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Grewal A, Hepburn KJ, Lear SA, Adshade M, Card KG. The impact of housing prices on residents' health: a systematic review. BMC Public Health 2024; 24:931. [PMID: 38561729 PMCID: PMC10983630 DOI: 10.1186/s12889-024-18360-w] [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: 08/04/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Rising housing prices are becoming a top public health priority and are an emerging concern for policy makers and community leaders. This report reviews and synthesizes evidence examining the association between changes in housing price and health outcomes. METHODS We conducted a systematic literature review by searching the SCOPUS and PubMed databases for keywords related to housing price and health. Articles were screened by two reviewers for eligibility, which restricted inclusion to original research articles measuring changes in housing prices and health outcomes, published prior to June 31st, 2022. RESULTS Among 23 eligible studies, we found that changes in housing prices were heterogeneously associated with physical and mental health outcomes, with multiple mechanisms contributing to both positive and negative health outcomes. Income-level and home-ownership status were identified as key moderators, with lower-income individuals and renters experience negative health consequences from rising housing prices. This may have resulted from increased stress and financial strain among these groups. Meanwhile, the economic benefits of rising housing prices were seen to support health for higher-income individuals and homeowners - potentially due to increased wealth or perception of wealth. CONCLUSIONS Based on the associations identified in this review, it appears that potential gains to health associated with rising housing prices are inequitably distributed. Housing policies should consider the health inequities born by renters and low-income individuals. Further research should explore mechanisms and interventions to reduce uneven economic impacts on health.
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Affiliation(s)
- Ashmita Grewal
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr. , Burnaby, BC, V5A 1S6, Canada.
| | - Kirk J Hepburn
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr. , Burnaby, BC, V5A 1S6, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr. , Burnaby, BC, V5A 1S6, Canada
| | - Marina Adshade
- Vancouver School of Economics, University of British Columbia, Vancouver, BC, Canada
| | - Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr. , Burnaby, BC, V5A 1S6, Canada
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Are EB, Card KG, Colijn C. The role of vaccine status homophily in the COVID-19 pandemic: a cross-sectional survey with modelling. BMC Public Health 2024; 24:472. [PMID: 38355444 PMCID: PMC10868109 DOI: 10.1186/s12889-024-17957-5] [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: 06/05/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Vaccine homophily describes non-heterogeneous vaccine uptake within contact networks. This study was performed to determine observable patterns of vaccine homophily, as well as the impact of vaccine homophily on disease transmission within and between vaccination groups under conditions of high and low vaccine efficacy. METHODS Residents of British Columbia, Canada, aged ≥ 16 years, were recruited via online advertisements between February and March 2022, and provided information about vaccination status, perceived vaccination status of household and non-household contacts, compliance with COVID-19 prevention guidelines, and history of COVID-19. A deterministic mathematical model was used to assess transmission dynamics between vaccine status groups under conditions of high and low vaccine efficacy. RESULTS Vaccine homophily was observed among those with 0, 2, or 3 doses of the vaccine. Greater homophily was observed among those who had more doses of the vaccine (p < 0.0001). Those with fewer vaccine doses had larger contact networks (p < 0.0001), were more likely to report prior COVID-19 (p < 0.0001), and reported lower compliance with COVID-19 prevention guidelines (p < 0.0001). Mathematical modelling showed that vaccine homophily plays a considerable role in epidemic growth under conditions of high and low vaccine efficacy. Furthermore, vaccine homophily contributes to a high force of infection among unvaccinated individuals under conditions of high vaccine efficacy, as well as to an elevated force of infection from unvaccinated to suboptimally vaccinated individuals under conditions of low vaccine efficacy. INTERPRETATION The uneven uptake of COVID-19 vaccines and the nature of the contact network in the population play important roles in shaping COVID-19 transmission dynamics.
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Affiliation(s)
- Elisha B Are
- Mathematics, Simon Fraser University, Burnaby, BC, Canada.
- Pacific Institute On Pathogens, Pandemics and Society (PIPPS), Simon Fraser University, Burnaby, BC, Canada.
| | - Kiffer G Card
- Pacific Institute On Pathogens, Pandemics and Society (PIPPS), Simon Fraser University, Burnaby, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Institute for Social Connection, Victoria, BC, Canada
| | - Caroline Colijn
- Mathematics, Simon Fraser University, Burnaby, BC, Canada
- Pacific Institute On Pathogens, Pandemics and Society (PIPPS), Simon Fraser University, Burnaby, BC, Canada
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Yuen AWH, Sang JM, Wang L, Barath J, Lachowsky NJ, Lal A, Elefante J, Hart TA, Skakoon-Sparling S, Grey C, Grace D, Cox J, Lambert G, Noor SW, Apelian H, Parlette A, Card KG, Hull MW, Jollimore J, Moore DM. Attitudes of Gay, Bisexual, and Other Men Who Have Sex with Men (GBM) toward Their Use of Amphetamine-Type Stimulants and Relation to Reducing Use in Three Canadian Cities. Subst Use Misuse 2023; 59:278-290. [PMID: 37867395 DOI: 10.1080/10826084.2023.2269577] [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] [Indexed: 10/24/2023]
Abstract
BACKGROUND We explored attitudes of gay, bisexual, and other men who have sex with men (GBM) toward their amphetamine-use and associations with reduced use over time. METHODS We recruited sexually-active GBM aged 16+ years in Montreal, Toronto, and Vancouver, Canada, from 02-2017 to 08-2019, with follow-up visits every 6-12 months until November 2020. Among participants who reported past-six-month (P6M) amphetamine-use at enrollment, we used logistic regression to identify demographic, psychological, social, mental health, other substance-use, and behavioral factors associated with reporting needing help reducing their substance-use. We used mixed-effects logistic regression to model reduced P6M amphetamine-use with perceived problematic-use as our primary explanatory variable. RESULTS We enrolled 2,449 GBM across sites. 15.5-24.7% reported P6M amphetamine-use at enrollment and 82.6 - 85.7% reported needing no help or only a little help in reducing their substance use. Reporting needing a lot/of help or completely needing help in reducing substance-use was associated with group sex participation (AOR = 2.35, 95%CI:1.25-4.44), greater anxiety symptomatology (AOR = 2.11, 95%CI:1.16-3.83), greater financial strain (AOR = 1.35, 95%CI:1.21-1.50), and greater Escape Motive scores (AOR = 1.07, 95%CI:1.03-1.10). Reductions in P6M amphetamine-use were less likely among GBM who perceived their amphetamine-use as problematic (AOR = 0.17 95% CI 0.10 - 0.29). CONCLUSIONS Most amphetamine-using GBM did not feel they needed help reducing their substance use, and many reported reduced amphetamine-use at subsequent visits. Those who perceived their use as problematic were less likely to reduce their use. Further interventions to assist GBM in reducing their use are needed to assist those who perceive their use as problematic.
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Affiliation(s)
| | - Jordan M Sang
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- University of Victoria, Victoria, BC, Canada
- Community-Based Research Centre, Vancouver, BC, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Trevor A Hart
- Toronto Metropolitan University, Toronto, ON, Canada
- University of Toronto, ON, Canada
| | | | | | | | - Joseph Cox
- McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Gilles Lambert
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Syed W Noor
- Toronto Metropolitan University, Toronto, ON, Canada
- Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | - Herak Apelian
- McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | | | - Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- University of Victoria, Victoria, BC, Canada
- Simon Fraser University, Burnaby, BC, Canada
| | - Mark W Hull
- University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - David M Moore
- University of British Columbia, Vancouver, BC, Canada
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Card KG, Grewal A, Closson K, Martin G, Baracaldo L, Allison S, Kruger DJ, Walsh Z. Therapeutic Potential of Psilocybin for Treating Psychological Distress among Survivors of Adverse Childhood Experiences: Evidence on Acceptability and Potential Efficacy of Psilocybin Use. J Psychoactive Drugs 2023:1-11. [PMID: 37815125 DOI: 10.1080/02791072.2023.2268640] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Survivors of adverse childhood experience are at elevated risk for psychological distress. In recent years, renewed interest in psychedelic medicine has highlighted the therapeutic potential of psilocybin for those who have experienced childhood adversity. However, recreational psilocybin use remains illegal and access to approved therapies is difficult. Such use provides an opportunity to explore the therapeutic potential of psilocybin for psychological distress among people with adverse childhood experiences. Therefore, we conducted an online survey to assess interest in, acceptability of, and experiences with psilocybin. We further explored whether the association between Adverse Childhood Experiences Questionnaire (ACEQ) scores and psychological distress was lower among those who had used psilocybin in the past three months. Results showed high levels of interest in and acceptability of psilocybin that did not differ across ACEQ scores. Results also showed that the effect of adverse childhood experiences on psychological distress was lower for people who had recently used psilocybin (p = .019). Taken together, these findings suggest that psilocybin therapy may be potentially acceptable and may feasibly help in supporting survivors of adverse childhood experiences with particularly strong benefits to those with more severe childhood adversity.
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Affiliation(s)
- Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Ashmita Grewal
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Kalysha Closson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Gina Martin
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | | | - Sandra Allison
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Daniel J Kruger
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Zach Walsh
- Department of Psychology, University of British Columbia, Vancouver, Canada
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Martin G, Cosma A, Roswell T, Anderson M, Treble M, Leslie K, Card KG, Closson K, Kennedy A, Gislason M. Measuring negative emotional responses to climate change among young people in survey research: A systematic review. Soc Sci Med 2023; 329:116008. [PMID: 37329721 DOI: 10.1016/j.socscimed.2023.116008] [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: 02/06/2023] [Revised: 05/14/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Climate change is a threat to the mental and emotional wellbeing of all humans, but young people are particularly vulnerable. Emerging evidence has found that young people's awareness of climate change and the danger it poses to the planet can lead to negative emotions. To increase our understanding about this, survey instruments are needed that measure the negative emotions young people experience about climate change. RESEARCH QUESTIONS (1) What survey instruments are used to measure negative emotional responses to climate change in young people? (2) Do survey instruments measuring young people's negative emotional responses to climate change have evidence of reliability and validity? (3) What factors are associated with young people's negative emotional responses to climate change? METHODS A systematic review was conducted by searching seven academic databases on November 30, 2021, with an update on March 31, 2022. The search strategy was structured to capture three elements through various keywords and search terms: (1) negative emotions, (2) climate change, and (3) surveys. RESULTS A total of 43 manuscripts met the study inclusion criteria. Among the 43 manuscripts, 28% focused specifically on young people, while the other studies included young people in the sample but did not focus exclusively on this population. The number of studies using surveys to examine negative emotional responses to climate change among young people has increased substantially since 2020. Survey instruments that examined worry or concern about climate change were the most common. CONCLUSION Despite growing interest in climate change emotions among young people, there is a lack of research on the validity of measures of such emotions. Further efforts to develop survey instruments geared to operationalize the emotions that young people are experiencing in relation to climate change are needed.
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Affiliation(s)
- Gina Martin
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada; Department of Geography & Environment, Western University, London, Canada.
| | - Alina Cosma
- Department of Sociology, Trinity College Dublin, Dublin, Ireland; Sts Cyril and Methodius Faculty of Theology, Olomouc University Social Health Institute, Palacky University in Olomouc, Olomouc, Czech Republic
| | - Tasha Roswell
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - Martin Anderson
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - Matthew Treble
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - Kathleen Leslie
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Kalysha Closson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; Center on Gender Equity and Health, University of California, San Diego, San Diego, CA, United States
| | - Angel Kennedy
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Maya Gislason
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Skakoon-Sparling S, Card KG, Novick JR, Berlin GW, Lachowsky NJ, Adam B, Brennan DJ, Sang JM, Noor SW, Cox J, Moore DM, Grace D, Grey C, Daroya E, Hart TA. The relevance of communal altruism for sexual minority men in contemporary contexts. J Community Psychol 2023; 51:1461-1478. [PMID: 35932490 DOI: 10.1002/jcop.22923] [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] [Received: 03/25/2022] [Revised: 06/17/2022] [Accepted: 07/24/2022] [Indexed: 05/23/2023]
Abstract
There are many reasons why individuals engage in prosocial behavior; communal sexual altruism is based on the notion that some practice safer sex in the interest of promoting the well-being of their community/in-group. Given that definitions of what constitutes "safer sex" have changed with advances in human immunodeficiency virus (HIV) prevention, we investigated the importance of communal sexual altruism (herein "altruism") among urban gay, bisexual, and other sexual minority men (GBM) in the contemporary context. Using a sample of 2449 GBM we examined the association of both safer-sex-related attitudes (e.g., HIV treatment optimism-skepticism) and behaviors (e.g., condomless anal sex [CAS]) with altruism scores. Higher altruism scores were associated with a lower likelihood of CAS and a greater frequency of discussing HIV status with new partners. These findings demonstrate that many GBM are motivated to engage in several kinds of behaviors that improve the well-being of their in-group (i.e., the GBM community).
