Faculty Publications (Human & Social Development)

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    ‘There is no justice in nursing school’: A qualitative analysis of nursing students' experiences of discrimination shared on Reddit
    (Journal of Advanced Nursing, 2024) Slemon, Allie; Dhari, Shavinder; Christie, Tanya; Aubrey, Gavin
    Aim: To explore nursing students' experiences of stigma and discrimination within nursing programmes as shared on Reddit, and how other Reddit users offer support and guidance. Design: Qualitative interpretive description. Methods: Through a critical social theory lens, this study draws on students' posts from three nursing subreddits: r/studentnurse, r/nursingstudent and r/nursing. Data were collected from March 2013 to March 2023. Reflexive thematic analysis was conducted to generate broad themes of nursing students' experiences of stigma and discrimination, and how other Reddit users offered support and guidance. Results: A total of 43 posts with 1412 associated comments were included in this analysis, which generated three predominant themes of nursing students' experiences. Nursing students faced stigma and discrimination across contexts, including from peers, nurses and other healthcare providers working in clinical practicum sites, and patients. Nursing students' posts described navigating the impacts and consequences of such experiences, including on well-being, and programme and career success. In contexts where students were often alone in their experiences of stigma and discrimination within their programmes and with few identified supports, Reddit users sought support and community through Reddit. While many comments offered validation and support, challenges of this social media platform included conflicting advice and unhelpful, judgmental messages. Conclusions: Despite widely articulated social justice commitments in the profession, nursing students continue to experience stigma and discrimination across contexts within their nursing programmes. Implications for Profession: Nurses and nurse educators have a responsibility to acknowledge and make visible such experiences, and take direct action to prevent and remediate stigma and discrimination within nursing education. Impact: This research contributes to the growing empirical evidence that nursing students' experience stigma and discrimination within nursing programmes and the healthcare system. Reporting Method: Adherence to COREQ guidelines was maintained. Patient or Public Contribution: No patient or public contribution.
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    Patterns of service utilization across the full continuum of care: Using patient journeys to assess disparities in access to health services
    (Knowledge, 2024) Bambi, Jonas; Dong, Gracia Yunruo; Santoso, Yudi; Moselle, Ken; Dugas, Sophie; Olobatuyi, Kehinde; Rudnick, Abraham; Chang, Ernie; Kuo, Alex
    Healthcare organizations have a contractual obligation to the public to address population-level inequities to health services access and shed light on them. Various studies have focused on achieving equitable access to healthcare services for vulnerable patients. However, these studies do not provide a nuanced perspective based on the local reality across the full continuum of care. In previous work, graph topology was used to provide visual depictions of the dynamics of patients’ movement across a complex healthcare system. Using patients’ encounters data represented as a graph, this study expands on previous work and proposes a methodology to identify and quantify cohort-specific disparities in accessing healthcare services across the continuum of care. The result has demonstrated that a more nuanced approach to assessing access-to-care disparity is doable using patients’ patterns of service utilization from a longitudinal cross-continuum healthcare dataset. The proposed method can be used as part of a toolkit to support healthcare organizations that wish to structure their services to provide better care to their vulnerable populations based on the local realities. This provides a first step in addressing inequities for vulnerable patients in accessing healthcare services. However, additional steps need to be considered to fully address these inequities.
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    Participatory system mapping for food systems: Lessons learned from a case study of Comox Valley, Canada
    (Challenges, 2024) Ghadiri, Mohaddese; Newell, Robert; Krawchenko, Tamara
    Food systems are complex and multifaceted, comprising a diverse range of actors, processes, and interactions. Participatory system mapping can be employed to help understand this complexity and support the development of sustainable and resilient food systems. This article shares a participatory mapping approach that has been developed as part of the Climate–Biodiversity–Health (CBH) Nexus project in the Comox Valley, British Columbia, Canada. This research pursues two main aims: (1) to ground truth in the CBH system map of food systems, developed with the participation of stakeholders; and (2) to explain how participatory system mapping can be employed to clarify the complexity of food systems in a clear and concise manner for all stakeholders. This research contributes to the literature on participatory system mapping, including critiques of its practical utility, by employing participatory approaches to visualize multi-dimensional and multi-level system maps with an emphasis on verifying that they are clear, understandable/useful, and reliable for diverse stakeholder audiences.
