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Campus sexual violence (CSV) is a pervasive problem across universities. This study identified distinct patterns of CSV based on its forms (sexual harassment, unwanted sexual behaviors, and sexual coercion) and its associated consequences (mental health, physical health, personal/social life, and academic/professional life). Additionally, it investigated how holding a marginalized social identity (cisgender woman status, gender and sexual minority status, disability status, and visible minority status) or reporting a history of child sexual abuse predicted CSV pattern membership. A total of 6,554 students completed an online questionnaire as part of a large-scale university-based study in Quebec, Canada. Latent class analysis revealed a 5-class model: No CSV (64% of students), Sexual harassment + Fewer consequences (15% of students), Poly-CSV + Fewer consequences (10% of students), Poly-CSV + Personal and social life consequences (8% of students), and Poly-CSV + Co-occurring consequences (3% of students). Survivors of child sexual abuse, cisgender women, students with disabilities, and gender and sexual minority students were more likely to experience patterns of CSV characterized by multiple forms of CSV and co-occurring consequences. [ABSTRACT FROM AUTHOR]

Introduction: Among transgender, non-binary, and/or gender expansive (TNG) persons, interest in medical and/or surgical forms of gender affirmation is heterogenous, as is access to those forms of medically necessary health care. Yet, the literature characterizing TNG persons' interest in medical and/or surgical gender-affirming care, barriers to accessing that care, and how societal narratives and expectations impact TNG individuals' self-image and mental health, as well as their personal choices regarding gender-affirming care remains sparse. Here we present qualitative research exploring TNG participants' interest in gender-affirming care and how such interventions impact identity formation. Method: We conducted semi-structured qualitative interviews with a convenience sample of 54 TNG persons in the U.S. and Canada from Facebook pages used to recruit TNG research participants. One-hour interviews were conducted by an openly TNG researcher; participants were compensated. Results: The most frequently sought gender-affirming care was hormone therapy, followed by chest ("top") surgery, genital ("bottom") surgery, electrolysis, breast augmentation, hysterectomy, and voice training. Less commonly desired interventions included fertility preservation, facial feminization/masculinization, and vocal surgery. Participants described four main categories of access barriers: financial (e.g., cost of medical/surgical care, inadequate insurance), logistical (e.g., no local providers, gatekeeping policies around body size and mental health, pandemic-related delays), personal fears about sub-optimal outcomes (e.g., complications, loss of sensation, undesired esthetic and/or functional results), and societal discrimination (e.g., familial rejection, job loss, safety concerns). Participants reported primarily seeking this healthcare for social legibility, alleviating dysphoria/pursuing euphoria, and/ or gender exploration. All who sought gender-affirming care reported improved mental health—including depression, anxiety, dissociation, and eating disorders—and social relationships, though many struggled to find TNG-competent mental health providers. Conclusion: This work provides key insights into how gender-affirming care can contribute to improving mental health for TNG communities, which will assist health providers in optimally treating TNG patients. [ABSTRACT FROM AUTHOR]

2SLGBTQ+ leisure spaces and activities can promote resilience and enable 2SLGBTQ+ individuals to escape heterosexism and cisgenderism in mainstream society. Yet, these spaces can be problematic for people with diverse identities, including transgender/gender nonconforming, racialized, and/or disabled individuals. This study reports findings from a cross-sectional survey that examined experiences of diverse 2SLGBTQ+ people in Canada and the United States within physical and virtual 2SLGBTQ+ leisure spaces most frequented in the past two years. Relationships between experiencing intersectional discrimination in these spaces, social wellbeing within the leisure space, mental health, and resilience-promoting factors were explored. The results suggest disabled individuals were at increased risk for experiencing intersectional discrimination. Additionally, intersectional discrimination was negatively associated with mental health, and this association was mediated by social wellbeing. These results suggest that more frequent experiences of intersectional discrimination were associated with lower social wellbeing within leisure spaces, which in turn was associated with poorer mental wellbeing. Antidiscrimination policies and inclusive leadership practices were shown to be significant moderators of the discrimination--social wellbeing and the discrimination--mental health relationships, meaning that these moderators could reduce the negative impact of intersectional discrimination on these outcomes, while social support from friends was found to be moderator for mental health. Further research is necessary to examine these relationships in a range of 2SLGBTQ+ leisure spaces, including those that are infrequently accessed, as well as explore additional moderators with larger samples and describe the ways diverse 2SLGBTQ+ people engage with 2SLGBTQ+ leisure spaces. [ABSTRACT FROM AUTHOR]