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Affiliation(s)
- Shayna Skakoon-Sparling
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
| | - Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jake R Novick
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
| | - Graham W Berlin
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Barry Adam
- Department of Sociology, Anthropology, and Criminology, University of Windsor, Windsor, Ontario, Canada
| | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Syed W Noor
- Department of Kinesiology & Health Science, Louisiana State University Shreveport, Shreveport, Louisiana, USA
| | - Joseph Cox
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
- Direction régionale de santé publique de Montréal, Montreal, Quebec, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cornel Grey
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Emerich Daroya
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Trevor A Hart
- Department of Psychology, Toronto Metropolitan University (formerly Ryerson), Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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7
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Stein O, Sang JM, Wang L, Cui Z, Zhu J, Lal A, Card KG, Lachowsky NJ, Hogg R, Moore DM. Factors associated with improvements in symptoms of anxiety and depression among gay, bisexual and other men who have sex with men (gbMSM) in Vancouver, Canada: A prospective cohort study. J Affect Disord 2023; 328:334-340. [PMID: 36806593 DOI: 10.1016/j.jad.2023.02.048] [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] [Received: 06/01/2022] [Revised: 01/27/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Depression and anxiety are commonly experienced among gay, bisexual and other men-who-have-sex-with-men (gbMSM). We explored factors associated with improvements in mental health symptoms among gbMSM with abnormal depression and anxiety scores over a period of four years, in Vancouver, Canada. METHODS Sexually active gbMSM ≥16 years of age were recruited using respondent-driven sampling from February 2012 to February 2015. Participants completed a computer-assisted questionnaire which included the Hospital Anxiety and Depression Scale (HADS), and psychometric scales to measure loneliness, self-esteem and social connectedness, every 6 months until July 2019. Generalized linear mixed models were used to assess factors associated with normal/borderline HADS scores (<11) following a previous abnormal score (≥11) for each of anxiety and depression subscales. RESULTS We recruited 694 participants, of whom 580 had at least one follow-up visit. Across all visits, 43.6 % of participants ever had abnormal anxiety scores and 16.2 % ever had abnormal depression scores. Among those with abnormal anxiety scores, 34.9 % of follow-up visits demonstrated reductions in anxiety scores. Among those with abnormal depression scores 51.0 % of follow-up visits demonstrated reductions in depression scores. Reductions in anxiety scores were associated with increased self-esteem, decreased loneliness and the number of gbMSM seen/spoken to in the previous month. Reductions in depression scores were associated with increased self-esteem, decreased loneliness and having a regular partner. CONCLUSION Improvements in mental health symptoms were frequently observed. Social connectedness was related with improved anxiety and depression symptoms. Interventions to improve social connectedness may help to improve mental health for gbMSM.
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Affiliation(s)
- Olivia Stein
- Faculty of Land and Food Systems, University of British Columbia, Canada
| | - Jordan M Sang
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lu Wang
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Zishan Cui
- Faculty of Medicine, University of British Columbia, Canada
| | - Julia Zhu
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Allan Lal
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kiffer G Card
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Nathan J Lachowsky
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Robert Hogg
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Medicine, University of British Columbia, Canada.
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Dharma C, Guimond T, Salway T, Lachowsky NJ, Card KG, Gesink D. Geosexual Archetype, Preventive Behaviours, and Sexually Transmitted Infections among High Risk Men who Have Sex with Men. Sex Transm Dis 2023:00007435-990000000-00196. [PMID: 37074320 DOI: 10.1097/olq.0000000000001819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Social geography plays an important role in transmission of sexually transmitted infections (STIs) among men who have sex with men (MSMs). Previous qualitative work had identified seven "geosexual archetypes", each with distinct travel patterns for sex and potentially important differences in STI rates. The objective of this paper was to explore what could be learned about STI transmission by looking at STI prevention strategies (condom use and PrEP use) and prevalence of STIs among these geosexual archetypes. METHODS We analyzed data from the Sex Now 2019 online survey in Canada. MSM who reported 3 or more partners in the past 6 months were included in the analysis (n = 3,649). RESULTS The most common archetype was "geoflexible" (sex at home, partner's home, and other places; 35.6%), followed by "privates" (sex only at own/partner's home; 23.0%); the least common archetypes was "rover" (sex not at home nor partner's place; 4.0%). There were significant variations in both STI prevention strategies and prevalence of bacterial STIs in the past-year by geosexual archetype. In particular, among those who were HIV negative, those who reported a geoflexible archetype and used PrEP but did not use condoms consistently had a 52.6% prevalence of bacterial STIs, which was much higher compared to all other groups. Within other archetypes, those living with HIV had the highest prevalence of bacterial STIs. CONCLUSIONS Geosexual archetype together with participant's STI prevention strategies was a strong predictor of bacterial STI risk. Understanding how place is connected to bacterial STIs is key in prevention as individuals do not live in isolation.
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Affiliation(s)
- Christoffer Dharma
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tim Guimond
- Department of Psychiatry, Faculty of Medicine, University of Toronto
| | | | | | - Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Card KG, Shen T, Barath J, Sang J, Lal A, Moore DM, Lachowsky NJ. Patterns of Event-Level Concurrent Substance Use During Sex Among Gay, Bisexual, and Other Men Who Have Sex with Men in Metro Vancouver. AIDS Behav 2023:10.1007/s10461-023-04036-w. [PMID: 36943600 DOI: 10.1007/s10461-023-04036-w] [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] [Accepted: 03/05/2023] [Indexed: 03/23/2023]
Abstract
This study identified patterns of sexualized substance use among gay, bisexual, and other men who have sex with men (gbMSM) and examined associated risk factors for sexually transmitted and blood borne infections (STBBI). Data were from a longitudinal cohort recruited using respondent-driven sampling between Feb-2017 and Feb-2019. Participants reported on events with up to five of their most recent sexual partners. Latent class analysis examined patterns of concurrent substance use 2 h prior to or during sex. Multinomial regression identified demographic, partner-level, and event-level factors associated across 11,877 sexual events reported by 757 participants. Most combinations of substance use were rare, but most drugs were frequently combined with other drugs when they were used prior to or during a sexual event. Six latent classes of concurrent event-level substance use were identified. The referent class (58.8% of events) was characterized by limited use of any drugs. The Common Drug Use class (12.1%) was characterized by use of alcohol, cannabis, and poppers and the Licit Drug Use class (21.6%) was characterized by use of alcohol alone. The Party 'N' Play (PnP) class (2.3%) was characterized by use of crystal methamphetamine GHB, Poppers, and Erectile Drugs; The Multi-use (3.5%) class was characterized by the PnP substances plus alcohol and ecstasy; and the Cannabis + class was characterized by use of Cannabis, Erectile Drugs, and Ecstasy. Relative to the referent class, all other classes were associated with events with more behavioural and network risk factors for STBBIs-highlighting the need for harm reduction interventions for gbMSM who use these drugs.
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Affiliation(s)
- Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
| | - Tian Shen
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jordan Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
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Moebes ZR, Card KG, Koenig B, Benoit C. Lower-risk substance use guidelines accessible by youth. Subst Abuse Treat Prev Policy 2023; 18:10. [PMID: 36782291 PMCID: PMC9926657 DOI: 10.1186/s13011-023-00516-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Lower-risk substance use guidelines (LRSUGs) are an evidence-based harm reduction strategy used to provide information to people who use drugs so they can reduce harms associated with substance use. OBJECTIVES This study aimed to identify LRSUGs accessible to youth and to characterize the recommendations within these guidelines. The overall goal is to identify gaps in current LRSUGs and to inform researchers and policymakers of the kinds of health information youth can access. METHODS We conducted a digital assessment using the Google search engine to identify LRSUGs that could be identified by youth when searching for official sources of information related to commonly used substances, including cannabis, caffeine, alcohol, hallucinogens, prescription opioids, nicotine, and/or prescription stimulants. LRSUGs were coded and data were extracted from them to identify gaps. RESULTS One hundred thirty LRSUGs were identified; most focused on alcohol (n = 40, 31%), cannabis (n = 30, 23%), and caffeine (n = 21, 16%). LRSUGs provided recommendations about dosing (n = 108, 83%), frequency of use (n = 72, 55%), and when to use (n = 86, 66%). Most LRSUGs were published by health (n = 51, 39%) and third-sector organizations (n = 41, 32%), followed by provincial/state (n = 18, 14%), government (n = 14, 11%), municipal (n = 4, 3%), and academic (n = 2, 2%) sources. Only 16% (n = 21) of LRSUGs were youth-specific and one-quarter (n = 32, 25%) of LRSUGs provided gender-specific recommendations. Most guidelines featured information on short (n = 76, 58%) and long-term (n = 69, 53%) negative effectives and positive effects of substances (n = 56, 43%). Less than half (n = 50, 38%) of LRSUGs cited evidence in support of the information they provided. CONCLUSIONS We identified several areas in the current LRSUGs for youth that need to be addressed. Among the gaps are a lack of LRSUGs developed specifically for youth, a lack of youth engagement in developing harm reduction strategies centered around them, and a lack of evidence-based LRSUGs. Youth-oriented, evidence-based LRSUGs are needed to better support youth who use substances and help them manage the negative effects of substance use.
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Affiliation(s)
- Zakkaery R. Moebes
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, BC Victoria, Canada
| | - Kiffer G. Card
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, BC Victoria, Canada
- grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - Brett Koenig
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, BC Victoria, Canada
| | - Cecilia Benoit
- grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, BC Victoria, Canada
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11
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Closson K, Nicholson V, Lee M, McLinden T, Cassidy-Matthews C, G Card K, E Marziali M, Trigg J, Wang L, Parashar S, S G Montaner J, Gibbs A, Hart TA, Kaida A, Hogg RS. Associations between psychosocial factors and antiretroviral therapy outcomes differ by gender and sexual orientation among people living with HIV in British Columbia, Canada. AIDS Care 2023; 35:296-305. [PMID: 36169492 DOI: 10.1080/09540121.2022.2126959] [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] [Indexed: 10/14/2022]
Abstract
Little is known about how the co-occurrence of psychosocial factors affect sub-populations of people living with HIV (PLWH). We used cross-sectional data from 999 PLWH, aged ≥19, accessing antiretroviral therapy (ART) in British Columbia, Canada (2007-2010) to examine associations between psychosocial factors and ART-related outcomes separately for trans/cis inclusive women; heterosexual men; and gay, bisexual, and other men who have sex with men (gbMSM). Multivariable logistic regression examined associations between psychosocial factors (0-3): any violence in the past 6 months, depressive symptoms in the past week, and current street drug use (heroin, crack, meth or speedball) with sub-optimal adherence (outcome 1: average annual ART adherence <95% from interview until end of follow-up, death, or December 31st, 2018) and ever viral rebound (outcome 2) adjusting for potential confounders. Of 999 PLWH (264 women, 382 heterosexual men, and 353 gbMSM), women and heterosexual men had significantly higher median counts than gbMSM. Overall, higher counts were associated with sub-optimal adherence (adjusted odds ratio [aOR] = 1.26/1-unit increase, 95%CI = 1.07-1.49). All effect estimates were of a greater magnitude among gbMSM, but not significant for women or heterosexual men, highlighting the need for population (e.g., gender and sexual orientation)-centered care and research.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Valerie Nicholson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Taylor McLinden
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Kiffer G Card
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Megan E Marziali
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jason Trigg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Surita Parashar
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Andrew Gibbs
- South African Medical Research Council, Gender and Health Unit, Durban, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal (UKZN), Durban, South Africa
| | - Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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12
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Sang JM, Cui Z, Wang L, Bacani N, Lachowsky NJ, Lal A, Card KG, Roth EA, Montaner JSG, Howard T, Hogg RS, Moore DM. Treatment interruptions and community connectedness among gbMSM living with HIV in Metro Vancouver, Canada. AIDS Care 2023; 35:139-147. [PMID: 36345611 DOI: 10.1080/09540121.2022.2142927] [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] [Indexed: 11/10/2022]
Abstract
HIV treatment interruptions are a major public health concern that demonstrate a lack of engagement in care and is detrimental to the health of people living with HIV. Community connectedness have demonstrated a protective effect for psychosocial health but are not well understood for HIV treatment outcomes. We explored associations between community connectedness and treatment interruptions among gay, bisexual and other men who have sex with men (gbMSM) living with HIV in Vancouver, British Columbia. We analyzed survey data from the Momentum Health Study and identified treatment interruptions through data linkages with the provincial HIV Drug Treatment Program as episodes lasting more than 60 days beyond an expected antiretroviral therapy refill date from February 2012 to July 2019. We built a mixed-effects logistic regression model, adjusting for confounders. Of 213 gbMSM living with HIV, 54 experienced treatment interruption (25.4%) over a median five-year follow-up. Multivariable results found the number gbMSM who spoken to in the past month (aOR = 0.995; 95% CI = 0.991, 1.000 (per 100-unit increase)) and attending a gay community meeting more than once per month (aOR = 0.32; 95% CI = 0.11, 0.89) were associated with lower odds of treatment interruptions. These results highlight the importance of social connections in facilitating effective HIV care.
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Affiliation(s)
- Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Nicanor Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kiffer G Card
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Terry Howard
- Momentum Health Study Community Advisory Board, Vancouver, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
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13
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Card KG, Skakoon-Sparling S. Are social support, loneliness, and social connection differentially associated with happiness across levels of introversion-extraversion? Health Psychol Open 2023; 10:20551029231184034. [PMID: 37426942 PMCID: PMC10328046 DOI: 10.1177/20551029231184034] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
This study examines whether extraversion moderates the association between subjective happiness and measures of social connectedness using data from Canadian residents, aged 16+, recruited online during the third wave of the COVID-19 pandemic (21 April 2021-1 June 2021). To accomplish this aim we tested the moderating effect of extraversion scores on the association between Subjective Happiness scores and several social health measures: Perceived Social Support, Loneliness, social network size, and time with friends. Among 949 participants, results show that lower social loneliness (p < .001) and higher social support from friends (p = .001) and from family (p = .007) was more strongly correlated with subjective happiness for people with low extraversion compared to those with high extroversion. Anti-loneliness interventions should consider the need to promote social connections among individuals across the introversion-extraversion continuum.
