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Kiekens WJ, Van der Ploeg R, Fish JN, Salway T, Kaufman TML, Baams L. Trends in Bullying Victimization and Social Unsafety for Sexually and Gender Diverse Students. J Youth Adolesc 2024:10.1007/s10964-024-01943-6. [PMID: 38270823 DOI: 10.1007/s10964-024-01943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
Research has documented trends in bullying victimization for sexually diverse adolescents in the US, but trends regarding school social unsafety are understudied and there is a dearth of research examining these trends for gender diverse adolescents. This study aimed to identify disparities in bullying victimization and feelings of social unsafety in schools for sexually and gender diverse adolescents. Data stem from the 2014 (N = 15,800; M age = 14.17, SD = 1.50), 2016 (N = 22,310; M age = 14.17, SD = 1.49), and 2018 (N = 10,493; M age = 14.02, SD = 1.52) survey cycles of the Social Safety Monitor, a Dutch cross-sectional school-based study. Findings indicate that sexual orientation disparities remained relatively small, but stable over time, while gender diverse adolescents remained more likely to be victimized and feel unsafe in school, with larger disparities overall. Monitoring these trends is highly relevant, especially considering recent negative developments regarding societal acceptance of sexual and gender diversity.
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Affiliation(s)
- W J Kiekens
- Department of Sociology/Interuniversity Center for Social Science Theory and Methodology, (ICS), University of Groningen, Grote Rozenstraat 31, 9712 TG, Groningen, The Netherlands.
| | - R Van der Ploeg
- Department of Pedagogy and Educational Sciences, University of Groningen, Grote Rozenstraat 38, 9712 TJ, Groningen, The Netherlands
| | - J N Fish
- Department of Family Science, School of Public Health, University of Maryland, 4200 Valley Dr., College Park, MD, 20740, USA
| | - T Salway
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - T M L Kaufman
- Department of Education and Pedagogy, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
| | - L Baams
- Department of Pedagogy and Educational Sciences, University of Groningen, Grote Rozenstraat 38, 9712 TJ, Groningen, The Netherlands
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Dulai JJS, Salway T, Ablona A. Strong community belonging moderates poor mental health in lesbian, gay, and bisexual individuals living in Canada: an intersectional analysis of a national population-based survey. Can J Public Health 2023; 114:916-927. [PMID: 37479947 PMCID: PMC10726692 DOI: 10.17269/s41997-023-00794-1] [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: 12/09/2022] [Accepted: 05/30/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES Lesbian, gay, and bisexual (LGB) individuals report worse mental health than heterosexuals; however, this disparity may vary across intersecting social locations and be moderated by community belonging. METHODS We investigated these relationships using the Canadian Community Health Survey 2015-2016. Log-binomial regression models were used to estimate associations between self-rated mental health and social locations (sexual orientation, gender, race, immigration, education, income), community belonging, and interactions between explanatory variables. RESULTS Poor mental health was 1.79 (95%CI: 1.37-2.33) times higher in lesbian/gay individuals and 3.3 (95%CI: 2.89-3.76) times higher in bisexuals when compared to heterosexuals. LGB participants across all social locations reported poorer mental health as compared with heterosexuals, with bisexuals consistently displaying worse mental health. Strong community belonging modifies this relationship, reducing disparities across all sexual orientations and social locations. CONCLUSION The intersections of differing social locations and community belonging should be considered when addressing LGB Canadians' mental health needs.
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Affiliation(s)
- Joshun J S Dulai
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Centre for Gender and Sexual Health Equity, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Aidan Ablona
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
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De Anda JA, Irvine MA, Zhang W, Salway T, Haag D, Gilbert M. Cost-effectiveness of internet-based HIV screening among gay, bisexual and other men who have sex with men (GBMSM) in Metro Vancouver, Canada. PLoS One 2023; 18:e0294628. [PMID: 38011230 PMCID: PMC10681302 DOI: 10.1371/journal.pone.0294628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND GetCheckedOnline is an internet-based screening service aiming to increase HIV testing among gay, bisexual and other men who have sex with men (GBMSM). We assessed the cost-effectiveness of GetCheckedOnline in its first implementation phase at different uptake scenarios compared to clinic-based screening services alone in Metro Vancouver, Canada. METHODS From a healthcare payer's perspective, our cost-utility analysis used an established dynamic GBMSM HIV compartmental model estimating the probability of acquiring HIV, progressing through diagnosis, disease stages and treatment over a 30-year time horizon. The base case scenario assumed 4.7% uptake of GetCheckedOnline in 2016 (remainder using clinic-based services), with 74% of high-risk and 44% of low-risk infrequent testers becoming regular testers in five years. Scenario analyses tested increased GetCheckedOnline uptake to 10% and 15%. RESULTS The cost per test for GetCheckedOnline was $29.40 compared to clinic-based services $56.92. Compared with clinic-based screening services, the projected increase in testing frequency with 4.7% uptake of GetCheckedOnline increased the costs by $329,600 (95% Credible Interval: -$498,200, $571,000) and gained 4.53 (95%CrI: 0, 9.20) quality-adjusted life years (QALYs) in a 30-year time horizon. The probability of GetCheckedOnline being cost-effective was 34% at the threshold of $50,000 per QALY, and increased to 73% at the threshold of $100,000 per QALY. The results were consistent in the other uptake scenarios. The probability of GetCheckedOnline being cost-effective became 80% at the threshold of $50,000 per QALY if assuming 5-year time horizon. CONCLUSIONS GetCheckedOnline is almost half the cost of clinic-based services on a per-test basis. However, increased access to testing should be balanced with risk profiles of patients to ensure the implementation can be a cost-effective strategy for increasing HIV screening among GBMSM in Metro Vancouver. Additional analyses are needed to understand the impact of internet-based screening including screening for other STIs and in other populations.
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Affiliation(s)
- Jose A. De Anda
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A. Irvine
- Institute of Applied Mathematics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Wei Zhang
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | - Travis Salway
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Devon Haag
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
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Salway T, Kinitz DJ, Kia H, Ashley F, Giustini D, Tiwana A, Archibald R, Mallakzadeh A, Dromer E, Ferlatte O, Goodyear T, Abramovich A. A systematic review of the prevalence of lifetime experience with 'conversion' practices among sexual and gender minority populations. PLoS One 2023; 18:e0291768. [PMID: 37792717 PMCID: PMC10550144 DOI: 10.1371/journal.pone.0291768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023] Open
Abstract
RATIONALE Conversion practices (CPs) refer to organized attempts to deter people from adopting or expressing non-heterosexual identities or gender identities that differ from their gender/sex assigned at birth. Numerous jurisdictions have contemplated or enacted legislative CP bans in recent years. Syntheses of CP prevalence are needed to inform further public health policy and action. OBJECTIVES To conduct a systematic review describing CP prevalence estimates internationally and exploring heterogeneity across country and socially relevant subgroups. METHODS We performed literature searches in eight databases (Medline, Embase, PsycInfo, Social Work Abstracts, CINAHL, Web of Science, LGBTQ+ Source, and Proquest Dissertations) and included studies from all jurisdictions, globally, conducted after 2000 with a sampling frame of sexual and gender minority (SGM) people, as well as studies of practitioners seeing SGM patients. We used the Hoy et al. risk of bias tool for prevalence studies and summarized distribution of estimates using median and range. RESULTS We identified fourteen articles that reported prevalence estimates among SGM populations, and two articles that reported prevalence estimates from studies of mental health practitioners. Prevalence estimates among SGM samples ranged 2%-34% (median: 8.5). Prevalence estimates were greater in studies conducted in the US (median: 13%), compared to Canada (median: 7%), and greater among transgender (median: 12%), compared to cisgender (median: 4%) subsamples. Prevalence estimates were greatest among people assigned male at birth, whether transgender (median: 10%) or cisgender (median: 8%), as compared to people assigned female at birth (medians: 5% among transgender participants, 3% among cisgender participants). Further differences were observed by race (medians: 8% among Indigenous and other racial minorities, 5% among white groups) but not by sexual orientation. CONCLUSIONS CPs remain prevalent, despite denouncements from professional bodies. Social inequities in CP prevalence signal the need for targeted efforts to protect transgender, Indigenous and racial minority, and assigned-male-at-birth subgroups.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - David J. Kinitz
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hannah Kia
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada
| | - Florence Ashley
- Faculty of Law & Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Dean Giustini
- Biomedical Branch Library, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amrit Tiwana
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Reilla Archibald
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Amirali Mallakzadeh
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Elisabeth Dromer
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Olivier Ferlatte
- École de santé publique, Université de Montréal, Montréal, Quebec, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Quebec, Canada
| | - Trevor Goodyear
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Cooper S, Péloquin T, Lachowsky NJ, Salway T, Oliffe JL, Klassen B, Brennan DJ, Houle J, Ferlatte O. Conformity to Masculinity Norms and Mental Health Outcomes Among Gay, Bisexual, Trans, Two-Spirit, and Queer Men and Non-Binary Individuals. Am J Mens Health 2023; 17:15579883231206618. [PMID: 37886907 PMCID: PMC10612460 DOI: 10.1177/15579883231206618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/21/2023] [Accepted: 09/14/2023] [Indexed: 10/28/2023] Open
Abstract
Homophobia and biphobia negatively impact the mental health of gay, bisexual, trans, Two-Spirit, and queer men and non-binary individuals (GBT2Q) and sexual and gender minority men, but little is known about the impact of gender-related oppression. The current study examines the impact of pressure to conform to masculine norms in Canada-based GBT2Q individuals. Specifically, the associations between (a) gender expression and pressure to be masculine and (b) pressure to be masculine and depression, anxiety, and self-rated mental health were investigated. Drawing from an online national cross-sectional survey of 8,977 GBT2Q individuals and sexual and gender minority men living in Canada aged 15 years or older, 56.4% (n = 5,067) of respondents reported experiencing pressure to conform to masculine norms. Respondents were more likely to report masculine pressure if they were younger than 30 years, described their gender expression as fluid, identified their sexuality as queer, were an ethnoracial minority, and were trans. Pressure to be masculine was associated with increased odds of depression, anxiety, and reporting poor or fair mental health. The current study provides evidence of the detrimental impact of pressure to conform to masculine norms on the mental health of gay, bisexual, trans, Two-Spirit, and queer men and non-binary peoples.
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Affiliation(s)
- Sarah Cooper
- École de Santé Publique de l’Université de Montréal, Montréal, Quebec, Canada
- Centre de Recherche en Santé Publique, Montréal, Quebec, Canada
| | - Tristan Péloquin
- École de Santé Publique de l’Université de Montréal, Montréal, Quebec, Canada
| | - Nathan J. Lachowsky
- Community-Based Research Centre, Vancouver, British Columbia, Canada
- School of Public Health & Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Travis Salway
- Community-Based Research Centre, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
| | - John L. Oliffe
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Nursing, The University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Klassen
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - David J. Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Olivier Ferlatte
- École de Santé Publique de l’Université de Montréal, Montréal, Quebec, Canada
- Centre de Recherche en Santé Publique, Montréal, Quebec, Canada
- Community-Based Research Centre, Vancouver, British Columbia, Canada
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Coulaud PJ, Jesson J, Bolduc N, Ferlatte O, Bertrand K, Salway T, Jauffret-Roustide M, Knight R. Association between level of compliance with COVID-19 public health measures and depressive symptoms: A cross-sectional survey of young adults in Canada and France. PLoS One 2023; 18:e0289547. [PMID: 37531389 PMCID: PMC10395933 DOI: 10.1371/journal.pone.0289547] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 07/20/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND While compliance with preventive measures remains central to limit the spread of COVID-19, these measures critically affected mental health of young adults. We therefore investigated the association between the level of compliance with COVID-19 preventive measures and depressive symptoms among young adults in Canada and France. METHODS From October to December 2020, we conducted a cross-sectional online survey of young adults ages 18-29 years in Canada (n = 3246) and France (n = 2680) to collect demographic data, experiences with COVID-19 preventive measures, and mental health. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9). Compliance profiles were built using cluster analysis. Weighted multivariable logistic regression was used to estimate associations between compliance level and major depressive symptoms (PHQ-9 score≥15) in each country. RESULTS One third of respondents reported major depressive symptoms (Canada: 36.4%, France: 23.4%). Four compliance profiles were identified: high (42.5%), medium-high (21.7%), medium-low (18.1%), and low (17.7%), with high levels more frequently observed in Canada compared to France. In both countries, participants in low compliance profile (Canada: Adjusted Odds Ratio (AOR) [95% Confidence Interval] 0.75 [0.58, 0.98], France: AOR 0.60 [0.46, 0.75]), in the medium-low (Canada: AOR 0.58 [0.48, 0.72], France: AOR 0.81 [0.66, 1.01]), and medium-high compliance profiles (Canada: AOR 0.78 [0.65, 0.93], France: AOR 0.77 [0.63, 0.93]) were less likely to report major depressive symptoms compared to the high compliance profile. Ethno-racial minorities, sexual and gender minority, and unemployed young adults had higher odds of reporting such symptoms. CONCLUSIONS Major depressive symptoms were associated with high compliance with COVID-19 preventive measures among young adults. The implementation of socially-isolating measures should be coupled with mental health interventions to address mental health needs of young adults, with enhanced supports for sub-groups who are structurally disadvantaged (e.g., racialized, unemployed, sexual and gender minority).