Early identification of neurodevelopmental disabilities (NDDs) is critical to a good prognosis. Several factors such as overlapping diagnoses can complicate this process and thus delay access to services. This study sought to identify meaningful clinical profiles, beyond diagnostic labels, in 194 children with NDDs referred to an assessment clinic. Cluster analyses were applied to eight selected behavioral and cognitive variables. Results suggested a cluster structure in which three homogenous groups differed significantly from one another: children who presented either (1) heterogeneous diagnoses and ambiguous profiles, (2) a clinical profile closely aligned to a classic presentation of ASD, and (3) emotional and behavioral challenges. These distinct profiles may have implications for assessment and clinical practices. [ABSTRACT FROM AUTHOR]

Aims: Identify the relationship between experiences of discrimination or violence and health outcomes for transgender and nonbinary Black, Indigenous and People of Colour (BIPOC) compared to their white trans and nonbinary peers. Design: A national online survey, the 2019 Canadian Trans and Nonbinary Youth Health Survey, was conducted among youth ages 14–25, in English and French. Methods: Participants were recruited from November 2018 to May 2019 (N = 1519). BIPOC youth comprised 25.7% of the sample (n = 390). Questions about six types of discrimination (e.g. racism and sexism) and violence (physically threatened or injured), plus foregone health care, self‐harm and suicidality were drawn from existing validated measures. Analyses involved cross‐tabulations with chi‐square tests and logistic regressions. Results: Trans and non‐binary BIPOC reported significantly higher prevalence of suicide attempts (24.9% vs. 19.5%) and violence victimization compared to white youth. They had significantly higher odds of self‐harm and foregone health care when experiencing discrimination by ethnicity or culture. All types of violence were significantly associated with higher odds of foregone physical health care, self‐harm, suicide ideation and suicide attempt. Conclusion: In Canada, trans and nonbinary youth who are BIPOC face disparities in health outcomes and experiences of violence and discrimination compared to white trans and nonbinary youth. Impact Nurses should assess for violence exposure and discrimination among trans and/or nonbinary youth of colour, and promote health equity by advocating for policies to reduce violence and discrimination, including racism, for trans and nonbinary young people. [ABSTRACT FROM AUTHOR]

Background: Fetal alcohol spectrum disorder (FASD) resulting from prenatal alcohol exposure (PAE) is a common neurodevelopmental disorder, but substantial interindividual heterogeneity complicates timely and accurate assessment, diagnosis, and intervention. The current study aimed to identify classes of children and adolescents with PAE assessed for FASD according to their pattern of significant neurodevelopmental functioning across 10 domains using latent class analysis (LCA), and to characterize these subgroups across clinical features. Methods: Data from the Canadian National FASD Database, a large ongoing repository of anonymized clinical data received from diagnostic clinics across Canada, was analyzed using a retrospective cross‐sectional cohort design. The sample included 1440 children and adolescents ages 6 to 17 years (M = 11.0, SD = 3.5, 41.7% female) with confirmed PAE assessed for FASD between 2016 and 2020. Results: Results revealed an optimal four‐class solution. The Global needs group was characterized by high overall neurodevelopmental impairment considered severe in nature. The Regulation and Cognitive needs groups presented with moderate but substantively distinguishable patterns of significant neurodevelopmental impairment. The Attention needs group was characterized by relatively low probabilities of significant neurodevelopmental impairment. Both the Global and Regulation needs groups also presented with the highest probabilities of clinical needs, further signifying potential substantive differences in assessment and intervention needs across classes. Conclusions: Four relatively distinct subgroups were present in a large heterogeneous sample of children and adolescents with PAE assessed for FASD in Canada. These findings may inform clinical services by guiding clinicians to identify distinct service pathways for these subgroups, potentially increasing access to a more personalized treatment approach and improving outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the feasibility, acceptability, and preliminary outcomes of an online self-compassion intervention for transgender adolescents, with the aim of improving mental health. Participants identified as transgender or gender expansive, were between the ages of 13 and 17, and lived in the U.S. or Canada. The empirically-based self-compassion program, Mindful Self-Compassion for Teens (formerly Making Friends with Yourself) was implemented in eight 1.5 hour sessions on the Zoom platform by two trained instructors. Surveys were administered pre-, post-intervention, and at 3 months follow-up, and qualitative data were collected through end-of-program interviews and open-ended questions on the post-survey. All protocols were approved by the university IRB. Quantitative data analysis included repeated measures ANOVAs, and qualitative data were analyzed via both inductive and deductive methods. Results indicated that all but one psychosocial measure significantly improved from pre- to post-intervention, which then significantly improved at 3-month follow-up; most other improvements were maintained at follow-up. Four themes emerged from the qualitative data: virtual safe space; connection to body; personal growth; and recommended course changes and are discussed. Results suggest that self-compassion interventions can be incorporated into therapy programs to support and improve mental health for transgender adolescents. [ABSTRACT FROM AUTHOR]