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Affiliation(s)
- Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- The Institute for Social Connection, Victoria, BC, Canada
| | - Shayna Skakoon-Sparling
- The Institute for Social Connection, Victoria, BC, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
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14
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Dulai JJS, Gilbert M, Lachowsky NJ, Card KG, Klassen B, Dame J, Burchell AN, Worthington C, Ablona A, Anand P, Blaque E, Ryu H, Stewart M, Brennan DJ, Grace D. Acceptability of an existing online sexually transmitted and blood-borne infection testing model among gay, bisexual and other men who have sex with men in Ontario, Canada. Digit Health 2023; 9:20552076231173557. [PMID: 37214661 PMCID: PMC10192952 DOI: 10.1177/20552076231173557] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Objectives Gay, bisexual and other men who have sex with men (GBM) are disproportionately affected by sexually transmitted and blood-borne infections (STBBI) due to stigma and other factors such as structural barriers, which delay STBBI testing in this population. Understanding acceptability of online testing is useful in expanding access in this population, thus we examined barriers to clinic-based testing, acceptability of a potential online testing model, and factors associated with acceptability among GBM living in Ontario. Methods Sex Now 2019 was a community-based, online, bilingual survey of GBM aged ≥15. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated using modified Poisson regression with robust variances. Multivariable modelling was conducted using the Hosmer-Lemeshow-Sturdivant approach. Results Among 1369 participants, many delayed STBBI testing due to being too busy (31%) or inconvenient clinic hours (29%). Acceptability for online testing was high (80%), with saving time (67%) as the most common benefit, and privacy concerns the most common drawback (38%). Statistically significant predictors of acceptability for online testing were younger age (PR = 0.993; 95%CI: 0.991-0.996); a greater number of different sexual behaviours associated with STBBI transmission (PR = 1.031; 95%CI: 1.018-1.044); identifying as an Indigenous immigrant (PR = 1.427; 95%CI: 1.276-1.596) or immigrant of colour (PR = 1.158; 95%CI: 1.086-1.235) compared with white non-immigrants; and currently using HIV pre-exposure prophylaxis (PrEP) compared to not currently using PrEP (PR = 0.894; 95%CI: 0.828-0.965). Conclusions Acceptability of online testing was high among GBM in Ontario. Implementing online STBBI testing may expand access for certain subpopulations of GBM facing barriers to current in-person testing.
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Affiliation(s)
- Joshun JS Dulai
- Dalla Lana School of Public Health,
University of Toronto, Canada
- Community-Based Research
Centre, Canada
| | - Mark Gilbert
- Community-Based Research
Centre, Canada
- Clinical Prevention Services, British
Columbia Centre for Disease Control, Canada
- School of Population and Public Health,
University of British Columbia, Canada
| | - Nathan J Lachowsky
- Community-Based Research
Centre, Canada
- School of Public Health and Social
Policy, University of Victoria, Canada
| | - Kiffer G Card
- Community-Based Research
Centre, Canada
- School of Public Health and Social
Policy, University of Victoria, Canada
| | | | | | - Ann N Burchell
- Dalla Lana School of Public Health,
University of Toronto, Canada
- St. Michael's Hospital, Unity Health Toronto, Canada
- Temerty Faculty of Medicine, University
of Toronto, Canada
| | | | - Aidan Ablona
- Community-Based Research
Centre, Canada
- Clinical Prevention Services, British
Columbia Centre for Disease Control, Canada
| | - Praney Anand
- Dalla Lana School of Public Health,
University of Toronto, Canada
- Alliance for South Asian AIDS
Prevention, Canada
| | - Ezra Blaque
- Dalla Lana School of Public Health,
University of Toronto, Canada
- Factor-Inwentash Faculty of Social Work,
University of Toronto, Canada
| | - Heeho Ryu
- Dalla Lana School of Public Health,
University of Toronto, Canada
| | | | - David J Brennan
- Dalla Lana School of Public Health,
University of Toronto, Canada
- Factor-Inwentash Faculty of Social Work,
University of Toronto, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health,
University of Toronto, Canada
- Community-Based Research
Centre, Canada
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15
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Card KG, Hepburn KJ. Is Neoliberalism Killing Us? A Cross Sectional Study of the Impact of Neoliberal Beliefs on Health and Social Wellbeing in the Midst of the COVID-19 Pandemic. Int J Health Serv 2022:207314221134040. [PMID: 36278290 PMCID: PMC9605858 DOI: 10.1177/00207314221134040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neoliberal ideology is linked to poorer collective health and well-being. At the individual level, however, neoliberal beliefs may actually promote self-efficacy, self-esteem, and self-reliance. We examined the effects of three beliefs underlying neoliberalism—(a) Personal Wherewithal, (b) Natural Competition, and (c) Anti-Government Interference—to understand the unique pathways by which neoliberalism affects health and well-being at the individual level. Participants were recruited using paid advertisements on social media in May/June 2020. Multivariable regression identified associations between each of the three identified neoliberal beliefs and participants’ (a) self-rated physical health, (b) number of health diagnoses, (c) life satisfaction, (d) loneliness, and (e) social trust of family, close friends/partners, coworkers, neighbors, and strangers. Among 2632 respondents, personal wherewithal was associated with better health, life satisfaction, and social well-being (perhaps by promoting self-efficacy and self-reliance to undertake healthy behaviors), while anti-government beliefs were associated with worse life satisfaction and social well-being (perhaps by reducing benefits inherent in collective action and social connection). Those hoping to reduce the negative effects of neoliberalism on collective well-being must contend with the reinforcing effect that personal wherewithal might have in shaping the perceived benefits of neoliberalism among those with these beliefs.
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Affiliation(s)
- Kiffer G. Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Institute for Social Connection, Victoria, Canada
| | - Kirk J. Hepburn
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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16
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Armstrong HL, Gitelman J, Cui Z, Bacani N, Sereda P, Lachowsky NJ, Card KG, Sang JM, Raymond HF, Montaner J, Hall D, Howard T, Hull M, Hogg RS, Roth EA, Moore DM. Virological suppression among gay, bisexual, and other men who have sex with men living with HIV in Vancouver, Canada: A longitudinal cohort study from 2012-2017. PLoS One 2022; 17:e0276596. [PMID: 36269767 PMCID: PMC9586352 DOI: 10.1371/journal.pone.0276596] [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: 01/28/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In 2010, British Columbia (BC) implemented HIV Treatment as Prevention (TasP) as policy. We examined trends in virologic suppression and determinants of significant viremia among a prospective biobehavioural cohort of men who have sex with men (gbMSM) in Vancouver from 2012-2017. METHODS Respondent-driven sampling was used to recruit sexually active gbMSM (≥16 years) who completed biannual study visits with a computer-assisted self-interview and clinical CD4 and viral load (VL) testing. We linked participant data with the BC HIV Drug Treatment Program to obtain antiretroviral dispensing and VL data. We conducted a trend analysis of VL suppression using univariable generalized estimating equation (GEE) multi-level modelling and multivariable GEE to identify factors associated with episodes of VL ≥200 copies/mL. RESULTS Of 774 participants, 223 were living with HIV at baseline and 16 were diagnosed during follow-up (n = 239). We observed a significant trend towards reduced levels of unsuppressed VL (>200 copies/mL) from 22% (07/2012-12/2012) to 12% (07/2016-12/2016) (OR:0.87; 95%CI:0.83-0.91 for each 6-month period). Among those with at least one follow-up visit, (n = 178, median follow-up = 3.2 years, median age = 46.9 years), younger age (aOR:0.97; 95%CI:0.94-0.99, per year), ecstasy use (aOR:1.69; 95%CI:1.13-2.53), crystal methamphetamine use (aOR:1.71; 95%CI:1.18-2.48), seeking sex via websites (aOR:1.46; 95%CI:1.01-2.12), and lower HIV treatment optimism (aOR:0.94; 95%CI:0.90-0.97) were associated with episodes of elevated viremia. CONCLUSIONS During a period when TasP policy was actively promoted, we observed a significant trend towards reduced levels of unsuppressed VL. Continued efforts should promote HIV treatment optimism and engagement, especially among younger gbMSM and those who use ecstasy and crystal methamphetamine.
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Affiliation(s)
- Heather L. Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Psychology, University of Southampton, Southampton, United Kingdom
- * E-mail:
| | | | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Nicanor Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Kiffer G. Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Jordan M. Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Henry F. Raymond
- School of Public Health, Rutgers University, Piscataway, New Jersey, United States of America
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - David Hall
- Immunodeficiency Clinic, St. Paul’s Hospital, Vancouver, Canada
| | - Terry Howard
- Momentum Health Study, Community Advisory Board, Vancouver, Canada
| | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Eric A. Roth
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Anthropology, University of Victoria, Victoria, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
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17
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Card KG, Hepburn K. Social position and economic system justification in Canada: Implications for advancing health equity and social justice from an exploratory study of factors shaping economic system justification. Front Public Health 2022; 10:902374. [PMID: 36339181 PMCID: PMC9633253 DOI: 10.3389/fpubh.2022.902374] [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: 03/23/2022] [Accepted: 10/03/2022] [Indexed: 01/22/2023] Open
Abstract
Objective Many socio-economic reforms that could reduce health disparities are not implemented because people justify existing systems and fear changes thereto. This study aimed to identify socio-demographic factors associated with system justifying beliefs to better understand how they are maintained in Canada. In doing so, we hypothesized that (1) systems justification is a default cognitive position, buttressed by the palliative benefits of system-justification, (2) lack of success in a given system generally motivates people to doubt the legitimacy of that system, and (3) system-justifying beliefs are rejected only when the costs of doing so are low enough and/or the benefits are high enough to outweigh the innate needs-fulfillment benefits of system-justification. Methods Testing these hypotheses, we recruited participants living in Canada, aged 16+, to complete an online survey after being recruited via paid social media advertisements. Multivariable regression models identified factors associated with Economic System Justification Scale (ESJS) scores. Explanatory variables included demographic measures of social position, self-rated health, and patterns of social inclusion. Results Among 2,619 participants, system-justifying beliefs were wide-spread, with the average level of support across ESJS scale items exceeding 50%. Lower ESJS scores were associated with worse health, more loneliness, and lower socioeconomic status. Despite the pattern that marginalization erodes system-justification, several historically marginalized characteristics (e.g., non-white ethnicity and non-binary gender) were associated with relatively high system-justification, compared to matching privileged characteristics (e.g., white ethnicity; masculine gender). Conclusion Supporting our hypotheses, we identify a general trend that social marginalization is associated with less system-justification. Those benefitting from the status quo (e.g., healthier, wealthier, less lonely) were more likely to hold system-justifying beliefs. However, some groups who are disadvantaged within the existing system reported higher system-justification-suggesting that system oppression may be a key moderator of the effect of social position on system justification.
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18
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Martin G, Cosma A, Roswell T, Anderson M, Leslie K, Card KG, Closson K, Kennedy AM, Gislason MK. Measuring negative emotional responses to climate change among young people in survey research: a systematic review protocol. BMJ Open 2022; 12:e062449. [PMID: 36192097 PMCID: PMC9535206 DOI: 10.1136/bmjopen-2022-062449] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/20/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Many young people report experiencing negative emotional responses to their awareness of climate change and the threats it poses to their future. With that, an increasing number of survey instruments have been developed to examine young people's negative emotional responses to their awareness of climate change. This report describes a protocol for a systematic review that aims to identify, synthesise and critically appraise how negative emotional responses to climate change among young people have been measured in survey research. The research questions addressed in this review are: (1) How has negative emotional responses to climate change been defined and measured among young people? (2) How do survey instruments measuring young people's negative emotional responses to climate change vary in terms of reliability and validity? (3) What factors are associated with negative emotional responses to climate change among young people? METHODS AND ANALYSIS Seven academic databases (CINAHL, ERIC, MEDLINE, PsycINFO, Web of Science, Scopus, and Environment Complete) will be searched to retrieve studies published between 1 January 2006 and 31 March 2022 and published in English. Studies including survey instruments that measure negative emotional responses among young people (aged 10-24 years) will be eligible for inclusion. Targeted journals will be hand-searched. This review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines for systematic reviews. The methodological quality, in terms of reliability and validity, of the included studies will be assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist for risk of bias of patient-reported outcome measures. To rate the quality of the instruments, we will use a modified Grading of Recommendations, Assessment, Development and Evaluations technique defined by the COSMIN guidelines. ETHICS AND DISSEMINATION Ethical approval is not applicable for this study. We will disseminate the findings through publication in peer-reviewed journals and presentations. PROSPERO REGISTRATION NUMBER CRD42022295733.
