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A grounded theory study was undertaken to describe how adolescents make decisions about sunbathing during the transition from childhood to adolescence and to propose an explanation for the relationships among factors affecting the adoption of sun tanning. In-depth interviews (n = 40) were conducted separately with adolescents (aged 12 to 16 years) and their parents. Constant comparative analysis of adolescents' accounts identified two methods that adolescents described as a means of getting a suntan: intentional sun tanning and incidental sun tanning. The process of adolescents' decision-making about getting a suntan can be understood by examining the following sequence: becoming motivated to get a tan, experimenting with sun tanning, and establishing self as an intentional tanner or incidental tanner. Implications for developing strategies to prevent the adoption of sun-tanning habits among adolescents are presented. [ABSTRACT FROM AUTHOR]

The purpose of this article is to evaluate the quality of published studies conducted in North America that assessed behavior change interventions to prevent HIV'AIDS among people ages 12-24 years. A search of the Medline, HealthStar, and AIDSLINE electronic databases was completed. English language articles published between 1995 and 2000 were screened for relevance. A scoring system was developed to assess eligible studies on the following criteria: (a) selection bias, (b) study design, (c) sample size, (d) description of intervention, (e) theoretical basis for intervention, (f) data collection, (g) long-term follow-up, and (h) attrition and withdrawals. Two reviewers evaluated studies. Of the 20 eligible studies, all (n = 20) used convenience samples. The most common research design used was the experimental (n = 16). Ten studies were rated as 'Strong,' 6 were of 'Moderate' quality, and 4 were rated as 'Weak.' The quality of intervention evaluations related to HIV/AIDS prevention among young people appears to be improving, although recruitment of probability samples, use of standardized outcomes, and attrition rates remain as challenges. [ABSTRACT FROM AUTHOR]

Background: As stigma is a socially constructed concept, it would follow that stigma related to sexual behaviours and sexually transmitted infections would carry with it many of the gender-based morals that are entrenched in social constructs of sexuality. In many societies, women tend to be judged more harshly with respect to sexual morals, and would therefore have a different experience of stigma related to sexual behaviours as compared to men. While a variety of stigma scales exist for sexually transmitted infections (STIs) in general; none incorporate these female-specific aspects. The objective of this study was to develop a scale to measure the unique experience of STI-related stigma among women.Methods: A pool of items was identified from qualitative and quantitative literature on sexual behaviour and STIs among women. Women attending a social evening program at a local community health clinic in a low-income neighbourhood with high prevalence of substance use were passively recruited to take part in a cross-sectional structured interview, including questions on sexual behaviour, sexual health and STI-related stigma. Exploratory factor analysis was used to identify stigma scales, and descriptive statistics were used to assess the associations of demographics, sexual and drug-related risk behaviours with the emerging scales.Results: Three scales emerged from exploratory factor analysis--female-specific moral stigma, social stigma (judgement by others) and internal stigma (self-judgement)--with alpha co-efficients of 0.737, 0.705 and 0.729, respectively. In this population of women, internal stigma and social stigma carried higher scores than female-specific moral stigma. Aboriginal ethnicity was associated with higher internal and female-specific moral stigma scores, while older age (>30 years) was associated with higher female-specific moral stigma scores.Conclusion: Descriptive statistics indicated an important influence of culture and age on specific types of stigma. Quantitative researchers examining STI-stigma should consider incorporating these female-specific factors in order to tailor scales for women. [ABSTRACT FROM AUTHOR]

Little is known about the psychosocial factors associated with sexual assault experienced by males. Men (N=358), 19-35 years of age, recruited by community outreach, completed questionnaires. Eligibility criteria included: being HIV-negative and self-identifying as gay or bisexual. Lifetime prevalence rates of childhood sexual abuse, juvenile prostitution, and adult sexual assault were determined. The mental health of this population was explored including associations between sexual victimization and mental health disorders (alcohol abuse, suicidal ideation and attempts, mood disorders, and poor self-esteem). Almost 1 in 10 of the men had engaged in juvenile prostitution, 14% were forced into sexual activity before 14 years of age, and 14% were sexually victimized after the age of 14. Those exposed to non-consensual sex were 2.9 (95% CI: 1.8-4.7) times more likely to abuse alcohol than those free of victimization. Those who reported childhood sexual abuse were 3.3 (95% CI: 1.7-6.4) times more likely to have attempted suicide. Juvenile prostitution was associated with current depression (OR=6.4; 95% CI: 2.8-14.9). Health professionals have the responsibility to respond competently and sensitively to victims of sexual violence. To do this, many need to recognize the prevalence of male sexual trauma, to deconstruct their personal beliefs about same-sex sexual violence, and to learn to ask sensitive questions in their assessment interviews. [ABSTRACT FROM AUTHOR]

To address the need for a better understanding of the perspective of Canadian youths on tobacco dependence, a qualitative study using ethnographic techniques was conducted to describe the patterns of language that they use to describe tobacco dependence and the meaning that it has for them. The study was comprised of three inter-related phases: (1) A secondary analysis of 47 individual unstructured interviews with adolescents was completed to identify the words and phrases they use to explain tobacco dependence; (2) contrast and structural questions focusing on tobacco dependence were developed and used in open-ended interviews with 13 adolescents. Data analysis of the transcribed interviews resulted in a set of 60 key phrases that represented the primary ways youths describe the need to smoke; and (3) interviews were conducted with 14 adolescents that involved an open card sort using the set of 60 key phrases. All card sorts and transcribed interview data were analyzed to identify domains representing types of tobacco dependence and sub-types within each domain. From their descriptions about the need to smoke, five aspects of tobacco dependence were identified: social, pleasurable, empowering, emotional, and full-fledged. This study provides a step in elucidating the construct of tobacco dependence among the young. Further research is required to extend this understanding and to develop appropriate measures. [ABSTRACT FROM AUTHOR]

Studies of parents' online safety concerns typically centre on information privacy and on worries over unknown third parties preying on children, whereas investigations into youth perspectives on online safety have found young people to focus on threats to safety or reputation by known individuals. The case of youth who are themselves parents raises questions regarding how these differing perspectives are negotiated by individuals who are in dual roles as youth and parents. Using interview and ethnographic observation data from the longitudinal Young Parent Study in British Columbia, Canada, this analysis investigates social media and online safety practices of 113 young parents. Online safety concerns of young parents in this study focused on personal safety, their children's online privacy and image management. These concerns reflect their dual roles, integrating youth image and information management concerns with parental concerns over the safety and information privacy of their own children., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (© The Author(s) 2021.)

Suicide is a critical public health concern globally. Sex workers experience a disproportionate burden of social and health inequities driven by forms of violence, stigma, and criminalization, yet empirical research on suicidality is limited. This study longitudinally investigated the burden and socio-structural correlates of recent suicidality among women sex workers in Vancouver, Canada. Data (2010-2017) were drawn from a community-based, prospective cohort of cis and trans women sex workers across Metro Vancouver. Women completed biannual interviewer-administered questionnaires, and correlates of suicidality in the last 6 months were analyzed using bivariate and multivariable logistic regression with generalized estimating equations (GEE). Of 867 women at baseline, 48% ( n = 413) reported lifetime suicidality, 16% (n = 141) reported suicidality in the last 6 months, and 29% reported suicidality at some point during the study. In multivariable analysis, factors independently associated with suicidality included physical/sexual childhood abuse (adjusted odds ratio [AOR]: 2.99; 95% confidence interval [CI] = [1.75, 5.10]), mental health issues (depression/anxiety/posttraumatic stress disorder; AOR = 2.19; 95% CI = [1.63, 2.95]), intimate partner violence (AOR: 2.11; 95% CI = [1.60, 2.80]), physical/sexual client violence (AOR: 1.82; 95% CI = [1.33, 2.50]), and homelessness (AOR: 1.44; 95% CI = [1.10, 1.89]). Older age (AOR: 0.97; 95% CI = [0.95, 0.99]) and higher social cohesion (AOR: 0.88; 95% CI = [0.78, 0.99]) were significantly associated with reduced odds of suicidality. Findings reveal key socio-structural correlates of suicidality among sex workers including experiences of historical and interpersonal violence, trauma/mental health issues, and homelessness. Strengthening social cohesion may have a protective effect on suicidality. Trauma-informed community-led structural interventions tailored to sex workers are urgently needed alongside a legal framework that enables collectivization and connectedness.