Sexual minority women (SMW) are at high risk of experiencing stigma, mental health problems, and being victims of intimate partner violence (IPV). This vulnerability can be explained by the sexual and gender minority stress model, stating that sexual and gender minority people suffer from specific stress factors added to general stressors, leading to more mental health and relationships problems. OBJECTIVE: The main goal of this study was to assess the impact of minority stress factors and former IPV victimization on the current mental health of Canadian SMW, as a function of their sexual and gender identity. METHOD: In total, 209 individuals identifying as women (M age = 33.9), living in Canada and who lived in a past violent relationship with a woman responded to an online survey. Well-validated questionnaires assessed sexual orientation and gender identity, former IPV behaviors, minority stress factors, depression, and anxiety. RESULTS: Hierarchical regressions showed that past psychological aggression was positively associated with anxiety symptoms and past sexual coercion with depressive symptoms. Not being monosexual was also associated more severe symptoms of depression and age was negatively associated with the severity of anxiety symptoms. After controlling for age, race/ethnicity, sexual and gender identity and former IPV victimization, having negative feelings about being a SMW was strongly associated with both depression and anxiety symptoms. CONCLUSION: These results provide new information on the interconnected associations between former IPV, minority stress and SMW's mental health. Findings highlight the need to adapt clinical interventions to help buffer against victimization faced by IPV victims who identify as sexual and gender minorities. [ABSTRACT FROM AUTHOR]

Although there is an increasing awareness of the critical role of gender within pediatric rehabilitation, little is known about the strategies that clinicians use to provide such care. The purpose of this study was to explore clinicians' strategies for providing gender-sensitive care within a pediatric rehabilitation hospital. We used a qualitative needs assessment design and a convenience sampling strategy to recruit clinicians from a pediatric rehabilitation hospital. We conducted interviews with 23 pediatric rehabilitation health care providers from various disciplines. We applied a thematic analysis to the interview transcripts. Our analysis revealed the following themes regarding clinicians' strategies in providing gender-sensitive care: (1) awareness of gender biases and not making assumptions; (2) recognizing gender-based vulnerabilities; (3) respecting patient values, preferences and needs; and (4) advocacy. Health care providers working within pediatric rehabilitation have several strategies for providing a gender-sensitive care approach to clients. Clinicians should seek training (i.e., appropriate terminology, creating inclusive spaces) in how to recognize gender-based health vulnerabilities, especially among patients who identify as non-binary or transgender. Clinicians should make an effort to try to be aware of their own biases and not make gender-based assumptions. Advocacy, respecting patient values, preferences and needs are important aspects of providing gender-sensitive care. [ABSTRACT FROM AUTHOR]

Dating violence during adolescence is a major public health issue: it is highly prevalent and extensive research has documented its physical and psychological consequences, yet very little has focused on its sexual consequences. The present study investigated the longitudinal associations between dating violence victimization (psychological, sexual or physical) and sexual well-being (sexual satisfaction and sexual distress) among 1442 sexually active adolescents aged between 14 and 17 years who completed at least one of three data waves (51.1% girls; 45.7% boys; 0.3% non-binary; 3.0% varying gender identity). The study also examined whether these associations differed by gender identity and sexual minority status. Adolescents completed online questionnaires on electronic tablets during class. The results indicated that psychological, physical (except for boys), and sexual dating violence victimization were all associated with lower sexual satisfaction and greater sexual distress over time. Moreover, the between-level associations between dating violence and poorer sexual outcomes were stronger among girls and gender varying adolescents than among boys. The within-level association between physical dating violence and sexual satisfaction was significant among adolescents with a nonvarying sexual minority status, but not among those with a nonvarying heterosexual status or that varied in sexual minority status. Findings offer cues for dating violence prevention and intervention programs by suggesting the need to examine sexual well-being over time., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Data indicate that 82% of transgender individuals have considered killing themselves and 40% have attempted suicide, with suicidality highest among transgender youth. Using minority stress theory and the interpersonal theory of suicide, this study aims to better understand suicide risk among transgender youth. The present study examines the influence of intervenable risk factors: interpersonal and environmental microaggressions, internalized self-stigma, and adverse childhood experiences (ACEs), and protective factors: school belonging, family support, and peer support on both lifetime suicide attempts and past 6-month suicidality in a sample of transgender youth (n = 372). SPSS 22 was utilized to examine the impact of the independent variables on both suicidality and lifetime suicide attempt through two separate logistic regressions. Fifty six percent of youth reported a previous suicide attempt and 86% reported suicidality. Logistic regressions indicated that models for both lifetime suicide attempts and suicidality were significant. Interpersonal microaggressions, made a unique, statistically significant contribution to lifetime suicide attempts and emotional neglect by family approached significance. School belonging, emotional neglect by family, and internalized self-stigma made a unique, statistically significant contribution to past 6-month suicidality. Results have significant practice and policy implications. Findings offer guidance for practitioners working with parents and caregivers of trans youth, as well as, for the creation of practices which foster interpersonal belonging for transgender youth. [ABSTRACT FROM AUTHOR]