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    Examining how postpartum videoconferencing support sessions can facilitate connections between parents: A poststructural and sociomaterial analysis
    (Nursing Reports, 2024) Aston, Megan; Price, Sheri; MacLeod, Anna; Stone, Kathryn; Benoit, Britney; Joy, Phillip; Ollivier, Rachel; Sim, Sarah Meaghan; Etowa, Josephine; Jack, Susan; Marcellus, Lenora; Iduye, Damilola
    Postpartum support for new parents can normalize experiences, increase confidence, and lead to positive health outcomes. While in-person gatherings may be the preferred choice, not all parents can or want to join parenting groups in person. Online asynchronous chat spaces for parents have increased over the past 10 years, especially during the COVID pandemic, when “online” became the norm. However, synchronous postpartum support groups have not been as accessible. The purpose of our study was to examine how parents experienced postpartum videoconferencing support sessions. Seven one-hour videoconferencing sessions were conducted with 4–8 parents in each group (n = 37). Nineteen parents from these groups then participated in semi-structured interviews. Feminist poststructuralism and sociomaterialism were used to guide the research process and analysis. Parents used their agency to actively think about and interact using visual (camera) and audio (microphone) technologies to navigate socially constructed online discourses. Although videoconferencing fostered supportive connections and parents felt less alone and more confident, the participants also expressed a lack of opportunities for individual conversations. Nurses should be aware of the emerging opportunities that connecting online may present. This study was not registered.
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    A methodological approach to exracting patterns of service utilization from a cross-continuum high dimensional healthcare dataset to support care delivery optimization for patients with complex problems
    (BioMedInformatics, 2024) Bambi, Jonas; Santoso, Yudi; Sadri, Hanieh; Moselle, Ken; Rudnick, Abraham; Robertson, Stan; Chang, Ernie; Kuo, Alex; Howie, Joseph; Dong, Gracia Yunruo; Olobatuyi, Kehinde; Hajiabadi, Mahdi; Richardson, Ashlin
    Background: Optimizing care for patients with complex problems entails the integration of clinically appropriate problem-specific clinical protocols, and the optimization of service-system-encompassing clinical pathways. However, alignment of service system operations with Clinical Practice Guidelines (CPGs) is far more challenging than the time-bounded alignment of procedures with protocols. This is due to the challenge of identifying longitudinal patterns of service utilization in the cross-continuum data to assess adherence to the CPGs. Method: This paper proposes a new methodology for identifying patients’ patterns of service utilization (PSUs) within sparse high-dimensional cross-continuum health datasets using graph community detection. Result: The result has shown that by using iterative graph community detections, and graph metrics combined with input from clinical and operational subject matter experts, it is possible to extract meaningful functionally integrated PSUs. Conclusions: This introduces the possibility of influencing the reorganization of some services to provide better care for patients with complex problems. Additionally, this introduces a novel analytical framework relying on patients’ service pathways as a foundation to generate the basic entities required to evaluate conformance of interventions to cohort-specific clinical practice guidelines, which will be further explored in our future research.
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    Rethinking public transit networks using climate change mitigation and social justice lenses: Great Victoria Area case study
    (Sustainability, 2024) Ghadiri, Mohaddese; Newell, Robert
    Public transit has a relatively low GHG-to-passenger ratio and offers affordable options for local travel compared with personal vehicle travel. Investments in an effective public transit network are therefore critical for progress toward climate change mitigation and social justice. Using the Greater Victoria Area (GVA) in British Columbia, Canada, as a case study, this research identified, mapped, and examined three new regional transit network scenarios, which, respectively, align with the objectives in the planning and policy areas of (1) climate change mitigation, (2) social justice, and (3) climate justice. The methods involved a literature review to develop an analytical framework for mapping and examining new transit networks using the climate change mitigation, social justice, and climate justice lenses. The framework was revised through a research practitioner workshop, and it was then applied using network analysis techniques to (re)map the GVA’s transit networks under the three scenarios. The key outcomes of the project included an analytical framework and a process for analyzing and remapping transit networks in ways that align with climate and social justice objectives. The findings indicated the need to add some bus routes and stops, especially in the northern part of the GVA, and two new fast transit networks according to the justice lenses.
