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Given contemporary attention to diversity and inclusion on Canadian university campuses, and given human rights protections for sexual orientation and gender identity, it is tempting to believe that marginalization is a thing of the past for lesbian, gay, bisexual, transgender and queer (LGBTQ) academics. Our qualitative study (n = 8), focusing on everyday experiences rather than overt discrimination, documents numerous microaggressions, the often-unintended interactions that convey messages of marginality. With colleagues, students and administrators, participants reported isolation, tokenism, invisibility, hyper-visibility, dismissal, exoticization, and lack of institutional support. Maintaining constant vigilance and caution was taxing. The everyday microaggressions that lead to isolation and a sense of dis-ease in pervasively cisgender-normative and heteronormative institutions are very difficult to challenge, as they are not the kinds of experiences anti-discrimination policies and procedures are designed to address.

This article reports the findings of an online survey designed to collect information about substance use (licit, illicit, or pharmaceutical) and mental health (depression or anxiety) among social workers. Among the 489 participants, Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) screenings indicated symptoms of depression and anxiety at a higher prevalence than those of the general Canadian population. There were relatively few correlations between mental health scores and substance use. PHQ-9 total score significantly predicted past-year antidepressant use and past-year sleeping medication use. GAD-7 total score significantly predicted past-year benzodiazepine use and past-year melatonin use. Effects of substances (e.g. cannabis, alcohol, benzodiazepines, cocaine, ecstasy) were predominantly beneficial or nonproblematic (e.g. enjoyment/pleasure; socializing enhanced; concentration/focus improved). Subjective experiences of social workers should be sought to understand potential relationships between mental health scores and enhancement effects of substance use. Substances are being used, at least in part, for their performance-enhancing effects to meet the expectations of day-to-day life. Interventions can shift toward root causes, with institutions held more accountable for supporting social workers and promoting "workplace care." [ABSTRACT FROM AUTHOR]

This paper is based on a larger qualitative study of exclusion and belonging as experienced by members of marginalized groups in the professions. The current analysis draws on a subsample of 13 racialized and Indigenous academics at Canadian universities to examine their experiences of both everyday racism -- subtle, almost intangible micro-level interactions that convey messages of not fully belonging -- and overt racism and colonialism. Overt experiences were less common, though intensely painful. Though in some ways they are more straightforward to address, as they are more obvious, they also consume considerable time and energy. Instances of everyday racism and colonialism were more common, often intricately interwoven with the very fabric of the institutional culture. Their cumulative nature is exhausting. Diversity initiatives, while popular in contemporary universities, are failing to approach equity, in that they deny the need for change in institutional cultures.

In the 40 years since federal employment equity initiatives were launched in Canada, they have faced persistent backlash. This backlash is grounded in and fueled by conceptualizations of justice and equality that are rooted in ideologies of individualism and meritocracy. Here we draw on 140 qualitative interviews with members of six professions from across Canada, who self‐identify as Indigenous, Black or racialized, ethnic minority, disabled, 2SLGBTQ+, and/or from working‐class origins, to explore tensions between concepts of justice grounded in group‐based oppressions and those grounded in individual egalitarianism. Though affirmative action and employment equity opened up opportunities, people were still left to fight for individual rights. This push to individualism was intensified by persistent hostile misperceptions that people are less qualified and in receipt of 'unfair advantages.' Through discursive misdirection, potential for transformative institutional change is undermined by liberal discourses of individualism and meritocracy. [ABSTRACT FROM AUTHOR]

Systemic racism within health care is increasingly garnering critical attention, but to date attention to the racism experienced by health professionals themselves has been scant. In Canada, anti-Black racism may be embodied in structures, policies, institutional practices and interpersonal interactions. Epistemic racism is an aspect of systemic racism wherein the knowledge claims, ways of knowing and 'knowers' themselves are constructed as invalid, or less credible. This critical interpretive qualitative study examined the experiences of epistemic racism among 13 healthcare professionals across Canada who self-identified as Black women. It explores the ways knowledge claims and expert authority are discredited and undermined, despite the attainment of professional credentials. Three themes were identified: 1. Not being perceived or portrayed as credible health professionals; 2. Requiring invisible labour to counter professional credibility 'deficit'; and 3. Devaluing knowledge while imposing stereotypes. The Black women in our study faced routine epistemic racism. They were not afforded the position of legitimate knower, expert, authority, despite their professional credentials as physicians, nurses and occupational therapists. Their embodied cultural and community knowledges were disregarded in favour of stereotyped assumptions. Adopting the professional comportment of 'Whiteness' was one way these health care providers strived to be perceived as credible professionals. Their experiences are characteristic of 'misogynoir', a particular form of racism directed at Black women. Anti-Black epistemic racism constitutes one way Whiteness is perpetuated in health professions institutions. [ABSTRACT FROM AUTHOR]