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Affiliation(s)
- Pierre-Julien Coulaud
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julie Jesson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Naseeb Bolduc
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olivier Ferlatte
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - Karine Bertrand
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Marie Jauffret-Roustide
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Centre d'Étude des Mouvements Sociaux (EHESS/CNRS UMR8044/INSERM U1276), Paris, France
- Baldy Center on Law and Social Policy, Buffalo University, Buffalo, NY, United States of America
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
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Tiwana A, Salway T, Schillaci-Ventura J, Watt S. Geographic distribution of conversion therapy prevalence in Canada. Findings from a national cross-sectional survey, 2020. F1000Res 2023; 12:844. [PMID: 38434633 PMCID: PMC10905130 DOI: 10.12688/f1000research.134292.1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Conversion therapy practices (CTPs) are discredited efforts that target lesbian, gay, bisexual, trans, queer, Two-Spirit, or other (LGBTQ2S+) people and seek to change, deny, or discourage their sexual orientation, gender identity, and/or gender expression. This study aims to investigate the prevalence of CTPs across Canadian provinces and territories and identify whether CTP bans reduce the prevalence of CTPs. METHODS We collected 119 CTPs from 31 adults (18+) in Canada who have direct experience with CTPs, know people who have gone to CTPs, or know of conversion therapy practitioners using a 2020 anonymous online survey. Mapping analysis was conducted using ArcGIS Online. CTP prevalence was compared between provinces/territories with and without bans using chi-square tests. RESULTS Three provinces and eleven municipalities had CTP bans. The prevalence of CTPs in provinces/territories with bans was 2.34 per 1,000,000 population (95% CI 1.65, 3.31). The prevalence of CTPs in provinces/territories without bans was 4.13 per 1,000,000 population (95% CI 3.32, 5.14). Accounting for the underlying population, provinces/territories with the highest prevalence of CTPs per 1,000,000 population were New Brunswick (6.69), Nova Scotia (6.50), and Saskatchewan (6.37). CONCLUSIONS Findings suggest only 55% of Canadians were protected under CTP bans. The prevalence of CTPs in provinces/territories without bans was 1.76 times greater than provinces/territories with bans. CTPs are occurring in most provinces/territories, with higher prevalence in the west and the Atlantic. These findings and continued efforts to monitor CTP prevalence can help inform policymakers and legislators as society is increasingly acknowledging CTPs as a threat to the health and well-being of LGBTQ2S+ people.
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Affiliation(s)
- Amrit Tiwana
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Sarah Watt
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Goodyear T, Delgado-Ron JA, Ashley F, Knight R, Salway T. Sexual Orientation and Gender Identity and Expression Change Efforts and Suicidality: Evidence, Challenges, and Future Research Directions. LGBT Health 2023; 10:339-343. [PMID: 36913530 PMCID: PMC11079439 DOI: 10.1089/lgbt.2022.0359] [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] [Indexed: 03/14/2023] Open
Abstract
Sexual orientation and gender identity and expression change efforts (SOGIECE) aim to deny or suppress nonheterosexual and transgender identities. SOGIECE, including "conversion practices," are controversial and remain prevalent despite contemporary legislative bans and denouncement of these harmful practices from numerous health profession organizations. Recent work has questioned the validity of epidemiological studies associating SOGIECE with suicidal thoughts and suicide attempts. This perspective article addresses such critiques, arguing that the balance of available evidence indicates SOGIECE contribute to suicidality, while proposing methods to better account for structural context and the multitude of factors that may explain both SOGIECE attendance and suicidality.
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Affiliation(s)
- Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - J. Andrés Delgado-Ron
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Florence Ashley
- Faculty of Law and Joint Centre for Bioethics, University of Toronto, Toronto, Canada
| | - Rod Knight
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- École de Santé Publique, Université de Montréal, Montréal, Canada
| | - Travis Salway
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
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9
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Gupta A, Salway T, Jessani A. Cost-related avoidance of oral health service utilization among lesbian, gay, and bisexual individuals in Canada. J Public Health Dent 2023; 83:254-264. [PMID: 37329179 DOI: 10.1111/jphd.12574] [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: 12/03/2021] [Revised: 04/12/2023] [Accepted: 05/17/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES This study estimates the frequency of cost-related oral health service avoidance (CROHSA) among lesbian, gay, and bisexual (LGB) individuals in Canada relative to heterosexual persons. METHODS Heterosexual and sexual minority individuals in Canada were compared using the national probability-based Canadian Community Health Survey 2017-2018. Logistic regression was used to quantify associations between LGB status and CROHSA. Mediators were tested following Andersen's behavioral model of health service utilization and included partnership status, oral health status, presence of dental pain, educational attainment, insurance status, smoking status, general health status, and personal income. RESULTS From our sample of 103,216 individuals, 34.8% of LGB individuals reported avoiding oral health care due to cost compared to 22.7% of heterosexual persons. Disparities were most pronounced among bisexual individuals (odds ratio [OR] 2.29 95% confidence interval [CI] 1.42, 3.49). Disparities persisted despite adjustment for confounding using age, gender/sex, and ethnicity (OR 2.23 95% CI 1.42, 3.49). Disparities were fully mediated by eight hypothesized mediators namely, educational attainment, smoking status, partnership status, income, insurance status, oral health status, and the presence of dental pain (OR 1.69 95% CI 0.94, 3.03). In contrast, lesbian/gay individuals did not have elevated odds of experiencing CROHSA compared to heterosexual individuals (OR 1.27 95% CI 0.84, 1.92). CONCLUSION CROHSA is elevated for bisexual individuals relative to heterosexual individuals. Targeted interventions should be explored to improve oral healthcare access among this population. Future research should assess the role of minority stress and social safety on oral health inequities among sexual minority groups.
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Affiliation(s)
- Amit Gupta
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Travis Salway
- British Columbia Centre for Disease Control, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Abbas Jessani
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
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Goodyear T, Ferlatte O, Fast D, Salway T, Jenkins E, Robinson S, Knight R. Using photovoice to understand experiences of opioid use among sexual and gender minority youth in Vancouver, Canada. Cult Health Sex 2023; 25:599-616. [PMID: 35622430 PMCID: PMC9701249 DOI: 10.1080/13691058.2022.2079153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/15/2022] [Indexed: 05/10/2023]
Abstract
In Canada, sexual and gender minority youth use opioids at disproportionately high rates. Yet, little is known about the distinct contexts of opioid use within this group, challenging capacity to develop well founded policy and practice supports. This case study aims to examine - in depth - the experiences and contexts of opioid use among a sample of four sexual and gender minority youth in Vancouver, Canada. Qualitative data from photovoice methods and in-depth, semi-structured interviews were collected in 2019. Analysis adopted a reflexive thematic approach from a critical interpretive standpoint, informed by minority stress theory. Three interconnected themes were constructed: (i) minoritised contexts of entry into and continuation of opioid use; (ii) mental health-maintaining and stress-mitigating effects of opioid use in the context of minoritisation; and (iii) intersections of stigma, violence and poverty with opioid use and minoritisation. Findings suggest that the health of sexual and gender minority youth who use opioids is shaped by minority stress and overlapping forms of structural marginalisation. They signal the need for responsive strategies that hold promise in supporting this population, including advancing integrated approaches to substance use and mental health care alongside interventions targeted towards the social and structural determinants of health.
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Affiliation(s)
- Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Olivier Ferlatte
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- École de Santé Publique de l’Université de Montréal, Montreal, QC, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Travis Salway
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Samantha Robinson
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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11
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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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12
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Gilbert M, Ablona A, Chang HJ, Grennan T, Irvine MA, Sarai Racey C, Salway T, Naus M, Dawar M, Ogilvie G. Uptake of Mpox vaccination among transgender people and gay, bisexual and other men who have sex with men among sexually-transmitted infection clinic clients in Vancouver, British Columbia. Vaccine 2023; 41:2485-2494. [PMID: 36894397 PMCID: PMC9990897 DOI: 10.1016/j.vaccine.2023.02.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 12/05/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES As the primary public health strategy for controlling the 2022 Mpox outbreak, it is critical to evaluate the impact of Mpox vaccination campaigns for transgender people and gay, bisexual and other men who have sex with men (T/GBM). We measured vaccine uptake and associated factors among T/GBM clients of an urban STI clinic in British Columbia (BC). METHODS We conducted a cross-sectional online survey between August 8-22, 2022 of clients who had attended the STI clinic, 5-7 weeks following the first-dose Mpox vaccination campaign in BC. We drew on a systematic review of factors associated with vaccine uptake to develop survey questions, and measured vaccine uptake among vaccine-eligible T/GBM. RESULTS Overall, 51% of T/GBM had received the first dose of the vaccine. The sample (331 participants) was majority White and university educated, identified as a man and gay, 10% had trans experience, and 68% met eligibility criteria for vaccination. Among vaccine-eligible participants identifying as T/GBM, 66% had been vaccinated; being unvaccinated was more common among participants identifying as bisexual or heteroflexible/mostly straight, and who spent less time with other T/GBM. Eligible yet unvaccinated participants had lower perceived susceptibility, and reported fewer cues to action (e.g., fewer saw information promoting the vaccine), and increased constraints to vaccine access; vaccine barriers related to accessing clinics and privacy were common. The majority (85%) of those eligible and unvaccinated at time of survey were willing to receive the vaccine. CONCLUSION In this sample of STI clinic clients, vaccine uptake among eligible T/GBM was high in the initial weeks following a Mpox vaccination campaign. However, uptake was patterned on social gradients with lower uptake among T/GBM who may be less effectively engaged by available promotion channels. We recommend early, intentional and diverse engagement of T/GBM populations in Mpox and other targeted vaccination programs.
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Affiliation(s)
- Mark Gilbert
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Aidan Ablona
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Hsiu-Ju Chang
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Troy Grennan
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Department of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Irvine
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - C Sarai Racey
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Travis Salway
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Monika Naus
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meena Dawar
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Coulaud PJ, Jesson J, Bolduc N, Ferlatte O, Jenkins E, Bertrand K, Salway T, Jauffret-Roustide M, Knight R. Young Adults' Mental Health and Unmet Service Needs in the Context of the COVID-19 Pandemic Across Canada and France. Community Ment Health J 2023; 59:222-232. [PMID: 35763148 PMCID: PMC9243891 DOI: 10.1007/s10597-022-01000-1] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/10/2022] [Indexed: 01/25/2023]
Abstract
While young adults experienced mental health challenges during the COVID-19 pandemic, little is known about how their mental health needs were subsequently met through access to mental health services (MHS). From October to December 2020, we conducted an online survey of young adults (18-29 years) living in Canada and France to investigate factors associated with unmet MHS needs. Of the 3222 participants expressing a need to access MHS (50.7% of the total sample), 58.2% in Canada and 74.8% in France reported unmet MHS needs. In both countries, those who identified as men and those who lost income due to COVID-19, were more likely to report unmet MHS needs. In Canada, participants from Quebec, those living in rural areas, and those who experienced ethno-racial discrimination had higher odds of reporting such unmet needs. Urgent investments are needed to improve access to MHS for young adults during and after the COVID-19 pandemic.
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Affiliation(s)
- Pierre-Julien Coulaud
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall (Woodward Instructional Resource Centre), Vancouver, BC, V6T 1Z3, Canada.
| | - Julie Jesson
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Naseeb Bolduc
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Olivier Ferlatte
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 1560 Rue Sherbrooke E, Montreal, H2L 4M1, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Karine Bertrand
- Department of Community Health Science, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
- Centre for Gender and Sexual Health Equity, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Marie Jauffret-Roustide
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Centre d'Étude des Mouvements Sociaux (EHESS/CNRS UMR8044/INSERM U1276), 54 Boulevard Raspail, 75006, Paris, France
- Baldy Center on Law and Social Policy, Buffalo University, 511 O'Brian Hall Buffalo, New York, 14260, USA
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall (Woodward Instructional Resource Centre), Vancouver, BC, V6T 1Z3, Canada
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14
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Delgado-Ron JA, Jeyabalan T, Watt S, Black S, Gumprich M, Salway T. Sampling Sexual and Gender Minority Youth With UnACoRN (Understanding Affirming Communities, Relationships, and Networks): Lessons From a Web-Based Survey. J Med Internet Res 2023; 25:e44175. [PMID: 36633900 PMCID: PMC9893884 DOI: 10.2196/44175] [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: 11/08/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Periodic surveys of sexual and gender minority (SGM) populations are essential for monitoring and investigating health inequities. Recent legislative efforts to ban so-called conversion therapy make it necessary to adapt youth surveys to reach a wider range of SGM populations, including those <18 years of age and those who may not adopt an explicit two-spirit, lesbian, gay, bisexual, transgender, and queer (2S/LGBTQ) identity. OBJECTIVE We aimed to share our experiences in recruiting SGM youth through multiple in-person and online channels and to share lessons learned for future researchers. METHODS The Understanding Affirming Communities, Relationships, and Networks (UnACoRN) web-based survey collected anonymous data in English and French from 9679 mostly SGM respondents in the United States and Canada. Respondents were recruited from March 2022 to August 2022 using word-of-mouth referrals, leaflet distribution, bus advertisements, and paid and unpaid campaigns on social media and a pornography website. We analyzed the metadata provided by these and other online resources we used for recruitment (eg, Bitly and Qualtrics) and describe the campaign's effectiveness by recruitment venue based on calculating the cost per completed survey and other secondary metrics. RESULTS Most participants were recruited through Meta (13,741/16,533, 83.1%), mainly through Instagram; 88.96% (visitors: 14,888/18,179) of our sample reached the survey through paid advertisements. Overall, the cost per survey was lower for Meta than Pornhub or the bus advertisements. Similarly, the proportion of visitors who started the survey was higher for Meta (8492/18,179, 46.7%) than Pornhub (58/18,179, 1.02%). Our subsample of 7037 residents of Canada had a similar geographic distribution to the general population, with an average absolute difference in proportion by province or territory of 1.4% compared to the Canadian census. Our US subsample included 2521 participants from all US states and the District of Columbia. A total of CAD $8571.58 (the currency exchange rate was US $1=CAD $1.25) was spent across 4 paid recruitment channels (Facebook, Instagram, PornHub, and bus advertisements). The most cost-effective tool of recruitment was Instagram, with an average cost per completed survey of CAD $1.48. CONCLUSIONS UnACoRN recruited nearly 10,000 SGM youth in the United States and Canada, and the cost per survey was CAD $1.48. Researchers using online recruitment strategies should be aware of the differences in campaign management each website or social media platform offers and be prepared to engage with their framing (content selection and delivery) to correct any imbalances derived from it. Those who focus on SGM populations should consider how 2S/LGBTQ-oriented campaigns might deter participation from cisgender or heterosexual people or SGM people not identifying as 2S/LGBTQ, if relevant to their research design. Finally, those with limited resources may select fewer venues with lower cost per completed survey or that appeal more to their specific audience, if needed.
