" full of opportunities, but not for everyone": A narrative inquiry into mechanisms of labor market inequity among precariously employed gay, bisexual, and queer men.

BACKGROUND: This study brings lesbian, gay, bisexual, transgender (trans), and queer (LGBTQ+) populations into scholarly discourse related to precarious employment through a political economy of queer struggle. METHODS: Drawing on narrative inquiry, 20 gay, bisexual, and queer men shared stories of precarious employment that were analyzed using Polkinghorne's narrative analysis. RESULTS: Results tell an overarching narrative in three parts that follow the trajectory of participants' early life experiences, entering the labor market and being precariously employed. Part 1: Devaluation of LGBTQ+ identities and adverse life experiences impacted participants' abilities to plan their careers and complete postsecondary education. Part 2: Participants experienced restricted opportunities due to safety concerns and learned to navigate white, cis, straight, Canadian ideals that are valued in the labor market. Part 3: Participants were without protections to respond to hostile treatment for fear of losing their employment. CONCLUSIONS: These stories of precarious employment illustrate unique ways that LGBTQ+ people might be particularly susceptible to exploitative labor markets.

Medical Students' Perspectives on Family Planning and Impact on Specialty Choice.

Importance: Physicians are known to delay childbearing compared with nonphysicians and to experience higher rates of age-related pregnancy complications. Delay of childbearing is more pronounced in surgical specialties, and family planning and building goals may influence specialty choice. Objective: To assess medical students' perspectives on the development of family planning goals and the timing of family building within a medical career to elucidate how these perceptions impact their choice of specialty. Design, Setting, and Participants: This qualitative study included fourth-year medical students at the University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada, and was conducted between May and August 2021. Participants were purposively sampled to maximize diversity of gender and specialty choice. Interviews were conducted via videoconferencing software that were recorded, transcribed verbatim, and verified for accuracy. Thematic analysis was completed independently by 2 researchers and consensus on final themes was reached through discussion among study investigators. Data were analyzed between September and December 2021. Main Outcomes and Measures: Participants were asked to share their perceptions of personal family planning goals, support currently in place, family planning education in medicine and factors contributing to their choice of specialty and program. Thematic analysis was completed. Results: A total of 34 fourth-year medical students (median [range] age, 26 [24-33] years; 23 females [67.6%]) were interviewed. Four main themes were identified: (1) there is no ideal time to family build in a medical career, (2) family planning is a taboo topic, (3) surgical specialties offer less support for family building, and (4) residents who have children are perceived to place a burden on their colleagues. Medical students considered their family planning while deliberating among specialty choices and their experiences were highly influential in shaping their specialty selection. Conclusions and Relevance: Results of this qualitative study suggest that medical students perceive that family building during training may have unfavorable implications for team dynamics and relationships with colleagues, and these perceptions may affect specialty choice and family planning goals. Integration of family planning discussions and support for family building into medical curricula is needed along with efforts to improve culture by supporting team dynamics and workload when students take parental leave.

Community and Health Care Provider Preferences for Bacterial Sexually Transmitted Infection Testing Interventions for Gay, Bisexual, and Other Men Who Have Sex With Men: e-Delphi Study.

