Factor-Inwentash Faculty of Social Work

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The Factor-Inwentash Faculty of Social Work at the University of Toronto is Canada’s first school of social work. The Faculty is distinguished by its emphasis on the integration of research and practice in both the classroom and practicum education.

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2473. How Does Acquiring a Vaccine-Preventable Disease Impact Parental and Physician Responses to Vaccine Hesitancy?
(Oxford University Press, 2018-11-26) Allan, Kate; Fallon, Barbara; Maguire, Jonathon; Tran, Dat
Background: Vaccine hesitancy poses an urgent threat to public health. This study aims to determine the frequency of children diagnosed with vaccine-preventable diseases (VPDs) accompanied by parental vaccine hesitancy, how physicians counsel parents of these children, and parents’ intentions to vaccinate thereafter. Methods: A one-time survey was sent to pediatricians and pediatric subspecialists through the Canadian Paediatric Surveillance Program (CPSP). Results: In total, 925 pediatricians responded to the survey. 196 (21%) reported having seen a patient in the preceding 12 months who was diagnosed with a VPD whereby the patient or a sibling was not vaccinated or vaccination was delayed by parental choice. The most commonly diagnosed VPDs were pertussis (31%), varicella (27%), and pneumococcal disease (10%). The vast majority (94%) of pediatricians indicated that the VPDs were not acquired outside of Canada. The child’s vaccination status against the VPD prior to contracting the VPD was reported as follows: 81% (156/192) had no immunization and 19% had delayed immunization. When asked about intervention strategies, 23% (41/181) of respondents reported that they had used a formal strategy or structured approach to discuss vaccination with the vaccine-hesitant parent(s) prior to the patient contracting a VPD. 57% (101/178) reported that a formal strategy was used after the patient contracted the VPD. Respondents indicated that their impression was that 35% (64/183) of vaccine-hesitant parents would not vaccinate in the future; 33% (60/183) of respondents were unsure. 79% (147/186) of respondents reported that they were aware of existing tools to manage vaccine hesitancy (e.g., Canadian Paediatric Society Practice Point Working with vaccine-hesitant parents). Of those who were aware of existing tools, 69% (100/145) had used the tools. Conclusion: Pediatricians frequently encounter children with VPDs whose parents are vaccine hesitant. A substantial number of Canadian pediatricians are either unaware of existing tools to address vaccine hesitancy or are not using them. It was the pediatricians’ impression that a significant proportion of vaccine-hesitant parents would not vaccinate in the future despite their children having acquired a VPD.
About - The Digital Story Project
(Migrant Mothers Project, 2014) Migrant Mothers Project
Acceptability and Preferences for Hypothetical Rectal Microbicides among a Community Sample of Young Men Who Have Sex with Men and Transgender Women in Thailand: A Discrete Choice Experiment
(Springer, 2016-11) Newman, Peter A; Cameron, Michael P; Roungprakhon, Surachet; Tepjan, Suchon; Scarpa, Riccardo
From publisher: Rectal microbicides (RMs) may offer substantial benefits in expanding HIV prevention options for key populations. From April to August 2013, we conducted Tablet-Assisted Survey Interviewing, including a discrete choice experiment, with participants recruited from gay entertainment venues and community-based organizations in Chiang Mai and Pattaya, Thailand. Among 408 participants, 74.5 % were young men who have sex with men, 25.5 % transgender women, with mean age = 24.3 years. One-third (35.5 %) had ≤9th grade education; 63.4 % engaged in sex work. Overall, 83.4 % reported they would definitely use a RM, with more than 2-fold higher odds of choice of a RM with 99 versus 50 % efficacy, and significantly higher odds of choosing gel versus suppository, intermittent versus daily dosing, and prescription versus over-the-counter. Sex workers were significantly more likely to use a RM immediately upon availability, with greater tolerance for moderate efficacy and daily dosing. Engaging key populations in assessing RM preferences may support biomedical research and evidence-informed interventions to optimize the effectiveness of RMs in HIV prevention.