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Affiliation(s)
- Jorge Andrés Delgado-Ron
- Reaffirm Collaborative, Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Thiyaana Jeyabalan
- Reaffirm Collaborative, Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - Sarah Watt
- Reaffirm Collaborative, Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Stéphanie Black
- Reaffirm Collaborative, Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Martha Gumprich
- Reaffirm Collaborative, Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Travis Salway
- Reaffirm Collaborative, Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
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15
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Coulaud PJ, Salway T, Jesson J, Bolduc N, Ferlatte O, Bertrand K, Desgrées du Loû A, Jenkins E, Jauffret-Roustide M, Knight R. Moderation of the association between COVID-19-related income loss and depression by receipt of financial support: Repeated cross-sectional surveys of young adults in Canada and France (2020-2021). SSM Popul Health 2023; 21:101340. [PMID: 36644570 PMCID: PMC9832713 DOI: 10.1016/j.ssmph.2023.101340] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/17/2022] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Background To mitigate the adverse effects of the COVID-19 pandemic on financial resources, governments and family/friends mobilized financial support interventions (e.g., emergency aid funds) and assistance. However, little is known about how financial assistance alleviated mental health problems. This study aimed to investigate the moderating effect of financial support from the government or from family/friends on the association between income loss and depression among young adults. Methods Two online cross-sectional surveys among young adults ages 18-29 living in Canada and France were conducted in 2020 (n = 4,511) and 2021 (n = 3,329). Moderate-to-severe depressive symptoms were measured using the Patient Health Questionnaire-9 (cut-off score: ≥10). Two logistic regression models were performed for each survey with an interaction term between income loss and financial support (government or family/friends modeled separately), controlling for demographics. Results Overall, half reported depressive symptoms (2020/2021: 53.5%/45.6%), and over a third lost income (2020/2021: 10.2%/11.6% all income, 37.7%/21.6% some income). In 2020, 40.6% received government financial support (17.7% in 2021) while family/friends support was received by 12% (in both surveys). In both surveys, among those who received governmental financial support, income loss was associated with depression, whether participants lost all their income (e.g., 2020: Adjusted Odds Ratios (AOR) 1.75, 95% Confidence Interval [1.29-2.44]), or some of their income (e.g., 2020: AOR 1.45 [1.17-1.81]). However, among those who received family/friends financial support, income loss was no longer significantly associated with depression in both cycles, whether participants lost all their income (e.g., 2020: AOR 1.37 [0.78-2.40]), or some of their income (e.g., 2020: AOR 1.31 [0.86-1.99]). Conclusions Association between income loss and depression was moderated by receipt of family/friends financial support but not by receipt of government financial support. Financial support interventions may help to mitigate the negative effects of income loss on young adults mental health during periods of economic crisis.
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Affiliation(s)
- Pierre-julien Coulaud
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Corresponding author. British Columbia Centre on Substance Use, 400-1045, Howe St, Vancouver, BC V6Z 2A9, Canada.
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada,Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Julie Jesson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Naseeb Bolduc
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olivier Ferlatte
- École de Santé Publique de l’Université de Montréal, Montreal, Quebec, Canada,Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Quebec, Canada
| | - Karine Bertrand
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Annabel Desgrées du Loû
- Centre Population et Développement, Université Paris Cité, Institut de Recherche pour le Développement, Inserm, Paris, France
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie Jauffret-Roustide
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada,Centre d'Étude des Mouvements Sociaux (EHESS/CNRS UMR8044/INSERM U1276), Paris, France,Baldy Center on Law and Social Policy, Buffalo University, NY, USA
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada,École de Santé Publique de l’Université de Montréal, Montreal, Quebec, Canada
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16
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Clark KA, Salway T, McConocha EM, Pachankis JE. How do sexual and gender minority people acquire the capability for suicide? Voices from survivors of near-fatal suicide attempts. SSM Qual Res Health 2022; 2:100044. [PMID: 35845718 PMCID: PMC9282160 DOI: 10.1016/j.ssmqr.2022.100044] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Despite well-documented disparities by sexual and gender minority (SGM) status in suicide attempt and mortality rates, few studies have investigated the lived experiences that contribute to SGM people's disproportionate risk of suicide. Having a history of at least one near-fatal (or medically serious) suicide attempt serves as a proxy for suicide mortality, but no known study has involved SGM people who have made such an attempt. Ideation-to-action theories of suicide posit that individuals acquire the capability for suicide through repeated exposure to painful and provocative events - namely, traumatic, threatening, and risky experiences - that can diminish the pain and fear of death. Yet whether identity-specific features of acquired capability for suicide contribute to SGM people's disproportionate risk of suicide remains unknown. Drawing upon interviews with 22 SGM people who experienced a recent near-fatal suicide attempt, the current study sought to identify specific determinants of how SGM individuals acquire the capability to kill themselves, a potentially powerful, and modifiable, pathway to suicide. Results identified three SGM-specific contributors to the acquired capability for suicide: (1) identity invalidation during developmentally sensitive periods of childhood and adolescence that left participants feeling erased, invisible, and, in some cases, non-existent; (2) normalization of suicide within SGM social networks that increased acceptability and reduced the fear of suicide; and (3) structural stigma and SGM community trauma as habituating sources of pain that engendered feelings of exhaustion and positioned suicide as a reprieve from pervasive anti-SGM norms. This study demonstrates that dominant suicidology theories might need to be refined to account for the stigma-related determinants of SGM suicide. Further, this study reinforces the importance of qualitative methods for understanding the lived experience of suicide and calls for SGM-specific suicide prevention efforts to respond to stigma to support those SGM people who contemplate suicide.
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Affiliation(s)
- Kirsty A. Clark
- Department of Medicine, Health, and Society, Vanderbilt University, United States
- Corresponding. Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, 37235, United States. (K.A. Clark)
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Canada
| | | | - John E. Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, United States
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17
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Kinitz DJ, Salway T. Cisheteronormativity, Conversion Therapy, and Identity Among Sexual and Gender Minority People: A Narrative Inquiry and Creative Non-fiction. Qual Health Res 2022; 32:1965-1978. [PMID: 36120897 PMCID: PMC9629512 DOI: 10.1177/10497323221126536] [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: 06/15/2023]
Abstract
Sexual and gender minorities (SGMs) navigate systems of oppression that reify cisgender and heterosexual norms (cisheteronormativity) while developing their identities. 'Conversion therapy' represents a particularly prominent and harmful threat in this landscape. We explore how SGM who experienced conversion therapy develop their identities to understand antecedents to mental health struggles in this population. In-depth interviews were conducted with 22 people in Canada. A 'master narratives' framework combined with Polkinghorne's narrative analysis were used to explore individual-structural relations that affect identity in settings where cisheteronormative master narratives are amplified (i.e., conversion therapy). We present research findings through a creative non-fiction, which includes learning cisheteronormative master narratives; internalizing master narratives; feeling broken and searching for alternatives; and embracing self-love amidst pain. The amplification of master narratives through conversion therapy leads to conflict and delays in adopting a coherent identity. Health professionals should enact institutional practices that affirm SGM and thereby deemphasize cisheteronormativity.
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Key Words
- bisexual,
- conversion therapy,
- creative non-fiction,
- gay,
- identity,
- lesbian,
- master narrative framework,
- narrative inquiry,
- queer,
- sexual and gender minority health
- transgender,
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Affiliation(s)
- David J. Kinitz
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
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18
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Salway T, Rich AJ, Ferlatte O, Gesink D, Ross LE, Bränström R, Sadr A, Khan S, Grennan T, Shokoohi M, Brennan DJ, Gilbert M. Preventable mortality among sexual minority Canadians. SSM Popul Health 2022; 20:101276. [PMID: 36337988 PMCID: PMC9634359 DOI: 10.1016/j.ssmph.2022.101276] [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: 08/02/2022] [Revised: 10/02/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background Epidemiologic studies point to multiple health inequities among sexual minority people, but few studies have examined mortality. Some causes of death are more preventable than others, and access to prevention is theorized to follow patterns of access to social and material resources. The objective of this study is to compare estimates of preventable mortality between sexual minority (SM)-i.e., bisexual, lesbian, gay-and heterosexual adults in Canada. Methods A population-based retrospective cohort with 442,260 (unweighted N) Canadian adults, ages 18-59 years, was drawn from the Canadian Community Health Survey/Canadian Mortality Database linked database (2003-2017). The Rutstein preventability rating index was used to classify cause-specific mortality (low/high). Longitudinal analyses were conducted using Cox proportional hazards models. Results SM respondents had higher hazard of all-cause mortality (unadjusted hazard ratio [uHR] 1.28, 95% CI 1.06, 1.55). The uHR increased when the outcome was limited to highly-preventable causes of mortality (uHR 1.43, 95% CI 1.14, 1.80). The uHR further increased in sensitivity analyses using higher thresholds of the Rutstein index. SM respondents had higher hazard of cause-specific mortality for heart disease (uHR 1.53, 95% CI 1.03, 2.29), accidents (uHR 1.97, 95% CI 1.01, 3.86), HIV (uHR 75.69, 95% CI 18.77, 305.20), and suicide (uHR 2.22, 95% CI 0.93, 5.30) but not for cancer (uHR 0.86, 95% CI 0.60, 1.25). The adjusted HR (aHR) for highly-preventable mortality was not attenuated by adjustment for confounders (aHR 1.57, 95% CI 1.20, 2.05) but was reduced by adjustment for hypothesized mediators relating to access to social and material resources (marital status, children, income, education; aHR 1.11, 95% CI 0.78, 1.58). Conclusions Preventable mortality was elevated for SM Canadians compared to heterosexuals. Early and broad access to sexual minority-affirming primary and preventive healthcare should be expanded.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Corresponding author. Blusson Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Ashleigh J. Rich
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Olivier Ferlatte
- École de santé publique, Université de Montréal, Montréal, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Lori E. Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Richard Bränström
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Aida Sadr
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Syma Khan
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, Canada
- Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
| | - Mostafa Shokoohi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David J. Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Coulaud P, Salway T, Jesson J, Bolduc N, Ferlatte O, Bertrand K, Desgrées du Loû A, Jenkins E, Jauffret-Roustide M, Knight R. The effect of financial support on depression among young adults during the COVID-19 pandemic. Eur J Public Health 2022. [PMCID: PMC9594094 DOI: 10.1093/eurpub/ckac129.746] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background To mitigate the adverse effects of the COVID-19 pandemic on financial resources, governments provided financial support (e.g., emergency aid funds) as well as family via personal assistance. This study aims to assess the moderating effect of financial support from the government or from family on the association between income loss and depression among young adults. Methods Two online cross-sectional surveys among young adults (18-29) living in Canada and France were conducted in October-December 2020 (n = 4511) and July-December 2021 (n = 3329). Depressive symptoms were measured using PHQ-9 score+10. Two logistic regression models were performed for each survey with an interaction term between income loss and financial support (government or family modeled separately), controlling for demographics (e.g., country, age, gender, income, living conditions). Results In the total sample, half reported depressive symptoms (2020/2021: 53%/46%), and over a third lost income (2020/2021: 10%/12% all income, 38%/22% some income). In 2020, 41% received government financial support (2021: 18%) while family/friends support was constant (12%). In both surveys, among those who received government support, income loss was associated with depression, whether participants lost all income (2020: AOR 1.75 [1.29-2.44]; 2021: AOR 2.17 [1.36-3.44]), or some income (2020: AOR 1.31 [1.17-1.81]; 2021: AOR 1.46 [0.99-2.16]). However, among those who received family support, income loss was no longer significantly associated with depression, whether participants lost all income (2020: AOR 1.37 [0.78-2.40]; 2021: AOR 1.51 [0.88-2.56]), or some income (2020: AOR 1.31 [0.86-1.99]; 2021: AOR 1.10 [0.67-1.81]). Conclusions Association between income loss and depression was moderated by receipt of family financial support but not by receipt of government support. Financial support may help to mitigate the negative effects of income loss on young adults mental health during public health crisis. Key messages • Financial support may help to minimize risk of depressive symptoms among youth who lost income related to the COVID-19 pandemic. • Financial support through personal assistance (e.g., family, friends) appears to have a greater impact on youth mental health than COVID-specific government assistance funds.