Objective: Our primary objective was to examine the syndemic effect of HIV/HCV co-infection and mental health disorders (MHD) on the acute care hospitalization rate among people living with HIV (PLW-HIV) in British Columbia, Canada. Secondarily, we aimed to characterize the longitudinal trends in the aforementioned rate, while controlling for the effect of several factors., Methods: In this retrospective cohort study, individuals were antiretroviral therapy-naïve, ≥ 18 years old, initiated treatment between 1 January 2000 and 31 December 2014, and were followed for at least 6 months until 31 December 2015 or last contact. The outcome was acute care hospitalization rate (every 6-month interval) per individual. The exposure was the interaction between HIV/HCV co-infection and MHD. Generalized non-linear mixed-effects models were built., Results: Of the 4046 individuals in the final analytical sample, 1597 (39%) were PLW-HIV without MHD, 606 (15%) were people living with HIV and HCV (PLW-HIV/HCV) without MHD, 988 (24%) were PLW-HIV with MHD, and 855 (21%) were PLW-HIV/HCV with MHD. The adjusted rate ratios for acute care hospitalizations were 1.31 (95% [confidence interval] 1.13-1.52), 2.01 (95% CI 1.71-2.36), and 2.53 (95% CI 2.20-2.92) for PLW-HIV with MHD, PLW-HIV/HCV without MHD, and PLW-HIV/HCV with MHD, respectively, relative to PLW-HIV without MHD., Conclusion: The HIV/HCV co-infection and MHD interaction demonstrated a significant effect on the rate of acute care hospitalization, particularly for PLW-HIV/HCV with MHD. Implementing widely accessible integrative care model best practices may address this public health challenge.

Population health information interventions (PHIIs) use information in efforts to promote health. PHIIs may push information to a target audience (communication), pull information from the public (surveillance), or combine both in a bidirectional intervention. Although PHIIs have often been framed as non-invasive and ethically innocuous, in reality they may be intrusive into people's lives, affecting not only their health but their senses of security, respect, and self-determination. Ethical acceptability of PHIIs may have impacts on intervention effectiveness, potentially giving rise to unintended consequences. This article examines push, pull, and bidirectional PHIIs using empirical data from an ethnographic study of young mothers in Greater Vancouver, Canada. Data were collected from October 2013 to December 2014 via naturalistic observation and individual interviews with 37 young mothers ages 16-22. Transcribed interviews and field notes were analyzed using inductive qualitative thematic analysis. Both push and pull interventions were experienced as non-neutral by the target population, and implementation factors on a structural and individual scale affected intervention ethics and effectiveness. Based on our findings, we suggest that careful ethical consideration be applied to use of PHIIs as health promotion tools. Advancing the 'ethics of PHIIs' will benefit from empirical data that is informed by information and computer science theory and methods. Information technologies, digital health promotion services, and integrated surveillance programs reflect important areas for investigation in terms of their effects and ethics. Health promotion researchers, practitioners, and ethicists should explore these across contexts and populations., (© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

In Canada, the issue of creating safe and inclusive school environments for lesbian, gay, bisexual, transgender, and queer students has been in the spotlight. Several researchers and advocates have pointed out the positive effects of lesbian, gay, bisexual, transgender, and queer-positive policy frameworks on the health and wellbeing of all young people. In this article, we take a critical approach to analyzing narrative findings from qualitative interviews conducted with youth in three communities in British Columbia, Canada: "the North," Vancouver, and Abbotsford. Using a Foucauldian Discourse Analytic Approach and Butler's concept of Citationality, our analysis suggested that although explicit homophobia was largely absent from youth discussions, young people discursively constructed lesbian, gay, bisexual, transgender, and queer identities and "communities" in ways that reified heteronormativity. Youth made references to sociopolitical discourses of libertarianism and liberalism and to homonormative stereotypes regarding gay masculinity. A few young people also alluded to egalitarian, queer-positive discourses, which appeared to interrogate structures of heteronormativity. Since studies suggest a connection between the existence of institutional supports for lesbian, gay, bisexual, transgender, and queer students in schools and their mental and physical wellbeing, we conclude by considering the limitations and possibilities of these sociopolitical discourses in the struggle for sexual and gender equity, and how they might help frame future health-related, anti-homophobia policy frameworks in educational settings.

Objectives: In 2014, the Joint United Nations Programme HIV/AIDS (UNAIDS) set the target of dramatically reducing the burden of HIV through expansion of access to timely HIV treatment. In order to achieve this target it is necessary to expand access to care along the HIV cascade of care. This study examines the relationship between viral suppression and the availability of physicians providing HIV treatment in British Columbia, Canada., Methods: Data from the Drug Treatment Program of the British Columbia (BC) Centre for Excellence in HIV/AIDS was used for this analysis. The floating catchment method was used to assess physician availability. Multivariable Logistic Regression was used to implement a confounder selection technique to independently assess the relationship between physician availability and viral load suppression., Results: Individuals with more than 25 physicians within a one-hour catchment were more likely to reside in urban areas and almost twice as likely to have a suppressed viral load (adjusted odd ratio: 1.97; 95% CI 1.50 - 2.58)., Conclusions: This study highlights the impact of physicians' availability on viral load levels. Mapping technology was used to identify the locations in which patients were most impacted by the lack of physicians.

Objectives: Although previous cross-sectional studies have identified correlates of detectable plasma HIV-1 RNA viral load (VL) among HIV-positive people who use drugs (PWUD), longitudinal factors associated with heightened HIV transmission potential have not been well described. Therefore, we longitudinally examined factors associated with amount of person-time spent above log10(1500) copies/ml plasma among HIV-positive PWUD in Vancouver, Canada., Design: Data were derived from a long-running prospective cohort of HIV-positive PWUD linked to comprehensive clinical records including systematic VL monitoring., Methods: We used generalized estimating equations modeling to longitudinally examine factors associated with person-time (in days) with a VL more than log10(1500) copies/ml plasma in the previous 180 days., Results: Between December 2005 and May 2014, 845 PWUD were eligible and included in the study. Participants spent an average of 26.8% of observation time with a VL more than log10(1500) copies/ml. In multivariable analyses, homelessness (Adjusted Rate Ratio [ARR] = 1.45) and lack of social support (ARR = 1.27) were positively associated with person-time with a VL more than log10(1500) copies/ml. Older age (ARR = 0.97) and enrolment in addiction treatment (ARR = 0.75) were negatively associated with the outcome in multivariable analyses (all P < 0.05)., Conclusion: Social and structural factors, including periods of homelessness or lacking in social support, were independently associated with greater amount of time with heightened HIV transmission potential. These findings suggest the need for targeted efforts to address modifiable contextual factors that contribute to increased risk of onward HIV transmission among PWUD.