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Affiliation(s)
- Gina Martin
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Alina Cosma
- Department of Sociology, Trinity College Dublin, Dublin, Ireland
- Sts Cyril and Methodius Faculty of Theology, Olomouc University Social Health Institute, Palacky University in Olomouc, Olomouc, Czech Republic
| | - Tasha Roswell
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Martin Anderson
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Kathleen Leslie
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Angel M Kennedy
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Maya K Gislason
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Fonseca-Cuevas A, Nanditha NGA, Shen T, Moore DM, Lachowsky NJ, Card KG, Sang JM, Wang L, Chia J, Duailibe F, Hogg RS, Lima VD. Use of Gay Chatlines and Online Dating Platforms as Potential Mediators or Moderators in the Relationship Between Loneliness, Self-Rated Attractiveness and Human Immunodeficiency Virus Acquisition Risk Among Gay, Bisexual, and Other Men Who Have Sex With Men in Vancouver, Canada. Sex Transm Dis 2022; 49:706-712. [PMID: 35794818 PMCID: PMC9481688 DOI: 10.1097/olq.0000000000001672] [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: 03/15/2022] [Accepted: 06/22/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Gay, bisexual, and other men who have sex with men (gbMSM) remain disproportionately affected by human immunodeficiency virus (HIV). Interaction between psychosocial factors likely plays a role in HIV acquisition risk. We aimed to analyze the association of loneliness and self-rated attractiveness with HIV acquisition risk, and determine whether these associations were mediated by gay telephone chatlines or online dating platforms. METHODS This cross-sectional study included HIV-negative gbMSM 16 years or older enrolled into the Momentum Health Study from February 2012 to February 2015. Loneliness, self-rated attractiveness (exposures) and use of gay chatlines or online dating platforms (mediators) were assessed through self-interviews. Human immunodeficiency virus acquisition risk (outcome) was assessed by the HIV Incidence Risk Index. Weighted logistic regression modeled the association and moderation effect between exposures and outcome. Mediation models estimated 3-way direct effect among exposures, mediators, and outcome. RESULTS Of 542 gbMSM, those who were lonely (adjusted odds ratio [aOR], 1.54; 95% confidence intervals [CI], 1.04-2.28) and attractive (aOR, 1.69; 95% CI, 1.04-2.76) had increased odds for HIV acquisition risk. Our moderation analysis demonstrated a heightened joint effect among lonely and attractive participants (aOR, 1.70; 95% CI, 1.08-2.65). Use of gay telephone chatlines or online dating platforms mediated 30.5% of the association between loneliness and HIV acquisition risk, but did not mediate attractiveness and HIV acquisition risk. CONCLUSIONS Our findings suggest that the provision of interventions focusing on mental health support and safer sex practices through gay telephone chatlines or online dating platforms is promising to help alleviate the HIV burden among gbMSM.
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Affiliation(s)
| | - Ni Gusti Ayu Nanditha
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
- Department of Medicine
| | - Tian Shen
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
| | - David M. Moore
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver
| | - Nathan J. Lachowsky
- Canadian Institute for Substance Use Research
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria
| | - Kiffer G. Card
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Jordan M. Sang
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
| | - Lu Wang
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
| | - Jason Chia
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
| | - Felipe Duailibe
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
- Department of Medicine
| | - Robert S. Hogg
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Viviane D. Lima
- From the Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS
- Department of Medicine
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20
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Riadi I, Kervin L, Dhillon S, Teo K, Churchill R, Card KG, Sixsmith A, Moreno S, Fortuna KL, Torous J, Cosco TD. Digital interventions for depression and anxiety in older adults: a systematic review of randomised controlled trials. Lancet Healthy Longev 2022; 3:e558-e571. [PMID: 36102765 DOI: 10.1016/s2666-7568(22)00121-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 01/15/2023] Open
Abstract
One in five older adults experience symptoms of depression and anxiety. Digital mental health interventions are promising in their ability to provide researchers, mental health professionals, clinicians, and patients with personalised tools for assessing their behaviour and seeking consultation, treatment, and peer support. This systematic review looks at existing randomised controlled trial studies on digital mental health interventions for older adults. Four factors have been found that contributed to the success of digital mental health interventions: (1) ease of use; (2) opportunities for social interactions; (3) having human support; and (4) having the digital mental health interventions tailored to the participants' needs. The findings also resulted in methodological considerations for future randomised controlled trials on digital mental health interventions: (1) having a healthy control group and an intervention group with clinical diagnoses of mental illness; (2) collecting data on the support given throughout the duration of the interventions; (3) obtaining qualitative and quantitative data to measure the success of the interventions; and (4) conducting follow-up interviews and surveys up to 1 year post-intervention to determine the long-term outcomes. The factors that were identified in this systematic review can provide future digital mental health interventions researchers, health professionals, clinicians, and patients with the tools to design, develop, and use successful interventions for older users.
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Affiliation(s)
- Indira Riadi
- Department of Gerontology, Faculty of Arts and Social Sciences, Simon Fraser University, Vancouver, BC, Canada.
| | - Lucy Kervin
- Department of Gerontology, Faculty of Arts and Social Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Sandeep Dhillon
- Department of Gerontology, Faculty of Arts and Social Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Kelly Teo
- Department of Gerontology, Faculty of Arts and Social Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Ryan Churchill
- Department of Gerontology, Faculty of Arts and Social Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Andrew Sixsmith
- Department of Gerontology, Faculty of Arts and Social Sciences, Simon Fraser University, Vancouver, BC, Canada; STAR Institute, Simon Fraser University, Surrey, BC, Canada
| | - Sylvain Moreno
- the School of Interactive Arts and Technology, Simon Fraser University, Surrey, BC, Canada; AGE-WELL National Innovation Hub: Digital Health Circle, Surrey, BC, Canada
| | - Karen L Fortuna
- Geisel School of Medicine, Department of Psychiatry, Dartmouth College, Concord, MA, USA
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Theodore D Cosco
- Department of Gerontology, Faculty of Arts and Social Sciences, Simon Fraser University, Vancouver, BC, Canada; Oxford Institute of Population Ageing, University of Oxford, Oxford, UK; Harper, London, UK
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21
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Card KG, Adshade M, Hogg RS, Jollimore J, Lachowsky NJ. What public health interventions do people in Canada prefer to fund? A discrete choice experiment. BMC Public Health 2022; 22:1178. [PMID: 35698077 PMCID: PMC9189791 DOI: 10.1186/s12889-022-13539-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/04/2021] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To assess public support of tailored and targeted public health interventions for marginalized communities. Methods We conducted a discrete choice experiment using a web-based survey advertised to Facebook and Instagram users living in Canada, aged > 16. Participants were asked to choose between funding two hypothetical public health programs. Each program was described by its purpose; expected increase in life expectancy; and target audience. Demographically weighted generalized linear mixed-effects models were constructed to identify program factors associated with program selection. Results Participants completed up to 8 discrete choice comparison exercises each resulting in 23,889 exercises were completed by 3054 participants. Selected programs were less likely to focus on prevention (vs. treatment). For each 1-year increase in the marginal years of life gained, there was a 15% increase in the odds of a program being selected. Interventions tailored to marginalized communities or targeting stigmatized health conditions were less likely to be selected compared to interventions targeted to the general population or targeting chronic health conditions. Noteworthy exceptions included an increased preference for interventions aligning with the perceived needs or cultural expectations for marginalized communities. Conclusions Stigmatizing perceptions of health conditions and key populations likely influence public health programming preferences of Canadians. Public health implications Informational campaigns highlighting disparities experienced by marginalized populations may improve support for targeted and tailored interventions.
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Affiliation(s)
- Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. .,School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada. .,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada. .,Community-based Research Centre, Vancouver, BC, Canada.
| | - Marina Adshade
- Vancouver School of Economics, University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada.,Community-based Research Centre, Vancouver, BC, Canada
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22
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Card KG. Collectivism, individualism and COVID-19 prevention: a cross sectional study of personality, culture and behavior among Canadians. Health Psychol Behav Med 2022; 10:415-438. [PMID: 35528715 PMCID: PMC9067981 DOI: 10.1080/21642850.2022.2069571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Collectivism has been identified as a protective factor against COVID-19 – perhaps due to increased conformity with social norms regarding prevention behaviors. Other studies have also found that individualism can inspire uptake of preventative behaviors as a means of personal protection. It is possible that these cultural orientations may promote different patterns of prevention (e.g. mask wearing vs. social distancing). Furthermore, existing studies examining the role of individualism and collectivism during the COVID-19 pandemic have frequently failed to account for other psychological processes, including differences in personality, which could help provide a better understanding of the psychological process underlying prevention behavior. Methods Participants were recruited using social media advertisements. The Cultural Orientations Scale measured individualism–collectivism and hierarchism-egalitarianism. The Ten Item Personality Inventory measured the five factor model of personality. Multivariable models, dominance analyses and structural equation mediation tests were used to identify the most important predictors of COVID-19 prevention behavior (i.e. mask-wearing, hand-washing, reducing social interactions, physical distancing, staying at home and social bubbling), controlling for demographic and situational factors. Results Among 774 participants, most (i.e. 60–80%) reported uptake of COVID-19 prevention behaviors. Higher vertical (hierarchical) collectivism was associated with staying at home and higher horizontal (egalitarian) individualism was associated with mask-wearing and reducing social interactions. Neither Vertical Collectivism nor Horizontal Collectivism were significantly associated with any of the prevention behaviors when controlling for personality traits and confounding variables. Agreeableness was identified as a key mediator of the correlation between these cultural orientations on general uptake of COVID-19 prevention behaviors. Conclusions Cultural orientations (e.g. collectivism-individualism, hierarchism-egalitarianism) and personality traits (e.g. Agreeableness) are salient correlates of COVID-19 prevention behaviors and therefore should be accounted for in the development, design and delivery of health promotion messages aiming to increase uptake of these behaviors.
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Affiliation(s)
- Kiffer G. Card
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
- The GenWell Project Society, Toronto, Ont., Canada
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23
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Card KG, Bodner A, Li R, Lail S, Aran N, Grewal A, Skakoon-Sparling S. Loneliness and social support as key contributors to burnout among Canadians workers in the third wave of the COVID-19 pandemic: A cross-sectional study. J Occup Health 2022; 64:e12360. [PMID: 36111392 PMCID: PMC9478518 DOI: 10.1002/1348-9585.12360] [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: 06/26/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 12/02/2022] Open
Abstract
Objective COVID‐19 has dramatically affected Western Society's relationship with work and contributed to increased worker burnout. Existing studies on burnout have mostly emphasized workplace culture, leadership, and employee engagement as key contributors to burnout. In this cross‐sectional study, we examine the associations between Malach‐Pines Short Burnout Measure (MPSBM) scores and participant's self reported personal characteristics, financial strain, workplace conditions, work‐life balance, and social inclusion among Canadians living during the third wave of the COVID‐19 pandemic. Methods To identify the most salient correlates of burnout, Canadian residents, aged 16+, were recruited using paid social media advertisements in French and English to complete a cross‐sectional study. Multivariable linear regression and dominance analysis identified the most salient correlates of MPSBM scores. Exposure variables included demographic factors, financial strain, workplace conditions, work‐life balance, social support, and loneliness. Results Among 486 participants, family social support (adjusted β = −0.14, 95%CI = −0.23, −0.05), emotional loneliness (adjusted β = 0.26, 95% CI = 0.18, 0.35), insufficient sleep (adjusted β = 0.38, 95% CI = 0.16, 0.60) and “me time” (adjusted β = 0.22, 95% CI = 0.03, 0.42), and indicators of financial security (e.g., owning vs renting; adjusted β = −0.36, 95% CI = −0.54, −0.17; insufficient pay: adjusted β = −0.36, 95% CI = −0.54, −0.17) were key burnout indicators. People with a bachelor's degree (vs ≤high school diploma; adjusted β = 0.29, 95% CI = 0.01, 0.58) also had higher burnout scores. Conclusion Interventions addressing workplace culture, leadership, and other proximal workplace stressors, while important, are likely insufficient to meet the needs of workers. Our findings suggest that broader, holistic multicomponent approaches that address multiple upstream dimensions of health—including mental health—are likely necessary to prevent and reduce burnout.
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Affiliation(s)
- Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,The Institute for Social Connection, Toronto, Ontario, Canada
| | - Aidan Bodner
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Richard Li
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Simran Lail
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Niloufar Aran
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Ashmita Grewal
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Shayna Skakoon-Sparling
- Department of Psychology, Toronto Metropolitan University (Formerly Ryerson), Toronto, Ontario, Canada
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24
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Armstrong HL, Sang JM, Skala A, Wang L, Zhu J, Lachowsky NJ, Card KG, Benoit C, Olarewaju G, Hogg RS, Moore DM, Roth EA. Factors associated with transactional sex among a cohort of gay, bisexual, and other men who have sex with men in Vancouver, Canada. Sex Health 2021; 18:487-497. [PMID: 34844666 DOI: 10.1071/sh21128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022]
Abstract
Background Gay, bisexual, and other men who have sex with men (GBM) who engage in transactional sex (sex in exchange for drugs, money, or goods) experience increased risk of sexually transmitted infections (STI), including HIV. This study explored additional psychosocial and health-related factors associated with transactional sex among GBM. Methods Respondent-driven sampling was used to recruit GBM in Vancouver, Canada, from 2012 to 2015, with follow up every 6months until July2019. We examined factors associated with transactional sex using multivariable three-level mixed-effects modelling. Results Among 698 GBM, 22.1% reported ever receiving drugs, money, or goods for sex. Transactional sex was more likely to be reported by GBM who were younger (<30years) and who had lower incomes, less education, and insecure housing. GBM reporting transactional sex were more likely to report substance use (i.e. crystal methamphetamine, poppers, GHB, and non-steroid injection drugs) and higher risk sexual behaviours (i.e. more sex partners, sex party attendance, and condomless anal sex with serodifferent or unknown HIV status partners); however, they were no more likely to be living with HIV or to report a recent bacterial STI diagnosis. GBM who reported higher loneliness, anxiety, and cognitive escape were also more likely to report transactional sex. Conclusions More than one-fifth of GBM in Vancouver reported transactional sex and those who did were more likely to also experience psychosocial stressors, increased substance use, and higher risk sexual behaviours. Programs which consider the interconnections of personal, social, and structural challenges faced by GBM engaging in transactional sex are necessary to support improved mental, physical, and sexual health for these men.