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Affiliation(s)
- P Coulaud
- Department of Medicine, University of British Columbia , Vancouver, Canada
- BC Centre on Substance Use , Vancouver, Canada
| | - T Salway
- Faculty of Health Sciences, Simon Fraser University , Burnaby, Canada
- Columbia Centre for Disease Control British , Vancouver, Canada
- Centre for Gender and Sexual Health Equity , Vancouver, Canada
| | - J Jesson
- Faculty of Health Sciences, Simon Fraser University , Burnaby, Canada
| | - N Bolduc
- Department of Medicine, University of British Columbia , Vancouver, Canada
- School of Population and Public Health, University of British Columbia , Vancouver, Canada
| | - O Ferlatte
- School of Public Health, University of Montreal , Montreal, Canada
| | - K Bertrand
- Faculty of Medicine and Health Sciences, University of Sherbrooke , Montreal, Canada
| | | | - E Jenkins
- School of Nursing, University of British Columbia , Vancouver, Canada
| | - M Jauffret-Roustide
- Department of Medicine, University of British Columbia , Vancouver, Canada
- Centre d'Étude des Mouvements Sociaux , Paris, France
- Baldy Center on Law and Social Policy, Buffalo University , New York, USA
| | - R Knight
- Department of Medicine, University of British Columbia , Vancouver, Canada
- BC Centre on Substance Use , Vancouver, Canada
- Centre for Gender and Sexual Health Equity , Vancouver, Canada
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20
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MacKinnon KR, Kia H, Salway T, Ashley F, Lacombe-Duncan A, Abramovich A, Enxuga G, Ross LE. Health Care Experiences of Patients Discontinuing or Reversing Prior Gender-Affirming Treatments. JAMA Netw Open 2022; 5:e2224717. [PMID: 35877120 PMCID: PMC9315415 DOI: 10.1001/jamanetworkopen.2022.24717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as detransition. OBJECTIVE To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice. DESIGN, SETTING, AND PARTICIPANTS Using constructivist grounded theory as a qualitative approach, data were collected in the form of in-depth interviews. Data were analyzed using an inductive 2-stage coding process to categorize and interpret detransition-related health care experiences to inform clinical practice. Between October 2021 and January 2022, individuals living in Canada who were aged 18 years and older with experience of stopping, shifting, or reversing a gender transition were invited to partake in semistructured virtual interviews. Study advertisements were circulated over social media, to clinicians, and within participants' social networks. A purposive sample of 28 participants who discontinued, shifted, or reversed a gender transition were interviewed. MAIN OUTCOMES AND MEASURES In-depth, narrative descriptions of the physical and mental health experiences of people who discontinued or sought to reverse prior gender-affirming medical and/or surgical interventions. RESULTS Among the 28 participants, 18 (64%) were assigned female at birth and 10 (36%) were assigned male at birth; 2 (7%) identified as Jewish and White, 5 (18%) identified as having mixed race and ethnicity (which included Arab, Black, Indigenous, Latinx, and South Asian), and 21 (75%) identified as White. Participants initially sought gender-affirmation at a wide range of ages (15 [56%] were between ages 18 and 24 years). Detransition occurred for various reasons, such as an evolving understanding of gender identity or health concerns. Participants reported divergent perspectives about their past gender-affirming medical or surgical treatments. Some participants felt regrets, but a majority were pleased with the results of gender-affirming medical or surgical treatments. Medical detransition was often experienced as physically and psychologically challenging, yet health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs. CONCLUSIONS AND RELEVANCE This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions.
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Affiliation(s)
| | - Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Florence Ashley
- Faculty of Law & Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | | | - Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel Enxuga
- School of Social Work, McGill University, Montreal, Québec, Canada
| | - Lori E. Ross
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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21
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Salway T, Black S, Kennedy A, Watt S, Ferlatte O, Gaspar M, Knight R, Gilbert M. "Syndemic moral distress": sexual health provider practices in the context of co-occurring, socially produced sexual and mental health epidemics. BMC Health Serv Res 2022; 22:750. [PMID: 35668408 PMCID: PMC9169335 DOI: 10.1186/s12913-022-08149-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 'Syndemic' refers to socially produced, intertwined, and co-occurring epidemics. Syndemic theory is increasingly used to understand the population-level relationships between sexual health (including HIV) and mental health (including problematic substance use) epidemics. Syndemic-informed clinical interventions are rare. METHODS We therefore asked 22 sexual health practitioners from six sexual health clinics in British Columbia, Canada to define the word 'syndemic' and then asked how the theory related to their clinical practice. RESULTS Responses to syndemic theory ranged widely, with some practitioners providing nuanced and clinically informed definitions, others expressing a vague familiarity with the term, and others still having no prior knowledge of it. Where practitioners acknowledged the relevance of syndemic theory to their practice, they articulated specific ways in which syndemics create moral distress, that is, feeling that the most ethical course of action is different from what they are mandated to do. While some practitioners routinely used open-ended questions to understand the social and economic contexts of patients' sexual health needs, they described an uneasiness at potentially having surfaced concerns that could not be addressed in the sexual health clinic. Many observed persistent social, mental health, and substance use-related needs among their patients, but were unable to find feasible solutions to these issues. CONCLUSIONS We therefore propose that interventions are needed to support sexual health practitioners in addressing psychosocial health needs that extend beyond their scope of practice, thereby reducing 'syndemic moral distress'.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A1S6, Canada. .,BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada. .,Centre for Gender and Sexual Health Equity, 1190 Hornby Street, 11th Floor, Vancouver, BC, V6Z1Y6, Canada.
| | - Stéphanie Black
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A1S6, Canada.,BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.,Centre for Gender and Sexual Health Equity, 1190 Hornby Street, 11th Floor, Vancouver, BC, V6Z1Y6, Canada
| | - Angel Kennedy
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A1S6, Canada
| | - Sarah Watt
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Drive, Burnaby, BC, V5A1S6, Canada.,BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.,Centre for Gender and Sexual Health Equity, 1190 Hornby Street, 11th Floor, Vancouver, BC, V6Z1Y6, Canada
| | - Olivier Ferlatte
- École de Santé Publique de L'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, H3N1X9, Canada.,Centre de Recherche en Santé Publique, 7101 Avenue du Parc, Montréal, Québec, H3N1X9, Canada
| | - Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T3M7, Canada
| | - Rod Knight
- BC Centre On Substance Use, 1045 Howe Street, Suite 400, Vancouver, BC, V6Z2A9, Canada.,Faculty of Medicine, University of British Columbia, 2194 Health Sciences Mall, Vancouver, BC, V6T1Z3, Canada
| | - Mark Gilbert
- BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, BC, V6T1Z3, Vancouver, Canada
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22
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Kinitz DJ, Goodyear T, Dromer E, Gesink D, Ferlatte O, Knight R, Salway T. "Conversion Therapy" Experiences in Their Social Contexts: A Qualitative Study of Sexual Orientation and Gender Identity and Expression Change Efforts in Canada. Can J Psychiatry 2022; 67:441-451. [PMID: 34242106 PMCID: PMC9152241 DOI: 10.1177/07067437211030498] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe in what forms, with whom, where, when, and why Canadians experience sexual orientation and gender identity and expression change efforts (SOGIECE). METHODS This qualitative study is grounded in a transformative paradigm. We conducted semi-structured interviews with a purposive sample of 22 adults recruited from across Canada who have experienced "conversion therapy." Directed content analysis was used, employing deductive and inductive coding approaches, to synthesize the findings and address 5 policy-relevant questions. RESULTS What are SOGIECE? Formal and informal methods of SOGIECE were used, including pharmacologic interventions, denial of gender-affirming care, and coaching to repress sexual orientation and/or gender identity and expression. With whom did SOGIECE occur? Practitioners included religious leaders, licenced health-care professionals (e.g., psychiatrists and psychologists), peers, and family members. Where did SOGIECE occur? SOGIECE occurred in 3 predominant settings: faith-based, health care, and social life. When did SOGIECE occur? SOGIECE rarely occurred over a restricted time frame; often, SOGIECE began while participants were adolescents or young adults and continued multiple years under various forms. Others described SOGIECE as a context in which their life was embedded for many years. Why did people attend SOGIECE? Cisheteronormative social and religious expectations taught participants that being non-cisgender or non-heterosexual was incompatible with living a good and respectable life. CONCLUSIONS SOGIECE are not a circumscribed set of practices. Our study shows that SOGIECE are a larger phenomenon that consists of intentional and explicit change efforts as well as heterosexual- and cisgender-dominant social norms expressed and enforced across a wide range of settings and circumstances. This study provides critical context to inform contemporary social and health policy responses to SOGIECE. Policies should account for the overt, covert, and insidious ways that SOGIECE operate in order to effectively promote safety, equity, and health for sexually diverse and gender-diverse people.
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Affiliation(s)
- David J Kinitz
- Social and Behavioural Health Sciences, Dalla Lana School of Public Health, 7938University of Toronto, Ontario, Canada
| | - Trevor Goodyear
- School of Nursing, 8166The University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Elisabeth Dromer
- École de Santé Publique de l'5622Université de Montréal, Québec, Canada.,Centre de Recherche en Santé Publique, 5622Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Québec, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, 7938University of Toronto, Ontario, Canada
| | - Olivier Ferlatte
- École de Santé Publique de l'5622Université de Montréal, Québec, Canada.,Centre de Recherche en Santé Publique, 5622Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Québec, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.,Faculty of Medicine, 8166The University of British Columbia, Vancouver, British Columbia, Canada
| | - Travis Salway
- Faculty of Health Sciences, 1763Simon Fraser University, Burnaby, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
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23
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Gupta AK, Salway T. Prescription Drug Insurance and Cost-Related Medication Nonadherence Among Lesbian, Gay, and Bisexual Individuals in Canada. LGBT Health 2022; 9:426-435. [PMID: 35537531 DOI: 10.1089/lgbt.2021.0273] [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: 11/12/2022] Open
Abstract
Purpose: This study estimates the frequency of uninsurance for prescription drugs and cost-related medication nonadherence (CRNA) among lesbian, gay, and bisexual (LGB) persons in Canada, compared with the heterosexual population. Methods: Logistic regression was used to quantify associations between sexual orientation, insurance status, and CRNA within the national probability-based Canadian Community Health Survey, 2015-2016. This sample included 98,413 individuals aged 15-80 years, including 2803 LGB individuals. Results: From our sample of Canadians, 22.2% of LGB respondents reported being uninsured for prescription drugs, compared with 20.0% of heterosexual persons (unadjusted odds ratio [UOR] 1.00, 95% confidence interval [CI] 0.75-1.33). LGB individuals had more than twice the odds of reporting CRNA compared with heterosexual individuals (UOR 2.48, 95% CI 1.99-3.10). This disparity was most pronounced among bisexual respondents, who had over three times the odds of reporting CRNA in comparison to heterosexual respondents (UOR 3.45, 95% CI 2.65-4.51). The odds ratio (OR) for CRNA comparing bisexual with heterosexual individuals remained statistically significant after adjustment for race/ethnicity, gender/sex, and age (OR 2.67, 95% CI 1.97-3.61) and was further attenuated with adjustment for partnership status, employment status, income, educational attainment, prescription drug insurance status, general health status, and immigration status (OR 2.09, 95% CI 1.51-2.89). Conclusion: LGB Canadians reported more CRNA but comparable prescription drug insurance frequencies to heterosexual persons. Factors pertaining to medication access (e.g., income, partnership status) and health needs appear to be the most important contributors to disparities.
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Affiliation(s)
- Amit K Gupta
- British Columbia Centre for Disease Control, Vancouver, Canada.,Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Travis Salway
- British Columbia Centre for Disease Control, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, Canada
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24
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Goodyear T, Kinitz DJ, Dromer E, Gesink D, Ferlatte O, Knight R, Salway T. "They Want You to Kill Your Inner Queer but Somehow Leave the Human Alive": Delineating the Impacts of Sexual Orientation and Gender Identity and Expression Change Efforts. J Sex Res 2022; 59:599-609. [PMID: 33871297 PMCID: PMC8557955 DOI: 10.1080/00224499.2021.1910616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Sexual orientation and gender identity and expression change efforts (SOGIECE) aim to suppress the sexual and gender identities of Two-Spirit, lesbian, gay, bisexual, trans, and other queer (2SLGBTQ+) people. Exposure to SOGIECE is associated with significant psychosocial morbidity. Yet, there is a dearth of knowledge specifying the ways in which these psychosocial impacts are produced and experienced. This qualitative interpretive description study aimed to delineate the impacts of SOGIECE. To do so, we thematically analyzed data from in-depth interviews, conducted between January and July 2020, with 22 people with lived experience of SOGIECE. Study participants indicated that feelings of shame and brokenness related to their sexual and gender identities were deeply implicated in and shaped by experiences with SOGIECE. SOGIECE also had socially isolating effects, which had restricted participants' opportunities for meaningful connection with others, including romantic partners and 2SLGBTQ+ communities. Further, SOGIECE had contributed to experiences of profound emotional distress, mental illness (e.g., anxiety, depression), and suicidality. These findings underscore the need for several responsive policy and programmatic interventions, including legislation to prevent SOGIECE, enhanced sexuality- and gender-related educational efforts with the families and support persons of 2SLGBTQ+ people, and targeted mental health screening and supports for SOGIECE survivors.