BACKGROUND: Canadian clinical guidelines recommend at least annual and up to quarterly bacterial sexually transmitted infection (STI) testing among sexually active gay, bisexual, and other men who have sex with men (GBM). However, testing rates are suboptimal. Innovative solutions are needed to close the gap because there is currently limited knowledge on how best to approach this issue. OBJECTIVE: Our aim was to build consensus regarding interventions with the greatest potential for improving local STI testing services for GBM communities in Toronto, Ontario, Canada, using a web-based e-Delphi process. METHODS: The e-Delphi method involves using a panel format to conduct successive rounds of prioritization, with feedback between rounds, to determine priorities among groups. We recruited experts separately from the community (GBM who sought or underwent STI testing in the preceding 18 months; conducted between October 2019 and November 2019) and health care providers (those who offered STI testing to GBM in the past 12 months; conducted between February 2020 and May 2020). The experts prioritized 6 to 8 potential interventions on a 7-point Likert scale ranging from definitely not a priority to definitely a priority over 3 survey rounds and ranked their top 3 interventions. Consensus was defined as ≥60% within a ±1 response point. Summaries of responses were provided in successive rounds. We reported the percentage of a priority (encompassing somewhat a priority, a priority, and definitely a priority responses) at the end of the final round of the survey. RESULTS: Of the community experts (CEs), 84% (43/51) completed all rounds; 19% (8/43) were living with HIV; 37% (16/43) were HIV negative and on pre-exposure prophylaxis; and 42% (18/43) were HIV negative and not on pre-exposure prophylaxis. We reached consensus on 6 interventions: client reminders (41/43, 95%), express testing (38/43, 88%), routine testing (36/43, 84%), an online booking app (36/43, 84%), online-based testing (33/43, 77%), and nurse-led testing (31/43, 72%). The CEs favored convenient interventions that also maintain a relationship with their provider. Of the provider experts (PEs), 77% (37/48) completed all rounds; 59% (22/37) were physicians. Consensus was reached on the same 6 interventions (range 25/37, 68%, to 39/39, 100%) but not for provider alerts (7/37, 19%) and provider audit and feedback (6/37, 16%). Express testing, online-based testing, and nurse-led testing were prioritized by >95% (>37/39) of the PEs by the end of round 2 because of streamlined processes and decreased need to see a provider. CONCLUSIONS: Both panels were enthusiastic about innovations that make STI testing more efficient, with express testing rating highly in both the prioritizations and top 3 rankings. However, CEs preferred convenient interventions that involved their provider, whereas PEs favored interventions that prioritized patient independence and reduced patient-provider time. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13801.

Progression of a large syphilis outbreak in rural North Carolina through space and time: Application of a Bayesian Maximum Entropy graphical user interface.

In 2001, the primary and secondary syphilis incidence rate in rural Columbus County, North Carolina was the highest in the nation. To understand the development of syphilis outbreaks in rural areas, we developed and used the Bayesian Maximum Entropy Graphical User Interface (BMEGUI) to map syphilis incidence rates from 1999-2004 in seven adjacent counties in North Carolina. Using BMEGUI, incidence rate maps were constructed for two aggregation scales (ZIP code and census tract) with two approaches (Poisson and simple kriging). The BME maps revealed the outbreak was initially localized in Robeson County and possibly connected to more urban endemic cases in adjacent Cumberland County. The outbreak spread to rural Columbus County in a leapfrog pattern with the subsequent development of a visible low incidence spatial corridor linking Roberson County with the rural areas of Columbus County. Though the data are from the early 2000s, they remain pertinent, as the combination of spatial data with the extensive sexual network analyses, particularly in rural areas gives thorough insights which have not been replicated in the past two decades. These observations support an important role for the connection of micropolitan areas with neighboring rural areas in the spread of syphilis. Public health interventions focusing on urban and micropolitan areas may effectively limit syphilis indirectly in nearby rural areas.

Integrating coordination of food purchasing into activity space-based food environment research: Toward a household perspective.

Despite the advances in person-based approaches to studying food environments, most studies using these approaches have relied on individual-centered activity space measures and largely ignored cohabiting household members who play crucial roles in shaping an individual's food access, food behaviors, and diet. This can be problematic for completely capturing food environments relevant to an individual and add uncertainties to explorations of how individuals' food environments relate to their food behaviors. This viewpoint discusses the need for, and implications of, considering household members when measuring food access and disentangling the behavioral pathways connecting the food environment to diet. Ultimately, a conceptual framework and potential questions are proposed to integrate household members into food environment research.

Geosexual Archetype, Preventive Behaviors, and Sexually Transmitted Infections Among High-Risk Men Who Have Sex With Men.