Background: The burden of HCV among those living with HIV remains a major public health challenge. We aimed to characterize trends in healthcare-related visits (HRV) of people living with HIV (PLW-HIV) and those living with HIV and HCV (PLW-HIV/HCV), in British Columbia (BC), and to identify risk factors associated with the highest HRV rates over time., Methods: Eligible individuals, recruited from the BC Seek and Treat for Optimal Prevention of HIV/AIDS population-based retrospective cohort (N = 3955), were ≥ 18 years old, first started combination antiretroviral therapy (ART) between 01/01/2000-31/12/2013, and were followed for ≥6 months until 31/12/2014. The main outcome was HRV rate. The main exposure was HIV/HCV co-infection status. We built a confounder non-linear mixed effects model, adjusting for several demographic and time-dependent factors., Results: HRV rates have decreased since 2000 in both groups. The overall age-sex standardized HRV rate (per person-year) among PLW-HIV and PLW-HIV/HCV was 21.11 (95% CI 20.96-21.25) and 41.69 (95% CI 41.51-41.88), respectively. The excess in HRV in the co-infected group was associated with late presentation for ART, history of injection drug use, sub-optimal ART adherence and a higher number of comorbidities. The adjusted HRV rate ratio for PLW-HIV/HCV in comparison to PLW-HIV was 1.18 (95% CI 1.13-1.24)., Conclusions: Although HRV rates have decreased over time in both groups, PLW-HIV/HCV had 18% higher HRV than those only living with HIV. Our results highlight several modifiable risk factors that could be targeted as potential means to minimize the disease burden of this population and of the healthcare system.

Background: Online health services are a rapidly growing aspect of public health provision, including testing for sexually transmitted and other blood-borne infections (STBBI). Generally, healthcare providers, policymakers, and clients imbue online approaches with great positive potential (e.g., encouraging clients' agency; providing cost-effective services to more clients). However, the promise of online health services may vary across contexts and be perceived in negative or ambiguous ways (e.g., risks to 'gold standard' care provision; loss of provider control over an intervention; uncertainty related to budget implications). This study examines attitudes and perceptions regarding the development of a novel online STBBI testing service in Vancouver, Canada. We examine the perceptions about the intervention's potential by interviewing practitioners and planners who were engaged in the development and initial implementation of this testing service., Methods: We conducted in-depth interviews with 37 healthcare providers, administrators, policymakers, and community-based service providers engaged in the design and launch of the new online STBBI testing service. We also conducted observations during planning and implementation meetings for the new service. Thematic analysis techniques were employed to identify codes and broader discursive themes across the interview transcripts and observation notes., Results: Some study participants expressed concern that the potential popularity of the new testing service might increase demand on existing sexual health services or become fiscally unsustainable. However, most participants regarded the new service as having the potential to improve STBBI testing in several ways, including reducing waiting times, enhancing privacy and confidentiality, appealing to more tech-savvy sub-populations, optimizing the redistribution of demands on face-to-face service provision, and providing patient-centred technology to empower clients to seek testing., Conclusions: Participants perceived this online STBBI testing service to have the potential to improve sexual health care provision. But, they also anticipated actions-and-reactions, revealing a need to monitor ongoing implementation dynamics. They also identified the larger, potentially system-transforming dimension of the new technology, which enables new system drivers (consumers) and reduces the amount of control health care providers have over online STBBI testing compared to conventional in-person testing.

Introduction: Antiretroviral therapy (ART) scale-up is central to the global strategy to control the HIV/AIDS pandemic. To accelerate efforts towards ending the AIDS epidemic, the Joint United Nations Programme on HIV/AIDS released the 90-90-90 and 95-95-95 targets, which have recently been approved by the United Nations (UN). This study characterizes the province of British Columbia (BC)'s progress towards achieving the UN targets, predicts a trajectory up to 2030 according to each of the individual steps (i.e. %Diagnosed, %On ART and %Virologically Suppressed), and identifies the population sub-groups at higher risk of not achieving these targets., Methods: The analyses were based on linked individual-level datasets of people living with HIV (PLWH) in BC, aged ≥18 months, from 2000 to 2013. Using past trends in HIV prevalence and of each individual UN targets, we forecasted these outcomes until 2030 via generalized additive models. We ran a second set of analyses to assess the associations between individual demographic and behavioural factors and each of the individual steps of the UN targets. Lastly, we performed sensitivity analyses to account for uncertainty associated with prevalence estimates and suppression definitions., Results: Among the estimated 10666 PLWH in BC in 2013, 82% were diagnosed, 76% of those diagnosed were on ART and 83% of those on ART were virologically suppressed. We identified that females, PLWH aged <30 years and those with unknown risk or who self-identify as having a history of injection drug use were the population subgroups that experienced the most challenge in engaging on ART and achieving viral suppression. Our model projections suggest that BC will achieve 90%-91%-90% and 97%-99%-97% by 2020 and 2030 respectively., Conclusions: As we approach 2020, BC is rapidly moving towards achieving the UN targets. However, region-specific challenges persist. Identification of remaining regional challenges will be essential to achieving the proposed UN targets and therefore fulfilling the promise to end AIDS as a pandemic by 2030., (© 2017 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.)

Investigating the determinants of positive mental health , as opposed to focusing on mental illness , is a new research direction with important implications for population health promotion. Past research suggests that mental health develops in early childhood and that social factors including highest household educational attainment may play an important role. The current study examined the association between household educational attainment and adolescent self-reported positive mental health in a nationally representative Canadian sample using data from the 2011-12 Canadian Community Health Survey. The sample included 10,091 adolescents aged 12 to19 living at home with at least one parent. Household educational attainment was obtained from a Statistics Canada derived variable documenting the highest level of education in the household. Adolescent positive mental health was assessed using the Mental Health Continuum scale. Multivariable logistic regression analyses showed that after adjusting for household income, single parent status, and household size, adolescents had lower odds of experiencing positive mental health in households in which attempted but not completed post-secondary was the highest education level compared to completed post-secondary education (OR = 0.64, 95% CI = 0.44, 0.95). This association was strongest in adolescents aged 12 to14 (OR = 0.43, 95% CI = 0.21, 0.84) and females (OR = 0.50, 95% CI = 0.29, 0.88). Contrary to expectations, we did not find an incremental increasing association between adolescent positive mental health and household educational attainment. Instead, results suggested that common underlying factors may have contributed both to uncompleted post-secondary education in the household and adolescents' diminished positive mental health.

Behavioral interventions have been essential components of HIV prevention approaches, especially those aimed to promote safe sexual practices. We conducted a comprehensive literature search without language restrictions between 1980 and July 2014 to identify randomized controlled trials or controlled studies investigating behavioral interventions which: included women living with HIV; focused on condom use promotion; presented/analyzed outcomes by gender; used a 3-month follow-up or more; and considered at least one HIV-related behavioral or biological outcome. Eight studies comprising a total of 1,355 women living with HIV were included in the meta-analyses, and 13 studies were qualitatively described. When compared to standard care or minimal support intervention, behavioral interventions did not demonstrate an effect on increasing consistent condom use at the 3-month follow-up (RR = 0.92; 95%CI: 0.73, 1.16; p = 0.48), 6-month follow-up (RR = 1.13; 95%CI: 0.96, 1.34; p = 0.15), and 12-month follow-up (RR = 0.91; 95%CI: 0.77, 1.08; p = 0.30). Behavioral interventions also failed to reach positive effect in reduction of unprotected sexual intercourse at 6-months (MD = -1.80; 95%CI: -4.21, 0.62; p = 0.14) and 12-months follow-up (MD = -1.39; 95%CI: -2.29, 0.21; p = 0.09). These findings should be interpreted with caution since they are based on a few small trials. New researches are needed to assess the potential gains from a combination of interventions that promote safe sexual behavior with a harm reduction and gender approach, particularly in developing countries where HIV infection rates remain high.