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Affiliation(s)
- Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, Canada
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - David J. Kinitz
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elisabeth Dromer
- École de santé publique de l’Université de Montréal, Montreal, Quebec, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Quebec, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Olivier Ferlatte
- École de santé publique de l’Université de Montréal, Montreal, Quebec, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Quebec, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Travis Salway
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Corresponding Author: Travis Salway, PhD, Faculty of Health Sciences, Simon Fraser University, Blusson Hall 10506, 8888 University Drive, Burnaby, British Columbia, Canada, V5A 1S6.
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25
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Kia H, Grace D, Strike C, Ferlatte O, Knight R, Salway T, Ross LE. "They Haven't Made a Slot for Us Yet": Conceptualizing the Health Care and Social Service Needs of Older Gay Men Living with HIV in Canada. J Homosex 2022; 69:332-355. [PMID: 32946344 DOI: 10.1080/00918369.2020.1819712] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this paper, we present the findings of a qualitative study aimed at conceptualizing the service needs of aging gay men living with HIV (GMLH). Our analysis is based on interview data from 16 gay-identified men living with HIV, ages 50 and over. Drawing on a framework of intersectionality, which theoretically accounts for interlocking expressions of marginalization in groups affected by multiple systems of oppression, we highlight the practical, social, and mental health needs of this population, as well as services that could be designed or adapted to address these concerns. We also emphasize the relevance of specialized training for caring professionals serving older GMLH, and articulate the need for initiatives that more fully engage gay men aging with HIV in the development and delivery of services intended for their use.
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Affiliation(s)
- Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Olivier Ferlatte
- École de santé publique, Université de Montréal, Montreal, Canada
| | - Rod Knight
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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26
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Salway T, Ashley F. Ridding Canadian medicine of conversion therapy. CMAJ 2022; 194:E17-E18. [PMID: 35012950 PMCID: PMC8800469 DOI: 10.1503/cmaj.211709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Travis Salway
- Faculty of Health Sciences (Salway), Simon Fraser University, Burnaby, BC; British Columbia Centre for Disease Control (Salway); Centre for Gender and Sexual Health Equity (Salway), Vancouver, BC; University of Toronto Faculty of Law and Joint Centre for Bioethics (Ashley), Toronto, Ont.
| | - Florence Ashley
- Faculty of Health Sciences (Salway), Simon Fraser University, Burnaby, BC; British Columbia Centre for Disease Control (Salway); Centre for Gender and Sexual Health Equity (Salway), Vancouver, BC; University of Toronto Faculty of Law and Joint Centre for Bioethics (Ashley), Toronto, Ont
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St-Jean M, Closson K, Salway T, Card K, Patterson TL, Hogg RS, Lima VD. Sexual minority status modifies the association between HIV risk behavior and prevalent mood or anxiety disorders in British Columbia, Canada. Soc Psychiatry Psychiatr Epidemiol 2022; 57:207-218. [PMID: 34279694 DOI: 10.1007/s00127-021-02141-6] [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: 10/29/2020] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed at determining to what extent sexual minority status modifies the association between HIV risk behavior and prevalent mood or anxiety disorder diagnosis in British Columbia (BC), Canada, using a population-based survey. METHODS This analysis was based on the cross-sectional 2013-2014 Canadian Community Health Survey. The sample was restricted to respondents in BC with valid responses to the survey items considered. A multivariable logistic model, where the behavioral HIV risk score exposure was nested into the sexual minority status modifier, estimated the odds of having a prevalent mood or an anxiety disorder. The behavioral HIV risk score (0, 1, 2, ≥ 3) included the following five measures: (1) age at first intercourse < 14 years, (2) condom use during last intercourse, (3) history of sexually transmitted infections, (5) number of sexual partners in the past 12 months (< 4, ≥ 4), and substance use in the past 12 months. RESULTS Of the weighted sample (2,521,252), 97% (95% confidence interval (CI) 97-98) were heterosexual, while 3% (95% CI 2-3) were lesbian, gay, and bisexual (LGB). The prevalence of a mood or anxiety disorder diagnosis was 12% (95% CI 11-13). For every 1-level increment in the behavioral HIV risk score, the adjusted odds ratio of having a prevalent mood or anxiety disorder diagnosis was 1.29 (95% CI 1.03-1.54) for heterosexual respondents and 2.37 (95% CI 1.84-2.90) for LGB respondents. CONCLUSION Sexual minority status modified the relationship between HIV risk behavior and prevalent mood or anxiety disorders, with a stronger association among LGB respondents. Healthcare providers should prioritize integrated care that addresses the intersectionality between sexual risk, substance use, and mood or anxiety disorders.
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Affiliation(s)
- Martin St-Jean
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kalysha Closson
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,Division of Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Kiffer Card
- British Columbia 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
- British Columbia 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
- British Columbia 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.
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Kia H, Salway T, Lacombe-Duncan A, Ferlatte O, Ross LE. "You Could Tell I Said the Wrong Things": Constructions of Sexual Identity Among Older Gay Men in Healthcare Settings. Qual Health Res 2022; 32:255-266. [PMID: 34875919 PMCID: PMC8727827 DOI: 10.1177/10497323211050373] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Older gay men commonly conceal their sexual identity in healthcare settings due to past experiences and expectations of encountering stigma and discrimination in these contexts. Although insights on how older gay men construct their sexual identity in healthcare may help contextualize this phenomenon, this question remains under-explored. Accordingly, we present the findings of a secondary grounded theory analysis of individual interview data, which we originally collected to examine the healthcare experiences of 27 gay men ages 50 and over, to explore constructions of sexual identity among the group. Our findings broadly reveal that older gay men's varying exposure to intersecting systems of oppression, together with their perceptions of different healthcare settings, may be critical in shaping their constructions of sexual identity in these contexts. Our research supports the need for healthcare policies and practices that address stigma and discrimination as salient barriers to sexual identity disclosure among older gay men.
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Affiliation(s)
- Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Olivier Ferlatte
- École de Santé Publique, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS Du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
| | - Lori E. Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Slemon A, Richardson C, Goodyear T, Salway T, Gadermann A, Oliffe JL, Knight R, Dhari S, Jenkins EK. Widening mental health and substance use inequities among sexual and gender minority populations: Findings from a repeated cross-sectional monitoring survey during the COVID-19 pandemic in Canada. Psychiatry Res 2022; 307:114327. [PMID: 34923446 PMCID: PMC8647565 DOI: 10.1016/j.psychres.2021.114327] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 11/25/2021] [Accepted: 12/04/2021] [Indexed: 01/03/2023]
Abstract
This paper examines the mental health and substance use impacts of the COVID-19 pandemic among sexual and gender minority (SGM) populations as compared to non-SGM populations, and identifies risk factors for mental health and substance use impacts among SGM groups. Data were drawn from two rounds of a repeated cross-sectional monitoring survey of 6027 Canadian adults, with Round 1 conducted May 14-19, 2020 and Round 2 conducted September 14-21, 2020. Bivariate cross-tabulations with chi-square tests were utilized to identify differences in mental health and substance use outcomes between SGM and non-SGM groups. Separate multivariable logistic regression models were used to identify risk factors for mental health and substance use outcomes for all SGM respondents. Compared to non-SGM respondents, a greater proportion of SGM participants reported mental health and substance use impacts of the COVID-19 pandemic, including deterioration in mental health, poor coping, suicidal thoughts, self-harm, alcohol and cannabis use, and use of substances to cope. Among SGM respondents, various risk factors, including having a pre-existing mental health condition, were identified as associated with mental health and substance use impacts. These widening inequities demonstrate the need for tailored public mental health actions during and beyond the pandemic.
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Affiliation(s)
- Allie Slemon
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.
| | - Chris Richardson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.
| | - Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre on Substance Use, Vancouver, BC, Canada.
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada; Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada.
| | - Anne Gadermann
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada; The Human Early Learning Partnership, University of British Columbia, Vancouver, BC, Canada.
| | - John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver BC, Canada.
| | - Shivinder Dhari
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.
| | - Emily K. Jenkins
- School of Nursing, University of British Columbia, Vancouver, BC, Canada,Corresponding author at: School of Nursing, University of British Columbia, T201-2211 Westbrook Mall, Vancouver, BC, Canada, V6T 2B5
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Moallef S, Salway T, Phanuphak N, Kivioja K, Pongruengphant S, Hayashi K. The relationship between sexual and gender stigma and suicide attempt and ideation among LGBTQI + populations in Thailand: findings from a national survey. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1987-1997. [PMID: 35599251 PMCID: PMC9477892 DOI: 10.1007/s00127-022-02292-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 04/12/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Thailand has one of the highest suicide rates in Southeast Asia; yet, little is known about suicidality among lesbian, gay, bisexual, trans, queer, intersex, and other gender and sexually diverse (LGBTQI +) people living in the region, who may experience elevated risk for suicide. We sought to identify the prevalence of lifetime suicidal attempts and ideation among a nationally recruited sample of LGBTQI + people in Thailand. We further examined the relationship between levels of sexual/gender stigma and suicidal attempt and ideation. METHODS Data were derived from a national online survey of Thai LGBTQI + individuals between January and March 2018. Multivariable logistic regression was used to examine the relationship between sexual/gender stigma scales, adapting a previously validated instrument, and suicide attempt and ideation. RESULTS Among 1,290 LGBTQI + participants, the median age was 27 years. The prevalence of suicide attempt and ideation was 16.8% and 50.7%, respectively. In multivariable analyses, after adjusting for potential confounders, experiences of perceived and enacted sexual/gender stigma were independently and positively associated with suicide attempt (adjusted odds ratio [AOR] = 1.25; 95% confidence interval CI:1.10-1.41 and AOR = 1.31; 95% CI:1.11-1.55, respectively) and ideation (AOR = 1.30; 95% CI:1.17-1.43 and AOR = 1.34; 95% CI:1.14-1.58, respectively). CONCLUSION One-sixth of the sample reported a suicide attempt, while a half reported ever contemplating suicide. Both experiences of perceived and enacted sexual/gender stigma were associated with lifetime suicide attempt and ideation. Multi-level interventions are needed to decrease stigma and in turn suicide among LGBTQ + people in Thailand, including anti-discrimination policies and support for mental health and well-being.
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Affiliation(s)
- Soroush Moallef
- United Nations Development Programme, Bangkok, Thailand ,British Columbia Centre On Substance Use, St. Paul’s Hospital, Vancouver, BC Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada ,British Columbia Centre for Disease Control, Vancouver, BC Canada ,Centre for Gender and Sexual Health Equity, Vancouver, BC Canada
| | | | - Katri Kivioja
- United Nations Development Programme, Bangkok, Thailand
| | | | - Kanna Hayashi
- British Columbia Centre On Substance Use, St. Paul's Hospital, Vancouver, BC, Canada. .,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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31
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Watt S, Salway T, Gómez-Ramírez O, Ablona A, Barton L, Chang HJ, Pedersen H, Haag D, LeMoult J, Gilbert M. Rumination, risk, and response: a qualitative analysis of sexual health anxiety among online sexual health chat service users. Sex Health 2022; 19:182-191. [DOI: 10.1071/sh21198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022]
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32
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Brennan DJ, Kesler M, Lachowsky NJ, Davies A, Georgievski G, Adam BD, Collict D, Hart TA, Salway T, Griffiths D. Sociodemographic and Psychological Predictors of Seeking Health Information Online among GB2M in Ontario: Findings from the #iCruise Project. Int J Sex Health 2021; 34:337-350. [PMID: 38596527 PMCID: PMC10903557 DOI: 10.1080/19317611.2021.2000087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/22/2021] [Accepted: 10/23/2021] [Indexed: 04/11/2024]
Abstract
Objectives The current study examines the experiences of gay, bisexual, two-spirit and other men who have sex with men (GB2M) who use networking applications and their engagements with online sexual health outreach workers disseminating healthcare information through these digital spaces. Methods The iCruise study was a longitudinal mixed-methods study across Ontario, Canada which collected data on online sexual health information seeking behaviors. Results Results offer insight into differences in information seeking behaviors among diverse groups of queer men. Conclusions Implications for the dissemination of health information based on the results of information seeking patterns is discussed as well.
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Affiliation(s)
- David J. Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Maya Kesler
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Nathan J. Lachowsky
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Adam Davies
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Canada
| | - Georgi Georgievski
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Barry D. Adam
- Department of Sociology, Anthropology and Criminology, University of Windsor, Windsor, Canada
| | - David Collict
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Trevor A. Hart
- Department of Psychology, Ryerson University, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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33
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Salway T, Ablona A, Chang HJ, Watt S, Worthington C, Grace D, Wong J, Ogilvie G, Grennan T, Gilbert M. Self-rated mental health among sexual health service clients during the first months of the COVID-19 pandemic, British Columbia, Canada. Prev Med 2021; 153:106789. [PMID: 34506815 PMCID: PMC8431968 DOI: 10.1016/j.ypmed.2021.106789] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/03/2021] [Accepted: 09/04/2021] [Indexed: 11/29/2022]
Abstract
We investigated self-reported mental health during the first three months of the COVID-19 pandemic (March-May 2020), using a survey of HIV-testing and sexual health service clients from British Columbia, Canada (N = 1198). Over half (55%) reported their mental health as poor at the beginning of the COVID-19 pandemic, more than double that of the general Canadian population in the same time frame (22%). Acknowledging that this burden of poor mental health that is likely to persist in the coming years, we propose that sexual health clinics should facilitate access to mental health supports as a low-barrier point of primary care contact.