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    The Index of Economic Disparity: Measuring trends in economic disparity across Canadian Census Subdivisions and rural and urban communities
    (Canadian Geographies / Géographies canadiennes, 2023) Weaver, David; Krawchenko, Tamara; Markey, Sean
    Territorial inequalities have long been a subject of study and concern in Canada. In the face of large structural changes such as industrial shifts and the decarbonization of our economies, there is an urgency to understand such inequalities and design effective policy interventions for those places facing persistent economic decline. This paper shares a novel composite index that measures economic disparity across Canadian Census Subdivisions (CSDs) using Census data from 2001 through 2016 and the 2011 National Household Survey. Named the “Index of Economic Disparity,” it is comprised of an equally weighted average of four sub-indices that assign percentile rankings for all CSDs based on whether they experience persistent and substantial decline in key economic areas: population, labour force outcomes, working-age share of population, and industrial diversity. The variation of outcomes across geographies—urban and rural—highlights the importance of place-based policies.
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    Analyzing patterns of service utilization using graph topology to understand the dynamic of the engagement of patients with complex problems with health services
    (Biomedinformatics, 2024) Bambi, Jonas; Santoso, Yudi; Moselle, Ken; Robertson, Stan; Rudnick, Abraham; Chang, Ernie; Kuo, Alex
    Background: Providing care to persons with complex problems is inherently difficult due to several factors, including the impacts of proximal determinants of health, treatment response, the natural emergence of comorbidities, and service system capacity to provide timely required services. Providing visibility into the dynamics of patients’ engagement can help to optimize care for patients with complex problems. Method: In a previous work, graph machine learning and NLP methods were used to model the products of service system dynamics as atemporal entities, using a data model that collapsed patient encounter events across time. In this paper, the order of events is put back into the data model to provide topological depictions of the dynamics that are embodied in patients’ movement across a complex healthcare system. Result: The results show that directed graphs are well suited to the task of depicting the way that the diverse components of the system are functionally coupled—or remain disconnected—by patient journeys. Conclusion: By setting the resolution on the graph topology visualization, important characteristics can be highlighted, including highly prevalent repeating sequences of service events readily interpretable by clinical subject matter experts. Moreover, this methodology provides a first step in addressing the challenge of locating potential operational problems for patients with complex issues engaging with a complex healthcare service system.
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    Cost-effectiveness of a police education program on HIV and overdose among people who inject drugs in Tijuana, Mexico
    (The Lancet Regional Health - Americas, 2024) Cepeda, Javier A.; Beletsky, Leo; Abramovitz, Daniela; Saldana, Carlos Rivera; Kahn, James G.; Bañuelos, Arnulfo; Rangel, Gudelia; Arredondo, Jaime; Vickerman, Peter; Bórquez, Annick; Strathdee, Steffanie A.; Martin, Natasha K.
    Background: Incarceration is associated with drug-related harms among people who inject drugs (PWID). We trained >1800 police officers in Tijuana, Mexico on occupational safety and HIV/HCV, harm reduction, and decriminalization reforms (Proyecto Escudo). We evaluated its effect on incarceration, population impact and cost-effectiveness on HIV and fatal overdose among PWID. Methods: We assessed self-reported recent incarceration in a longitudinal cohort of PWID before and after Escudo. Segmented regression was used to compare linear trends in log risk of incarceration among PWID pre-Escudo (2012-2015) and post-Escudo (2016-2018). We estimated population impact using a dynamic model of HIV transmission and fatal overdose among PWID, with incarceration associated with syringe sharing and fatal overdose. The model was calibrated to HIV and incarceration patterns in Tijuana. We compared a scenario with Escudo (observed incarceration declines for 2 years post-Escudo among PWID from the segmented regression) compared to a counterfactual of no Escudo (continuation of stable pre-Escudo trends), assessing cost-effectiveness from a societal perspective. Using a 2-year intervention effect and 50-year time horizon, we determined the incremental cost-effectiveness ratio (ICER, in 2022 USD per disability-adjusted life years [DALYs] averted). Findings: Compared to stable incarceration pre-Escudo, for every three-month interval in the post-Escudo period, recent incarceration among PWID declined by 21% (adjusted relative risk = 0.79, 95% CI: 0.68-0.91). Based on these declines, we estimated 1.7% [95% interval: 0.7%-3.5%] of new HIV cases and 12.2% [4.5%-26.6%] of fatal overdoses among PWID were averted in the 2 years post-Escudo, compared to a counterfactual without Escudo. Escudo was cost-effective (ICER USD 3746/DALY averted compared to a willingness-to-pay threshold of $4842-$13,557). Interpretation: Escudo is a cost-effective structural intervention that aligned policing practices and human-rights-based public health practices, which could serve as a model for other settings where policing constitutes structural HIV and overdose risk among PWID.