This study examines gradients in depressive symptoms by socioeconomic position (SEP; i.e., income, education, employment) in a sample of men who have sex with men (MSM). Data were used from EXPLORE, a randomized, controlled behavioral HIV prevention trial for HIV-uninfected MSM in six U.S. cities (n = 4,277). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression scale (short form). Multiple linear regressions were fitted with interaction terms to assess additive and multiplicative relationships between SEP and depressive symptoms. Depressive symptoms were more prevalent among MSM with lower income, lower educational attainment, and those in the unemployed/other employment category. Income, education, and employment made significant contributions in additive models after adjustment. The employment-income interaction was statistically significant, indicating a multiplicative effect. This study revealed gradients in depressive symptoms across SEP of MSM, pointing to income and employment status and, to a lesser extent, education as key factors for understanding heterogeneity of depressive symptoms.

Purpose: To examine the extent to which sexual identity disparities in mental health outcomes (anxiety disorder, mood disorder, anxiety-mood disorder, and co-occurring anxiety or mood disorder and heavy drinking) are mediated by life stress or moderated by a sense of community belonging., Methods: This study pooled data from a large, national, multi-year sample of Canadians aged 18-59 years, who self-identified as lesbian, gay, bisexual, or heterosexual (N = 222,548). A series of stratified binary mediation models were fitted. Significance of the indirect effect was determined by using bootstrapping to obtain standard errors and confidence intervals., Results: Sexual minority (versus heterosexual) respondents were significantly more likely to describe their lives as stressful, their sense of community belonging as weak, and had significantly greater odds of the negative mental health outcomes. Perceived life stress partially mediated the effects of sexual identity on the mental health outcomes. The differences between the mediated effects for the gay/lesbian and bisexual subgroups were statistically significant (all p < 0.05). When stratified by sense of community belonging, life stress mediated the relationship with mood disorders for the gay/lesbian group, where a strong sense of community belonging was associated with greater odds of mood disorders for gay/lesbian versus heterosexual respondents., Conclusions: These mediation and moderated mediation models provide further evidence for a social patterning of the mental health disparities experienced by sexual minorities in Canada.

As routine HIV testing approaches are implemented to enhance participation rates in HIV testing, it is often widely believed that these approaches are socially and ethically justifiable given the underlying assumption that these practices will result in the widespread reduction of HIV-related stigma. Nonetheless, a variety of empirical and theoretical gaps on how HIV testing practices may impact on HIV stigma remain, raising questions about the social underpinnings of the public health rationale. We draw on 50 interviews with 18-24 year-old men to determine how HIV-related stigma is experienced differentially across subgroups of young men in relation to both voluntary and routine testing practices. The men's experiences with routine testing highlight how (mis)interpretations of universal, routine testing practices may serve to (unintentionally) burden disadvantaged subgroups of men; however, when these practices are adequately explicated, the universal dimension of a routine offer greatly diminished these concerns. These findings also show that, under the right conditions, a routine offer can provide transformative opportunities for individuals to reconceptualise their expectations over HIV and HIV-related stigma., (© 2015 Foundation for the Sociology of Health & Illness.)

Background: Heavy episodic drinking (HED) is associated with sexual risk behavior and HIV seroconversion among men who have sex with men (MSM), yet few studies have examined heavy drinking typologies in this population., Methods: We analyzed data from 4,075 HIV-uninfected MSM (aged 16 to 88) participating in EXPLORE, a 48-month behavioral intervention trial, to determine the patterns and predictors of HED trajectories. HED was defined as the number of days in which ≥5 alcohol drinks were consumed in the past 6 months. Longitudinal group-based mixture models were used to identify HED trajectories, and multinomial logistic regression was used to determine correlates of membership in each group., Results: We identified 5 distinct HED trajectories: nonheavy drinkers (31.9%); infrequent heavy drinkers (i.e., <10 heavy drinking days per 6-month period, 54.3%); regular heavy drinkers (30 to 45 heavy drinking days per 6 months, 8.4%); drinkers who increased HED over time (average 33 days in the past 6 months to 77 days at end of follow-up, 3.6%); and very frequent heavy drinkers (>100 days per 6 months, 1.7%). Intervention arm did not predict drinking trajectory patterns. Younger age, self-identifying as white, lower educational attainment, depressive symptoms, and stimulant use were associated with reporting heavier drinking trajectories. Compared to nonheavy drinkers, participants who increased HED more often experienced a history of childhood sexual abuse (CSA). Over the study period, depressive symptomatology increased significantly among very frequent heavy drinkers., Conclusions: Socioeconomic factors, substance use, depression, and CSA were associated with heavier drinking patterns among MSM. Multicomponent interventions to reduce HED should seek to mitigate the adverse impacts of low educational attainment, depression, and early traumatic life events on the initiation, continuation, or escalation of frequent HED among MSM., (Copyright © 2015 by the Research Society on Alcoholism.)

There is little information on the private lives of women engaged in sex work, particularly how power dynamics within intimate relationships may affect intimate partner violence (IPV). Using baseline data of sex workers enrolled in a longitudinal cohort, "An Evaluation of Sex Workers' Health Access" (AESHA), the present study examined the association between sexual relationship power and IPV among sex workers in non-commercial partnerships in Vancouver, Canada. Pulweritz's Sexual Relationship Power Scale (SRPS) and The World Health Organization (WHO) Intimate Partner Violence against Women Scale (Version9.9) were used. Bivariable and multivariable logistic regression techniques were used to investigate the potential confounding effect of sexual relationship power on IPV among sex workers. Adjusted odds ratios (AOR) and 95% confidence intervals (CIs) were reported. Of 510 sex workers, 257 (50.4%) reported having an non-commercial intimate partner and were included in this analysis. In the past 6 months, 84 (32.7%) sex workers reported IPV (physical, sexual or emotional). The median age was 32 years, 39.3% were of Aboriginal ancestry, and 27.6% were migrants. After controlling for known confounders (e.g., age, Aboriginal ancestry, migrant status, childhood trauma, non-injection drug use), low relationship power was independently associated with 4.19 increased odds (95% CI: 1.93-9.10) and medium relationship power was associated 1.95 increased odds (95% CI: 0.89-4.25) of IPV. This analysis highlights how reduced control over sexual-decision making is plays a critical role in IPV among sex workers, and calls for innovation and inclusive programming tailored to sex workers and their non-commercial intimate partnerships.