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Affiliation(s)
| | - Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Ales Skala
- University of British Columbia, Vancouver, BC, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Julia Zhu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; and University of Victoria, Victoria, BC, Canada
| | | | | | - Gbolahan Olarewaju
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; and University of British Columbia, Vancouver, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; and Simon Fraser University, Burnaby, BC, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; and University of British Columbia, Vancouver, BC, Canada
| | - Eric A Roth
- University of Victoria, Victoria, BC, Canada
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25
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Card KG, Lachowsky NJ, Hogg RS. Using Google Trends to Inform the Population Size Estimation and Spatial Distribution of Gay, Bisexual, and Other Men Who Have Sex With Men: Proof-of-concept Study. JMIR Public Health Surveill 2021; 7:e27385. [PMID: 34618679 PMCID: PMC8669582 DOI: 10.2196/27385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/04/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background We must triangulate data sources to understand best the spatial distribution and population size of marginalized populations to empower public health leaders to address population-specific needs. Existing population size estimation techniques are difficult and limited. Objective We sought to identify a passive surveillance strategy that utilizes internet and social media to enhance, validate, and triangulate population size estimates of gay, bisexual, and other men who have sex with men (gbMSM). Methods We explored the Google Trends platform to approximate an estimate of the spatial heterogeneity of the population distribution of gbMSM. This was done by comparing the prevalence of the search term “gay porn” with that of the search term “porn.” Results Our results suggested that most cities have a gbMSM population size between 2% and 4% of their total population, with large urban centers having higher estimates relative to rural or suburban areas. This represents nearly a double up of population size estimates compared to that found by other methods, which typically find that between 1% and 2% of the total population are gbMSM. We noted that our method was limited by unequal coverage in internet usage across Canada and differences in the frequency of porn use by gender and sexual orientation. Conclusions We argue that Google Trends estimates may provide, for many public health planning purposes, adequate city-level estimates of gbMSM population size in regions with a high prevalence of internet access and for purposes in which a precise or narrow estimate of the population size is not required. Furthermore, the Google Trends platform does so in less than a minute at no cost, making it extremely timely and cost-effective relative to more precise (and complex) estimates. We also discuss future steps for further validation of this approach.
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Affiliation(s)
- Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Robert S Hogg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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26
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Roth EA, Cui Z, Armstrong HL, Rich AJ, Lachowsky NJ, Sereda P, Card KG, Bacani N, Moore D, Hogg R. Longitudinal Analysis of HIV Risk and Substance Use Patterns for Men Who Have Sex with Men and Women and Men Who Have Sex with Men Only. J Bisex 2021; 21:405-423. [PMID: 35935471 PMCID: PMC9355115 DOI: 10.1080/15299716.2021.1982102] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Men Who Have Sex with Men and Women (MSMW) experience discrimination from same-sex and heterosexual communities partially because of perceptions they feature high-risk sexual behavior, elevated polysubstance use levels, and constitute an HIV bridge population. We used a longitudinal multivariate generalized linear mixed model comparing sexual risk and substance use patterns for Men Who Have Sex with Men Only (MSMO) with MSMW in the same cohort study. Data consisted of 771 men reporting 3,705 sexual partnerships from 2012-2017. For high-risk sexual behavior multivariate results showed non-significant (p>0.05) differences for partner number and commercial sex work, and significantly less (p<0.05) HIV prevalence and condomless anal sex. However, MSMW had significantly higher levels of hallucinogen and prescription opioid use, and substance treatment histories. Only one HIV-positive MSMW had a transmittable viral load, negating the concept of an HIV bridge population. Results indicate the need for additional longitudinal studies comparing MSMO and MSMW.
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Affiliation(s)
- Eric Abella Roth
- Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Heather L Armstrong
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada, University of Southampton, Southampton, United Kingdom
| | - Ashleigh J Rich
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan J Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Nic Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - David Moore
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Robert Hogg
- Faculty of Health Sciences, Simon Fraser University, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
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27
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Aguilera-Mijares S, Sang JM, Wang L, Barath J, Card KG, Lachowsky NJ, Lal A, Roth E, Hogg RS, Moore DM. Variations in Sexual Behaviors by Use of Specific Substances Among Vancouver Gay, Bisexual, and Other Men Who Have Sex with Men: An Event-Level Analysis. Arch Sex Behav 2021; 50:2875-2886. [PMID: 34561794 DOI: 10.1007/s10508-021-02068-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 10/22/2020] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 06/13/2023]
Abstract
Event-level studies measure substance use and sexual behaviors happening during a specific sexual encounter, ensuring that both variables are temporally paired. This study explored the event-level associations between a range of sexual behaviors (masturbation, anal sex, oral sex, rimming, fisting, sex toys, and group sex) and five sexualized substances (poppers, methamphetamine, GHB, ecstasy/MDMA, and ketamine) used during 11,582 sexual events reported by 762 gay, bisexual, and other men who have sex with men (GBMSM) in Vancouver, Canada. Data were obtained from a prospective cohort of GBMSM who self-reported their behaviors via computer-based questionnaires on their last sexual encounter with up to five of their most recent partners in the past six months. These clustered data were analyzed with multivariable generalized linear mixed models. Participants reported popper use in 16.1% of sexual encounters, methamphetamine in 8.6%, gamma-hydroxybutyrate (GHB) in 4.1%, ecstasy/3,4-methylenedioxymethamphetamine (MDMA) in 3.3%, and ketamine in 1.5%. Condomless receptive anal sex (25.0% of events) was associated with increased odds of using poppers, methamphetamine, GHB, and ecstasy/MDMA. Group sex (13.1% of events) and sharing sex toys (2.0% of events) were more likely with the use of all five substances. Receiving money/drugs/goods in exchange for sex (2.5% of events) was associated with increased odds of poppers, methamphetamine, GHB, and ecstasy/MDMA use. GBMSM living with HIV (29.9% of participants) had higher odds of using poppers, methamphetamine, and GHB, but lower odds of using ecstasy/MDMA. In conclusion, these event-level results suggest public health strategies are needed to address the possible negative impacts of sexualized substance use among GBMSM.
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Affiliation(s)
- Santiago Aguilera-Mijares
- Health Services and Systems Innovation, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | - Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada.
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Kiffer G Card
- Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
| | - Eric Roth
- Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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28
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Lo Hog Tian JM, Watson JR, Ibáñez-Carrasco F, Tran B, Parsons JA, Maunder RG, Card KG, Baral S, Hui C, Boni AR, Ajiboye M, Lindsay JD, Rourke SB. Impact of experienced HIV stigma on health is mediated by internalized stigma and depression: results from the people living with HIV stigma index in Ontario. BMC Public Health 2021; 21:1595. [PMID: 34496825 PMCID: PMC8427956 DOI: 10.1186/s12889-021-11596-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background Experiences of HIV stigma remain prevalent across Canada, causing significant stress and negatively affecting the health and wellbeing of people living with HIV. While studies have consistently demonstrated that stigma negatively impacts health, there has been limited research on the mechanisms behind these effects. This study aims to identify which dimensions of stigma have significant relationships with self-rated health and examine the mechanisms by which those types of stigma impact self-rated health. Methods We recruited 724 participants to complete the People Living with HIV Stigma Index in Ontario, designed by people living with HIV to measure nuanced changes in stigma and discrimination. The present study utilizes data from externally validated measures of stigma and health risks that were included in the survey. First, we conducted multiple regression analyses to examine which variables had a significant impact on self-rated health. Results from the multiple regression guided the mediation analysis. A parallel mediation model was created with enacted stigma as the antecedent, internalized stigma and depression as the mediators, and self-rated health as the outcome. Results In the multiple regression analysis, internalized stigma (coefficient = −0.20, p < 0.01) and depression (coefficient = −0.07, p < 0.01) were both significant and independent predictors of health. Mediation analyses demonstrated that the relationship between enacted stigma and self-rated health is mediated in parallel by both internalized stigma [coefficient = −0.08, se = 0.03, 95% CI (−0.14, −0.02)] and depression [coefficient = −0.16, se = 0.03, 95% CI (−0.22, −0.11)]. Conclusions We developed a mediation model to explain how HIV-related stigma negatively impacts health. We found that that enacted stigma, or experiences of prejudice or discrimination, can lead to internalized stigma, or internalization of negative thoughts regarding one’s HIV status and/or increased depressive symptoms which then may lead to worse overall health. Highlighting the importance of internalized stigma and depression has the potential to shape the development of targeted intervention strategies aimed at reducing the burden of stigma and improving the health and wellbeing of people living with HIV.
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Affiliation(s)
- Jason M Lo Hog Tian
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James R Watson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | | | - Billy Tran
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Janet A Parsons
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada.,Department of Physical Therapy and the Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | - Kiffer G Card
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Faculty of Health Sciences, Simon Frasier University, Burnaby, Canada
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA
| | - Christian Hui
- Canadian HIV Stigma Index Steering Committee, Toronto, Canada.,Ontario Positive Asians, Toronto, Canada.,Ryerson University, Toronto, Canada
| | - Anthony R Boni
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Monisola Ajiboye
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada.,International Community of Women Living with HIV, London, UK
| | - Joanne D Lindsay
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Sean B Rourke
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada.
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Nosyk B, Slaunwhite A, Urbanoski K, Hongdilokkul N, Palis H, Lock K, Min JE, Zhao B, Card KG, Barker B, Meilleur L, Burmeister C, Thomson E, Beck-McGreevy P, Pauly B. Evaluation of risk mitigation measures for people with substance use disorders to address the dual public health crises of COVID-19 and overdose in British Columbia: a mixed-method study protocol. BMJ Open 2021; 11:e048353. [PMID: 34108170 PMCID: PMC8190984 DOI: 10.1136/bmjopen-2020-048353] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic was preceded by an ongoing overdose crisis and linked to escalating drug overdose deaths in British Columbia (BC). At the outset of these dual public health emergencies, the BC government announced interim Risk Mitigation Guidance (RMG) that permitted prescribing medication alternatives to substances, including opioids, alcohol, stimulants and benzodiazepines, an intervention sometimes referred to as 'safe supply'. This protocol outlines the approach for a study of the implementation of RMG and its impacts on COVID-19 infection, drug-related and systemic harms, continuity of care for people with substance use disorder (SUD), as well as their behavioural, psychosocial and well-being outcomes. METHODS AND ANALYSIS We conducted a parallel mixed-method study that involved both analysis of population-level administrative health data and primary data collection, including a 10-week longitudinal observational study (target n=200), a cross-sectional survey (target n=200) and qualitative interviews (target n=60). We implemented a participatory approach to this evaluation, partnering with people with lived or living expertise of drug use, and researchers and public health decision-makers across the province. Linked population-level administrative databases will analyse data from a cohort of BC residents with an indication of SUD between 1996 and 2020. We will execute high-dimensional propensity score matching and marginal structural modelling to construct a control group and to assess the impact of RMG dispensation receipt on a collaboratively determined set of primary and secondary outcomes. ETHICS AND DISSEMINATION Study activities were developed to adhere to the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, recommended COVID-19 research practices, and guided by the Truth and Reconciliation Commission's Calls to Action for public health, data governance and research ethics related to Indigenous people. Results will be disseminated incrementally, on an ongoing basis, through the consortium established for this study, then published in peer-reviewed journals.
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Affiliation(s)
- Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Karen Urbanoski
- Canadian Institute for Substance Use Research, Victoria, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Natt Hongdilokkul
- British Columbia Office of the Human Rights Commissioner, Vancouver, British Columbia, Canada
| | - Heather Palis
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Kurt Lock
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jeong E Min
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Bin Zhao
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Kiffer G Card
- Canadian Institute for Substance Use Research, Victoria, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Brittany Barker
- First Nations Health Authority, West Vancouver, British Columbia, Canada
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Louise Meilleur
- First Nations Health Authority, West Vancouver, British Columbia, Canada
| | - Charlene Burmeister
- Professionals for Ethical Engagement of Peers, Vancouver, British Columbia, Canada
| | - Erica Thomson
- BC/Yukon Association of Drug War Survivors, New Westminster, British Columbia, Canada
| | - Phoenix Beck-McGreevy
- BC/Yukon Association of Drug War Survivors, New Westminster, British Columbia, Canada
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, Victoria, British Columbia, Canada
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
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Vallance K, Stockwell T, Wettlaufer A, Giesbrecht N, Chow C, Card KG, Farrell-Low A. Strategies for engaging policy stakeholders to translate research knowledge into practice more effectively: Lessons learned from the Canadian Alcohol Policy Evaluation project. Drug Alcohol Rev 2021; 41:246-255. [PMID: 34046948 DOI: 10.1111/dar.13313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/03/2020] [Revised: 04/19/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Evidence-based alcohol policies have the potential to reduce a wide range of related harms. Yet, barriers to adoption and implementation within governments often exist. Engaging relevant stakeholders may be an effective way to identify and address potential challenges thereby increasing reach and uptake of policy evaluation research and strengthening jurisdictional responses to alcohol harms. METHODS As part of the 2019 Canadian Alcohol Policy Evaluation project, we conducted interviews with government stakeholders across alcohol-related sectors prior to a second round of researcher-led policy assessments in Canada's 13 provinces and territories. Stakeholders were asked for feedback on the design and impact of an earlier policy assessment in 2013 and for recommendations to improve the design and dissemination strategy for the next iteration. Content analysis was used to identify ways of improving stakeholder engagement. RESULTS We interviewed 25 stakeholders across 12 of Canada's 13 jurisdictions, including representatives from government health ministries and from alcohol regulation, distribution and finance departments. In providing feedback on our stakeholder engagement strategy, participants highlighted the importance of maintaining ongoing contact; presenting results in accessible online formats; providing advance notice of results; and offering jurisdiction-specific webinars. DISCUSSION AND CONCLUSIONS This study offers important insight into the engagement preferences of government stakeholders involved in the health, regulation, distribution and financial aspects of alcohol control policy. Findings suggest that seeking input from stakeholders as part of conducting evaluation research is warranted; increasing the relevance, reach and uptake of results. Specific stakeholder engagement strategies are outlined.