BACKGROUND: Social geography plays an important role in transmission of sexually transmitted infections (STIs) among men who have sex with men. Previous qualitative work had identified 7 "geosexual archetypes," each with distinct travel patterns for sex and potentially important differences in STI rates. The objective of this article was to explore what could be learned about STI transmission by looking at STI prevention strategies (condom use and preexposure prophylaxis use) and prevalence of STIs among these geosexual archetypes. METHODS: We analyzed data from the Sex Now 2019 online survey in Canada. Men who have sex with men who reported 3 or more partners in the past 6 months were included in the analysis (n = 3649). RESULTS: The most common archetype was "geoflexible" (sex at home, partner's home, and other places; 35.6%), followed by "privates" (sex only at own/partner's home; 23.0%); the least common archetypes was "rover" (sex not at home or partner's place; 4.0%). There were significant variations in both STI prevention strategies and prevalence of bacterial STIs in the past year by geosexual archetype. In particular, among those who were HIV negative, those who reported a geoflexible archetype and used preexposure prophylaxis but did not use condoms consistently had a 52.6% prevalence of bacterial STIs, which was much higher compared with all other groups. Within other archetypes, those living with HIV had the highest prevalence of bacterial STIs. CONCLUSIONS: Geosexual archetype together with participant's STI prevention strategies was a strong predictor of bacterial STI risk. Understanding how place is connected to bacterial STIs is key in prevention as individuals do not live in isolation.

The impact of a stress management intervention including cultural components on stress biomarker levels and mental health indicators among indigenous women.

We examined the effectiveness of a 26-week culture-inclusive intervention on reducing salivary stress biomarker levels, and perceived stress, depressive, and post-traumatic stress disorder (PTSD) symptoms measured using scales in 53 Indigenous women in Ontario, Canada. Statistical analyses compared the average biomarker levels, and the area under the curve (AUC) of biomarkers. Differences in biomarkers and mental health scale scores pre- and post-intervention were compared using mixed models with a random intercept. Interaction terms were included between the intervention and age, education, disability, and HIV status, individually, to test for sub-group differences. Cortisol AUC post-intervention was decreased compared to pre-intervention (ß -1.29 µg/dL; 95%CI -2.35, -0.23). There was a slight decrease in perceived stress levels (aOR: -2.80; 95%CI -5.09, -0.50). The associations were stronger among women of younger age, higher education, and no disabilities. These interventions can be effective, but future interventions should target Indigenous population sub-groups to address individual needs.

Acceptability of bariatric surgery in people with endometrial cancer and atypical hyperplasia: A qualitative study.

OBJECTIVE: In young individuals with obesity, infertility, and endometrial cancer, significant, sustained weight loss through bariatric surgery may result in a durable oncologic and reproductive response. However, it is not known whether bariatric surgery is acceptable to this patient population. We performed a qualitative study to understand the acceptability of bariatric surgery in young individuals with obesity and endometrial cancer or atypical hyperplasia. STUDY DESIGN: All participants were of reproductive age with body mass index [BMI] ≥ 35 and grade 1 endometrial cancer or atypical hyperplasia. Semi-structured interviews were used to explore participant perception of their weight, fertility, and the possibility of bariatric surgery as part of the treatment strategy for their endometrial cancer/atypical hyperplasia. Thematic saturation was reached after 14 interviews. RESULTS: Fourteen participants with a median age of 34 years (range 27-38) and BMI of 42 (33-64) were interviewed. Participants were reluctant to accept bariatric surgery as a treatment option due to 1) lack of knowledge about the procedure, 2) stigma attached to bariatric surgery, and 3) fear of the risks associated with bariatric surgery. Their perception towards their weight, fertility, and cancer diagnosis was characterized by concepts of 'helplessness', 'isolation', 'frustration', and 'guilt'. We observed a significant gap in participant understanding of the complex interplay between their cancer, infertility, and obesity. CONCLUSIONS: More support and resources are required, with patient-oriented counseling focused on the implication of their weight on their cancer diagnosis and fertility, before presenting bariatric surgery as a treatment option.

Preventable mortality among sexual minority Canadians.