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Affiliation(s)
- Travis Salway
- Simon Fraser University, Canada; BC Centre for Disease Control, Canada; Centre for Gender and Sexual Health Equity, Canada.
| | | | | | - Sarah Watt
- Simon Fraser University, Canada; BC Centre for Disease Control, Canada
| | | | | | - Jason Wong
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - Gina Ogilvie
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - Troy Grennan
- BC Centre for Disease Control, Canada; University of British Columbia, Canada
| | - Mark Gilbert
- BC Centre for Disease Control, Canada; University of British Columbia, Canada.
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34
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McAuliffe C, Pumarino J, Thomson KC, Richardson C, Slemon A, Salway T, Jenkins EK. Correlates of suicidal ideation related to the COVID-19 Pandemic: Repeated cross-sectional nationally representative Canadian data. SSM Popul Health 2021; 16:100988. [PMID: 34909458 PMCID: PMC8656176 DOI: 10.1016/j.ssmph.2021.100988] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/12/2021] [Accepted: 11/29/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE With significant levels of mental distress reported by populations, globally, the magnitude of suicidal ideation during and beyond the COVID-19 pandemic is a central concern. The goal of this study was to quantify the extent of pandemic-related suicidal ideation in the Canadian population during the first ten months of the pandemic and identify sociodemographic and pandemic-related stressors associated with increased risk of ideation. METHOD Data were derived from three rounds of a mental health monitoring survey, nationally representative by age, gender, household income, and region, delivered online in May 2020, September 2020, and January 2021. Bivariate analyses were used to quantify the proportion of respondents in Canada reporting suicidal ideation by sociodemographic factors and pandemic-related stressors. Unadjusted and adjusted multivariable logistic regression was used to study the association between suicidal ideation and correlates within four pandemic-related stressor categories (financial, relationship, substance use, COVID-19 exposure). RESULTS Of the 7002 respondents, 6.2% (n = 433) reported experiencing suicidal thoughts or feelings as a result of the pandemic within the two weeks prior to taking the survey. In terms of sociodemographic factors, suicidal ideation was more commonly reported among those who were not cisgender, <65 years-old, single, Indigenous, LGBT2Q+, and who experience a pre-existing mental health condition. After adjusting for sociodemographic factors, indicators across all four pandemic-related stressor categories were associated with two or more times the odds of suicidal ideation. CONCLUSION Disparities in COVID-19 related suicidal ideation have persisted throughout the first year of the pandemic for specific sociodemographic sub-groups and those who have faced stressors related to finances, relationships, increased substance use, and COVID-19 virus exposure. To best address these disparities and to prevent a transition from suicidal ideation to action, appropriate planning, resources, and policies are needed to ensure health and well-being for everyone.
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Affiliation(s)
- Corey McAuliffe
- School of Nursing, University of British Columbia, T201-2211 Westbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada
| | - Javiera Pumarino
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Kimberly C. Thomson
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 5881-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
- The Human Early Learning Partnership, University of British Columbia, Suite 440, 2206 East Mall, Vancouver, British Columbia, V6T 1Z3, Canada
| | - Chris Richardson
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 5881-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Allie Slemon
- School of Nursing, University of British Columbia, T201-2211 Westbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr., Burnaby, V5A1S6, Canada
- BC Centre for Disease Control, 655 West 12th Ave., Vancouver, BC, V5L 4R4, Canada
- Centre for Gender and Sexual Health Equity, 1190 Hornby St. (11th Floor), Vancouver, BC, V6Z 1Y6, Canada
| | - Emily K. Jenkins
- School of Nursing, University of British Columbia, T201-2211 Westbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada
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Gibb JK, Shokoohi M, Salway T, Ross LE. Sexual orientation-based disparities in food security among adults in the United States: results from the 2003-2016 NHANES. Am J Clin Nutr 2021; 114:2006-2016. [PMID: 34551071 DOI: 10.1093/ajcn/nqab290] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 05/28/2021] [Accepted: 08/11/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Access to sufficient, safe, culturally appropriate, and nutritious food is essential for maintaining both physical and mental health. Despite a growing body of evidence suggesting that sexual minority (SM) people experience significant disparities in socioeconomic and material resource security, there remains a paucity of empirical studies examining the prevalence of food insecurity among SM people relative to their heterosexual peers. OBJECTIVES To determine the prevalence of adult and household food insecurity across sexual orientation groups in the United States after adjusting for multiple covariates. METHODS We combined 7 cycles of US NHANES, 2003-2016 (N = 21,300) to examine sexual orientation-based disparities in adult food security among lesbian/gay (n = 373), bisexual (n = 606), same-sex experienced (SSE, n = 693), other sexual minorities (OSMs, n = 88), and heterosexual (n = 19,540) people. Food (in)security was measured using the US Food Security Survey Module and categorized as secure, marginally insecure, moderately insecure, and severely insecure. RESULTS Severe adult food insecurity was higher among bisexuals (17.16%; 95% CI: 14.36, 20.38), SSE (13.71%; 95% CI: 11.34, 16.48), OSMs (12.50%; 95% CI: 7.04, 21.24), and lesbians/gays (13.14%; 95% CI: 10.07, 16.97) compared with heterosexuals (8.23%; 95% CI: 7.85, 8.62). Multivariable multinomial logistic regression analysis adjusting for gender, race/ethnicity, age, citizenship, education, household size, income, cycle year, emergency food use, and Supplemental Nutrition Assistance Program participation showed that bisexuals, OSMs, SSE, and lesbians/gays were more likely to experience moderate to severe food insecurity compared with heterosexuals. CONCLUSIONS SM people are significantly more likely to experience increased likelihood of food insecurity relative to their heterosexual peers.
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Affiliation(s)
- James K Gibb
- Department of Health & Society, University of Toronto, Scarborough, Ontario, Canada.,Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Mostafa Shokoohi
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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36
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Goodyear T, Slemon A, Richardson C, Gadermann A, Salway T, Dhari S, Knight R, Jenkins E. Increases in Alcohol and Cannabis Use Associated with Deteriorating Mental Health among LGBTQ2+ Adults in the Context of COVID-19: A Repeated Cross-Sectional Study in Canada, 2020-2021. Int J Environ Res Public Health 2021; 18:12155. [PMID: 34831910 PMCID: PMC8620284 DOI: 10.3390/ijerph182212155] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022]
Abstract
Lesbian, gay, bisexual, trans, other queer, and Two-Spirit (LGBTQ2+) people are particularly at risk for the psycho-social consequences of the COVID-19 pandemic, though population-tailored research within this context remains limited. This study examines the extent of, and associations between, increased alcohol and cannabis use and deteriorating mental health among LGBTQ2+ adults in Canada during the COVID-19 pandemic. Data are drawn from LGBTQ2+ respondents to a repeated, cross-sectional survey administered to adults living in Canada (May 2020-January 2021). Bivariate cross-tabulations and multivariable logistic regression models were utilized to examine associations between increased alcohol and cannabis use, and self-reported mental health, overall coping, and suicidal thoughts. Five-hundred and two LGBTQ2+ participants were included in this analysis. Of these, 24.5% reported increased alcohol use and 18.5% reported increased cannabis use due to the pandemic. In the adjusted analyses, increased alcohol use was associated with poor overall coping (OR = 2.28; 95% CI = 1.28-4.07) and worse self-reported mental health (OR = 1.98; 95% CI = 1.21-3.25), whereas increased cannabis use was associated with suicidal thoughts (OR = 2.30; 95% CI = 1.16-4.55). These findings underscore the need for population-tailored, integrated substance use and mental health supports to address interrelated increases in alcohol/cannabis use and worsening mental health among LGBTQ2+ adults, in the context of the COVID-19 pandemic and beyond.
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Affiliation(s)
- Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (T.G.); (A.S.); (S.D.)
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada;
| | - Allie Slemon
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (T.G.); (A.S.); (S.D.)
| | - Chris Richardson
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (C.R.); (A.G.)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Anne Gadermann
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (C.R.); (A.G.)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
- The Human Early Learning Partnership, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Travis Salway
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada;
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Shivinder Dhari
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (T.G.); (A.S.); (S.D.)
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada;
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (T.G.); (A.S.); (S.D.)
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Gilbert M, Chang HJ, Ablona A, Salway T, Ogilvie GS, Wong J, Haag D, Pedersen HN, Bannar-Martin S, Campeau L, Ford G, Worthington C, Grace D, Grennan T. Accessing needed sexual health services during the COVID-19 pandemic in British Columbia, Canada: a survey of sexual health service clients. Sex Transm Infect 2021; 98:360-365. [PMID: 34740976 PMCID: PMC8577923 DOI: 10.1136/sextrans-2021-055013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/24/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives We assessed COVID-19 pandemic impacts on accessing needed sexual health services, and acceptability of alternative service delivery models, among sexual health service clients in British Columbia (BC), Canada. Methods We administered an online survey on 21 July–4 August 2020 to clients using a provincial STI clinic or internet-based testing service, GetCheckedOnline, in the year prior to March 2020. We used logistic regression to identify factors associated with having unmet sexual health needs (ie, not accessing needed services) during March–July 2020 and the likelihood of using various alternative service models, if available. Results Of 1198 survey respondents, 706 (59%) reported needing any sexual health service since March 2020; of these 706, 365 (52%) did not access needed services and 458 (66%) had avoided or delayed accessing services. GetCheckedOnline users (univariate OR (uOR)=0.62; 95% CI 0.43 to 0.88) or clients with more urgent needs (eg, treatment for new STI, uOR 0.40 (95% CI 0.21 to 0.7)) had lower odds of unmet sexual health needs. The most common factors reported for avoiding or delaying access were public messaging against seeking non-urgent healthcare (234/662, 35%), concern about getting COVID-19 while at (214/662, 32%) or travelling to (147/662, 22%) a clinic or lab and closure of usual place of accessing services (178/662, 27%). All factors were positively associated with having unmet sexual health needs, with public messaging showing the strongest effect (adjusted OR=4.27 (95% CI 2.88 to 6.42)). Likelihood of using alternative sexual health service models was high overall, with the most appealing options being home self-collection kits (634/706, 90%), receiving test kits or antibiotics at home (592/700, 85%) and express testing (565/706, 80%). Conclusions Of BC sexual health service clients needing services during March–July 2020, many had unmet needs. Offering alternative service delivery methods may help to improve access during and beyond the COVID-19 pandemic.
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Affiliation(s)
- Mark Gilbert
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada .,School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Hsiu-Ju Chang
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Aidan Ablona
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Gina Suzanne Ogilvie
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Jason Wong
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Devon Haag
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Heather Nicole Pedersen
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Laurence Campeau
- Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Geoffrey Ford
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Catherine Worthington
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Troy Grennan
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada.,Division of Infectious Diseases, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Gilbert M, Chang HJ, Ablona A, Salway T, Ogilvie G, Wong J, Campeau L, Worthington C, Grace D, Grennan T. Partner number and use of COVID-19 risk reduction strategies during initial phases of the pandemic in British Columbia, Canada: a survey of sexual health service clients. Can J Public Health 2021; 112:973-983. [PMID: 34731488 PMCID: PMC8565172 DOI: 10.17269/s41997-021-00566-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/30/2021] [Indexed: 11/24/2022]
Abstract
Objectives Initial public health guidance related to sex and COVID-19 infection focused on reducing partner number. We characterized individuals having a higher partner number during the initial phases of the pandemic. Methods In British Columbia, the initial wave of COVID-19 cases was from March 14 to May 19, 2020, followed by gradual lifting of public health restrictions. We conducted an e-mail survey of existing sexual health service clients during the period of July 23 to August 4, 2020. We used bivariate logistic regression to examine the association between the reported number of sexual partners since the start of the pandemic and key variables (level of significance p < 0.01). Results Of the 1196 clients in our final sample, 42% reported 2+ partners since the start of the pandemic, with higher odds among participants who were men who have sex with men, and single or in open relationships prior to the pandemic. This group was more likely to perceive stigma associated with having sex during the pandemic, and had the highest use of strategies to reduce risk of COVID-19 infection during sexual encounters (mainly focused on reducing/avoiding partners, such as masturbation, limiting sex to a “bubble”, and not having sex). Conclusion Sexual health service clients in BC with 2+ partners during the initial phases of BC’s pandemic used strategies to reduce their risk of COVID-19 infection during sex. Our study provides support for a harm reduction approach to guidance on COVID-19 risk during sex, and highlights the need for further research on stigma related to having sex during the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.17269/s41997-021-00566-9.