Although barriers related to lesbian, gay, bisexual, transgender and queer (LGBTQ) youth's experiences accessing sexual health services have been examined in detail, research into the experiences and perceptions of clinicians providing these services has been conspicuously absent. The aim of this article is to explore the perceptions and experiences of clinicians providing sexual health services for LGBTQ youth. Drawing on in-depth, semi-structured interviews, this study examines 24 clinicians' experiences providing sexual health services to LGBTQ youth in five communities in British Columbia, Canada. Our findings reveal how many clinicians provide services to LGBTQ youth with a lack of cultural competency-either implicitly (e.g., by describing heteronormative practices) or explicitly (e.g., by expressing frustration that they had not been sufficiently provided with appropriate training related to LGBTQ youth sexual health). Institutional norms and values were identified as the dominant barriers in the effective provision of LGBTQ-tailored services. Many clinicians find themselves unprepared to provide culturally competent sexual health services that have both the capacity to address individual-level issues (e.g. promoting condom use) while considering (and adapting services to) the broader socio-cultural and structural conditions that can render LGBTQ youth socially vulnerable., (© The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Heteronormative assumptions can negatively influence the lives of young gay and bisexual men, and recent sociological analyses have identified the negative impacts of heteronormativity on heterosexual men (e.g. 'fag discourse' targeted at heterosexual adolescents). However, insights into how heteronormative discourses may be (re)produced in clinical settings and how they contribute to health outcomes for gay, bisexual and heterosexual men are poorly understood. This analysis draws on in-depth interviews with 45 men (15-25 years old) and 25 clinicians in British Columbia, Canada, to examine how heteronormative discourses affect sexually transmitted infection testing. The sexually transmitted infection/HIV testing experience emerged as a unique situation, whereby men's (hetero)sexuality was explicitly 'interrogated'. Risk assessments discursively linked sexual identity to risk in ways that reinforced gay men as the risky 'other' and heterosexual men as the (hetero)normal and, therefore, relatively low-risk patient. This, in turn, alleviated concern for sexually transmitted infection/HIV exposure in heterosexual men by virtue of their sexual identity (rather than their sexual practices), which muted discussions around their sexual health. The clinicians also positioned sexual identities and practices as important 'clues' for determining their patients' social contexts and supports while concurrently informing particular tailored clinical communication strategies. These findings highlight how men's experiences with sexually transmitted infection/HIV testing can (re)produce heteronormative assumptions and expectations or create opportunities for more equitable gendered relations and discourses.

We used a secondary, qualitative analysis of stakeholder perceptions of work stress in Australia to characterize the context for policy and practice intervention. Themes included: Individual versus contextual descriptions of stress; perceived 'gender' differences in manifesting and reporting of stress; the work/home interface; and perceived sectoral and occupational differences in compensation claim rates. We found that people often still perceive stress as an individual rather than organizational problem and view work stress as a stereotypically feminine weakness that affects only certain people. Organizations downplay and overlook risks, increasing worker reluctance to report stressors, creating barriers to job stress interventions. Our study may be relevant to other industrial countries where researchers currently study job stress interventions to improve their effectiveness. Comprehensive approaches can increase knowledge and decrease stigma about job stress and mental illness, and target both work- and non-work-related influences on mental health.

Background: The prevalence and correlates of mood disorders among people who self-identify as lesbian, gay or bisexual (LGB) are not well understood. Therefore, the current analysis was undertaken to estimate the prevalence and correlates of self-reported mood disorders among a nationally representative sample of Canadian adults (ages 18 to 59 years). Stratified analyses by age and sex were also performed., Methods: Using data from the 2007-2008 Canadian Community Health Survey, logistic regression techniques were used to determine whether sexual orientation was associated with self-reported mood disorders., Results: Among respondents who identified as LGB, 17.1% self-reported having a current mood disorder while 6.9% of heterosexuals reported having a current mood disorder. After adjusting for potential confounders, LGB-respondents remained more likely to report mood disorder as compared to heterosexual respondents (AOR: 2.93; 95% CI: 2.55-3.37). Gay and bisexual males were at elevated odds of reporting mood disorders (3.48; 95% CI: 2.81-4.31), compared to heterosexual males. Young LGB respondents (ages 18-29) had higher odds (3.75; 95% CI: 2.96-4.74), compared to same-age heterosexuals., Conclusions: These results demonstrate elevated prevalence of mood disorders among LGB survey respondents compared to heterosexual respondents. Interventions and programming are needed to promote the mental health and well being of people who identify as LGB, especially those who belong to particular subgroups (e.g., men who are gay or bisexual; young people who are LGB).

Sexual health and sexually transmitted infection (STI) testing is typically portrayed as a women's issue amid men's estrangement from healthcare services. While the underreporting of men's STIs has been linked to masculinities, little is known about how women interpret and respond to heterosexual men's sexual health practices. The findings drawn from this qualitative study of 34 young women reveal how femininities can be complicit in sustaining, as well as being critical of and disrupting masculine discourses that affirm sexual pleasure and resistance to health help-seeking as men's patriarchal privileges. Our analysis revealed three patterns: looking after the man's libido refers to women's emphasised femininity whereby the man's preference for unprotected sex and reticence to be tested for STIs was accommodated. Negotiating the stronger sex refers to ambivalent femininities, in which participants strategically resist, cooperate and comply with men's sexual health practices. Rejecting the patriarchal double standard that celebrates men as 'studs' and subordinates women as 'sluts' for embodying similar sexual practices reflects protest femininities. Overall, the findings reveal that conventional heterosexual gender relations, in which hegemonic masculinity is accommodated by women who align to emphasised femininity, continues to direct many participants' expectations around men's sexual health and STI testing., (© 2012 The Authors. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.)

Sexually transmitted infection testing rates among young men remain low, and their disengagement from sexual health services has been linked to enactments of masculinity that prohibit or truncate discussions of sexual health. Understanding how men align with multiple masculinities is therefore important for tailoring interventions that appropriately respond to their needs. We draw on 32 in-depth interviews with 15-24-year-old men to explore the discourses that facilitate or shut down sexual health communication with peers and sex partners. We employ a critical discourse analysis to explore how men's conversations about sexual health are constituted by masculine hierarchies (such as the ways in which masculinities influence men's ability to construct or challenge and contest dominant discourses about sexual health). Men's conversations about sexual health focused primarily around their sexual encounters - something frequently referred to as 'guy talk'. Also described were situations whereby participants employed a discourse of 'manning up' to (i) exert power over others with disregard for potential repercussions and (ii) deploy power to affirm and reify their own hyper-masculine identities, while using their personal (masculine) power to help others (who are subordinate in the social ordering of men). By better understanding how masculine discourses are employed by men, their sexual health needs can be advanced., (© 2012 The Authors. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.)

Web-based sexual-health promotion efforts often utilise reverse discourse - the acknowledgement and rejection of shame associated with stigmatised terms - both to challenge judgments about 'risky' behaviours (e.g., casual sex) and to appeal to young people. This study examines the use of reverse discourse in Internet-based sexual-health promotion and analyses young people's perspectives on this approach. During in-depth interviews and focus groups with young people (aged 15-24), participants shared their perspectives on written (e.g., clinical language; colloquial language) and visual (e.g., generic, stock images; sexualised images) depictions of sexual-health topics on the websites. More explicit styles elicited negative responses from young people in terms of perceived appeal, trust and quality of websites. Negative social mores were associated with some of the more explicit portrayals of young people's sexual lives on the websites, revealing how reverse discourse re-stigmatises young people by re-emphasising young people's sexual activity as inherently risky or immoral. Reverse discourse was perceived to have negative effects on the saliency and credibility of online sexual-health information. We discuss the theoretical basis for the operationalisation of reverse discourse in this context, and discuss the importance of considering sociotechnical aspects of Internet-based sexual-health interventions.