Background: Epidemiologic studies point to multiple health inequities among sexual minority people, but few studies have examined mortality. Some causes of death are more preventable than others, and access to prevention is theorized to follow patterns of access to social and material resources. The objective of this study is to compare estimates of preventable mortality between sexual minority (SM)-i.e., bisexual, lesbian, gay-and heterosexual adults in Canada. Methods: A population-based retrospective cohort with 442,260 (unweighted N) Canadian adults, ages 18-59 years, was drawn from the Canadian Community Health Survey/Canadian Mortality Database linked database (2003-2017). The Rutstein preventability rating index was used to classify cause-specific mortality (low/high). Longitudinal analyses were conducted using Cox proportional hazards models. Results: SM respondents had higher hazard of all-cause mortality (unadjusted hazard ratio [uHR] 1.28, 95% CI 1.06, 1.55). The uHR increased when the outcome was limited to highly-preventable causes of mortality (uHR 1.43, 95% CI 1.14, 1.80). The uHR further increased in sensitivity analyses using higher thresholds of the Rutstein index. SM respondents had higher hazard of cause-specific mortality for heart disease (uHR 1.53, 95% CI 1.03, 2.29), accidents (uHR 1.97, 95% CI 1.01, 3.86), HIV (uHR 75.69, 95% CI 18.77, 305.20), and suicide (uHR 2.22, 95% CI 0.93, 5.30) but not for cancer (uHR 0.86, 95% CI 0.60, 1.25). The adjusted HR (aHR) for highly-preventable mortality was not attenuated by adjustment for confounders (aHR 1.57, 95% CI 1.20, 2.05) but was reduced by adjustment for hypothesized mediators relating to access to social and material resources (marital status, children, income, education; aHR 1.11, 95% CI 0.78, 1.58). Conclusions: Preventable mortality was elevated for SM Canadians compared to heterosexuals. Early and broad access to sexual minority-affirming primary and preventive healthcare should be expanded.

Who's cooking tonight? A time-use study of coupled adults in Toronto, Canada.

Understanding how coupled adults arrange food-related labor in relation to their daily time allocation is of great importance because different arrangements may have implications for diet-related health and gender equity. Studies from the time-use perspective argue that daily activities such as work, caregiving, and non-food-related housework can potentially compete for time with foodwork. However, studies in this regard are mostly centered on individual-level analyses. They fail to consider cohabiting partners' time spent on foodwork and non-food-related activities, a factor that could be helpful in explaining how coupled partners decide to allocate time to food activities. Using 108 daily time-use logs from seventeen opposite-gender couples living in Toronto, Canada, this paper examines how male and female partners' time spent on non-food-related activities impact the total amount of time spent on foodwork by coupled adults and the difference in time spent on foodwork between coupled women and men. Results show that both male and female partners took a higher portion of foodwork when their partner worked longer. When men worked for additional time, the couple-level duration of foodwork decreased. Without a significant impact on the gender difference in foodwork duration, women's increased caregiving duration was associated with a reduction of total time spent on foodwork by couples. An increase in caregiving and non-food-related chores by men was associated with an increased difference in duration of foodwork between women and men, which helped secure a constant total amount of foodwork at the couple level. These behavioral variations between men and women demonstrate the gender differences in one's responsiveness to the change of partners' non-food-related tasks. The associations found among non-food-related activities and foodwork are suggestive of a need to account for partners' time allocation when studying the time-use dynamics of foodwork and other daily activities.

Perceived influence of alcohol consumption, substance use, and mental health on PrEP adherence and condom use among PrEP-prescribed gay, bisexual, and other men-who-have-sex-with-men: a qualitative investigation.

BACKGROUND: Gay, bisexual, and other men-who-have-sex-with-men (GBMSM) continue to be disproportionately affected by Human Immunodeficiency Virus (HIV). Although HIV pre-exposure prophylaxis (PrEP) offers an effective means of reducing incident HIV among this population, the HIV-preventive success of oral-based PrEP is contingent upon regimen adherence. Elevated rates of alcohol-, substance use-, and mental health-related issues among GBMSM potentially hinder PrEP-taking efforts, however the evidence for this remains mixed. Accordingly, the present study entailed a comprehensive qualitative investigation to explore PrEP-prescribed GBMSM's perceptions surrounding the influence of alcohol, substance use, and mental health on PrEP adherence. METHODS: PrEP-prescribed GBMSM (age ≥ 18 years; prescribed PrEP for ≥ 3 months) were recruited from two PrEP-delivery clinics in Toronto, Canada for focus groups as part of the formative phase of an alcohol-, substance use-, and mental health-focused randomized controlled intervention trial. Focus group discussions qualitatively explored perceived strengths and barriers associated with adherence to PrEP treatment; with an emphasis on alcohol, substance use, and mental health concerns. Condom use among PrEP-prescribed GBMSM within the context of these concerns was also discussed. RESULTS: A total of five focus groups involving 35 GBMSM were conducted (4-10/group; mean age = 42.4; white = 71.4%). Although participants themselves generally reported successfully adhering to their PrEP regimens-resulting from a strong, underlying motivation for self-care-they recognized the detrimental impact that alcohol, substance use, and mental health had on adherence among their peers. In this regard, alcohol and substances were perceived as detracting from adherence only when consumption was excessive or temporally linked to PrEP dosing. Pronounced mental health issues (e.g., severe depression) were also seen as hindering adherence, although these effects were nuanced and perceived as person-dependent. Alcohol and substances were linked to condomless sex, regardless of PrEP use, and PrEP was therefore viewed as an HIV-protective 'safety net.' CONCLUSIONS: Overall, findings suggest that PrEP adherence can often be successfully achieved in the presence of alcohol-, substance use-, and mental health-related issues. Augmenting self-care, and addressing pronounced addictions- and mental health-related concerns, may enhance PrEP treatment among GBMSM.

