the diving unit, an interview of the victim and his buddy by the researchers, and an examination of the diving equipment. RESULTS The symptoms that appeared before termination of a dive, as reported by the victim or his buddy, were as follows (in descending order of frequency): limb convulsions; hyperventilation; difficulty maintaining a steady depth; headache; and visual disturbances. The symptoms that appeared after detachment from the mouthpiece were, in descending order of frequency: headache; loss of consciousness; confusion; weakness; dizziness; and facial muscle twitching and limb convulsions. A high inspired CO2 [mean 4.2 kPa (29.9 mmHg)] was connected with loss of consciousness. No dive was terminated before at least two symptoms (mean 3.4) had been noted a minimum of 5 min before termination. DISCUSSION Symptoms that are accepted as being related to CNS oxygen toxicity, as well as others such as headache, difficulty maintaining a steady depth, hyperventilation, weakness, and a choking sensation, were more frequent among the O2 accident victims compared with divers who did not interrupt their dives. CONCLUSION Awareness of any unusual sensation can prevent a potentially dangerous situation from arising.
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Affiliation(s)
- R Arieli
- Israel Naval Medical Institute, IDF Medical Corps, Haifa, Israel.
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Berdichevsky Y, Zemel R, Bachmatov L, Abramovich A, Koren R, Sathiyamoorthy P, Golan-Goldhirsh A, Tur-Kaspa R, Benhar I. A novel high throughput screening assay for HCV NS3 serine protease inhibitors. J Virol Methods 2003; 107:245-55. [PMID: 12505640 DOI: 10.1016/s0166-0934(02)00255-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hepatitis C virus (HCV) infection is a major worldwide health problem, causing chronic hepatitis, liver cirrhosis and primary liver cancer (Hepatocellular carcinoma). HCV encodes a precursor polyprotein that is enzymatically cleaved to release the individual viral proteins. The viral non-structural proteins are cleaved by the HCV NS3 serine protease. NS3 is regarded currently as a potential target for anti-viral drugs thus specific inhibitors of its enzymatic activity should be of importance. A prime requisite for detailed biochemical studies of the protease and its potential inhibitors is the availability of a rapid reliable in vitro assay of enzyme activity. A novel assay for measurement of HCV NS3 serine protease activity was developed for screening of HCV NS3 serine protease potential inhibitors. Recombinant NS3 serine protease was isolated and purified, and a fluorometric assay for NS3 proteolytic activity was developed. As an NS3 substrate we engineered a recombinant fusion protein where a green fluorescent protein is linked to a cellulose-binding domain via the NS5A/B site that is cleavable by NS3. Cleavage of this substrate by NS3 results in emission of fluorescent light that is easily detected and quantitated by fluorometry. Using our system we identified NS3 serine protease inhibitors from extracts obtained from natural Indian Siddha medicinal plants. Our unique fluorometric assay is very sensitive and has a high throughput capacity making it suitable for screening of potential NS3 serine protease inhibitors.
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Affiliation(s)
- Yevgeny Berdichevsky
- Department of Molecular Microbiology and Biotechnology, The George S. Wise Faculty of Life Sciences, Green Building, Room 202, Tel-Aviv University, 69978, Ramat Aviv, Israel
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Arbel M, Abramovich A, Eichenbaum AL, Gover A, Kleinman H, Pinhasi Y, Yakover IM. Superradiant and stimulated superradiant emission in a prebunched beam free-electron maser. Phys Rev Lett 2001; 86:2561-2564. [PMID: 11289980 DOI: 10.1103/physrevlett.86.2561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2000] [Revised: 11/27/2000] [Indexed: 05/23/2023]
Abstract
An electron beam, prebunched at the synchronous free-electron laser frequency and passing through a magnetic undulator, emits coherent (superradiant) synchrotron undulator radiation at the bunching frequency. If an external electromagnetic wave is introduced into the interaction region, at the same frequency and at a proper phase, the radiation process will be stimulated (stimulated prebunched beam radiation). We report first experimental measurements of stimulated superradiant emission in a prebunched free-electron maser. Measurements are in good agreement with theory.
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Affiliation(s)
- M Arbel
- Department of Physical Electronics, Tel-Aviv University, Israel
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