Debates over how to determine age of consent for youth to participate in research feature prominently in the practice of researchers, research ethics boards (REBs), and community decision makers working with youth. In particular, tensions can arise over how the ethical principles of beneficence, autonomy, and justice are interpreted and applied in research involving young people. We discuss our experiences obtaining ethical approval to conduct a participatory action research project involving youth and the differences of opinion we encountered regarding underage youth's capability to make informed consent. We suggest that researchers, REBs, and community decision makers all share a responsibility to conduct proactive outreach to youth participants, so that they are adequately informed of their rights related to research.

Objectives: Methamphetamine (MA) use has been associated with health problems that commonly present in the emergency department (ED). This study sought to determine whether frequent MA injection was a risk factor for ED utilization among street-involved youth., Study Design: Prospective cohort study., Methods: Data were derived from a street-involved youth cohort known as the 'At Risk Youth Study'. Behavioural data including MA use were linked to ED records at a major inner-city hospital. Kaplan-Meier and Cox proportional hazards methods were used to determine the risk factors for ED utilization., Results: Between September 2005 and January 2007, 427 eligible participants were enrolled, among whom the median age was 21 (interquartile range 19-23) years and 154 (36.1%) were female. Within 1 year, 163 (38.2%) visited the ED, resulting in an incidence density of 53.7 per 100 person-years. ED utilization was significantly higher among frequent (i.e. ≥daily) MA injectors (log-rank P = 0.004). In multivariate analysis, frequent MA injection was associated with an increased hazard of ED utilization (adjusted hazard ratio = 1.84, 95% confidence interval 1.04-3.25; P = 0.036)., Conclusions: Street-involved youth who frequently inject MA appear to be at increased risk of ED utilization. The integration of MA-specific addiction treatment services within emergency care settings for high-risk youth is recommended., (Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Injection drug users (IDU) who use methamphetamine (MA) are at an increased risk of HIV infection due to engagement in injection-related risk behavior including syringe sharing. In this cohort study of young IDU aged 18-30, we investigated the relationship between injection MA use and syringe sharing, and whether difficulty accessing sterile syringes mediated this association. Behavioral questionnaires were completed by 384 IDU in Vancouver, Canada between October 2005 and May 2008. Generalized estimating equations were used to estimate direct and indirect effects. The median age of participants was 24 (IQR: 22-27) and 214 (55.7%) were male. Injecting MA was independently associated with syringe sharing. Mediation analyses revealed that difficulty accessing sterile syringes partially mediated the association between injecting MA and syringe sharing. Interventions to reduce syringe sharing among young methamphetamine injectors must address social and structural barriers to accessing HIV prevention programs.

Background: High rates of HIV infection among women of reproductive age have dramatic consequences for personal and public health. Prophylaxis during sexual intercourse in the form of condoms has been the most effective way to prevent both STI and HIV transmission among people living with HIV., Objectives: To investigate the effectiveness of behavioral interventions in promoting condom use among women living with HIV., Search Strategy: We conducted a comprehensive literature search in several scientific databases, clinical trials databases, conference proceedings, and conference websites to identify studies produced between 1980 and May 2010 that met our selection criteria., Selection Criteria: Studies were included in the analysis if they conducted a randomized controlled trial that examined the effects of behavioral interventions on condom use among HIV-positive women; considered at least one HIV-related behavioral outcome (e.g., reported protected anal, vaginal, or oral sex) or biological outcome (e.g., acquisition of STIs); and one follow-up assessment three months or more after the intervention. Studies were assessed irregardless of langauge or publication status., Data Collection and Analysis: We used random effects models to summarize odds ratios (ORs) that compared intervention and control groups with respect to a dichotomous outcome (consistent versus inconsistent condom use). We used funnel plots to examine publication bias and a χ(2) statistic to test for heterogeneity. The methodological and evidence quality was evaluated through risk of bias criteria and the GRADE system, respectively., Main Results: Five primary studies that collectively researched a total of 725 women living with HIV were analysed. When compared to standard care or minimal HIV support intervention, meta-analysis showed that behavioral interventions had no effect on increasing condom use among HIV-positive women. This finding was consistent at various follow-up meetings (3, 6, and 12-months) as well as over the entire 12-month follow-up period (OR= 0.82; 95% CI 0.65-1.04; p=0.11). Only one study presented adequate data to analyze the relationship between behavioral interventions and STI incidence. Studies included in this analysis demonstrated low risk of bias based on the risk of bias criteria. However, sample size was considered inadequate across all studies., Authors' Conclusions: Meta-analysis shows that behavioral interventions have little effect on increasing condom use among HIV-positive women. However, these findings should be used with caution since results were based on a few small trials that were targeted specifically towards HIV-positive women. To decrease sexual transmission of HIV among this population, we recommend interventions that combine condom promotion, family planning provision and counselling, and efforts to reduce viral loads among HIV-positive women and their partners (e.g., HAART treatment provision). New research is needed to address the needs of HIV-positive women, including an assessment of the impact of interventions that combine safer sexual behavior and harm reduction approaches.

The purpose of this study was to determine the incidence and predictors of initiating methamphetamine injection among a cohort of injection drug users (IDU). We conducted a longitudinal analysis of IDU participating in a prospective study between June 2001 and May 2008 in Vancouver, Canada. IDU who had never reported injecting methamphetamine at the study's commencement were eligible. We used Cox proportional hazards models to identify the predictors of initiating methamphetamine injection. The outcome was time to first report of methamphetamine injection. Time-updated independent variables of interest included sociodemographic characteristics, drug use patterns, and social, economic and environmental factors. Of 1317 eligible individuals, the median age was 39.9 and 522 (39.6%) were female. At the study's conclusion, 200 (15.2%) participants had initiated injecting methamphetamine (incidence density: 4.3 per 100 person-years). In multivariate analysis, age (adjusted hazard ratio [aHR]: 0.96 per year older, 95%CI: 0.95-0.98), female sex (aHR: 0.58, 95%CI: 0.41-0.82), sexual abuse (aHR: 1.63, 95%CI: 1.18-2.23), using drugs in Vancouver's drug scene epicentre (aHR: 2.15 95%CI: 1.49-3.10), homelessness (aHR: 1.43, 95%CI: 1.01-2.04), non-injection crack cocaine use (aHR: 2.06, 95%CI: 1.36-3.14), and non-injection methamphetamine use (aHR: 3.69, 95%CI: 2.03-6.70) were associated with initiating methamphetamine injection. We observed a high incidence of methamphetamine initiation, particularly among young IDU, stimulant users, homeless individuals, and those involved in the city's open drug scene. These data should be useful for the development of a broad set of interventions aimed at reducing initiation into methamphetamine injection among IDU.

Actions in Canada are being designed to transform the way research evidence is generated and used to improve population health. Capacity is being built in population health intervention research. The primary target is more understanding and examination of policies and programs that could redress inequities in health. The Population Health Intervention Research Initiative for Canada is a loosely-networked collaboration designed to advance the science of the field as well as the quantity, quality and use of population health intervention research to improve the health of Canadians. In the first few years there have been new training investments, new funding programs, new working guidelines for peer review, symposia and new international collaborations. This has been brought about by the strategic alignment of communication, planning and existing investments and the leveraging of new resources.