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    Cultivating psychological well-being amongst older gay men: A qualitative exploration
    (SSM - Qualitative Research in Health, 2024) Amato, Anthony Theodore; Wonsiak, Tessa; Handlovsky, Ingrid; Ferlatte, Olivier; Kia, Hannah; Oliffe, John L.
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    "To do so in a patient-centred way is not particularly lucrative": The effects of neoliberal health care on PrEP implementation and delivery
    (Social Science & Medicine, 2024) Sinno, Jad; Daroya, Emerich; Wells, Alex; Hull, Mark; Lachowsky, Nathan; Tan, Darrell H. S.; Grace, Daniel
    Background: HIV pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention used by HIV-negative people to prevent HIV acquisition. Despite increased use of PrEP worldwide, several barriers to PrEP implementation have resulted in insufficient uptake, inadequate adherence, and frequent discontinuation. Our objective was to interrogate the social, political, and economic conditions shaping PrEP implementation and delivery among gay, bisexual, queer and other men who have sex with men (GBQM) in Ontario, Canada. Methods: Six focus groups and three interviews with 20 stakeholders in Ontario (e.g., healthcare professionals, clinicians, community-based organization staff, and government staff) were conducted between July and October 2021. Participants were asked about the personal, workplace, and structural factors shaping PrEP delivery strategies for GBQM. Transcripts were analyzed using reflexive thematic analysis informed by the political economy of PrEP and employed a critique of neoliberalism. Results: Participants critiqued the problematic arrangements of the current healthcare system in Canada. Neoliberal governmentality and policies have resulted in inequitable PrEP care by establishing funding structures prioritizing profit and requiring patients and providers to function as individual entrepreneurs. Consequently, healthcare disparities are compounded for marginalized peoples who lack the resources and capacity to navigate existing healthcare systems. Participants identified several pathways to improve the implementation of PrEP, including greater institutional and governmental supports for PrEP and healthcare, leveraging communities and collaboration, and moving beyond risk-based health frameworks. Conclusion: Socio-political-economic changes reflecting post-neoliberal principles are needed to overcome existing barriers to PrEP care, and sexual and reproductive healthcare more broadly.
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    Depression during the COVID-19 pandemic among older adults with stroke history: Findings from the Canadian Longitudinal Study on Aging
    (International Journal of Geriatric Psychiatry, 2024) MacNeil, Andie; Li, Grace; Gulati, Ishnaa; Taunque, Aneisha; Jiang, Ying; de Groh, Margaret; Fuller-Thomson, Esme
    Objectives: The COVID-19 pandemic and accompanying public health measures exacerbated many known risk factors for depression, while also increasing numerous health-related stressors for people with stroke history. Using a large longitudinal sample of older adults, the current study examined the prevalence of incident and recurrent depression among participants with stroke history, and also identified factors that were associated with depression during the pandemic among this population. Methods: Data came from four waves of the Canadian Longitudinal Study on Aging's (CLSA) comprehensive cohort (n = 577 with stroke history; 46.1% female; 20.8% immigrants; mean age = 74.56 SD = 9.19). The outcome of interest was a positive screen for depression, based on the CES-D-10, collected during the 2020 CLSA COVID autumn questionnaire. Bivariate and multivariate logistic regression analyses were conducted to identify factors that were associated with depression. Results: Approximately 1 in 2 (49.5%) participants with stroke history and a history of depression experienced a recurrence of depression early in the pandemic. Among those without a history of depression, approximately 1 in 7 (15.0%) developed depression for the first time during this period. The risk of depression was higher among immigrants, those who were lonely, those with functional limitations, and those who experienced COVID-19 related stressors, such as increased family issues, difficulty accessing healthcare, and becoming ill or having a loved one become ill or die during the pandemic. Conclusions: Interventions that target those with stroke history, both with and without a history of depression, are needed to buffer against the stressors of the COVID-19 pandemic and support the mental health of this population.