Debates surrounding class inequality and social mobility often highlight the role of higher education in reducing income inequality and promoting equity through upward social mobility. We explore the lived experience of social mobility through an analysis of 11 semistructured interviews with Canadian academics who self-identified as having working-class or impoverished family origins. While economic capital increased substantially, cultural capital and habitus left many feeling like cultural outsiders. Isolation--both chosen and imposed--reduced professional networks, diminishing social capital. Caught between social worlds, participants mobilized symbolic capital in moral boundary marking, aligning themselves strategically with either their current class status or their working-class roots. While upward social mobility is a path toward reducing economic inequality, the lived experience of social mobility suggests it may exact a high emotional cost. Les debats autour des inegalites de classes et de la mobilite sociale mettent souvent en evidence le role de l'enseignement superieur dans la reduction des inegalites de revenus et la promotion de l'equite par le biais d'une mobilite sociale ascendante. Nous explorons l'experience vecue de la mobilite sociale en analysant onze entretiens semi-structures avec des universitaires canadiens qui se sont identifies comme issus de la classe ouvriere. Tandis que le capital economique augmentait considerablement, capital culturel et habitus laissaient beaucoup se sentir etrangers a la culture. Isolement--a la fois choisi et impose--a restreint les reseaux professionnels, limitant le capital social. Pris au piege entre des deux mondes sociaux, les participants ont mobilise un capital symbolique sous forme de limites morales, s'alignant strategiquement avec leur statut de classe actuel ou leurs racines dans la classe ouvriere. Si la mobilite sociale reduit les inegalites economiques, elle peut avoir un cout emotionnel eleve., MUCH OF THE DEBATE surrounding class inequality and social mobility highlights the role of education in reducing income inequality and promoting equity (e.g., Wakeling and Laurison 2017). Pursuing higher education [...]

In the health professions, altruism is a foundational value upon which professional privilege is built. This imperative towards self-sacrifice for the benefit of others is a key component of what it means to be professional. This paper explores how altruism operates as a coded mechanism of exclusion and oppression for disabled health professionals. Analysis is based on interviews with fifteen Canadian disabled healthcare professionals in medicine, nursing, occupational therapy, and social work about their experiences of inclusion and exclusion. Themes including the disproportionate sacrifice of time, resources, and income emerged, as did the need to manage political disclosure, often embodying the role of the 'super-crip' with patients/clients and colleagues so as to maintain others' faith in their professional competence and their professional privilege. Further discussion includes questions of how to 'crip' altruism as a professional value and the role of altruism as an ableist force within the health professions. Altruism, the idea of helping others even at cost to oneself, is an important value for health professionals. Disabled health professionals sacrifice more than non-disabled healthcare professionals to meet this obligation. Disabled healthcare professionals may work without accommodations, putting in extra time and effort to prove their altruism. Disabled healthcare professionals experience that disclosing disability may mean their colleagues will treat them as patients. [ABSTRACT FROM AUTHOR]

Post-secondary institutions are increasingly promoting equity, diversity and inclusion (EDI) in health professions education. Yet, institutions continue to be spaces of exclusion and marginalization for health professional students from marginalized groups. To explore the education experiences of health professionals from marginalized groups in Canada. We draw on a subset of data from a larger qualitative study examining experiences of health professionals who self-identify as disabled, working-class origin, racialized, ethnic minority, and/or minority sexual/gender identity (LGBTQ+). This analysis includes 35 participants from medicine, nursing, and occupational therapy. We identified five main themes: 1) isolation, being the "only one"; 2) normative curricula; 3) marginalization by classmates and instructors; 4) exclusionary social and cultural capital; and 5) coping strategies. Learners from marginalized groups are still experiencing marginalization in health professional education, despite institutional commitments to EDI. An overhaul of professional education is needed to address exclusionary processes. [ABSTRACT FROM AUTHOR]

Objective: South Asians living in western countries have increased risk for developing diet-related chronic disease compared to Caucasians of European heritage. To increase understanding of social and cultural factors associated with their food habits, this study examined the meanings of food, health and well-being embedded in the food practices of families of Punjabi heritage living in Metro Vancouver, Canada. Design: Qualitative research design. Setting: Metro Vancouver, British Columbia, Canada. Method: Data collection included individual interviews with 39 members of 12 families of Punjabi Sikh origin (ages 13 to 70 years) and participant observation of a grocery shopping trip and family meal. Themes were generated through constant comparative analysis of transcripts to describe, organize and interpret influences on participants' food decision-making in families. Findings: Participants' descriptions of their eating habits were characterized by contrasts between elders' reliance on traditional Indian foods and young people's desire for their diets to include at least some "western" food. Participants articulated two different understandings of how food habits affect physical health: a scientific approach that related specific food components (eg, fat, cholesterol, vitamins) to risk of chronic disease, and a view based on centuries of traditional knowledge about food. Food choice was also shaped by concerns for the psychosocial well-being of individual family members, exemplified by women's attention to food preferences of individuals in the family. Conclusion: These findings add to understanding of the varied ways food practices are implicated in constructing ethnic identities, and provide insight into cultural influences on health behaviours. (Contains 1 table and 1 figure.)