Background: Methamphetamine (MA) use continues to be a major public health concern in many urban settings. We sought to assess potential relationships between MA use and individual, social, and structural HIV vulnerabilities among sexual minority (lesbian, gay, bisexual or transgendered) drug users., Methods: Beginning in 2005 and ending in 2008, 2109 drug users were enrolled into one of three cohort studies in Vancouver, Canada. We analysed longitudinal data from all self-identified sexual minority participants (n = 248). Logistic regression using generalized estimating equations (GEE) was used to examine the independent correlates of MA use over time. All analyses were stratified by biological sex at birth., Results: At baseline, 104 (7.5%) males and 144 (20.4%) females reported sexual minority status, among whom 64 (62.1%) and 58 (40.3%) reported MA use in the past six months, respectively. Compared to heterosexual participants, sexual minority males (odds ratio [OR] = 3.74, p < 0.001) and females (OR = 1.80, p = 0.003) were more likely to report recent MA use. In multivariate analysis, MA use among sexual minority males was associated with younger age (adjusted odds ratio [AOR] = 0.93 per year older, p = 0.011), Aboriginal ancestry (AOR = 2.59, p = 0.019), injection drug use (AOR = 3.98, p < 0.001), having a legal order or area restriction (i.e., "no-go zone") impact access to services or influence where drugs are used or purchased (AOR = 4.18, p = 0.008), unprotected intercourse (AOR = 1.62, p = 0.048), and increased depressive symptoms (AOR = 1.67, p = 0.044). Among females, MA use was associated with injection drug use (AOR = 2.49, p = 0.002), Downtown South residency (i.e., an area known for drug use) (AOR = 1.60, p = 0.047), and unprotected intercourse with sex trade clients (AOR = 2.62, p = 0.027)., Conclusions: Methamphetamine use was more prevalent among sexual minority males and females and was associated with different sets of HIV risks and vulnerabilities. Our findings suggest that interventions addressing MA-related harms may need to be informed by more nuanced understandings of the intersection between drug use patterns, social and structural HIV vulnerabilities, and gender/sexual identities. In particular, MA-focused prevention and treatment programs tailored to disenfranchised male and female sexual minority youth are recommended.

Background: The relationship between an adolescent's micro-environment (e.g. the home) and the likelihood of engagement in sexual risk behaviour is poorly understood. Therefore, we sought to examine the household-level correlates of condom use at last intercourse among a nationally representative sample of Canadian adolescents aged 15 to 19., Methods: Using data from the 2005 Canadian Community Health Survey, we conducted logistic regression analyses to determine whether factors related to characteristics of the household environment were associated with self-reported condom use at last intercourse., Results: Among 3974 sexually active adolescents, condom use at last intercourse was reported by 74.8%. After adjusting for household education and income, participants who reported living in larger dwellings were less likely to report condom non-use, while those reporting greater numbers of persons in the household were more likely to report condom non-use. Other significant correlates of condom non-use included older age, female sex, alternative birth control methods and having a weak sense of community belonging., Conclusion: Our results demonstrate that factors related to the household environment are independently associated with condom use among adolescents. Policies and programs that aim to promote condom use should seek to address issues such as privacy, which may limit adolescents' ability to engage in safer sexual practices.

The role that environmental factors play in driving HIV and STI transmission risk among street-involved youth has not been well examined. We examined factors associated with number of sex partners using quasi-Poisson regression and consistent condom use using logistic regression among participants enroled in the At Risk Youth Study (ARYS). Among 529 participants, 253 (47.8%) reported multiple partners while only 127 (24.0%) reported consistent condom use in the past 6 months. Homelessness was inversely associated with consistent condom use (adjusted odds ratio [aOR]=0.47, p=0.008), while unstable housing was positively associated with greater numbers of sex partners (adjusted incidence rate ratio [aIRR]=1.44, p=0.010). These findings indicate the need for interventions which modify environmental factors that drive risk among young street-involved populations.

Background: The prevalence of HIV and sexually transmitted infections (STIs) among street-involved youth greatly exceed that of the general adolescent population; however, little is known regarding the structural factors that influence disease transmission risk among this population., Methods: Between September 2005 and October 2006, 529 street-involved youth were enroled in a prospective cohort known as the At Risk Youth Study (ARYS). We examined structural factors associated with number of sex partners using quasi-Poisson regression and consistent condom use using logistic regression., Results: At baseline, 415 (78.4%) were sexually active, of whom 253 (61.0%) reported multiple sex partners and 288 (69.4%) reported inconsistent condom use in the past six months. In multivariate analysis, self-reported barriers to health services were inversely associated with consistent condom use (adjusted odds ratio [aOR] = 0.52, 95%CI: 0.25 - 1.07). Structural factors that were associated with greater numbers of sex partners included homelessness (adjusted incidence rate ratio [aIRR] = 1.54, 95%CI: 1.11 - 2.14) and having an area restriction that affects access to services (aIRR = 2.32, 95%CI: 1.28 - 4.18). Being searched or detained by the police was significant for males (aIRR = 1.36, 95%CI: 1.02 - 1.81)., Conclusion: Although limited by its cross-sectional design, our study found several structural factors amenable to policy-level interventions independently associated with sexual risk behaviours. These findings imply that the criminalization and displacement of street-involved youth may increase the likelihood that youth will engage in sexual risk behaviours and exacerbate the negative impact of resultant health outcomes. Moreover, our findings indicate that environmental-structural interventions may help to reduce the burden of these diseases among street youth in urban settings.

Background: Northeastern British Columbia is undergoing rapid in-migration of young, primarily male workers in response to the "boom" in the oil/gas industries. Accompanying the boom is a rise in Chlamydia rates among youth, which exceed the provincial average by 22%. STI testing reduces the disease burden, contributing to STI prevention., Objectives: 1) To document youths' perceptions regarding the socio-cultural and structural forces that affect young oil/gas workers' access to STI testing; 2) to gather service providers' perspectives on sexual health service delivery for workers; and 3) to develop recommendations to improve the accessibility of STI testing., Methods: We conducted ethnographic fieldwork (8 weeks) in a remote oil/gas community, including in-depth interviews with 25 young people (ages 15-25) and 14 health and social service providers., Results: Participants identified limited opportunities to access testing, geographic isolation, and 'rigger' culture as three key categories inhibiting STI testing among oil/gas Workers., Discussion: These results suggest the need for place-based approaches to STI control. Innovative outreach strategies are suggested to address oil/gas workers' needs, including a locally tailored STI awareness campaign, condom distribution, expanded clinic hours, and onsite STI testing.

Objectives: Vancouver's DTES represents a high-risk neighbourhood, in which there exist a number of community clinics and outreach programs. The purpose of this study was twofold: 1) to describe the population of women attending a weekly women's program with respect to demographics, risk behaviours and prevalence of STI, and 2) to assess the uptake of STI screening in this setting., Methods: A cross-sectional survey was undertaken during a weekly community clinic-based women's program from October to December, 2004. Women were recruited at the start of the program each week and were invited to provide urine samples for chlamydia and gonorrhea screening., Results: Among 126 respondents, the median age was 42 (36-49), more than half (52%) self-identified as White and 40% as Aboriginal ethnicity. Forty percent were currently involved in the sex trade. Two thirds reported a Pap smear in the past year, while 14% had not accessed sexual health care (Pap smear, STI or HIV testing). Among the 92/126 (74%) women providing a urine sample, the prevalence of chlamydia and gonorrhea was 2.2% and 0.0%, respectively., Conclusion: The majority of women accessing this program were over 35 years of age, and while nearly half were currently involved in the sex trade, cross-sectional screening did not reveal a substantial prevalence of STIs. Women who were not regular program attendees reported less sexual health care, and represented the only two cases of chlamydia found. Innovative programs that better serve the needs of populations that remain unable or unwilling to seek sexual health care in its current formats are needed.