Intracommunity support and knowledge sharing is used in transgender ("trans") communities as they navigate systems of oppression. Even for individuals with access to accepting families and service providers, connecting with other trans individuals can provide useful insight and resources. Conducted between December 2018 and April 2019, this scoping literature review examines the extent, range and nature of research activity regarding intracommunity knowledge and support sharing within trans communities. Drawing from Weeks' framework regarding sexual communities and the concepts of positive in‐group identity and group‐level coping, this review specifically addresses the guiding questions of what, how and why knowledge and support are shared within trans communities. Empirical studies conducted between 2004 and 2019 in the United States and Canada that were published in English and had a discernible trans sample or subsample were included. Thirty‐one studies met the criteria. Key themes from this literature are (a) sharing information related to advocacy & education, identity/expression and personal stories/experience while (b) utilising an array of both online and/or in‐person methods in order to (c) build community/support and navigate identity development and transition. Implications from the review, including impacts on both clients and students in social work and care programs, are discussed. [ABSTRACT FROM AUTHOR]

Research on enacted stigma, or stigma- and bias-based victimization, including bullying and harassment, among lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth often focuses on one context (e.g., school) or one form (e.g., bullying or microaggressions), which limits our understanding of these experiences. We conducted qualitative go-along interviews with 66 LGBTQ adolescents (14–19 years) in urban, suburban, town, and rural locations in the United States and Canada identified through purposive and snowball sampling. Forty-six participants (70%) described at least one instance of enacted stigma. Three primary themes emerged: (1) enacted stigma occurred in many contexts; (2) enacted stigma restricted movement; and (3) second-hand accounts of enacted stigma shaped perceptions of safety. Efforts to improve well-being among LGBTQ youth must address the diverse forms and contexts of enacted stigma that youth experience, which limit freedom of movement and potential access to opportunities that encourage positive youth development. School nurses can play a critical role in reducing enacted stigma in schools and in collaboration with community partners. [ABSTRACT FROM AUTHOR]

Background: Fetal alcohol spectrum disorder (FASD) resulting from prenatal alcohol exposure (PAE) is a common neurodevelopmental disorder, but substantial interindividual heterogeneity complicates timely and accurate assessment, diagnosis, and intervention. The current study aimed to identify classes of children and adolescents with PAE assessed for FASD according to their pattern of significant neurodevelopmental functioning across 10 domains using latent class analysis (LCA), and to characterize these subgroups across clinical features., Methods: Data from the Canadian National FASD Database, a large ongoing repository of anonymized clinical data received from diagnostic clinics across Canada, was analyzed using a retrospective cross-sectional cohort design. The sample included 1440 children and adolescents ages 6 to 17 years (M = 11.0, SD = 3.5, 41.7% female) with confirmed PAE assessed for FASD between 2016 and 2020., Results: Results revealed an optimal four-class solution. The Global needs group was characterized by high overall neurodevelopmental impairment considered severe in nature. The Regulation and Cognitive needs groups presented with moderate but substantively distinguishable patterns of significant neurodevelopmental impairment. The Attention needs group was characterized by relatively low probabilities of significant neurodevelopmental impairment. Both the Global and Regulation needs groups also presented with the highest probabilities of clinical needs, further signifying potential substantive differences in assessment and intervention needs across classes., Conclusions: Four relatively distinct subgroups were present in a large heterogeneous sample of children and adolescents with PAE assessed for FASD in Canada. These findings may inform clinical services by guiding clinicians to identify distinct service pathways for these subgroups, potentially increasing access to a more personalized treatment approach and improving outcomes., (© 2023 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.)