Acceptability of an existing online sexually transmitted and blood-borne infection testing model among gay, bisexual and other men who have sex with men in Ontario, Canada
(SAGE Publications, 2023) Dulai, Joshun Js; Gilbert, Mark; Lachowsky, Nathan J; Card, Kiffer G; Klassen, Ben; Dame, Jessy; Burchell, Ann N; Worthington, Catherine; Ablona, Aidan; Anand, Praney; Blaque, Ezra; Ryu, Heeho; Stewart, MacKenzie; Brennan, David J; Grace, Daniel
Objectives: Gay, bisexual and other men who have sex with men (GBM) are disproportionately affected by sexually transmitted and blood-borne infections (STBBI) due to stigma and other factors such as structural barriers, which delay STBBI testing in this population. Understanding acceptability of online testing is useful in expanding access in this population, thus we examined barriers to clinic-based testing, acceptability of a potential online testing model, and factors associated with acceptability among GBM living in Ontario. Methods: Sex Now 2019 was a community-based, online, bilingual survey of GBM aged ≥15. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated using modified Poisson regression with robust variances. Multivariable modelling was conducted using the Hosmer-Lemeshow-Sturdivant approach. Results: Among 1369 participants, many delayed STBBI testing due to being too busy (31%) or inconvenient clinic hours (29%). Acceptability for online testing was high (80%), with saving time (67%) as the most common benefit, and privacy concerns the most common drawback (38%). Statistically significant predictors of acceptability for online testing were younger age (PR = 0.993; 95%CI: 0.991–0.996); a greater number of different sexual behaviours associated with STBBI transmission (PR = 1.031; 95%CI: 1.018–1.044); identifying as an Indigenous immigrant (PR = 1.427; 95%CI: 1.276–1.596) or immigrant of colour (PR = 1.158; 95%CI: 1.086–1.235) compared with white non-immigrants; and currently using HIV pre-exposure prophylaxis (PrEP) compared to not currently using PrEP (PR = 0.894; 95%CI: 0.828–0.965). Conclusions: Acceptability of online testing was high among GBM in Ontario. Implementing online STBBI testing may expand access for certain subpopulations of GBM facing barriers to current in-person testing.
Acceptability of HIV Pre-Exposure Prophylaxis (PrEP) and Implementation Challenges Among Men Who Have Sex with Men in India: A Qualitative Investigation
(Mary Ann Liebert, 2015) Chakrapani, Venkatesan; Newman, Peter A; Shunmugam, Murali; Mengle, Shruta; Varghese, Jarvis; Nelson, Ruban; Bharat, Shalini
From publisher: This qualitative study explored the acceptability of HIV pre-exposure prophylaxis (PrEP) among MSM in India, and identified facilitators and barriers to future PrEP uptake. In 2014, we conducted 10 focus groups (n=61) among a purposive sample of diverse MSM recruited through community-based organizations in Chennai and Mumbai, and 10 key informant interviews with community leaders and health care providers. Participants' mean age was 26.1 years (SD 4.8); 62% completed secondary education, and 42% engaged in sex work. No focus group participants had heard of PrEP, but once explained, most reported they would likely use it. PrEP was alternately perceived as a ‘back-up plan’, a condom substitute, or a burden with concurrent condom use. Facilitators were potential for covert use, sex without condoms, and anxiety-less sex. Potential barriers emerged around stigma associated with PrEP use, fear of disclosures to one's family, wife, or male steady partner, and being labeled as HIV-positive or promiscuous by peers. Preferences emerged for intermittent rather than daily PrEP use, injectable PrEP, and free or subsidized access through community organizations or government hospitals. Key informants expressed additional concerns about risk compensation, non-adherence, and impact on ART availability for treatment. Demonstration projects are needed in India to support PrEP implementation tailored for at-risk MSM. Educational interventions for MSM should address concerns about PrEP effectiveness, side effects, and mitigate risk compensation. Community engagement may facilitate broad acceptability and challenge stigma around PrEP use. Importantly, provision of free or subsidized PrEP is necessary to making implementation feasible among low socioeconomic status MSM in India.
Access experiences and attitudes toward abortion among youth experiencing homelessness in the United States: A systematic review
(Public Library of Science, 2021-07-01) Munro, Sarah; Benipal, Savvy; Williams, Aleyah; Wahl, Kate; Trenaman, Logan; Begun, Stephanie
Objectives: We sought to review the literature on the access experiences and attitudes toward abortion among youth experiencing homelessness in the United States. Methods: We conducted a systematic review of peer‐reviewed literature published from 2001 to 2019. We included qualitative studies involving US participants that focused on access experiences, views, or accounts of unintended pregnancy and/or abortion among youth experiencing homelessness. We excluded studies published before 2001 as that was the year mifepristone medication abortion was made available in the US and we aimed to investigate experiences of access to both medical and surgical abortion options. Results: Our thematic analysis of the data resulted in five key themes that characterize the abortion attitudes and access experiences of youth experiencing homelessness: (1) engaging in survival sex and forced sex, (2) balancing relationships and autonomy, (3) availability does not equal access, (4) attempting self-induced abortions using harmful methods, and (5) feeling resilient despite traumatic unplanned pregnancy experiences. Conclusions: Youth experiencing homelessness experience barriers to abortion access across the US, including in states with a supportive policy context and publicly funded abortion services. In the absence of accessible services, youth may consider harmful methods of self-induced abortion. Improved services should be designed to offer low-barrier abortion care with the qualities that youth identified as important to them, including privacy and autonomy.