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    Farewell to humanism? Considerations for nursing philosophy and research in posthuman times
    (Nursing Philosophy, 2023) Petrovskaya, Olga
    In this paper, I argue that critical posthumanism is a crucial tool in nursing philosophy and scholarship. Posthumanism entails a reconsideration of what ‘human’ is and a rejection of the whole tradition founding Western life in the 2500 years of our civilization as narrated in founding texts and embodied in governments, economic formations and everyday life. Through an overview of historical periods, texts and philosophy movements, I problematize humanism, showing how it centres white, heterosexual, able-bodied Man at the top of a hierarchy of beings, and runs counter to many current aspirations in nursing and other disciplines: decolonization, antiracism, anti-sexism and Indigenous resurgence. In nursing, the term humanism is often used colloquially to mean kind and humane; yet philosophically, humanism denotes a Western philosophical tradition whose tenets underpin much of nursing scholarship. These underpinnings of Western humanism have increasingly become problematic, especially since the 1960s motivating nurse scholars to engage with antihumanist and, recently, posthumanist theory. However, even current antihumanist nursing arguments manifest deep embeddedness in humanistic methodologies. I show both the problematic underside of humanism and critical posthumanism's usefulness as a tool to fight injustice and examine the materiality of nursing practice. In doing so, I hope to persuade readers not to be afraid of understanding and employing this critical tool in nursing research and scholarship.
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    Measures of HIV pre-exposure prophylaxis uptake among gay, bisexual, and other men who have sex with men in Canada and demographic disparities among those at elevated likelihood for HIV acquisition
    (AIDS and Behavior, 2021) Colyer, Sean; Lachowsky, Nathan; Schmidt, Axel J.; Adam, Barry D.; Paquette, Dana; Hart, Trevor A.; Brennan, David J.; Blais, Martin; Kroch, Abigail E.
    HIV pre-exposure prophylaxis (PrEP) is an effective prevention tool being scaled up in Canada. We describe PrEP uptake and identify demographic correlates of uptake among gay, bisexual, and other men who have sex with men (gbMSM) at elevated HIV risk using data from an online survey of gbMSM residing in Canada between Oct 2017 and Jan 2018. Among the 969 participants at elevated HIV risk who had recently tested for HIV, 96.0%, 83.3%, 72.6%, and 39.7% reported awareness, knowledge, acceptability, and pursuit of PrEP, respectively; 27.1% had ever and 24.6% were currently taking PrEP. The strongest correlate of PrEP uptake was living in a city of ≥500,000 inhabitants; others included being out to all or almost all family, friends, and colleagues regarding sexual attraction to men, greater financial coping, and being 30–49 years of age. Improved upscaling of PrEP in Canada may be accomplished through consideration of these disparities.