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Affiliation(s)
- Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada.,Department of Psychology, University of Victoria, Victoria, Canada
| | - Ashley Wettlaufer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Norman Giesbrecht
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Clifton Chow
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Kiffer G Card
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Amanda Farrell-Low
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
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Lima VD, Zhu J, Card KG, Lachowsky NJ, Chowell-Puente G, Wu Z, Montaner JSG. Can the combination of TasP and PrEP eliminate HIV among MSM in British Columbia, Canada? Epidemics 2021; 35:100461. [PMID: 33984688 DOI: 10.1016/j.epidem.2021.100461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/09/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In British Columbia (BC), the HIV epidemic continues to disproportionally affect the gay, bisexual and other men who have sex with men (MSM). In this study, we aimed to evaluate how Treatment as Prevention (TasP) and pre-exposure prophylaxis (PrEP), if used in combination, could lead to HIV elimination in BC among MSM. METHODS Considering the heterogeneity in HIV transmission risk, we developed a compartmental model stratified by age and risk-taking behaviour for the HIV epidemic among MSM in BC, informed by clinical, behavioural and epidemiological data. Key outcome measures included the World Health Organization (WHO) threshold for disease elimination as a public health concern and the effective reproduction number (Re). Model interventions focused on the optimization of different TasP and PrEP components. Sensitivity analysis was done to evaluate the impact of sexual mixing patterns, PrEP effectiveness and increasing risk-taking behaviour. RESULTS The incidence rate was estimated to be 1.2 (0.9-1.9) per 1000 susceptible MSM under the Status Quo scenario by the end of 2029. Optimizing all aspects of TasP and the simultaneous provision of PrEP to high-risk MSM resulted in an HIV incidence rate as low as 0.4 (0.3-0.6) per 1000 susceptible MSM, and an Re as low as 0.7 (0.6-0.9), indicating that disease elimination was possible when TasP and PrEP were combined. Provision of PrEP to younger MSM or high-risk and younger MSM resulted in a similar HIV incidence rate, but an Re with credible intervals that crossed one. CONCLUSION Further optimizing all aspects of TasP and prioritizing PrEP to high-risk MSM can achieve the goal of disease elimination in BC. These results should inform public health policy development and intervention programs that address the HIV epidemic in BC and in other similar settings where MSM are disproportionately affected.
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Affiliation(s)
- Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Jielin Zhu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Gerardo Chowell-Puente
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA
| | - Zunyou Wu
- Division of HIV Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Sang JM, Cui Z, Sereda P, Armstrong HL, Olarewaju G, Lal A, Card KG, Roth EA, Hogg RS, Moore DM, Lachowsky NJ. Longitudinal Event-Level Sexual Risk and Substance Use among Gay, Bisexual, and Other Men Who Have Sex with Men. Int J Environ Res Public Health 2021; 18:3183. [PMID: 33808675 PMCID: PMC8003364 DOI: 10.3390/ijerph18063183] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 01/19/2023]
Abstract
(1) Background: Condomless anal sex and substance use are associated with STI risk among gay, bisexual, and other men who have sex with men (gbMSM). Our first study objective was to describe event-level sexual risk and substance use trends among gbMSM. Our second study objective was to describe substances associated with event-level sexual risk. (2) Methods: Data come from the Momentum Health Study in Vancouver, British Columbia and participants were recruited from 2012-2015, with follow-up until 2018. Stratified by self-reported HIV status, we used generalized estimating equations to assess trends of sexual event-level substance use and assessed interactions between substance use and time period on event-level higher risk sex defined as condomless anal sex with an HIV serodifferent or unknown status partner. (3) Results: Event-level higher risk anal sex increased across the study period among HIV-negative/unknown (baseline prevalence: 13% vs. study end prevalence: 29%) and HIV-positive gbMSM (baseline prevalence: 16% vs. study end prevalence: 38%). Among HIV-negative/unknown gbMSM, event-level erectile drug use increased, while alcohol use decreased over the study period. Overall, interactions between substance use and time on higher risk anal sex were not statistically significant, regardless of serostatus. However, we found a number of time-specific significant interactions for erectile drugs, poppers, Gamma-hydroxybutyrate (GHB), crystal methamphetamine and ecstasy/MDMA use among HIV-negative/unknown gbMSM. (4) Conclusion: Significant differences in substance use trends and associated risks exist and are varied among gbMSM by serostatus. These findings provide a more comprehensive understanding of the effects of event-level substance use on sexual risk through longitudinal follow-up of nearly six years.
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Affiliation(s)
- Jordan M. Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (Z.C.); (P.S.); (G.O.); (A.L.); or (R.S.H.); (D.M.M.); (N.J.L.)
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (Z.C.); (P.S.); (G.O.); (A.L.); or (R.S.H.); (D.M.M.); (N.J.L.)
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (Z.C.); (P.S.); (G.O.); (A.L.); or (R.S.H.); (D.M.M.); (N.J.L.)
| | | | - Gbolahan Olarewaju
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (Z.C.); (P.S.); (G.O.); (A.L.); or (R.S.H.); (D.M.M.); (N.J.L.)
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (Z.C.); (P.S.); (G.O.); (A.L.); or (R.S.H.); (D.M.M.); (N.J.L.)
| | - Kiffer G. Card
- School of Public Health and Social Policy, University of Victoria, Victoria, BC V8P 5C2, Canada; (K.G.C.); (E.A.R.)
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Eric A. Roth
- School of Public Health and Social Policy, University of Victoria, Victoria, BC V8P 5C2, Canada; (K.G.C.); (E.A.R.)
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (Z.C.); (P.S.); (G.O.); (A.L.); or (R.S.H.); (D.M.M.); (N.J.L.)
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (Z.C.); (P.S.); (G.O.); (A.L.); or (R.S.H.); (D.M.M.); (N.J.L.)
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (Z.C.); (P.S.); (G.O.); (A.L.); or (R.S.H.); (D.M.M.); (N.J.L.)
- School of Public Health and Social Policy, University of Victoria, Victoria, BC V8P 5C2, Canada; (K.G.C.); (E.A.R.)
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 5C2, Canada
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Card KG, St Denis F, Higgins R, Klassen B, Ablona A, Rutherford L, Jollimore J, Ibáñez-Carrasco F, Lachowsky NJ. Who knows about U = U? Social positionality and knowledge about the (un)transmissibility of HIV from people with undetectable viral loads. AIDS Care 2021; 34:753-761. [PMID: 33739198 DOI: 10.1080/09540121.2021.1902928] [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] [Indexed: 10/21/2022]
Abstract
"U = U" is the principle that HIV is untransmittable from people living with an undetectable HIV viral-load. Wide-spread knowledge about U = U is believed to produce public health benefit by reducing HIV-related stigma - promoting wellbeing for people living with HIV. Therefore, we examined the diffusion of U = U with respect to the social position of sexual and gender minority men (SGMM). Participants were SGMM recruited from 16 LGBTQ2S+ pride festivals across Canada. Social position was measured using an index assessing whether participants were (a) trans, (b) a person of colour, (c) Indigenous, (d) born abroad, (e) bisexual or straight, (f) not out, (g) struggling with money, (h) not college educated, (i) and not participating in LGBTQ2S+ Organizations, Queer Pop-ups, or HIV advocacy organizations. Multivariable logistic regression tested whether Index Scores were associated with knowledge about U = U. Among 2681 participants, 72.6% knew about U = U. For HIV-negative/unknown status SGMM, each 1-point increase in Social Positionality Index Scores was associated with a 21% reduction in the odds that they knew about U = U (aOR: 0.79 [0.73, 0.85], per 1-point increase). Results indicate that social marginalization harms the diffusion of HIV-related biomedical knowledge, independent of risk-taking behaviour and other factors.
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Affiliation(s)
- Kiffer G Card
- Community-based Research Centre, Vancouver, BC, Canada.,Faculty of Human and Social Development, School of Public Health and Social Policy, Victoria, BC, Canada
| | - Finn St Denis
- Community-based Research Centre, Vancouver, BC, Canada
| | - Rob Higgins
- Faculty of Human and Social Development, Social Dimensions of Health, Victoria, BC, Canada
| | | | - Aidan Ablona
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Leo Rutherford
- Faculty of Human and Social Development, Social Dimensions of Health, Victoria, BC, Canada
| | | | | | - Nathan J Lachowsky
- Community-based Research Centre, Vancouver, BC, Canada.,Faculty of Human and Social Development, School of Public Health and Social Policy, Victoria, BC, Canada
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Marziali ME, Hogg RS, Oduwole OA, Card KG. Predictors of COVID-19 testing rates: A cross-country comparison. Int J Infect Dis 2021; 104:370-372. [PMID: 33434661 PMCID: PMC7832722 DOI: 10.1016/j.ijid.2020.12.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/26/2020] [Revised: 12/25/2020] [Accepted: 12/29/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Cross-country comparisons of coronavirus disease (COVID-19) have largely been applied to mortality analyses. The goal of this analysis is to explore predictors of COVID-19 testing through cross-country comparisons, to better inform international health policies. METHODS Testing and case-based data were amassed from Our World in Data, and information regarding predictors was gathered from the World Bank. We investigate Human Development Index (HDI), health expenditure, universal health coverage (UHC), urban population, service industry workers (%), and air pollution as predictors. We explored testing data through July 31, 2020, or most recently available, using case-indexing methods, which involve synchronizing countries by date of first reported COVID-19 case as an index date and normalizing to the cumulative tests 25 days post-index date. Three multivariable linear regression models were built in a stepwise fashion to explore the association between the indexed number of COVID-19 tests and HDI scores. RESULTS A total of 86 countries were included in the final analytical sample, excluding countries with missing data. HDI and urban population were found to be significantly associated with testing levels. CONCLUSIONS Results suggest that social conditions and government capacity remain consistently salient in the consideration of testing rates. International efforts to assist low-HDI countries are needed to support the global COVID-19 response.
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Affiliation(s)
- Megan E Marziali
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Robert S Hogg
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, Canada.
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Marziali ME, McLinden T, Card KG, Closson K, Wang L, Trigg J, Salters K, Lima VD, Parashar S, Hogg RS. Social Isolation and Mortality Among People Living with HIV in British Columbia, Canada. AIDS Behav 2021; 25:377-388. [PMID: 32797358 PMCID: PMC7427496 DOI: 10.1007/s10461-020-03000-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Social isolation, a risk factor for poor health within the general population, may be exacerbated by unique challenges faced by people living with HIV (PLHIV). This analysis examines the association between social isolation and all-cause mortality among a cohort of PLHIV experiencing multiple social vulnerabilities. The analytical sample included 936 PLHIV ≥ 19 years, living in British Columbia, Canada, and enrolled in the Longitudinal Investigation into Supportive and Ancillary Health Services (LISA) Study (2007–2010). Participants were classified as Socially Connected (SC), Minimally Isolated (MI) or Socially Isolated (SI) via latent class analysis. Cross-sectional survey data was linked to longitudinal clinical data from a provincial HIV treatment database. Mortality was assessed longitudinally up to and including December 31st, 2017. Through multivariable logistic regression, an association between SI and all-cause mortality was found (adjusted OR: 1.48; 95% CI 1.08, 2.01). These findings emphasize the need to mitigate effects of social isolation among PLHIV.
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Affiliation(s)
- Megan E Marziali
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Taylor McLinden
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kiffer G Card
- Faculty of Human and Social Development, School of Public Health and Social Policy, University of Victoria, Victoria, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Kalysha Closson
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lu Wang
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jason Trigg
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kate Salters
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Viviane D Lima
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Surita Parashar
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Robert S Hogg
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
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Card KG, Sorge J, Klassen B, Higgins R, Tooley L, Ablona A, Jollimore J, Lachowsky NJ. Democratizing Access to Community-Based Survey Findings Through Dynamic Data Visualizations. Arch Sex Behav 2021; 50:119-128. [PMID: 32909142 DOI: 10.1007/s10508-020-01806-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 01/03/2020] [Revised: 07/06/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
OurStats ( https://www.cbrc.net/ourstats ) is a data visualization dashboard developed by the Community-Based Research Centre (CBRC) to increase access to data from the Sex Now surveys-Canada's largest community-based surveillance study of gay and bisexual men. An evaluation of the OurStats dashboard was conducted using an online survey distributed through the CBRC and Advance Alliance-an alliance of Canada's leading HIV and queer men's health organizations. Since being launched in November 2019 (through December 2019), 350 unique visitors used the OurStats Dashboard (5.8 per day). Based on responses from 10 community partners, all respondents said they would probably/definitely use OurStats again and would probably/definitely recommend it to colleagues; nine felt it was much/somewhat better than traditional academic outputs (e.g., poster presentations, journal articles); and seven felt it was much/somewhat better than traditional knowledge translation outputs (e.g., fliers, posters, and social media posts). Respondents said they would use OurStats to identify needs of gay and bisexual men (n = 9), prepare grant/funding applications (n = 9), prepare presentations about Sex Now data (n = 7), and evaluate the impact of local programs (n = 4). Overall, half felt that OurStats was somewhat/extremely easy to use and half felt that it was somewhat difficult to use. The most commonly identified requested improvement was to provide help documentation that explained how each of the display settings changed the visualizations. From these findings, we conclude that dynamic visualizations for community-based survey data are highly feasible and acceptable, provided appropriate support is available to help community partners use these tools.
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Affiliation(s)
- Kiffer G Card
- Community Based Research Centre Society, Vancouver, BC, Canada.
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada.