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Affiliation(s)
- Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th, Vancouver, British Columbia, V5Z 4R4, Canada. .,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Hsiu-Ju Chang
- Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th, Vancouver, British Columbia, V5Z 4R4, Canada
| | - Aidan Ablona
- Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th, Vancouver, British Columbia, V5Z 4R4, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, BC Women's, Vancouver, British Columbia, Canada
| | - Jason Wong
- Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th, Vancouver, British Columbia, V5Z 4R4, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurence Campeau
- Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Catherine Worthington
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Troy Grennan
- Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th, Vancouver, British Columbia, V5Z 4R4, Canada.,Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada
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Salway T, Butt ZA, Wong S, Abdia Y, Balshaw R, Rich AJ, Ablona A, Wong J, Grennan T, Yu A, Alvarez M, Rossi C, Gilbert M, Krajden M, Janjua NZ. A Computable Phenotype Model for Classification of Men Who Have Sex With Men Within a Large Linked Database of Laboratory, Surveillance, and Administrative Healthcare Records. Front Digit Health 2021; 2:547324. [PMID: 34713035 PMCID: PMC8521949 DOI: 10.3389/fdgth.2020.547324] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Most public health datasets do not include sexual orientation measures, thereby limiting the availability of data to monitor health disparities, and evaluate tailored interventions. We therefore developed, validated, and applied a novel computable phenotype model to classify men who have sex with men (MSM) using multiple health datasets from British Columbia, Canada, 1990-2015. Methods: Three case surveillance databases, a public health laboratory database, and five administrative health databases were linked and deidentified (BC Hepatitis Testers Cohort), resulting in a retrospective cohort of 727,091 adult men. Known MSM status from the three disease case surveillance databases was used to develop a multivariable model for classifying MSM in the full cohort. Models were selected using "elastic-net" (GLMNet package) in R, and a final model optimized area under the receiver operating characteristics curve. We compared characteristics of known MSM, classified MSM, and classified heterosexual men. Findings: History of gonorrhea and syphilis diagnoses, HIV tests in the past year, history of visit to an identified gay and bisexual men's clinic, and residence in MSM-dense neighborhoods were all positively associated with being MSM. The selected model had sensitivity of 72%, specificity of 94%. Excluding those with known MSM status, a total of 85,521 men (12% of cohort) were classified as MSM. Interpretation: Computable phenotyping is a promising approach for classification of sexual minorities and investigation of health outcomes in the absence of routinely available self-report data.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Zahid A Butt
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Younathan Abdia
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Robert Balshaw
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Ashleigh J Rich
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Aidan Ablona
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Carmine Rossi
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
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Ferlatte O, Salway T, Oliffe JL, Rice SM, Gilbert M, Young I, McDaid L, Ogrodniczuk JS, Knight R. Depression and Suicide Literacy among Canadian Sexual and Gender Minorities. Arch Suicide Res 2021; 25:876-891. [PMID: 32532179 PMCID: PMC9328778 DOI: 10.1080/13811118.2020.1769783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The purpose of this study was to examine and compare depression and suicide literacy among Canadian sexual and gender minorities (SGM). Online surveys comprised of the 22-item depression literacy scale (D-LIT) and the 12-item literacy of suicide scale (LOSS) were completed by 2,778 individuals identifying as SGM. Relationships between depression and suicide literacy and demographic characteristics were evaluated using multivariable linear regression. Overall, SGM correctly answered 71.3% of the questions from the D-LIT and 76.5% of the LOSS. D-LIT scores were significantly lower among cisgender men and D-LIT and LOSS scores were lower among transgender women when compared to cisgender women. LOSS and D-LIT scores were significantly lower among SGM without a university degree (compared to those with a university degree) and among SGM from ethnic minority groups (compared to White SGM). D-LIT scores, but not LOSS scores, were significantly lower among Indigenous SGM compared to White SGM. The findings provide evidence of differences in suicide and depression literacy between SGM subgroups along multiple social axes. Interventions to increase depression and suicide literacy should be prioritized as part of a mental health promotion strategy for SGM, targeting subgroups with lower literacy levels, including cisgender men, transgender women, Indigenous people, racialized minorities, and those without a university degree.
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Kinitz DJ, Salway T, Kia H, Ferlatte O, Rich AJ, Ross LE. Health of two-spirit, lesbian, gay, bisexual and transgender people experiencing poverty in Canada: a review. Health Promot Int 2021; 37:6306809. [PMID: 34148086 DOI: 10.1093/heapro/daab057] [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] [Indexed: 11/12/2022] Open
Abstract
Two-spirit, lesbian, gay, bisexual and transgender (2SLGBTQ+) people are disproportionately represented among those experiencing poverty. Both 2SLGBTQ+ people and people experiencing poverty face poorer health outcomes and greater difficulty accessing healthcare. Evidence of intersectional impacts of 2SLGBTQ+ status and poverty on health can help to inform economic and health policy. The objective of this review is to determine what is known about the health of 2SLGBTQ+ people in Canada experiencing poverty. Following the PRISMA framework, we searched and summarized Canadian literature on 2SLGBTQ+ poverty indexed in Medline, Sociological Abstracts, PsycInfo and EconList (N = 33). 2SLGBTQ+ poverty-related literature remains sparse but is expanding as illustrated by the fact that most (31/33) studies were published in the past decade. Half the studies analysed poverty as a focal variable and half as a covariate. Intersectionality theory assists in understanding the three health-related themes identified-healthcare access, physical health and mental health and substance use-as these outcomes are shaped by intersecting social structures that result in unique forms of discrimination. Those at the intersection of poverty and 2SLGBTQ+ status face poorer health outcomes than other 2SLGBTQ+ people in Canada. Discrimination was an overarching finding that explained persistent associations between 2SLGBTQ+ status, poverty and health. Research that directly interrogated the experiences of 2SLGBTQ+ populations experiencing poverty was sparse. In particular, there is a need to conduct research on underrepresented 2SLGBTQ+ sub-groups who are disproportionately impacted by poverty, including transgender, bisexual and two-spirit populations.
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Affiliation(s)
- David J Kinitz
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Travis Salway
- Faculty of Health Science, Simon Fraser University, Burnaby, Canada
| | - Hannah Kia
- School of Social Work, University of British Columbia, Vancouver, Canada
| | - Olivier Ferlatte
- École de santé publique, Université de Montréal and Centre de recherche en santé publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Ashleigh J Rich
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lori E Ross
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Salway T, Juwono S, Klassen B, Ferlatte O, Ablona A, Pruden H, Morgan J, Kwag M, Card K, Knight R, Lachowsky NJ. Experiences with sexual orientation and gender identity conversion therapy practices among sexual minority men in Canada, 2019-2020. PLoS One 2021; 16:e0252539. [PMID: 34081740 PMCID: PMC8174694 DOI: 10.1371/journal.pone.0252539] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/15/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND "Conversion therapy" practices (CTP) are organized and sustained efforts to avoid the adoption of non-heterosexual sexual orientations and/or of gender identities not assigned at birth. Few data are available to inform the contemporary prevalence of CTP. The aim of this study is to quantify the prevalence of CTP among Canadian sexual and gender minority men, including details regarding the setting, age of initiation, and duration of CTP exposure. METHODS Sexual and gender minority men, including transmen and non-binary individuals, aged ≥ 15, living in Canada were recruited via social media and networking applications and websites, November 2019-February 2020. Participants provided demographic data and detailed information about their experiences with CTP. RESULTS 21% of respondents (N = 9,214) indicated that they or any person with authority (e.g., parent, caregiver) ever tried to change their sexual orientation or gender identity, and 10% had experienced CTP. CTP experience was highest among non-binary (20%) and transgender respondents (19%), those aged 15-19 years (13%), immigrants (15%), and racial/ethnic minorities (11-22%, with variability by identity). Among the n = 910 participants who experienced CTP, most experienced CTP in religious/faith-based settings (67%) or licensed healthcare provider offices (20%). 72% of those who experienced CTP first attended before the age of 20 years, 24% attended for one year or longer, and 31% attended more than five sessions. INTERPRETATION CTP remains prevalent in Canada and is most prevalent among younger cohorts, transgender people, immigrants, and racial/ethnic minorities. Legislation, policy, and education are needed that target both religious and healthcare settings.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- Community-Based Research Centre, Vancouver, British Columbia, Canada
- * E-mail:
| | - Stephen Juwono
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Community-Based Research Centre, Vancouver, British Columbia, Canada
- Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ben Klassen
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Olivier Ferlatte
- Community-Based Research Centre, Vancouver, British Columbia, Canada
- l’École de santé publique de l’Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche en Santé Publique, Montréal, Québec, Canada
| | - Aidan Ablona
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Harlan Pruden
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Jeffrey Morgan
- Community-Based Research Centre, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Kwag
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Kiffer Card
- Community-Based Research Centre, Vancouver, British Columbia, Canada
- University of Victoria, Victoria, British Columbia, Canada
| | - Rod Knight
- Community-Based Research Centre, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan J. Lachowsky
- Community-Based Research Centre, Vancouver, British Columbia, Canada
- University of Victoria, Victoria, British Columbia, Canada
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Rich AJ, Poteat T, Koehoorn M, Li J, Ye M, Sereda P, Salway T, Hogg R. Development of a computable phenotype to identify a transgender sample for health research purposes: a feasibility study in a large linked provincial healthcare administrative cohort in British Columbia, Canada. BMJ Open 2021; 11:e040928. [PMID: 33766836 PMCID: PMC7996659 DOI: 10.1136/bmjopen-2020-040928] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Innovative methods are needed for identification of transgender people in administrative records for health research purposes. This study investigated the feasibility of using transgender-specific healthcare utilisation in a Canadian population-based health records database to develop a computable phenotype (CP) and identify the proportion of transgender people within the HIV-positive population as a public health priority. DESIGN The Comparative Outcomes and Service Utilization Trends (COAST) Study cohort comprises a data linkage between two provincial data sources: The British Columbia (BC) Centre for Excellence in HIV/AIDS Drug Treatment Program, which coordinates HIV treatment dispensation across BC and Population Data BC, a provincial data repository holding individual, longitudinal data for all BC residents (1996-2013). SETTING British Columbia, Canada. PARTICIPANTS COAST participants include 13 907 BC residents living with HIV (≥19 years of age) and a 10% random sample comparison group of the HIV-negative general population (514 952 individuals). PRIMARY AND SECONDARY OUTCOME MEASURES Healthcare records were used to identify transgender people via a CP algorithm (diagnosis codes+androgen blocker/hormone prescriptions), to examine related diagnoses and prescription concordance and to validate the CP using an independent provider-reported transgender status measure. Demographics and chronic illness burden were also characterised for the transgender sample. RESULTS The best-performing CP identified 137 HIV-negative and 51 HIV-positive transgender people (total 188). In validity analyses, the best-performing CP had low sensitivity (27.5%, 95% CI: 17.8% to 39.8%), high specificity (99.8%, 95% CI: 99.6% to 99.8%), low agreement using Kappa statistics (0.3, 95% CI: 0.2 to 0.5) and moderate positive predictive value (43.2%, 95% CI: 28.7% to 58.9%). There was high concordance between exogenous sex hormone use and transgender-specific diagnoses. CONCLUSIONS The development of a validated CP opens up new opportunities for identifying transgender people for inclusion in population-based health research using administrative health data, and offers the potential for much-needed and heretofore unavailable evidence on health status, including HIV status, and the healthcare use and needs of transgender people.
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Affiliation(s)
- Ashleigh J Rich
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mieke Koehoorn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jenny Li
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Monica Ye
- 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
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Salway T, Gesink D, Ferlatte O, Rich AJ, Rhodes AE, Brennan DJ, Gilbert M. Age, period, and cohort patterns in the epidemiology of suicide attempts among sexual minorities in the United States and Canada: detection of a second peak in middle adulthood. Soc Psychiatry Psychiatr Epidemiol 2021; 56:283-294. [PMID: 32789562 DOI: 10.1007/s00127-020-01946-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Sexual minority adults experience fivefold greater risk of suicide attempt, as compared with heterosexuals. Establishing age-specific epidemiological patterns of suicide is a prerequisite to planning interventions to redress the sexual orientation suicide inequity, and such patterns must be carefully interpreted in light of correlated period and cohort effects. We, therefore, combined US and Canadian data (1985-2017) from primary (two pooled multi-year national surveys, N = 15,477 and N = 126,463) and secondary (published, meta-analytic, N = 122,966) sources to separately estimate age, period, and cohort trends in self-reported suicide attempts among sexual minorities. METHODS Age- and gender-stratified cross-sectional data were used to infer age and cohort effects. Age-collapsed meta-analyzed data were used to infer period effects among sexual minorities of all genders. RESULTS We identified a bimodal age distribution in recent suicide attempts for sexual minorities across genders, though more pronounced among sexual minority men: one peak in adolescence (18-20 years of age for both genders) and one peak nearing mid-life (30-35 years of age for men; 35-40 years of age for women). This pattern was also apparent using recall data within birth cohorts of sexual minority men, suggesting it is not an artifact of birth cohort effects. Finally, we observed decreasing trends in lifetime suicide attempt prevalence estimates for both sexual minorities and heterosexuals, though these decreases did not affect the magnitude of the sexual orientation disparity. CONCLUSION In the context of exclusively adolescent-focused suicide prevention interventions for sexual minorities, tailored suicide prevention for sexual minority adults should be pursued throughout the life course.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. .,Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada. .,Centre for Gender and Sexual Health Equity, 1190 Hornby Street, 11th Floor, Vancouver, BC, V6Z 2K5, Canada.