Background: Public awareness of Transgender and Gender Diverse (TGD) identities has grown significantly; however, acceptance and support remain elusive for many TGD youth. Resultant experiences of marginalization and stigmatization contribute to elevated rates of psychological distress and suicidality among TGD youth. Emergent evidence suggests that the internet may offer TGD youth safety, support, and community previously unavailable. Aim: The primary aim of this qualitative inquiry is to engage in an in-depth exploration of the online experiences and processes which help protect against psychological distress and promote well-being among TGD youth. Methods: Data were culled from a mixed-methods, online study of sexual and gender minority youth from across the United States and Canada which followed Institutional Review Board approved protocols. Participants for this study represent a sample (n=260) of TGD participants aged 14-22 (x = 17.30). Data were analyzed using Charmaz' grounded theory strategies. Results: Data revealed that the internet offers TGD youth affirming spaces that, for the most part, do not exist in their offline lives. Online, TGD youth were able to engage meaningfully with others as their authentic selves, often for the first time. These experiences fostered well-being, healing, and growth through five processes: 1. Finding an escape from stigma and violence, 2. Experiencing belonging, 3. Building confidence, 4. Feeling hope, and 5. Giving back. Discussion: The unique and innovative ways in which participants use online spaces to foster resilience offer important insights to inform affirmative practices with TGD young people. [ABSTRACT FROM AUTHOR]

Transgender (trans) people experience high rates of mental health issues including depression and suicidality. Improving access to transition-related medicine such as hormones and surgeries is suggested as an important mechanism to address these mental health issues. Yet clinicians experience challenges assessing and referring trans people for transition-related medicine. Standardized assessment protocols have been therefore recommended to optimize care. Although standardized protocols are purported to expand access to hormones and surgeries for trans people, it is unclear whether these tools achieve this goal. We therefore conducted an institutional ethnography to explicate how standardized readiness assessments coordinate access to hormones and surgeries in Canada. We analyzed key texts, talked with trans people, clinicians, clinician-educators, and administrators (total n = 22), and observed clinician-education workshops. In the context of determining transition readiness, standardized protocols direct clinicians to explore alternative diagnoses and assess the degree to which any complex mental health condition is "managed" prior to initiating hormones or surgeries. In response, we found that trans patients downplay or withhold mental health concerns from clinicians, or otherwise do additional work (e.g., take up unwanted psychiatric interventions) to convince providers they are "mentally ready" to transition. This phenomenon is paradoxical in that transition-related medicine is recommended to mitigate trans people's psychosocial distress, but when patients reveal symptoms of distress they encounter significant barriers to treatment. We conclude that the logic underpinning pre-transition "mental readiness" assessments discredits the claim that standardized protocols optimize access to hormones and surgeries. [ABSTRACT FROM AUTHOR]

Background/context Unnecessary laboratory testing leads to considerable healthcare costs. Aspartate aminotransferase (AST), commonly ordered with alanine aminotransferase (ALT) and blood urea nitrogen (BUN), commonly ordered with creatinine (Cr), often add little value to patient management at significant cost. We undertook a choosing wisely based quality improvement initiative to reduce the frequency of testing. Objectives To reduce the ratio of AST/ALT and BUN/Cr to less than 5% for all inpatient and outpatient test orders. Measures Absolute number and ratio of AST/ALT and BUN/Cr; AST, ALT, BUN and Cr tests per 100 hospital days; projected annualised cost savings and monthly acute inpatient bed days. Improvements We created guidelines for appropriate indications of AST and BUN testing, provided education with audit and feedback and removed AST and BUN from institutional order sets. Impact/results The ratios of AST/ALT and BUN/Cr decreased significantly over the study period (0.37 to 0.14, 0.57 to 0.14, respectively), although the goal of 0.05 was not achieved due to a delay in adopting the choosing wisely strategies during the study time period by some inpatient units. The number of tests per 100 hospital days decreased from 20 to 7 AST (95% CI 19 to 20.5, 5.6 to 8.7, p<0.001) and from 72 to 17 BUN (95% CI 70 to 73.4, 16.6 to 22.9, p<0.001). The initiative resulted in a projected annualised cost savings of C$221 749. Discussion A significant decrease in the AST/ALT and BUN/Cr ratios can be achieved with a multimodal approach and will result in substantial healthcare savings. [ABSTRACT FROM AUTHOR]

The social environment in which lesbian, gay, bisexual, transgender, and queer (LGBTQ) youths live influences health and well-being. We describe the development of the LGBTQ Supportive Environments Inventory (LGBTQ SEI), designed to quantify the LGBTQ-inclusiveness of social environments in the United States and Canada. We quantify aspects of the social environment including: (1) presence/quality of LGBTQ youth-serving organizations; (2) LGBTQ-inclusive community resources; and (3) socioeconomic and political environment. Using geographic information systems (GIS) tools, we aggregated data to buffers around 397 schools in three regions. The LGBTQ SEI can be used to assess the role of the social environment in reducing health disparities for LGBTQ youths. [ABSTRACT FROM AUTHOR]