- Technology Enterprise Facility 291a, University of Victoria, Victoria, BC, V8N 5M8, Canada.
| | - Justin Sorge
- Community Based Research Centre Society, Vancouver, BC, Canada
| | - Ben Klassen
- Community Based Research Centre Society, Vancouver, BC, Canada
| | - Rob Higgins
- Community Based Research Centre Society, Vancouver, BC, Canada
| | - Len Tooley
- Community Based Research Centre Society, Vancouver, BC, Canada
| | - Aidan Ablona
- Community Based Research Centre Society, Vancouver, BC, Canada
| | - Jody Jollimore
- Community Based Research Centre Society, Vancouver, BC, Canada
| | - Nathan J Lachowsky
- Community Based Research Centre Society, Vancouver, BC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
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Selfridge M, Card KG, Lundgren K, Barnett T, Guarasci K, Drost A, Gray-Schleihauf C, Milne R, Degenhardt J, Stark A, Hull M, Fraser C, Lachowsky NJ. Exploring nurse-led HIV Pre-Exposure Prophylaxis in a community health care clinic. Public Health Nurs 2020; 37:871-879. [PMID: 32996157 DOI: 10.1111/phn.12813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/29/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Gay, bisexual, and other men who have sex with men (gbMSM) are 131 times more likely to acquire HIV compared with other Canadian men. Pre-Exposure Prophylaxis (PrEP) for HIV has the potential to reduce or eliminate disparities in HIV acquisition among key affected populations. This paper aims to discuss the feasibility and utility of a nurse-led PrEP program administered by the Cool Aid Community Health Centre (CACHC) in Victoria, British Columbia as a public health PrEP program was initiated. DESIGN, SAMPLE AND MEASUREMENTS A retrospective chart review of 124 gbMSM patients accessing PrEP at CACHC in 2018 collected information on patient demographics, STI testing results, and PrEP prescription pick-ups at 3 time points. RESULTS Ninety-nine (79.8%) patients have continued on PrEP, as defined as having picked up their second 90-day PrEP prescription. Both older age and having an Sexually Transmitted Infection after PrEP enrolment were significantly associated with staying on PrEP; decreased risk perceptions contributed most to clinic-level discontinuance. Very few patients who stayed on PrEP have transitioned to their own General Practitioner. CONCLUSIONS Patients appear to recognize their risk and are continuing on PrEP to reduce their risk of HIV. As evidenced by ability to recruit and maintain patients, we conclude that nurse-led PrEP at community health centres supports access and uptake of essential health services to optimize individual and population health.
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Affiliation(s)
- Marion Selfridge
- Cool Aid Community Health Centre, Victoria, BC, Canada.,Canadian Institute of Substance Use Research, Victoria, BC, Canada
| | - Kiffer G Card
- Canadian Institute of Substance Use Research, Victoria, BC, Canada.,Community Based Research Centre Society, Vancouver, BC, Canada
| | | | | | | | - Anne Drost
- Cool Aid Community Health Centre, Victoria, BC, Canada
| | | | - Roz Milne
- Cool Aid Community Health Centre, Victoria, BC, Canada
| | | | - Aeron Stark
- Cool Aid Community Health Centre, Victoria, BC, Canada
| | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Chris Fraser
- Cool Aid Community Health Centre, Victoria, BC, Canada
| | - Nathan J Lachowsky
- Community Based Research Centre Society, Vancouver, BC, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
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Brennan DJ, Card KG, Collict D, Jollimore J, Lachowsky NJ. How Might Social Distancing Impact Gay, Bisexual, Queer, Trans and Two-Spirit Men in Canada? AIDS Behav 2020; 24:2480-2482. [PMID: 32356033 PMCID: PMC7192562 DOI: 10.1007/s10461-020-02891-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- David J. Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Kiffer G. Card
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
- Community Based Research Centre, Vancouver, Canada
| | - David Collict
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
- Ontario Studies in Education, University of Toronto, Toronto, Canada
| | | | - Nathan J. Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
- Community Based Research Centre, Vancouver, Canada
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Marziali ME, Card KG, McLinden T, Wang L, Trigg J, Hogg RS. Physical Distancing in COVID-19 May Exacerbate Experiences of Social Isolation among People Living with HIV. AIDS Behav 2020; 24:2250-2252. [PMID: 32328849 PMCID: PMC7178096 DOI: 10.1007/s10461-020-02872-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Card KG, Selfridge M, Greer AM, Hepburn KJ, Fournier AB, Sorge J, Urbanoski K, Pauly B, Benoit C, Lachowsky NJ, Macdonald S. Event-level outcomes of police interactions with young people in three non-metropolitan cities across British Columbia, Canada. Int J Drug Policy 2020; 91:102824. [PMID: 32591221 DOI: 10.1016/j.drugpo.2020.102824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/10/2019] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
This study examines encounters between youth and police to identify individual, contextual, and social factors that predict the outcome of these encounters. Young people aged 16-30 years were surveyed between May 2017 and June 2018 in three non-metropolitan cities across British Columbia, Canada. Outcomes were analysed using multinomial logistic generalized estimating equations. A total of 675 encounters were reported by 360 participants. These outcomes resulted in participants being questioned (n = 227; 33.6%); given warnings (n = 132; 19.6%); being searched (n = 104; 15.4%); being given a ticket (n = 101; 15.0%); and being handcuffed or arrested (n = 111; 16.4%). Young Indigenous people (vs. white) were significantly more likely to be handcuffed or arrested (OR=3.26; 1.43, 7.43). Statistical significance held after adjusting for history of police encounters and contextual factors. Findings suggest that police discretion, which has the potential to benefit youth, may be undermined by discriminatory applications of discretion.
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Affiliation(s)
- Kiffer G Card
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada.
| | - Marion Selfridge
- Canadian Institute for Substance Use Research, Victoria, BC, Canada
| | - Alissa M Greer
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Criminology, Faculty of Arts and Social Sciences, Simon Fraser University, Burnaby BC, Canada
| | - Kirk J Hepburn
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada; School of Criminology, Faculty of Arts and Social Sciences, Simon Fraser University, Burnaby BC, Canada; School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada; Department of Sociology, Faculty of Social Sciences, University of Victoria, Victoria, BC, Canada; School of Health Information Science, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Anabelle Bernard Fournier
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Justin Sorge
- Canadian Institute for Substance Use Research, Victoria, BC, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Cecilia Benoit
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; Department of Sociology, Faculty of Social Sciences, University of Victoria, Victoria, BC, Canada
| | - Nathan J Lachowsky
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Scott Macdonald
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Health Information Science, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
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Lachowsky NJ, Card KG, Cui Z, Sereda P, Roth EA, Hogg RS, Moore DM. Agreement between gay, bisexual and other men who have sex with men's period prevalence and event-level recall of sexual behaviour: an observational respondent-driven sampling study. Sex Health 2020; 16:84-87. [PMID: 30566851 DOI: 10.1071/sh17223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 08/28/2018] [Indexed: 11/23/2022]
Abstract
Background Agreement between sexual behaviour recall measures among gay, bisexual and other men who have sex with men (GBM) in Vancouver, Canada was examined. METHODS Study participants were sexually active GBM aged ≥16 years recruited via respondent-driving sampling (RDS). Participants completed a computer-assisted self-interview survey, including individual-level period prevalence (last 6 months) and sexual event-level (last sex with each of the five most recent partners) measures. RDS-weighted kappa statistics assessed the agreement between these types of data across five different sexual risk outcomes, stratified by self-identified HIV status and other demographic factors (age, education, race/ethnicity). RESULTS Of 719 participants, 195 (RDS-weighted 23.4%) were HIV-positive. For HIV-negative GBM (n=524, RDS-weighted 76.6%), there were moderate agreements between period prevalence and event-level data for any anal intercourse (AI), any condomless AI and any fisting, but weak agreement for any discordant/unknown AI and any sex toy use. For HIV-positive GBM, there was moderate agreement for any AI, any condomless AI, any discordant/unknown AI and any fisting; there was weak agreement for any sex toy use. Agreement between measurement types was generally higher for GBM who were living with HIV, who were older and who completed secondary school; there was little difference in agreement levels by race/ethnicity. CONCLUSIONS We observed moderate agreement between sexual behaviour recall through event-level and period prevalence questions. Each method had differential advantages and ideal circumstances for use, which should be guided by one's research question and outcome measure of interest.
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Affiliation(s)
- Nathan J Lachowsky
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Kiffer G Card
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Zishan Cui
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Paul Sereda
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Eric A Roth
- Department of Anthropology, Faculty of Social Science, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
| | - Robert S Hogg
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - David M Moore
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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Card KG, Lachowsky NJ, Althoff KN, Schafer K, Hogg RS, Montaner JSG. A systematic review of the geospatial barriers to antiretroviral initiation, adherence and viral suppression among people living with HIV. Sex Health 2020; 16:1-17. [PMID: 30409243 DOI: 10.1071/sh18104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 07/04/2018] [Indexed: 11/23/2022]
Abstract
Background With the emergence of antiretroviral therapy (ART), Treatment as Prevention (TasP) has become the cornerstone of both HIV clinical care and HIV prevention. However, despite the efficacy of treatment-based programs and policies, structural barriers to ART initiation, adherence and viral suppression have the potential to reduce TasP effectiveness. These barriers have been studied using Geographic Information Systems (GIS). While previous reviews have examined the use of GIS for HIV testing - an essential antecedent to clinical care - to date, no reviews have summarised the research with respect to other ART-related outcomes. METHODS Therefore, the present review leveraged the PubMed database to identify studies that leveraged GIS to examine the barriers to ART initiation, adherence and viral suppression, with the overall goal of understanding how GIS has been used (and might continue to be used) to better study TasP outcomes. Joanna Briggs Institute criteria were used for the critical appraisal of included studies. RESULTS In total, 33 relevant studies were identified, excluding those not utilising explicit GIS methodology or not examining TasP-related outcomes. CONCLUSIONS Findings highlight geospatial variation in ART success and inequitable distribution of HIV care in racially segregated, economically disadvantaged, and, by some accounts, increasingly rural areas - particularly in the United States. Furthermore, this review highlights the utility and current limitations of using GIS to monitor health outcomes related to ART and the need for careful planning of resources with respect to the geospatial movement and location of people living with HIV (PLWH).
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Affiliation(s)
- Kiffer G Card
- Faculty of Health Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Keri N Althoff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine Schafer
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Robert S Hogg
- Faculty of Health Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
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Marziali ME, Card KG, McLinden T, Closson K, Wang L, Trigg J, Salters K, Lima VD, Parashar S, Hogg RS. Correlates of social isolation among people living with HIV in British Columbia, Canada. AIDS Care 2020; 33:566-574. [PMID: 32342701 DOI: 10.1080/09540121.2020.1757607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/12/2022]
Abstract
Our study aims to define and identify correlates of social isolation among people living with HIV (PLHIV). The Longitudinal Investigation into Supportive and Ancillary health services (LISA) study provided a cross-sectional analytic sample of 996 PLHIV in British Columbia, Canada (sampled between 2007 and 2010). Individuals marginalized by socio-structural inequities were oversampled; sampling bias was addressed through inverse probability of participation weighting. Through latent class analysis, three groups were identified: Socially Connected (SC) (n = 364, 37%), Minimally Isolated (MI) (n = 540, 54%) and Socially Isolated (SI) (n = 92, 9%). Correlates of the SI and MI classes, determined through multivariable multinomial regression using the SC class as a reference, include: recent violence (aOR 1.61, 95%CI 1.28-2.02 [MI vs. SC]; aOR 2.04, 95%CI 1.41-2.96 [SI vs. SC]) and a mental health diagnosis (aOR 1.50, 95% CI 1.31-1.72 [MI vs. SC]; aOR 1.43, 95%CI 1.11-1.83 [SI vs. SC]). Women (aOR 0.47; 95%CI 0.32-0.68 [SI vs. SC]), individuals of Indigenous ancestry (aOR 0.59; 95%CI 0.40-0.87 [SI vs. SC]) and people identifying as gay or lesbian (aOR 0.37; 95%CI 0.26-0.52 [SI vs. SC]) were less likely to experience isolation. These findings highlight the importance of supporting communities fostering connectedness and identifies populations susceptible to isolation.
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Affiliation(s)
- Megan E Marziali
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kiffer G Card
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Taylor McLinden
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lu Wang
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jason Trigg
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kate Salters
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Viviane D Lima
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Surita Parashar
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Robert S Hogg
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Marziali ME, Armstrong HL, Closson K, McLinden T, Wang L, Barath J, Harris M, Roth EA, Moore DM, Lachowsky NJ, Hogg RS, Sang JM, Card KG. Loneliness and self-rated physical health among gay, bisexual and other men who have sex with men in Vancouver, Canada. J Epidemiol Community Health 2020; 74:553-559. [PMID: 32269083 PMCID: PMC7527030 DOI: 10.1136/jech-2019-213566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/25/2019] [Revised: 02/02/2020] [Accepted: 03/04/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Due to stigma and discrimination, gay, bisexual and other men who have sex with men (gbMSM) potentially carry a heightened burden of loneliness. This analysis investigates loneliness among gbMSM and its relationship with self-rated physical health, along with the mediating effect of depression. METHODS Participants were recruited using respondent-driven sampling into the Momentum Health Study (February 2012-February 2015) with follow-up visits occurring every 6 months till February 2018. Using computer-assisted self-interviews, measures of loneliness were assessed using a 6-item Loneliness Scale for Emotional and Social Loneliness (lonely vs not lonely). Current physical health was self-assessed (poor, fair, good, very good or excellent). A multivariable generalised linear-mixed model with a logit link function was used to examine the relationship between loneliness and self-rated physical health. We further investigated the mediating effect of depressive symptomatology on this relationship via the Hospital Anxiety and Depression Scale. RESULTS Of the 770 participants included, we found that 61% (n=471) experienced loneliness at baseline. Of the 674 (88%) who reported good/very good/excellent physical health, 59% (n=391) reported loneliness, compared with 87% (n=80) of those in poor/fair self-rated physical health who reported feeling lonely. After adjustment for confounding, loneliness was associated with poor self-rated physical health (adjusted OR 1.71; 95% CI 1.13 to 2.60). Depressive symptomatology was found to partially mediate this relationship. CONCLUSION There may be a need for the integration of social, mental and physical health programming, targeted towards gbMSM, to alleviate the degree of loneliness experienced and its co-occurrence with poor self-rated physical health.