Community perspectives on ideal bacterial STI testing services for gay, bisexual, and other men who have sex with men in Toronto, Canada: a qualitative study.

BACKGROUND: Innovation is needed to produce sustained improvements in bacterial sexually transmitted infections (STI) testing given suboptimal access and uptake among sexually active gay, bisexual or other men who have sex with men (GBM). Yet, the STI testing processes and technologies that best address local testing barriers among GBM in Toronto is unknown. We aimed to explore men's perspectives regarding STI testing services for GBM to identify and prioritize new STI testing interventions in Toronto, Ontario, Canada. METHODS: We conducted four focus groups with twenty-seven GBM in 2017: two with cisgender men living with HIV, one with cisgender HIV-negative men, and one with transgender men. Twenty-seven men participated in the focus groups with 40% 18-30 years of age, 48% self-identifying as white, and the remainder self-identifying as Middle Eastern, Latino/Hispanic, Asian/Pacific Islander, South Asian, First Nations, African/Caribbean/Black, or mixed race. 59% of participants self-identified as living with HIV. Participants were asked about their STI testing experiences in Toronto, barriers and facilitators to testing, and ideal STI testing process. Focus groups were audio recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS: Core concepts included how clinical context, bacterial STI testing delivery, and interactions with healthcare providers can create barriers and recommendations for ways to improve. Regarding clinical context, participants desired more clinics with accessible locations/hours; streamlined testing that minimized use of waiting rooms and wait times; and improved clinic ambience. Bacterial STI testing delivery recommendations included standardization to ensure consistency in sexual history intake, tests offered, follow-up and public health reporting between clinics. Men also recommended reducing the multistep process testing by offering components such as lab requisitions and results online. Participants also recommended interactions with healthcare providers be professional and non-judgmental, offer compassionate and competent care with destigmatizing and lesbian, gay, bisexual and trans (LGBT) affirming communication. CONCLUSION: Concrete and practical solutions for improving existing sexual health services and facilitating optimal STI testing include streamlining testing options and providing patient-centred, LGBT-affirming care to enable optimal STI testing.

Spatial Access to Sexual Health Clinics Measured Through a Novel Accessibility Score in Toronto, Canada.

BACKGROUND: Understanding spatial access to sexual health services will provide the foundation for future resource planning and allocation. The purpose of this study was to evaluate the potential geographic access to sexual health services in Toronto, Canada, by developing a novel accessibility index to sexual health clinics. METHODS: We created an accessibility index using the 2-step floating catchment area method to quantify neighborhood-level access to sexual health clinics. The index assumed mixed modes of urban travel through walking and public transit, as well as through driving, and was estimated at the census tract level. RESULTS: Census tracts were grouped into quantiles by the estimated accessibility score. Census tracts with higher accessibility scores were characterized as those with greater residential instability and lower dependency and ethnic concentration. The downtown core area has all census tracts categorized as medium, high, or very high (average [SD] score, 1.320 [0.312]), whereas the noncore area has 56.98%, 302 of 530 census tracts categorized as medium, high, or very high (average [SD] score, -0.105 [0.960]). CONCLUSIONS: We demonstrated the benefit of using statistical methods to quantify the geographical access to sexual health services and identified neighborhoods with high and low levels of access. Findings from this study present an overview of the level of spatial access to sexual health clinics in Toronto based on clinic locations in 2018 and can be further used to characterize neighborhoods with a lower level of access and inform policy and planning decisions in the city.

