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Hiring, Training, and Supporting Peer Research Associates: Operationalizing Community-Based Research Principles within Epidemiological Studies By, With, and For Women Living With HIV

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-07-18
Abstract: 

Background

A community-based research (CBR) approach is critical to redressing the exclusion of women—particularly, traditionally marginalized women including those who use substances—from HIV research participation and benefit. However, few studies have articulated their process of involving and engaging peers, particularly within large-scale cohort studies of women living with HIV where gender, cultural and linguistic diversity, HIV stigma, substance use experience, and power inequities must be navigated.

Methods

Through our work on the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), Canada’s largest community-collaborative longitudinal cohort of women living with HIV (n = 1422), we developed a comprehensive, regionally tailored approach for hiring, training, and supporting women living with HIV as Peer Research Associates (PRAs). To reflect the diversity of women with HIV in Canada, we initially hired 37 PRAs from British Columbia, Ontario, and Quebec, prioritizing women historically under-represented in research, including women who use or have used illicit drugs, and women living with HIV of other social identities including Indigenous, racialized, LGBTQ2S, and sex work communities, noting important points of intersection between these groups.

Results

Building on PRAs’ lived experience, research capacity was supported through a comprehensive, multi-phase, and evidence-based experiential training curriculum, with mentorship and support opportunities provided at various stages of the study. Challenges included the following: being responsive to PRAs’ diversity; ensuring PRAs’ health, well-being, safety, and confidentiality; supporting PRAs to navigate shifting roles in their community; and ensuring sufficient time and resources for the translation of materials between English and French. Opportunities included the following: mutual capacity building of PRAs and researchers; community-informed approaches to study the processes and challenges; enhanced recruitment of harder-to-reach populations; and stronger community partnerships facilitating advocacy and action on findings.

Conclusions

Community-collaborative studies are key to increasing the relevance and impact potential of research. For women living with HIV to participate in and benefit from HIV research, studies must foster inclusive, flexible, safe, and reciprocal approaches to PRA engagement, employment, and training tailored to regional contexts and women’s lives. Recommendations for best practice are offered.

Document type: 
Article
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Using Geosocial Networking Apps to Understand the Spatial Distribution of Gay and Bisexual Men: Pilot Study

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2018-08-08
Abstract: 

Background: While services tailored for gay, bisexual, and other men who have sex with men (gbMSM) may provide support for this vulnerable population, planning access to these services can be difficult due to the unknown spatial distribution of gbMSM outside of gay-centered neighborhoods. This is particularly true since the emergence of geosocial networking apps, which have become a widely used venue for meeting sexual partners.

Objective: The goal of our research was to estimate the spatial density of app users across Metro Vancouver and identify the independent and adjusted neighborhood-level factors that predict app user density.

Methods: This pilot study used a popular geosocial networking app to estimate the spatial density of app users across rural and urban Metro Vancouver. Multiple Poisson regression models were then constructed to model the relationship between app user density and areal population-weighted neighbourhood-level factors from the 2016 Canadian Census and National Household Survey.

Results: A total of 2021 app user profiles were counted within 1 mile of 263 sampling locations. In a multivariate model controlling for time of day, app user density was associated with several dissemination area–level characteristics, including population density (per 100; incidence rate ratio [IRR] 1.03, 95% CI 1.02-1.04), average household size (IRR 0.26, 95% CI 0.11-0.62), average age of males (IRR 0.93, 95% CI 0.88-0.98), median income of males (IRR 0.96, 95% CI 0.92-0.99), proportion of males who were not married (IRR 1.08, 95% CI 1.02-1.13), proportion of males with a postsecondary education (IRR 1.06, 95% CI 1.03-1.10), proportion of males who are immigrants (IRR 1.04, 95% CI 1.004-1.07), and proportion of males living below the low-income cutoff level (IRR 0.93, 95% CI 0.89-0.98).

Conclusions: This pilot study demonstrates how the combination of geosocial networking apps and administrative datasets might help care providers, planners, and community leaders target online and offline interventions for gbMSM who use apps.

Document type: 
Article
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Gender Differences in the Correlates of Adolescents' Cannabis Use

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2009-07-03
Abstract: 

Adolescents' gender-specific cannabis use rates and their correlates were examined. Data were obtained via a cross-sectional survey conducted in 2004 in British Columbia, Canada, funded by the Canadian Institutes of Health Research. School districts were invited to participate, and schools within consenting districts were recruited. In total, 8,225 students (50% male) from Grades 7 to 12 participated. About 73% were “White,” and 47% had used cannabis in their lifetime. Cannabis users were grouped according to their frequency of use: “never users,” “frequent users,” or “heavy users.” Male heavy cannabis users (14.3% of boys) were more likely to be in Grade 9 or higher; be Aboriginal; report poorer economic status; never feel like an outsider; frequently use alcohol and tobacco; and have lower satisfaction with family, friends, and school compared with boys that never used. Female heavy users (8.7% of girls) were more likely to be in a higher grade; report poorer economic status, mental health, and academic performance; frequently use alcohol and tobacco; and have lower satisfaction with their school compared with female never users. Three important gender differences in the multivariate analysis of the correlates of cannabis use were noted: school grade (for boys only), Aboriginal status (for boys only), and mental health (for girls only). Despite the limitations of relying on self-reports, a subset of youth appears to be at risk for excessive cannabis use that may impair life opportunities and health. The gender differences may be important in the design and implementation of prevention or treatment programs for adolescents.