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Affiliation(s)
- Megan E Marziali
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Heather L Armstrong
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Psychology, University of Southampton, Southampton, UK
| | - Kalysha Closson
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Taylor McLinden
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lu Wang
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Justin Barath
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Marianne Harris
- AIDS Research Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eric A Roth
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - David M Moore
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Nathan J Lachowsky
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada.,School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
| | - Robert S Hogg
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Jordan M Sang
- Epidemiology and Population Health Program, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Kiffer G Card
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Selfridge M, Greer A, Card KG, Macdonald S, Pauly B. “It's like super structural” – Overdose experiences of youth who use drugs and police in three non-metropolitan cities across British Columbia. International Journal of Drug Policy 2020; 76:102623. [DOI: 10.1016/j.drugpo.2019.102623] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/17/2019] [Accepted: 12/02/2019] [Indexed: 01/01/2023]
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Card KG, Fournier AB, Sorge JT, Morgan J, Grace D, Ham D, Lachowsky NJ, Trussler T. Substance use patterns and awareness of biomedical HIV prevention strategies among sexual and gender minority men in Canada. AIDS Care 2020; 32:1506-1514. [PMID: 31983233 DOI: 10.1080/09540121.2020.1719026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sexual and gender minority men (SGMM) who use drugs are frequently cited as at-risk for HIV. Fortunately, biomedical prevention can greatly reduce transmission, provided individuals are aware of and interested in the uptake of these strategies. We examined associations between substance use patterns and biomedical prevention among SGMM in Canada. Latent class analysis identified patterns of substance use. Demographic-adjusted logistic regression models assessed the associations between latent classes and key biomedical prevention indicators. Among 669 participants living with HIV (PLWH) and 7,184 HIV-negative participants, six substance use classes characterized "limited" (46.0%; infrequent/low use of drugs), "common" (31.9%; alcohol, cannabis, and tobacco), "club" (5.2%; alcohol, cocaine, and psychedelics), "sex" (4.8%; alcohol, crystal methamphetamine, GHB, poppers, and erectile drugs), "prescription" (11.0%; alcohol and prescription drugs), and "polydrug" (1.1%; most drugs) use. HIV-negative men in the "prescription" and "sex" substance use classes were more likely to know about the preventive benefits of HIV treatment. All non-"limited use" HIV-negative men were more likely to report interest in taking pre-exposure prophylaxis (PrEP). For PLWH, substance use patterns were not associated with detectable viral loads or treatment awareness. While PLWH exhibited high levels of undetectability and treatment awareness regardless of substance use class, a variety of substance use patterns were associated with increased awareness, interest, and uptake of risk management strategies among HIV-negative participants.
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Affiliation(s)
- Kiffer G Card
- Community Based Research Centre for Gay Men's Health, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Canadian Institute for Substance Use Research, Victoria, Canada.,Canadian HIV Trials Network, Vancouver, Canada
| | | | - Justin T Sorge
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Canadian Institute for Substance Use Research, Victoria, Canada
| | - Jeffrey Morgan
- Community Based Research Centre for Gay Men's Health, Vancouver, Canada.,British Columbia Centre on Substance Use, Vancouver, Canada
| | - Daniel Grace
- Community Based Research Centre for Gay Men's Health, Vancouver, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David Ham
- Community Based Research Centre for Gay Men's Health, Vancouver, Canada
| | - Nathan J Lachowsky
- Community Based Research Centre for Gay Men's Health, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Canadian Institute for Substance Use Research, Victoria, Canada
| | - Terry Trussler
- Community Based Research Centre for Gay Men's Health, Vancouver, Canada
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Cheng B, Sang JM, Cui Z, Bacani N, Armstrong HL, Zhu J, Elefante J, Olarewaju G, Card KG, Blackwell E, Lachowsky NJ, Hogg RS, Roth EA, Moore DM. Factors Associated with Cessation or Reduction of Methamphetamine Use among Gay, Bisexual, and Other Men Who Have Sex with Men (gbMSM) in Vancouver Canada. Subst Use Misuse 2020; 55:1692-1701. [PMID: 32406780 PMCID: PMC7527035 DOI: 10.1080/10826084.2020.1756854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/24/2022]
Abstract
Background: Methamphetamine (MA) use among gay, bisexual, and other men who have sex with men (gbMSM) is a pervasive issue, associated with detrimental health outcomes. We identified factors associated with discontinuation or reduction in MA among a subset of gbMSM reporting frequent (at least weekly) use, with a specific focus on symptoms of anxiety and depression. Methods: We recruited sexually-active gbMSM aged ≥16 years in Vancouver, Canada into a prospective-cohort study using respondent-driven sampling. Participants completed study visits once every six months. We used generalized linear mixed models to identify factors associated with reductions in MA use following a visit where participants previously reported using MA at least weekly. Results: Of 584 cohort participants with at least one follow-up visit, 67 (11.5%) reported frequent MA use at baseline or in follow-up visits. Of these, 46 (68.7%) had at least one subsequent study visit where they transitioned to less frequent (monthly or less) or no MA use. In multivariable models, reduced MA use was less likely for those who spent >50% of social time with other gbMSM (aRR = 0.49, 95%CI:0.28-0.85), gave or received drugs in exchange for sex (aRR = 0.34, 95%CI:0.13-0.87), injected drugs (aRR = 0.35, 95%CI:0.18-0.68), or used gamma-hydroxybutyrate (GHB) (aRR = 0.41, 95%CI:0.21-0.78). Symptoms of anxiety or depression were not associated with reductions in MA use. Conclusions: Social connection and drug-related factors surrounding MA use were associated with reductions, but anxiety and depressive symptomatology were not. Incorporating socialization and polysubstance-related components with MA reduction may help in developing efficacious interventions toward reducing MA use for gbMSM.
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Affiliation(s)
- Brooke Cheng
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Jordan M Sang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Nicanor Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | - Julia Zhu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Julius Elefante
- St. Paul's Hospital, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Gbolahan Olarewaju
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kiffer G Card
- University of Victoria, Victoria, BC, Canada.,Canadian Institute for Substance Use Research, Victoria, BC, Canada
| | | | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,University of Victoria, Victoria, BC, Canada.,Canadian Institute for Substance Use Research, Victoria, BC, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Simon Fraser University, Burnaby, BC, Canada
| | - Eric A Roth
- University of Victoria, Victoria, BC, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Card KG, Armstrong HL, Wang L, Bacani N, Moore DM, Roth EA, Hogg RS, Lachowsky NJ. Escape expectancies and sexualized substance use among gay, bisexual, and other men who have sex with men. AIDS Care 2019; 32:1489-1497. [PMID: 31851524 DOI: 10.1080/09540121.2019.1705961] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
McKirnan's Cognitive Escape Theory (1996) is often characterized by the hypothesis that drugs are used during sex by gay, bisexual, and other men who have sex with men (gbMSM) to relieve internal cognitive conflict over safe-sex norms and sexual desire. We examined how McKirnan's Cognitive Escape Scale (CES) is related to other widely used constructs relevant to sexualized substance use with hopes of better situating the theory within the evolving landscape of HIV-prevention. Associations between CES and trait anxiety, depression, treatment optimism, sexual altruism, sexual sensation seeking, and self-perceived risk for HIV transmission/acquisition were tested. Mediation analyses tested whether associated psychological measures mediated the effect of CES on the proportion of events in which participants reported co-occurrent substance use and condomless anal sex. Results indicated that CES is associated with higher sexual sensation seeking, treatment optimism, trait anxiety, and perceived likelihood of HIV transmission/acquisition. Mediation analyses suggest that CES is related to but operates independently of treatment optimism, sensation seeking, and trait anxiety. Nevertheless, the intersection of HIV-related worries and substance use expectancies are clearly more nuanced than is widely reported is discussions on cognitive escape.
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Affiliation(s)
- Kiffer G Card
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Heather L Armstrong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Nicanor Bacani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - David M Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eric A Roth
- Department of Anthropology, University of Victoria, Victoria, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.,School of Public Health and Social Policy, University of Victoria, Victoria, Canada.,Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
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Shaw L, Wang L, Cui Z, Rich AJ, Armstrong HL, Lachowsky NJ, Sereda P, Card KG, Olarewaju G, Moore D, Hogg R, Roth EA. Longitudinal Event-Level Analysis of Gay and Bisexual Men's Anal Sex Versatility: Behavior, Roles, and Substance Use. J Sex Res 2019; 56:1136-1146. [PMID: 31461383 PMCID: PMC6791743 DOI: 10.1080/00224499.2019.1652238] [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: 06/10/2023]
Abstract
Gay and bisexual Men Who Have Sex with Men (GBM) are sexually unique in that they can practice penile-anal sex versatility, i.e. engage in insertive and receptive anal sex. Individual-level versatility is extensively researched both as a sexual behavior linked to HIV/STI transmission, and as a GBM identity that can change over time. However, there is a dearth of research on event-level versatility (ELV), defined as taking the receptive and insertive role in the same sexual encounter. We analyzed event-level data from 644 GBM in the Momentum Health Study from February 2012-February 2017 to identify factors associated with ELV prevalence, the relationship between ELV and anal sex role preference, and sero-adaptive and sexualized drug use strategies. Univariate analysis revealed ELV prevalence rates between 15% and 20%. A multivariate generalized linear mixed model indicated ELV significantly (p < .05) associated with versatile role preference and condomless sex. However, the majority of ELV came from GBM reporting insertive or receptive role preferences, and there was significantly higher condom use among sero-discordant partners, indicating sero-adaptation. Multivariate log-linear modeling identified multiple polysubstance combinations significantly associated with ELV. Results provide insights into GBM sexual behavior and constitute empirical data useful for future HIV/STI transmission pattern modeling.
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Affiliation(s)
- Lindsay Shaw
- Canadian Institute for Substance Use Research, University of Victoria
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS
| | - Zishan Cui
- British Columbia Centre for Excellence in HIV/AIDS
| | - Ashleigh J Rich
- British Columbia Centre for Excellence in HIV/AIDS
- Faculty of Medicine, University of British Columbia
| | - Heather L Armstrong
- British Columbia Centre for Excellence in HIV/AIDS
- Faculty of Medicine, University of British Columbia
| | - Nathan J Lachowsky
- British Columbia Centre for Excellence in HIV/AIDS
- School of Public Health and Social Policy, University of Victoria
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS
| | | | | | - David Moore
- British Columbia Centre for Excellence in HIV/AIDS
- Faculty of Medicine, University of British Columbia
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS
- Faculty of Health Sciences, Simon Fraser University
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Card KG, Lachowsky NJ, Cui Z, Shurgold S, Gislason M, Forrest JI, Rich AJ, Moore D, Roth E, Hogg RS. Exploring the role of sex-seeking apps and websites in the social and sexual lives of gay, bisexual and other men who have sex with men: a cross-sectional study. Sex Health 2019; 14:229-237. [PMID: 27977387 DOI: 10.1071/sh16150] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/27/2016] [Indexed: 01/10/2023]
Abstract
Background The objective of this study was to explore the relationship between online sex-seeking, community/social attachment and sexual behaviour. METHODS Respondent-driven sampling was used to recruit 774 sexually active gay and bisexual men in Vancouver, Canada, aged ≥16 years. Multivariable logistic regression compared men who had used online sex-seeking apps/websites in the past 6 months (n=586) with those who did not (n=188). RESULTS Multivariable results showed that online sex seekers were more likely to be younger [adjusted odds ratio (aOR)=0.95, 95% CI: (0.93-0.96)], college educated [aOR=1.60, 95% CI: (1.07, 2.40)], have more Facebook friends [aOR=1.07, 95% CI: (1.01, 1.13)], spend more social time with other gay men [aOR=1.99, 95% CI: (1.33-2.97)], and were less likely to identify emotionally with the gay community [aOR=0.93, 95% CI: (0.86-1.00)]. Further, they had displayed high sensation-seeking behaviour [aOR=1.08, 95% CI: (1.03-1.13)], were more likely to engage in serodiscordant/unknown condomless anal sex [aOR=2.34, 95% CI: (1.50-3.66)], use strategic positioning [aOR=1.72, 95% CI: (1.08-2.74)], ask their partner's HIV-status prior to sex [aOR=2.06, 95% CI: (1.27-3.37)], and have ever been tested for HIV [aOR=4.11, 95% CI: (2.04-8.29)]. CONCLUSION These findings highlight the online and offline social behaviour exhibited by gay and bisexual men, pressing the need for pro-social interventions to promote safe-sex norms online. We conclude that both Internet and community-based prevention will help reach app/web users.
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Affiliation(s)
- Kiffer G Card
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Nathan J Lachowsky
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Zishan Cui
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Susan Shurgold
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Maya Gislason
- Simon Fraser University, 8888 University Drive, Vancouver, BC V5A 1S6, Canada
| | - Jamie I Forrest
- University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4, Canada
| | - Ashleigh J Rich
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - David Moore
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Eric Roth
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Robert S Hogg
- B.C. Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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