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    Crystal methamphetamine use and initiation among gay, bisexual, and other men who have sex with men living with HIV in a treatment as prevention environment
    (Substance Use & Misuse, 2020) Colyer, Sean P.; Moore, David M.; Cui, Zishan; Zhu, Julia; Armstrong, Heather; Taylor, Matthew; Edward, Joshua; Howard, Terry; Dickie, Chad; Olarewaju, Gbolahan; Montaner, Julio S.G.; Hogg, Robert S.; Roth, Eric; Lachowsky, Nathan
    Background: Risk compensation in an HIV Treatment as Prevention (TasP) environment may increase high-risk sexual and substance use behaviours among people living with HIV. Objective: To examine recent crystal methamphetamine use/initiation in a longitudinal cohort of gay, bisexual, and other men who have sex with men (GBMSM) living with HIV in Metro Vancouver, Canada. Methods: Eligible participants were GBMSM aged >15 years who reported sex with another man in the past six months. Participants were recruited using respondent-driven sampling and self-completed a computer questionnaire every six months. We used multi-level generalized mixed-effect models to evaluate trends in recent crystal methamphetamine use (past six months), multivariable logistic regression to identify covariates of recent crystal methamphetamine use, and multivariable survival analysis to identify predictors of crystal methamphetamine initiation. Results: Of 207 GBMSM living with HIV at enrollment, 44.3% reported recent crystal methamphetamine use; this remained stable over the study period (2012-2016). HIV treatment optimism was not associated with crystal methamphetamine use/initiation. Crystal methamphetamine use was positively associated with depressive symptomology, sexual escape motivation, transactional sex, number of anal sex partners, condomless anal sex with seroconcordant partners, STIs, and other substance use. Recent crystal methamphetamine use was negatively associated with viral load sorting. Crystal methamphetamine initiation was predicted by escape motivation, transactional sex, and group sex participation. Conclusion: Results suggest that crystal methamphetamine use among GBMSM living with HIV is prevalent and increased crystal methamphetamine use/initiation is not a consequence of TasP public policy
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    A latent class analysis of substance use and culture among gay, bisexual and other men who have sex with men
    (Culture, Health & Sexuality, 2018) Card, Kiffer George; Armstrong, Heather; Carter, Allison; Cui, Zishan; Wang, Lu; Zhu, Julia; Lachowsky, Nathan; Moore, David M.; Hogg, Robert S.; Roth, Eric A.
    Assessments of gay and bisexual men’s substance use often obscures salient sociocultural and identity-related experiences related to how they use drugs. Latent class analysis was used to examine how patterns of substance use represent the social, economic and identity-related experiences of this population. Participants were sexually active gay and bisexual men (including other men who have sex with men), aged ≥ 16 years, living in Metro Vancouver (n = 774). LCA indicators included all substances used in the past six months self-reported by more than 30 men. Model selection was made with consideration to model parsimony, interpretability and optimisation of statistical criteria. Multinomial regression identified factors associated with class membership. A six-class solution was identified representing: ‘assorted drug use’ (4.5%); ‘club drug use’ (9.5%); ‘street drug use’ (12.1%); ‘sex drug use’ (11.4%); ‘conventional drug use’ (i.e. tobacco, alcohol, marijuana; 25.9%); and ‘limited drug use’ (36.7%). Factors associated with class membership included age, sexual orientation, annual income, occupation, income from drug sales, housing stability, group sex event participation, gay bars/clubs attendance, sensation seeking and escape motivation. These results highlight the need for programmes and policies that seek to lessen social disparities and account for social distinctions among this population.
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    Stigma, the media, and pre-exposure prophylaxis for HIV prevention: Observations for enhancing knowledge translation and resisting stigma in the Canadian context
    (AIDS and Behavior, 2019) Card, Kiffer George; Hawkins, Blake W.; Mortazavi, Leili; Gregory, Aidan; Ng, Keng Hon; Lachowsky, Nathan
    Pre-Exposure Prophylaxis (PrEP) is an effective, though sometimes stigmatized, strategy for HIV prevention. With the goal of examining how PrEP stigma can be addressed, this study examined the media’s handling of stigma related to PrEP by searching the Canadian Newsstream and Daily Xtra news databases for key terms related to PrEP. Overall, 101 media articles were thematically coded in triplicate; 36.3% of which included mentions of PrEP stigma. LGBT media sources were more likely than mainstream sources to have included content coded as relating to PrEP stigma (p = 0.02). In these articles, uncertainty regarding PrEP, and neo-liberal attitudes towards sexual responsibility were major factors associated with media discussion of PrEP stigma. We discuss the role that heuristics play in shaping lay readers perceptions and interpretation of PrEP media coverage and discuss methods for overcoming stigma using evidence-based communication strategies.
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    Gender differences in prevalence and correlates of high sexual self-efficacy among adolescents in Soweto, South Africa: implications for gender-sensitive research and programming
    (AIDS Care, 2018) Closson, Kalysha; Dietrich, Janan; Lachowsky, Nathan; Nkala, Busi; Cui, Zishan; Chia, Jason; Hogg, Robert S.; Gray, Glenda; Kaida, Angela; Miller, Cari L.