"They Want You to Kill Your Inner Queer but Somehow Leave the Human Alive": Delineating the Impacts of Sexual Orientation and Gender Identity and Expression Change Efforts.

Sexual orientation and gender identity and expression change efforts (SOGIECE) aim to suppress the sexual and gender identities of Two-Spirit, lesbian, gay, bisexual, trans, and other queer (2SLGBTQ+) people. Exposure to SOGIECE is associated with significant psychosocial morbidity. Yet, there is a dearth of knowledge specifying the ways in which these psychosocial impacts are produced and experienced. This qualitative interpretive description study aimed to delineate the impacts of SOGIECE. To do so, we thematically analyzed data from in-depth interviews, conducted between January and July 2020, with 22 people with lived experience of SOGIECE. Study participants indicated that feelings of shame and brokenness related to their sexual and gender identities were deeply implicated in and shaped by experiences with SOGIECE. SOGIECE also had socially isolating effects, which had restricted participants' opportunities for meaningful connection with others, including romantic partners and 2SLGBTQ+ communities. Further, SOGIECE had contributed to experiences of profound emotional distress, mental illness (e.g., anxiety, depression), and suicidality. These findings underscore the need for several responsive policy and programmatic interventions, including legislation to prevent SOGIECE, enhanced sexuality- and gender-related educational efforts with the families and support persons of 2SLGBTQ+ people, and targeted mental health screening and supports for SOGIECE survivors.

Measuring the Burden of Intimate Partner Violence by Sex and Sexual Identity: Results From a Random Sample in Toronto, Canada.

Debates on how sex, gender, and sexual identity relate to intimate partner violence (IPV) are longstanding. Yet the role that measurement plays in how we understand the distribution of IPV has been understudied. We investigated whether people respond differently to IPV items by sex and sexual identity and the implications this has for understanding differences in IPV burdens. Our sample was 2,412 randomly selected residents of Toronto, Canada, from the Neighborhood Effects on Health and Well-being (NEHW) study. IPV was measured using short forms of the Physical and Nonphysical Partner Abuse Scales (20 items). We evaluated the psychometric properties of this measure by sex and sexual identity. We examined whether experiences of IPV differed by sex and sexual identity (accounting for age and neighborhood clustering) and the impacts of accounting for latent structure and measurement variance. We identified differential item functioning by sex for six items, mostly related to nonphysical IPV (e.g., partner jealousy). Males had higher probabilities of reporting five of the six items compared to females with the same latent IPV scores. Being female and identifying as lesbian, gay, or bisexual were positively associated with experiencing IPV. However, the association between female sex and IPV was underestimated when response bias was not accounted for and outcomes were dichotomized as "any IPV." Common practices of assuming measurement invariance and dichotomizing IPV can underestimate the association between sex or gender and IPV. Researchers should continue to attend to gender-based and intersectional differences in IPV but test for measurement invariance prior to comparing groups and analyze scale (as opposed to binary) measures to account for chronicity or intensity.

"Conversion Therapy" Experiences in Their Social Contexts: A Qualitative Study of Sexual Orientation and Gender Identity and Expression Change Efforts in Canada.

OBJECTIVE: To describe in what forms, with whom, where, when, and why Canadians experience sexual orientation and gender identity and expression change efforts (SOGIECE). METHODS: This qualitative study is grounded in a transformative paradigm. We conducted semi-structured interviews with a purposive sample of 22 adults recruited from across Canada who have experienced "conversion therapy." Directed content analysis was used, employing deductive and inductive coding approaches, to synthesize the findings and address 5 policy-relevant questions. RESULTS: What are SOGIECE? Formal and informal methods of SOGIECE were used, including pharmacologic interventions, denial of gender-affirming care, and coaching to repress sexual orientation and/or gender identity and expression. With whom did SOGIECE occur? Practitioners included religious leaders, licenced health-care professionals (e.g., psychiatrists and psychologists), peers, and family members. Where did SOGIECE occur? SOGIECE occurred in 3 predominant settings: faith-based, health care, and social life. When did SOGIECE occur? SOGIECE rarely occurred over a restricted time frame; often, SOGIECE began while participants were adolescents or young adults and continued multiple years under various forms. Others described SOGIECE as a context in which their life was embedded for many years. Why did people attend SOGIECE? Cisheteronormative social and religious expectations taught participants that being non-cisgender or non-heterosexual was incompatible with living a good and respectable life. CONCLUSIONS: SOGIECE are not a circumscribed set of practices. Our study shows that SOGIECE are a larger phenomenon that consists of intentional and explicit change efforts as well as heterosexual- and cisgender-dominant social norms expressed and enforced across a wide range of settings and circumstances. This study provides critical context to inform contemporary social and health policy responses to SOGIECE. Policies should account for the overt, covert, and insidious ways that SOGIECE operate in order to effectively promote safety, equity, and health for sexually diverse and gender-diverse people.