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, ON, M5T 3M7, Canada
| | - Olivier Ferlatte
- École de santé Publique, Université de Montréal, 7101 Park Avenue, Montreal, QC, H3N 1X9, Canada.,Centre de Recherche en santé Publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, 1301, rue Sherbrooke Est, Montreal, QC, H3L 1M3, Canada
| | - Ashleigh J Rich
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Anne E Rhodes
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, ON, M5T 3M7, Canada.,Department of Psychiatry, University of Toronto, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, West 5th Campus, Administration-B3, 100 West 5th, Hamilton, ON, L8N 3K7, Canada.,Offord Centre for Child Studies, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - David J Brennan
- Factor-Inwentash School of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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Kinitz DJ, Salway T, Dromer E, Giustini D, Ashley F, Goodyear T, Ferlatte O, Kia H, Abramovich A. The scope and nature of sexual orientation and gender identity and expression change efforts: a systematic review protocol. Syst Rev 2021; 10:14. [PMID: 33419475 PMCID: PMC7796537 DOI: 10.1186/s13643-020-01563-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/17/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sexual orientation and gender identity and expression change efforts (SOGIECE) are a set of scientifically discredited practices that aim to deny and suppress the sexual orientations, gender identities, and/or gender expressions of sexual and gender minorities (SGM). SOGIECE are associated with significant adverse health and social outcomes. SOGIECE continue to be practiced around the world, despite denouncements from professional bodies and survivors, as well as calls for legislative advocacy to prohibit SOGIECE and protect SGM. There are substantial gaps in the availability of consolidated international research to support and refine legislative proposals related to SOGIECE, including those currently underway to enforce bans in Canada and elsewhere. We therefore propose the first systematic review of international data on SOGIECE that will outline the scope and nature of these practices worldwide. Specifically, we aim to estimate how many SGM have been exposed to SOGIECE, which sub-groups of SGM experience higher rates of SOGIECE, and how estimates of SOGIECE vary over time and place. In addition, we aim to describe when, where, how, and under what circumstances SGM are exposed to SOGIECE. METHODS To locate an interdisciplinary swath of papers, nine (9) bibliographic databases will be searched: Medline (OVID), Embase (OVID), PsycInfo and Social Work Abstracts via EBSCO, CINAHL, Web of Science Core Collection, LGBTQ+ Source, and Proquest Dissertations & Theses Global and Sociology Collection (ProQuest). A gold standard search will be developed for Medline and adapted to the other databases. Grey literature will be searched at relevant websites, and reference harvesting will be performed in relevant SOGIECE scientific consensus statements. Two authors will independently screen abstracts/titles, screen full texts, abstract data, and apply risk of bias assessments. A narrative synthesis will be implemented to summarize findings. DISCUSSION This review will address the gap in synthesized data regarding the prevalence of SOGIECE, social correlates of SOGIECE, variations of SOGIECE over time and place, and the circumstances, settings, and time-points of SOGIECE exposure. Findings from this review will directly inform ongoing and new legislative efforts to ban SOGIECE and other interventions that aim to stem SOGIECE practices and support SOGIECE survivors. SYSTEMATIC REVIEW REGISTRATION Registration with PROSPERO can be found under the registration number: CRD42020196393 .
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Affiliation(s)
- David J Kinitz
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall 10506; 8888 University Dr., Burnaby, B.C., V5A 1S6, Canada. .,British Columbia Centre for Disease Control, Vancouver, Canada. .,Centre for Gender and Sexual Health Equity, Vancouver, Canada.
| | - Elisabeth Dromer
- Université de Montréal, Montréal, Canada.,Centre de recherche en santé publique, Montreal, Canada
| | - Dean Giustini
- University of British Columbia Biomedical Branch Library, Vancouver, Canada
| | | | - Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Olivier Ferlatte
- Université de Montréal, Montréal, Canada.,Centre de recherche en santé publique, Montreal, Canada
| | - Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, Canada
| | - Alex Abramovich
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
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46
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Daly Z, Slemon A, Richardson CG, Salway T, McAuliffe C, Gadermann AM, Thomson KC, Hirani S, Jenkins EK. Associations between periods of COVID-19 quarantine and mental health in Canada. Psychiatry Res 2021; 295:113631. [PMID: 33310417 PMCID: PMC7718586 DOI: 10.1016/j.psychres.2020.113631] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/03/2020] [Indexed: 12/23/2022]
Abstract
Since the onset of the COVID-19 pandemic, many jurisdictions, including Canada, have made use of public health measures such as COVID-19 quarantine to reduce the transmission of the virus. To examine associations between these periods of quarantine and mental health, including suicidal ideation and deliberate self-harm, we examined data from a national survey of 3000 Canadian adults distributed between May 14-29, 2020. Notably, participants provided the reason(s) for quarantine. When pooling all reasons for quarantine together, this experience was associated with higher odds of suicidal ideation and deliberate self-harm in the two weeks preceding the survey. These associations remained even after controlling for age, household income, having a pre-existing mental health condition, being unemployed due to the pandemic, and living alone. However, the associations with mental health differed across reasons for quarantine; those who were self-isolating specifically due to recent travel were not found to have higher odds of suicidal ideation or deliberate self-harm. Our research suggests the importance of accounting for the reason(s) for quarantine in the implementation of this critical public health measure to reduce the mental health impacts of this experience.
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Affiliation(s)
- Zachary Daly
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allie Slemon
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris G Richardson
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Corey McAuliffe
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne M Gadermann
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberly C Thomson
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saima Hirani
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily K Jenkins
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
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47
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Richardson CG, Slemon A, Gadermann A, McAuliffe C, Thomson K, Daly Z, Salway T, Currie LM, David A, Jenkins E. Use of Asynchronous Virtual Mental Health Resources for COVID-19 Pandemic-Related Stress Among the General Population in Canada: Cross-Sectional Survey Study. J Med Internet Res 2020; 22:e24868. [PMID: 33315583 PMCID: PMC7775378 DOI: 10.2196/24868] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 10/08/2020] [Revised: 11/27/2020] [Accepted: 12/11/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in profound mental health impacts among the general population worldwide. As many in-person mental health support services have been suspended or transitioned online to facilitate physical distancing, there have been numerous calls for the rapid expansion of asynchronous virtual mental health (AVMH) resources. These AVMH resources have great potential to provide support for people coping with negative mental health impacts associated with the pandemic; however, literature examining use prior to COVID-19 illustrates that the uptake of these resources is consistently low. OBJECTIVE The aim of this paper is to examine the use of AVMH resources in Canada during the COVID-19 pandemic among the general population and among a participant subgroup classified as experiencing an adverse mental health impact related to the pandemic. METHODS Data from this study were drawn from the first wave of a large multiwave cross-sectional monitoring survey, distributed from May 14 to 29, 2020. Participants (N=3000) were adults living in Canada. Descriptive statistics were used to characterize the sample, and bivariate cross-tabulations were used to examine the relationships between the use of AVMH resources and self-reported indicators of mental health that included a range of emotional and coping-related responses to the pandemic. Univariate and fully adjusted multivariate logistic regression models were used to examine associations between sociodemographic and health-related characteristics and use of AVMH resources in the subgroup of participants who reported experiencing one or more adverse mental health impacts identified in the set of self-reported mental health indicators. RESULTS Among the total sample, 2.0% (n=59) of participants reported accessing AVMH resources in the prior 2 weeks to cope with stress related to the COVID-19 pandemic, with the highest rates of use among individuals who reported self-harm (n=5, 10.4%) and those who reported coping "not well" with COVID-19-related stress (n=22, 5.5%). Within the subgroup of 1954 participants (65.1% of the total sample) who reported an adverse mental health impact related to COVID-19, 54 (2.8%) reported use of AVMH resources. Individuals were more likely to have used AVMH resources if they had reported receiving in-person mental health supports, were connecting virtually with a mental health worker or counselor, or belonged to a visible minority group. CONCLUSIONS Despite substantial government investment into AVMH resources, uptake is low among both the general population and individuals who may benefit from the use of these resources as a means of coping with the adverse mental health impacts of the COVID-19 pandemic. Further research is needed to improve our understanding of the barriers to use.
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Affiliation(s)
- Chris G Richardson
- Centre for Health Evaluation and Outcome Sciences, Providence Healthcare Research Institute, St Paul's Hospital, Vancouver, BC, Canada
| | - Allie Slemon
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, Providence Healthcare Research Institute, St Paul's Hospital, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Corey McAuliffe
- Centre for Health Evaluation and Outcome Sciences, Providence Healthcare Research Institute, St Paul's Hospital, Vancouver, BC, Canada
| | - Kimberly Thomson
- Centre for Health Evaluation and Outcome Sciences, Providence Healthcare Research Institute, St Paul's Hospital, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Zachary Daly
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | - Leanne M Currie
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Anita David
- Patient Voices Network, Vancouver, BC, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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48
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Gómez-Ramírez O, Thomson K, Salway T, Haag D, Falasinnu T, Grennan T, Grace D, Gilbert M. "Mini Dial-A-Nurses" and "Good Brands": What Are the Desirable Features of Online HIV/STI Risk Calculators? AIDS Educ Prev 2020; 32:528-542. [PMID: 33779209 DOI: 10.1521/aeap.2020.32.6.528] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A wide variety of risk calculators estimate individuals' risk for HIV/sexually transmitted infections (STI) online. These tools can help target HIV/STI screening and optimize clinical decision-making. Yet, little evidence exists on suitable features for these tools to be acceptable to end-users. We investigated the desirable characteristics of risk calculators among STI clinic clients and testing service providers. Participants interacted with online HIV/STI risk calculators featuring varied target audiences, completion lengths, and message outputs. Thematic analysis of focus groups identified six qualities that would make risk calculators more appealing for online client use: providing personalized risk assessments based on users' specific sexual behaviors and HIV/STI-related concerns; incorporating nuanced risk assessment and tailored educational information; supplying quantifiable risk estimates; using non-stigmatizing and inclusive framing; including explanations and next steps; and developing effective and appropriate branding. Incorporating these features in the design of online HIV/STI risk calculators may improve their acceptability among end-users.
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Affiliation(s)
- Oralia Gómez-Ramírez
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Kim Thomson
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Travis Salway
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Devon Haag
- British Columbia Centre for Disease Control, Vancouver, Canada
| | | | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | | | - Mark Gilbert
- University of British Columbia, Vancouver, Canada
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49
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Ferlatte O, Panwala V, Rich AJ, Scheim AI, Blackwell E, Scott K, Salway T, Knight R. Identifying Health Differences Between Transgender and Cisgender Gay, Bisexual and Other Men Who Have Sex With Men Using a Community-Based Approach. J Sex Res 2020; 57:1005-1013. [PMID: 32186417 DOI: 10.1080/00224499.2020.1740148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this article, we describe a community-based research (CBR) approach to making a national online survey of gay, bisexual, and other men who have sex with men (GBMSM) inclusive of transgender GBMSM by working with members of the transgender community at all stages of the research process. This collaboration resulted in 209 transgender GBMSM completing our survey and we contrasted their health experiences with 7439 cisgender GBMSM. We found that transgender GBMSM were less likely than cisgender GBMSM to report intercourse without a condom (AOR 0.43; 95% CI: 0.28-0.66) and to have had an HIV test (AOR 0.64; 95% CI 0.49-0.85). Transgender GBMSM were more likely to report discrimination in the health care system in their lifetime (AOR 4.17; 95% CI 3.03-5.73), to self-rate their health as poor (AOR 3.47; 95% CI 2.52-4.80), and to have discussed depression (AOR 3.47; 95% CI 262-4.59) or anxiety (AOR 3.27; 95% CI 2.47-4.33) with a health care provider. Our experience highlights the feasibility of including transgender individuals in GBMSM research, while the results affirm the need for GBMSM health services to take into account the unique experiences of transgender GBMSM.
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Affiliation(s)
- Olivier Ferlatte
- Department of Social and Preventative Medicine, School of Public Health, University of Montreal
- Centre de Recherche en Santé Publique
- Community-Based Research Centre
| | | | - Ashleigh J Rich
- School of Population and Public Health, University of British Columbia
| | - Ayden I Scheim
- Department of Medicine, University of California San Diego
- Department of Epidemiology and Biostatistics, Drexel University
| | | | | | - Travis Salway
- Community-Based Research Centre
- Faculty of Health Sciences, Simon Fraser University
- British Columbia Centre for Disease Control
- Centre for Gender and Sexual Health Equity
| | - Rod Knight
- Community-Based Research Centre
- British Columbia Centre on Substance Use
- Department of Medicine, University of British Columbia
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50
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Ferlatte O, Salway T, Oliffe JL, Saewyc EM, Holmes C, Schick L, Purdie A, Damstrom-Albach DD, Mantler ERG, Ho D, Knight R. It is time to mobilize suicide prevention for sexual and gender minorities in Canada. Can J Public Health 2020; 111:737-742. [PMID: 32328989 PMCID: PMC7501336 DOI: 10.17269/s41997-020-00316-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 03/15/2020] [Indexed: 01/21/2023]
Abstract
Suicide is a significant health issue among sexual and gender minority adults (SGMA); yet, there are no tailored suicide prevention programs for these marginalized populations in Canada. We hosted two world cafés with community leaders, health professionals, policymakers, and researchers to identify recommendations for mobilizing SGMA-focused suicide prevention programs. We identified five priorities: (1) make society safer for sexual and gender minorities; (2) decrease barriers to mental health services; (3) support community-driven and community-based interventions; (4) increase suicide knowledge and reduce stigma; (5) expand the knowledge base on SGMA suicide. In the absence of a national Canadian SGMA suicide prevention policy, these priorities provide a starting point in addressing SGMA suicide inequities by advancing SGMA-tailored interventions.
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Affiliation(s)
- Olivier Ferlatte
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada.
- Centre de Recherche en Santé Publique, Montreal, Canada.
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - John L Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada
- Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth M Saewyc
- School of Nursing, University of British Columbia, Vancouver, Canada
- Stigma and Resilience Among Vulnerable Youth Centre (SARAVYC), Vancouver, Canada
- McCreary Centre Society, Vancouver, Canada
| | - Cindy Holmes
- School of Social Work, University of Victoria, Victoria, Canada
| | | | | | | | | | - Darren Ho
- Community-Based Research Centre, Vancouver, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
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