    Sexual self-efficacy (SSE) – one's confidence in their ability to perform given sexual behaviours, has been shown to predict adolescents’ HIV-prevention practices (e.g., Condom use). Few studies within sub-Saharan Africa, where HIV incidence and prevalence disproportionately affects young women, have examined gendered differences in SSE. We used multivariable logistic regression to identify correlates of high-SSE separately among adolescent men and women (aged 14–19) in Soweto, South Africa using a previously validated SSE scale (high-SSE [>3/6 items]; study-alpha = 0.75). SSE scale items assessed self-efficacy related to sexual refusal and condom use. Adolescent women were significantly more likely to report high-SSE than adolescent men (72.3% versus 49.5%; p < 0.01). High-SSE among adolescent men was associated with more positive beliefs about sexual relationships and negatively associated with probable depression. High-SSE among adolescent women was associated with increased HIV knowledge, more positive beliefs about condom use and sexual relationships, having an adult in the home, and negatively associated with being an older adolescent (16–17 versus ≤15), and ever experiencing physical violence. Differences in prevalence and correlates of SSE among adolescent men and women in South Africa highlight important areas for gender-sensitive interventions. Targeted efforts to reduce negative sexual beliefs, improve HIV knowledge and mental well-being may improve SSE and thus the uptake of HIV-prevention practices among adolescent men. For adolescent women, findings indicate programming should move beyond individual-levels determinants of behaviour to focus on improving enabling environments (e.g., Reduced violence and improved family relationships) in which sexual agency can be enacted.
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    Correlates of hazardous alcohol drinking among trans and non-binary people in Canada: A community-based cross-sectional study
    (Drug and Alcohol Dependence, 2023) Tran, Gioi Minh; Lachowsky, Nathan; Urbanoski, Karen A.; Scheim, Ayden I.; Bauer, Greta R.
    Purpose: Transgender and non-binary people (TGNB) have a higher rate of heavy episodic drinking than cisgender people; however, extant knowledge about predictors of hazardous alcohol drinking (HAD) among different TGNB groups is limited. This study examined predictors of HAD in a national sample of TGNB people in Canada. Methods: Logistic regression models were fit to examine the effects of 1) minority stressors and 2) stress-buffering factors on the likelihood of HAD, stratified by gender, among 2324 TGNB individuals from the Trans PULSE Canada survey, a cross-sectional survey conducted in 2019 among trans and non-binary people aged 14+ in Canada. Results: Almost 17% of participants reported past-year HAD. Lifetime day-to-day and lifetime major discrimination were associated with higher odds of HAD in the full sample [(AOR=1.37, 95% CI: 1.30, 1.44) and (AOR=1.69, 95% CI: 1.55, 1.86) respectively], and across all gender groups. Social support was associated with lower odds of HAD in trans men, non-binary people assigned female at birth (NB-AFAB), and non-binary people assigned male at birth (NB-AMAB) groups, but with higher odds of HAD in the trans women group. Misgendering was associated with lower odds of HAD in trans men and NB-AFAB, but higher odds of HAD in trans women and NB-AMAB. Mixed effects of gender distress, gender positivity, and gender-affirming medical care were also reported across groups. Conclusion: The study provided a more detailed understanding of the predictors of HAD across four TGNB groups. Public health interventions should focus on structural discrimination and social support for TGNB people.
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    The digital era and public sector reforms: Transformation or new tools for competing values?
    (Canadian Public Administration, 2022) Lindquist, Evert Anthony
    This article considers the tools and management approaches associated with the “digital-era” public sector reform, which many observers suggest has supplanted or should supplant previous reforms such as those associated with the New Public Management. This article levers and adapts the Competing Values Framework to categorize various public service reform movements—Traditional Public Administration, New Public Management, Public Value Management, and New Public Governance—and associated value systems and cultures. It argues that not only do these prior reform movements persist as values and repertoires in public service systems, but they are also each variously receiving oxygen from “digital” as the latest wave of technological innovation affecting societies, markets, and governments. It calls for more systematic empirical work to gauge how digital tools have been affecting the mix and balance of values and repertoires associated with these reform movements in different parts of public service systems in Canada and beyond.
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