Housing interventions for women experiencing intimate partner violence: a systematic review.

BACKGROUND: Intimate partner violence (IPV) is the leading cause of women's homelessness. However, what works best to respond to the needs of women experiencing IPV and homelessness remains unclear. We aimed to systematically review the effects of housing interventions on the physical, psychosocial, and economic wellbeing of women experiencing IPV. METHODS: In this systematic review, we searched 15 electronic databases and conducted an extensive grey literature and hand reference search between Jan 29, 2020, and May 31, 2021. We included controlled quantitative studies of housing interventions (from emergency shelter to permanent supportive housing) that were reported in English, without time restrictions, and examined any physical, psychosocial, or economic outcomes among women experiencing IPV. We critically appraised included studies using the Cochrane Effective Practice and Organisation of Care criteria and extracted data using a piloted extraction form. We synthesised our results using harvest plots to summarise whether the weight of the evidence suggested benefits, disadvantages, or null effects; patterns by study quality; and evidence gaps. This study is registered with PROSPERO, CRD42020176705. FINDINGS: We screened 23 902 unique records and identified 34 eligible studies with quantitative data on the outcomes of housing interventions among women experiencing IPV. Most studies evaluated the outcomes of either shelter interventions (18 studies [53%]) or shelter plus some other programming (eight [24%]). The remaining eight studies evaluated longer-term housing solutions, including supportive housing (five studies [15%]), critical time interventions (one [3%]), transitional housing (one [3%]), and stay-at-home models (one [3%]). There was no cumulative evidence of disadvantages following any IPV-housing intervention. Evidence of benefits was strongest for mental health outcomes, intent to leave partner, perceived safety, and housing and partner-related stress. Included studies were at high risk of bias across most domains (eg, confounding). INTERPRETATION: There is promising evidence on the continuum of IPV-housing services for women, especially in terms of proximal outcomes, such as mental health, intent to leave partner, safety, and housing stress. However, more research of higher quality is needed, particularly on long-term housing solutions and from outside of the USA. FUNDING: The Social Sciences and Humanities Research Council (430-2021-01176) and Canadian Institutes of Health Research (HSI-166388).

Age, period, and cohort patterns in the epidemiology of suicide attempts among sexual minorities in the United States and Canada: detection of a second peak in middle adulthood.

PURPOSE: Sexual minority adults experience fivefold greater risk of suicide attempt, as compared with heterosexuals. Establishing age-specific epidemiological patterns of suicide is a prerequisite to planning interventions to redress the sexual orientation suicide inequity, and such patterns must be carefully interpreted in light of correlated period and cohort effects. We, therefore, combined US and Canadian data (1985-2017) from primary (two pooled multi-year national surveys, N = 15,477 and N = 126,463) and secondary (published, meta-analytic, N = 122,966) sources to separately estimate age, period, and cohort trends in self-reported suicide attempts among sexual minorities. METHODS: Age- and gender-stratified cross-sectional data were used to infer age and cohort effects. Age-collapsed meta-analyzed data were used to infer period effects among sexual minorities of all genders. RESULTS: We identified a bimodal age distribution in recent suicide attempts for sexual minorities across genders, though more pronounced among sexual minority men: one peak in adolescence (18-20 years of age for both genders) and one peak nearing mid-life (30-35 years of age for men; 35-40 years of age for women). This pattern was also apparent using recall data within birth cohorts of sexual minority men, suggesting it is not an artifact of birth cohort effects. Finally, we observed decreasing trends in lifetime suicide attempt prevalence estimates for both sexual minorities and heterosexuals, though these decreases did not affect the magnitude of the sexual orientation disparity. CONCLUSION: In the context of exclusively adolescent-focused suicide prevention interventions for sexual minorities, tailored suicide prevention for sexual minority adults should be pursued throughout the life course.

