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Helping youth who self-harm

Peer reviewed: 
No, item is not peer reviewed.
Date created: 
2019
Abstract: 

Background: Approximately one in five young people will engage in self-harm at some point during adolescence.  Many of these youth would benefit from treatment to learn better ways of coping.

Methods: We used systematic review methods to identify randomized control trials (RCTs) evaluating interventions for youth who self-harm. Applying our inclusion criteria to the 49 studies identified from our searches, we accepted seven RCTs evaluating five interventions.

Results: All psychosocial interventions were delivered to youth engaging in self-harm.  Among them, four RCTs evaluated treatments that aimed to comprehensively address self-harm and were delivered as stand-alone interventions. The other three RCTs assessed treatments aimed to address self-harm by supplementing standard clinical care.  Of the stand-alone treatments, Dialectical Behaviour Therapy (DBT) and Mentalization-Based Treatment both proved effective. DBT stood out for significantly reducing self-harm, suicide attempts and suicidal ideation according to two RCTs, conducted in Norway and the United States.  One supplementary treatment, Resourceful Adolescent Parent Program, also succeeded. This program, provided to parents, was effective in reducing youth self-harm and suicide attempts.

Conclusions: By the time a young person or their family seeks help for self-harm, feelings of distress may be daunting. Consequently, it is essential that effective treatments are provided immediately. 

Gender Differences in Mental Disorders, Substance Use, and Service Use among Indigenous Canadians Experiencing Homelessness and Mental Illness

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-08-28
Abstract: 

Background

Indigenous people are over represented among homeless populations worldwide and the prevalence of Indigenous homelessness appears to be increasing in Canadian cities. Violence against Indigenous women in Canada has been widely publicized but has not informed the planning of housing interventions. Despite historical policies leading to disenfranchisement of Indigenous rights in gender-specific ways, little is known about contemporary differences in need between homeless Indigenous men and women. This study investigated mental health, substance use and service use among Indigenous people who met criteria for homelessness and mental illness, and hypothesized that, compared to men, women would have significantly higher rates of trauma, suicidality, substance dependence, and experiences of violence.

Methods

This study was conducted using baseline (pre-randomization) data from a multi-site trial. Inclusion in the current analyses was restricted to participants who self-reported Indigenous ethnicity, and combined eligible participants from Vancouver, BC and Winnipeg, MB. Logistic regression analyses were used to model the independent associations between gender and outcome variables.

Results

In multivariable regression models among Indigenous participants (n = 439), female gender was predictive of meeting criteria for PTSD, multiple mental disorders, current high suicidality and current substance dependence. Female gender was also significantly associated with reported physical (AOR: 1.52, 95% CI = 1.10–2.23) and sexual (AOR: 6.31, 95% CI = 2.78–14.31) violence.

Conclusions

Our analyses of Indigenous men and women who are homeless illustrate the distinct legacy of colonization on the experiences of Indigenous women. Our findings are consistent with the widely documented violence against Indigenous women in Canada. Housing policies and services are urgently needed that take Indigenous historical contexts, trauma and gender into account.

Document type: 
Article
File(s): 

The British Columbia Healthy Connections Project: Findings on Socioeconomic Disadvantage in Early Pregnancy

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-08-22
Abstract: 

Background

Maternal exposure to socioeconomic disadvantage increases the risk of child injuries and subsequent child developmental and mental health problems — particularly for young mothers. To inform early intervention planning, this research therefore aimed to describe the health and social adversities experienced by a cohort of girls and young women in early pregnancy in British Columbia (BC), Canada.

 Methods

Participants were recruited for the BC Healthy Connections Project (BCHCP), a randomized controlled trial examining the effectiveness of Nurse-Family Partnership, a home visitation program, in improving child and maternal outcomes. Baseline data were collected from 739 participants on trial entry. Participants were selected on the basis of preparing to parent for the first time and experiencing socioeconomic disadvantage. Analyses involved descriptive statistics and age-group comparisons.