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Article
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Opportunities to Learn and Barriers to Change: Crack Cocaine Use in the Downtown Eastside of Vancouver

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2008-11-17
Abstract: 

In 2004, a team comprised of researchers and service providers launched the Safer Crack Use, Outreach, Research and Education (SCORE) project in the Downtown Eastside of Vancouver, British Columbia, Canada. The project was aimed at developing a better understanding of the harms associated with crack cocaine smoking and determining the feasibility of introducing specific harm reduction strategies. Specifically, in partnership with the community, we constructed and distributed kits that contained harm reduction materials. We were particularly interested in understanding what people thought of these kits and how the kits contents were used. To obtain this information, we conducted 27 interviews with women and men who used crack cocaine and received safer crack kits. Four broad themes were generated from the data: 1) the context of crack use practices; 2) learning/transmission of harm reducon education; 3) changing practice; 4) barriers to change. This project suggests that harm reduction education is most successful when it is informed by current practices with crack use. In addition it is most effectively delivered through informal interactions with people who use crack and includes repeated demonstrations of harm reduction equipment by peers and outreach workers. This paper also suggests that barriers to harm reduction are systemic: lack of safe housing and private space shape crack use practices.

Document type: 
Article
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Becoming a ‘Real’ Smoker: Cultural Capital in Young Women's Accounts of Smoking and Other Substance Use

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2009-01-22
Abstract: 

This paper draws from a qualitative study of tobacco use by young women in Toronto, Canada. Narrative interviews were used to understand the multiple roles and functions of smoking within the everyday lives of female adolescents. Guided by a Bourdieusian theoretical framework this study employed the core construct of cultural capital in order to position tobacco and other substance use as field‐specific capital that young women accumulate while navigating the social worlds of adolescence. Departing from the psychosocial or peer‐influence models that inform the majority of tobacco research with young people, this analysis provides a nuanced understanding of how smoking, drinking, using drugs are much more than simple forms of teenage experimentation or rebellion, but can also serve as key resources for defining the self, acquiring status and making social distinctions within adolescent social worlds. In this context it is also argued that initiation into substance use practices is a way that young women demonstrate and develop social and cultural competencies.

Document type: 
Article
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Relief-oriented Use of Marijuana by Teens

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2009-04-23
Abstract: 

Background

There are indications that marijuana is increasingly used to alleviate symptoms and for the treatment of a variety of medical conditions both physical and psychological. The purpose of this study was to describe the health concerns and problems that prompt some adolescents to use marijuana for therapeutic reasons, and their beliefs about the risks and benefits of the therapeutic use of marijuana.

Methods

As part of a larger ethnographic study of 63 adolescents who were regular marijuana users, we analyzed interviews conducted with 20 youth who self-identified as using marijuana to relieve or manage health problems.

Results

Thematic analysis revealed that these teens differentiated themselves from recreational users and positioned their use of marijuana for relief by emphasizing their inability to find other ways to deal with their health problems, the sophisticated ways in which they titrated their intake, and the benefits that they experienced. These teens used marijuana to gain relief from difficult feelings (including depression, anxiety and stress), sleep difficulties, problems with concentration and physical pain. Most were not overly concerned about the risks associated with using marijuana, maintaining that their use of marijuana was not 'in excess' and that their use fit into the realm of 'normal.'

Conclusion

Marijuana is perceived by some teens to be the only available alternative for teens experiencing difficult health problems when medical treatments have failed or when they lack access to appropriate health care.

Document type: 
Article
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Better Science with Sex And Gender: Facilitating the Use of a Sex and Gender-Based Analysis in Health Research

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2009-05-06
Abstract: 

Much work has been done to promote sex and gender-based analyses in health research and to think critically about the influence of sex and gender on health behaviours and outcomes. However, despite this increased attention on sex and gender, there remain obstacles to effectively applying and measuring these concepts in health research. Some health researchers continue to ignore the concepts of sex and gender or incorrectly conflate their meanings. We report on a primer that was developed by the authors to help researchers understand and use the concepts of sex and gender in their work. We provide detailed definitions of sex and gender, discuss a sex and gender-based analysis (SGBA), and suggest three approaches for incorporating sex and gender in health research at various stages of the research process. We discuss our knowledge translation process and share some of the challenges we faced in disseminating our primer with key stakeholders. In conclusion, we stress the need for continued attention to sex and gender in health research.