The purpose of this study was to refine the Dimensions of Tobacco Dependence Scale (DTDS) - a measure of tobacco dependence for adolescents - by removing poorly discriminating items, testing the measurement structure of the remaining items and examining the predictive utility of the resulting scale in terms of its ability to explain the average number of cigarettes smoked per day (CPD). A total of 1425 current smokers (mean age 16 years) completed the questionnaire. Confirmatory factor analyses of the DTDS items supported a 4-factor model composed of social, emotional, nicotine and sensory related dimensions of tobacco dependence. Predictive utility and incremental validity of the DTDS was evident in the many sizable correlations between the DTDS and CPD as well as measures of self-rated addiction after controlling for scores on several other commonly used measures of nicotine dependence. The results indicate that the DTDS is a reliable and valid measure of tobacco dependence for adolescents that has the potential to enhance our understanding of the complex processes driving the emergence of tobacco dependence and cigarette smoking.

Cutaneous malignant melanoma is a significant public health problem in Western countries, and the probability that patients with one melanoma will develop a second one is high. This study is an attempt to assess and understand sun-related behavior in patients subsequent to a melanoma diagnosis. We recruited 35 melanoma patients diagnosed in 2001 or 2002, who resided in the Greater Vancouver Regional District of British Columbia, Canada, and 35 controls frequency matched by broad age-group, sex, ethnicity, and area of residence to patients. All participants were interviewed over the telephone in the autumn of 2003 to ascertain their outdoor activities for the previous summer months (June-August) of 2003, along with their clothing preferences, sunscreen use, sunburn frequency, and knowledge and attitudes regarding sun exposure and tanning. Patients were less involved in outdoor recreational activities than controls (mean monthly hours 23.0 vs. 31.0, P=0.023). In addition, patients protected themselves from sun exposure using clothing and sunscreen more often than controls. However, the data also revealed that patients still engaged in outdoor activities to a substantial degree, often without sun protection. Furthermore, 27% still had a positive or neutral attitude toward tanning, even after melanoma diagnosis. The continuing presence of unprotected episodes of summer sun exposure in patients with melanoma, coupled with sunburn prevalence similar to normal controls, suggests that better education and behavior modification programs are needed for patients with melanoma. The results may indicate the need for more emphasis on post-treatment counseling by physicians.

This study examined sun protection in families with adolescents from an action-theoretical perspective. Interview data were collected from 20 families about their attitudes and behaviors around sunbathing and sun protection. The data support the understanding of project as joint goal-directed action over time as the basis on which these behaviors are organized in families. Families used the language of goal-directed action to discuss family sun protection. Differences between families with focused and diffuse sun-protection projects are identified. Sun protection in families as one part of an array of family goal-directed actions and projects has implications for health promotion.

Background: In several studies, delays in malignant melanoma (MM) diagnosis have been correlated with increased tumor thickness, increased morbidity, and increased mortality., Objective: We sought to assess how MM is detected in British Columbia, Canada, and to understand the role of patient education and other factors on diagnostic delays., Methods: A self-administered questionnaire was distributed to 176 consecutive patients with histologically confirmed MM., Results: The total median delay was 4 months. There was no correlation between tumor thickness and delay times. Lesions found incidentally by physicians were less invasive (median Breslow thickness 0.59 vs 1.0 mm, P=.006) than those found by patients. The majority of patients had some knowledge of MM and recognized the importance of early detection. Nearly one fourth of respondents were unaware MM could develop from a melanocytic nevus. In general, MM knowledge did not affect total delay., Conclusion: Patients in British Columbia, Canada, report relatively short delays in diagnosis of MM. Delays were not correlated with increased tumor thickness or with patient knowledge regarding melanoma before diagnosis.

Emerging evidence indicates that the mechanisms that create health (or ill health) at the population level exist at the intersection between the individual and more "upstream" forces that shape our social contexts. To investigate this proposition, we collected detailed descriptions of youth's perceptions about the socio-cultural and other structural aspects of their contexts that shape their sexual behaviour patterns, and ultimately their health outcomes. In this paper, we examine how social context shaped experiences and perceptions pertaining to sexual behaviour among 18-24 year olds living in two Canadian communities (one rural and one urban). We investigate explanations for the struggle that youth engage in as they attempt to situate their emergent sexual behaviour patterns within community, family, peer, and broader social contexts. Two central processes appeared to be important to the experiences of youth in the current study and their recollections about their adolescent sexual experiences. These processes are embedded in social norms and structures and are directed at pathologizing sex and silencing meaningful discussion about sex. Together, they interact to create a climate of sex-based shame. The findings of this qualitative study add to previous sociological and feminist research that has also demonstrated how traditional approaches to understanding youth sexual behaviour tend to ignore or discount the "embeddedness" of young people in their social structures and contexts., (Copyright 2003 Elsevier Ltd.)

Objectives: This paper describes the sun-related behaviour of parents and their children, ages 5-12 years., Methods: In-person interviews were conducted with parents and observations of parents and their children to ascertain: 1) parents' self-reported use of sunscreen, 2) parent-proxy reports of children's sunscreen use, and 3) observations of parents' and children's use of shade, hats and protective clothing. Data collection took place at freshwater beaches in BC's Southern Interior, between 12 pm and 5 pm, over a seven-day period during August 1999., Results: 94 parents were interviewed and observed. Parent-proxy reports and observational data were collected on 161 children. Half (53%) of parents reported they were wearing sunscreen at the time of the on-beach interview. Most (65%) of parents reported that their children were wearing sunscreen at the time of the on-beach interview. Children's first application of sunscreen took place on average 1.5 hours prior to interview. Most parents (86%) reported that their children's sunscreen had not been reapplied at the time of interview. Few parents (13%) or children (5%) used shade as provided by nearby trees or umbrellas., Conclusion: Public education should emphasize sunscreen re-application. Actions should be taken to enhance the convenient use of shade structures at public beaches.

This study uses structural equation modeling to examine hypothesized relationships between sunburn and physical characteristics and potentially modifiable behavior. The analysis was based on self-reported data collected from a randomly selected national sample of Canadian adults. An initial model was tested with 50% of the cases (n = 1,408); the remaining cases (n = 1,298) were reserved for confirmatory testing. After the initial model failed, theoretically plausible effects were added incrementally to improve overall model fit. The initial model yielded: chi2(68 d.f.) = 3199.41 (P < .001) and the AGFI = .56. With 32 added effects, a fit model resulted in: chi2(36 d.f.) = 394.35 (P < .001), AGFI = 0.87, and IFI = 0.91 (the Critical-N was 210). Model fit was confirmed. Suntanning, failure to wear protective clothing, and sun exposure were associated with the frequency of severity-adjusted sunburns. Sunscreen use was not associated with sunburn frequency-severity.

Sunburn is a major preventable risk associated with the development of malignant melanoma and basal cell carcinoma. Thus, it is considered a key epidemiological concept to assess in prevention research and a core component of routine behavioural surveillance and program evaluation efforts. This review examined 38 English- language survey instruments and research reports published between 1990 and 1999 that used self-report data or parent-proxy reports of sunburn outcome. A qualitative review of the instruments and reports identified several methodological issues: the conceptual and operation definitions of sunburn; the recall period, and the use of self-reports and parent-proxy reports. As there was little consistency in definitional issues or recall periods across the studies, it is difficult to meaningfully compare their findings. Key issues that program evaluators and researchers should consider in determining the strengths and limitations of various definitions, measures and approaches are examined. Recommendations for measurement of sunburn and for further research are included.