Encouraging a teenager to have a conversation in a semistructured research interview is fraught with difficulties. The authors discuss the methodological challenges encountered when interviewing adolescents of European Canadian, African Canadian, and Punjabi Canadian families who took part in the Family Food Decision-Making Study in two regions of Canada. The researchers were interested in how family members made decisions about food choices. In all, 47 adolescents from 36 families agreed to an interview. The authors found recruitment of teens, locating a quiet space for interviews, the silencing effects of the tape recorder, and asking about abstract concepts to be constraints on adolescents' conversational abilities. Although each interviewer encountered many of the same challenges, some of those challenges played out differently in different ethnocultural groups. This article intersperses discussion about the challenges encountered with the four interviewers' reflections on their interviews with teens and with data from the interviews. (Contains 1 note.)

Investigated outcomes of a medical course addressing social and cultural issues on students' awareness and understanding. Found that students failed to recognize, or even denied, the effects of race, class, gender, culture, and sexual orientation. Those who acknowledged the effect of social differences tended to deny social inequality, or at best recognized disadvantages experienced by others, but not the accompanying privileges enjoyed by their own social group. (EV)

Introduction In a recent editorial in the Journal of the American Medical Association, Jeremy Sugarman argues that, "The time is ripe for evidence-based ethics. Similar to evidence-based medicine, an evidence-based [...]

Objective: To explore women's perceptions of family influences on food decision-making in the context of having had breast cancer or not having had breast cancer. Design: Individual interviews exploring women's perceptions of their eating habits, health status, and diet, health, and breast cancer beliefs. Setting: In Vancouver, a large, multicultural, Canadian city, interviews were held in women's homes or offices or at the university. Participants: A culturally diverse convenience sample of women aged 40 to 60 years, including breast cancer survivors (n = 29) and women who had not had breast cancer (n = 32). Analysis: Verbatim interview transcripts were coded by one of the authors, and themes were developed by sorting and summarizing transcript segments. Results: Women who had not had breast cancer believed that they were catering to family preferences, even at the expense of their own health. In particular, men's 'meat and potatoes' diet proved to be a barrier to dietary change. Breast cancer survivors experienced family members more as supporting than resisting healthful eating. Believing that the diagnosis had shifted their priorities, some women made healthful dietary changes regardless of family response. Conclusions and Implications: Women experience family influence as significant in food decision-making. An illness diagnosis may alter women's and their families' negotiations of competing values, such that healthful eating takes on greater priority than food preferences or maintaining social relations through catering to others' tastes. This may be an opportune time to help women introduce healthful eating. KEY WORDS: food choice, family, social influences, food behavior

Objective: To explore women's dietary actions after a breast cancer diagnosis and the factors influencing those actions. Design: Individual interviews exploring women's perceptions. Setting: Vancouver, British Columbia, Canada. Participants: A culturally diverse convenience sample of women (N = 30) aged 40 to 60 years diagnosed with breast cancer 6 months to 15 years previously. Phenomenon of Interest: Social and personal factors that influence dietary actions. Analysis: Verbatim interview transcripts were coded and themes developed by sorting and summarizing coded transcript segments. Results: Women held a wide range of beliefs concerning the relationship between diet and breast cancer, particularly their own cancer occurrence. Actions were not always consistent with professed beliefs. Some women believed that diet contributes to breast cancer, even their own cancer, yet made no diet changes; others did not believe in such a relationship but did change their diets postdiagnosis. Family support, employment, financial resources, cultural food patterns, and other health concerns were strong influences. Conclusions and Implications: Although beliefs about diet--cancer connections affect actions concerning diet change, the relationship is not consistent. Diet change is also affected by social, cultural, and economic concerns that are at least as important as a woman's beliefs. Nutrient supplements appear to be a common, although perhaps temporary, response to diagnosis. Future research should explore the possibilities for nutrition professionals to help women think critically about the range of influences on their diets. KEY WORDS: diet, food habits, knowledge, attitudes, breast cancer