Survey of Health Care Providers' Practices and Opinions Regarding Bacterial Sexually Transmitted Infection Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men.

BACKGROUND: Rates of bacterial sexually transmitted infections (STIs) continue to rise among gay, bisexual, and other men who have sex with men (GBMSM) globally. Testing and treatment can prevent morbidity and transmission. However, testing rates remain suboptimal. METHODS: In 2018, we conducted an online cross-sectional survey to explore STI testing ordering practices, 14 potential barriers for testing and 11 possible ways to improve testing from the perspective of health care providers in Toronto, Ontario. An estimated 172 providers were invited from primary care and sexual health clinic settings. Providers were eligible to complete the survey if they provided care for ≥1 GBMSM per week and were involved in the decision-making process in providing STI tests. We used descriptive statistics to summarize survey responses. RESULTS: Ninety-five providers (55% response rate) participated, of whom 68% worked in primary care and 32% in sexual health settings. Most (66%) saw ≤10 GBMSM clients per week. In primary care (65%) and sexual health (40%) clinic settings, insufficient consultation time was the most common barrier to STI testing. In primary care, other common barriers included difficulty introducing testing during unrelated consultations (53%), forgetting (47%), and patients being sexually inactive (31%) or declining testing (27%). The following were most likely to improve testing: express/fast-track testing services (89%), provider alerts when patients are due for testing (87%), patient-collected specimens (84%), nurse-led STI testing (79%), and standing orders (79%). CONCLUSIONS: Promising interventions to improve bacterial STI testing included initiatives that simplify and expedite testing and expand testing delivery to other health care professionals.

Effets du climat et des interventions de santé publique sur la pandémie de COVID-19 : une étude de cohorte prospective.

CONTEXTE: On ignore si les variations climatiques saisonnières, la fermeture des établissements scolaires ou d'autres interventions de santé publique entraîneront un ralentissement de la pandémie actuelle de maladie à coronavirus 2019 (COVID-19). Nous avons voulu déterminer si de façon globale la progression de l'épidémie est associée au climat ou aux interventions de santé publique visant à réduire la transmission du coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2). MÉTHODES: Nous avons procédé à une étude de cohorte prospective des 144 régions géopolitiques de la planète (375 609 cas) présentant au moins 10 cas de COVID-19, avec transmission locale, en date du 20 mars 2020, à l'exclusion de la Chine, de la Corée du Sud, de l'Iran et de l'Italie. Par analyse de régression à effets aléatoires pondérée, nous avons évalué le lien entre la progression de l'épidémie (exprimée sous forme de rapports de taux d'incidence [RTI] comparant les nombres cumulatifs de cas de COVID-19 du 27 mars 2020 à ceux du 20 mars 2020) avec les facteurs de latitude, température, humidité, fermeture des établissements scolaires, interdiction des grands rassemblements et mesures d'éloignement social qui étaient en place les 7 et 13 mars 2020 (période de 14 jours antérieure à l'évaluation). RÉSULTATS: Les analyses univariées ont révélé aucuns lien entre la progression de l'épidémie et les facteurs de latitude et de température, mais des liens négatifs faibles avec l'humidité relative (RTI par 10 %, 0,91, intervalle de confiance [IC] de 95 % 0,85­0,96) et l'humidité absolue (RTI par 5 g/m3 0,92, IC à 95 % 0,85­0,99). Des liens étroits ont été observés avec l'interdiction des grands rassemblements (RTI 0,65, IC à 95 % 0,53­0,79), la fermeture des établissements scolaires (RTI 0,63, IC à 95 % 0,52­0,78) et les mesures d'éloignement social (RTI 0,62, IC à 95 % 0,45­0,85). Dans un modèle multivarié, on a noté un lien étroit avec le nombre de mesures déployées par la santé publique (p pour tendance = 0,001), tandis que le lien avec l'humidité absolue s'atténuait. INTERPRÉTATION: La progression de l'épidémie de COVID-19 ne s'est pas révélée en lien avec la latitude ni avec la température, mais faiblement en lien avec l'humidité relative ou absolue. À l'inverse, les interventions de santé publique ont été étroitement associées à un ralentissement de la progression de l'épidémie.