 Results

Most participants reported having low income (84%), having limited education (52%) and being single (91%) at trial entry. Beyond these eligibility criteria, other health and social adversities included: housing instability (52%); severe anxiety or depression (47%); other diagnosed mental disorders (22%); prenatal nicotine and cannabis use (27 and 21%); physical health problems (20%); child maltreatment when younger (56%); and intimate partner violence recently (50%). As well, few (29%) had received income assistance entitlements. More than two thirds (70%) were experiencing four or more forms of adversity. Age-group differences were observed for cognitive functioning, being single, low income, limited education, psychological distress and service use (p-value ≤0.05).

 Conclusions

This cohort was selected on the basis of socioeconomic disadvantage. Yet all participants were experiencing substantial added adversities — at higher rates than other Canadians. Furthermore, despite Canada’s public programs, these pregnant girls and young women were not being adequately reached by social services. Our study adds new data to inform early intervention planning, suggesting that unacceptably high levels of socioeconomic disadvantage exist for some young British Columbians. Therefore greater health and social supports and services are warranted for these young mothers and their children.

 Trial registration

Registered August 24, 2012 with ClinicalTrials.gov Identifier: NCT01672060. Active not recruiting.

Document type: 
Article
File(s): 

The Relationship between Gender, Parenthood and Practice Intentions among Family Medicine Residents: Cross-Sectional Analysis of National Canadian Survey Data

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2019-08-15
Abstract: 

Background: Family medicine (FM) residents choose among a range of options as they enter practice, including practice model, clinical domains, settings, and populations. The choices they make have implications for primary care workforce planning and may differ between FM residents who are parents and those who are not, as well as between male and female FM residents. We investigate whether parenthood shapes intentions among FM residents entering practice and whether the effect of parenthood differs between male and female FM residents.

Methods: We conducted cross-sectional analysis of national survey data collected from FM residents in Canadian residency programs by the College of Family Physicians of Canada between 2014 and 2017. The survey captures information on intentions for comprehensive or focused practice, practice model, clinical domains, practice setting, and populations. We used chi-square tests and multivariable logistic regression to investigate the relationships between parenthood, gender, and practice intentions, adjusting for other physician personal characteristics.

Results: Almost a quarter of FM residents were parents or became parents during residency. Intentions for the provision comprehensive care were higher among parents, and intentions for clinically focused practice were lower. Differences in intentions for practice models, domains, and settings/population were primarily by gender, though in several cases the effects of parenthood differed between female and male FM residents. Even during residency, the effects of parenthood differ between male and female residents: while three quarters of male parents finish residency in two years, fewer than half of female parents do.

Conclusions: Both parenthood and gender independently shape practice intentions, but the effect of parenthood differs for male and female FM residents. Supporting FM residents who are parents may positively impact the quality and availability of primary care services, especially since parents are more likely to report intentions to provide comprehensive care soon after entering practice.

Background: Family medicine (FM) residents choose among a range of options as they enter practice, including practice model, clinical domains, settings, and populations. The choices they make have implications for primary care workforce planning and may differ between FM residents who are parents and those who are not, as well as between male and female FM residents. We investigate whether parenthood shapes intentions among FM residents entering practice and whether the effect of parenthood differs between male and female FM residents.

Methods: We conducted cross-sectional analysis of national survey data collected from FM residents in Canadian residency programs by the College of Family Physicians of Canada between 2014 and 2017. The survey captures information on intentions for comprehensive or focused practice, practice model, clinical domains, practice setting, and populations. We used chi-square tests and multivariable logistic regression to investigate the relationships between parenthood, gender, and practice intentions, adjusting for other physician personal characteristics.

Results: Almost a quarter of FM residents were parents or became parents during residency. Intentions for the provision comprehensive care were higher among parents, and intentions for clinically focused practice were lower. Differences in intentions for practice models, domains, and settings/population were primarily by gender, though in several cases the effects of parenthood differed between female and male FM residents. Even during residency, the effects of parenthood differ between male and female residents: while three quarters of male parents finish residency in two years, fewer than half of female parents do.

Conclusions: Both parenthood and gender independently shape practice intentions, but the effect of parenthood differs for male and female FM residents. Supporting FM residents who are parents may positively impact the quality and availability of primary care services, especially since parents are more likely to report intentions to provide comprehensive care soon after entering practice.

 

Document type: 
Article
File(s): 

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
File(s): 

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
File(s): 

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.

Document type: 
Article
File(s): 

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
File(s): 

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
File(s): 

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
File(s):