Document type: 
Article
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Self-Reported Physical and Mental Health Status and Quality Of Life in Adolescents: A Latent Variable Mediation Model

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2010-05-20
Abstract: 

Background

We examined adolescents' differentiation of their self-reported physical and mental health status, the relative importance of these variables and five important life domains (satisfaction with family, friends, living environment, school and self) with respect to adolescents' global quality of life (QOL), and the extent to which the five life domains mediate the relationships between self-reported physical and mental health status and global QOL.

Methods

The data were obtained via a cross-sectional health survey of 8,225 adolescents in 49 schools in British Columbia, Canada. Structural equation modeling was applied to test the implied latent variable mediation model. The Pratt index (d) was used to evaluate variable importance.

Results

Relative to one another, self-reported mental health status was found to be more strongly associated with depressive symptoms, and self-reported physical health status more strongly associated with physical activity. Self-reported physical and mental health status and the five life domains explained 76% of the variance in global QOL. Relatively poorer mental health and physical health were significantly associated with lower satisfaction in each of the life domains. Global QOL was predominantly explained by three of the variables: mental health status (d = 30%), satisfaction with self (d = 42%), and satisfaction with family (d = 20%). Satisfaction with self and family were the predominant mediators of mental health and global QOL (45% total mediation), and of physical health and global QOL (68% total mediation).

Conclusions

This study provides support for the validity and relevance of differentiating self-reported physical and mental health status in adolescent health surveys. Self-reported mental health status and, to a lesser extent, self-reported physical health status were associated with significant differences in the adolescents' satisfaction with their family, friends, living environment, school experiences, self, and their global QOL. Questions about adolescents' self-reported physical and mental health status and their experiences with these life domains require more research attention so as to target appropriate supportive services, particularly for adolescents with mental or physical health challenges.

Document type: 
Article
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Men’s Business, Women’s Work: Gender Influences and Fathers’ Smoking

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2010-05-20
Abstract: 

To further understand men’s continued smoking during their partner’s pregnancy and the postpartum period, a study was undertaken to explore women’s perspectives of men’s smoking. Using a gender lens, a thematic analysis of transcribed interviews with 27 women was completed. Women’s constructions of men’s smoking and linkages to masculine and feminine ideals are described. The findings highlight the ways women position themselves both as defenders and regulators of men’s smoking. Femininities that aligned women with hegemonic masculine principles underpinned their roles in relation to men’s smoking and presented challenges in influencing their partner’s tobacco reduction. By positioning the decision to quit smoking as a man’s solitary pursuit, women reduced potential relationship conflict and managed to maintain their identity as a supportive partner. Insights from this study provide direction for developing gender‐specific tobacco reduction initiatives targeting expectant and new fathers. Indeed, a lack of intervention aimed at encouraging men’s tobacco reduction has the potential to increase relationship tensions, and inadvertently maintain pressure on women to regulate fathers’ smoking. This study illustrates how gender‐based analyses can provide new directions for men’s health promotion programmes and policies.

 

Document type: 
Article
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Tobacco Use Patterns in Traditional and Shared Parenting Families: A Gender Perspective

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2010-05-10
Abstract: 

Background

Although researchers have focused on women's smoking during pregnancy and the postpartum period and the influence of household interactions on their tobacco reduction efforts, little attention has been given to parents' efforts to regulate smoking during the child-rearing years. The objective of this study was to examine how parenting young children and gender relations reflected in couple dynamics influence household tobacco use patterns and, specifically, women's tobacco reduction efforts.

Methods

As part of a longitudinal, grounded-theory study with 28 couples to examine the place of tobacco in the lives of new parents, each parent participated in one or two individual, semi-structured interviews during the first three years postpartum. Grounded theory methods and a gender relations framework were used to analyze transcribed data.

Results

Two different parenting styles that couples adhered to were identified. These parenting styles reflected performances of femininities and masculinities, and were associated with particular smoking patterns. Traditional parenting reinforced by women's alignment with emphasized femininities and men's alignment with hegemonic masculinities placed women with smoking partners at risk for relapse. Women's actions to be supportive partners facilitated couples' continued smoking. In shared parenting dyads, egalitarian practices tended to support successful transitions to smoke-free homes. Women's ability to exert more influence around family decision making, and the acceptance of new masculine identities associated with fatherhood were influential. In non-smoking dyads where the mother, father, or both reduced or stopped smoking, we observed a subtext of potential conflict in the event either the mother or father relapsed.

Conclusions

Decisions about tobacco use are made within relationships and social contexts that vary based on each individual's relationship to tobacco, divisions of domestic labour and childcare, and other activities that impact tobacco use. Sensitive approaches to tobacco reduction for women and men must be developed building on greater understanding of gender relations and how tobacco use is integrated in spousal and parental roles.

Document type: 
Article
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