Access to Justice in Ontario's Family Courts: The Parents' Perspective
(Faculty of Law, University of Windsor, 2016) Saini, Michael; Birnbaum, Rachel; Bala, Nicholas
Access to mental health and addiction services for youth and their families in Ontario: perspectives of parents, youth, and service providers
(Springer Nature, 2023-03-14) Kourgiantakis, Toula; Markoulakis, Roula; Lee, Eunjung; Hussain, Amina; Lau, Carrie; Ashcroft, Rachelle; Goldstein, Abby L; Kodeeswaran, Sugy; Williams, Charmaine C; Levitt, Anthony
Background Canadian youth (aged 16–24) have the highest rates of mental health and addiction concerns across all age groups and the most unmet health care needs. There are many structural barriers that contribute to the unmet mental health care needs of youth including lack of available and appropriate services, high costs, long wait times, fragmented and siloed services, lack of smooth transition between child and adult services, stigma, racism, and discrimination, as well as lack of culturally appropriate treatments. Levesque et al. (2013) developed a framework to better understand health care access and this framework conceptualizes accessibility across five dimensions: (1) approachability, (2) availability, (3) affordability, (4) appropriateness, and (5) acceptability. The purpose of this study was to explore access to addiction and mental health services for youth in Ontario, Canada from the perspectives of youth, parents, and service providers. Methods This qualitative study was a university-community partnership exploring the experiences of youth with mental health concerns and their families from the perspectives of youth, caregivers, and service providers. We conducted semi-structured interviews and used thematic analysis to analyze data. Results The study involved 25 participants (n = 11 parents, n = 4 youth, n = 10 service providers). We identified six themes related to structural barriers impacting access to youth mental health and services: (1) “The biggest barrier in accessing mental health support is where to look,” (2) “There’s always going to be a waitlist,” (3) “I have to have money to be healthy,” (4) “They weren’t really listening to my issues,” (5) “Having more of a welcoming and inclusive system,” and (6) “Health laws aren’t doing what they need to do.” Conclusion Our study identified five structural barriers that map onto the Levesque et al. healthcare access conceptual framework and a sixth structural barrier that is not adequately captured by this model which focuses on policies, procedures, and laws. The findings have implications for policies and service provisions, and underline the urgent need for a mental health strategy that will increase access to care, improve mental health in youth, decrease burden on parents, and reduce inequities in mental health policies and services.
Access to sexual and reproductive health care among young adult sex workers in Toronto, Ontario: a mixed-methods study
(Canadian Medical Association, 2021-05-14) Ross, Lori E.; Sterling, Andrea; Dobinson, Cheryl; Logie, Carmen H.; D'Souza, Sandra
Background: Young adult sex workers may benefit from sexual and reproductive health care services; however, little research has examined their access experiences. This study aimed to assess barriers to and facilitators of access to sexual and reproductive health care among young adult sex workers, and identify practices suggested by participants to improve services. Methods: This was a community-based mixed-methods study of adults aged 18–29 years who were currently or had previously been engaged in sex work, conducted in Toronto in 2017–2018. The study was guided by a Youth Advisory Committee of 4 youth with lived experience of sex work. Participants completed an online survey, or participated in a focus group or a one-on-one interview; all 3 modalities included parallel questions about barriers to and facilitators of access to sexual and reproductive health care. We summarized quantitative data using descriptive statistics and identified qualitative themes using thematic analysis, followed by triangulation of the 2 strands. Results: There were 54 survey respondents (response rate 48%) and 17 participants in the qualitative phase (14 in focus groups and 3 in interviews), for a total sample size of 71. Survey respondents reported suboptimal access to sexual and reproductive health care, with 8 (15%) reporting no regular source of care, and only 6 (11%) reporting that they disclose their sex work experience to providers. Actual or expected stigma regarding sex work on the part of providers was the dominant barrier to care, whereas nonjudgmental providers, particularly those who themselves have sex work experience, was a key facilitator. Participants suggested 7 practices to improve access to sexual and reproductive health care. Interpretation: Young adult sex workers face many barriers to accessing sexual and reproductive health care. Including people with sex work experience in the development of solutions will maximize the capacity to address the needs of this underserved population.
Achieving Optimal Mental Health Despite Exposure to Chronic Parental Domestic Violence: What Pathways are Associated with Resilience in Adulthood?
(Springer, 2022-04) Fuller-Thomson, Esme; Ryan-Morissette, Deirdre; Attar-Schwartz, Shalhevet; Brennenstuhl, Sarah
Despite the numerous adverse consequences of exposure to parental domestic violence (PDV), some of those with a history of PDV thrive in adulthood and achieve complete mental health (CMH). This study investigates whether lifetime history of mental illness (depression, anxiety, substance use disorder) and social support (social provision scale) mediate the relationship between exposure to PDV and CMH in adulthood. A sample of 17,739 respondents from the 2012 Canadian Community Health Survey-Mental Health including 326 with a history of chronic PDV (> 10 times before age 16). CMH was defined as: 1) the absence of mental illness and substance dependence; 2) happiness or life satisfaction; and 3) psychological and social well-being. Path analyses were used to test the objective. Those exposed to PDV had a significantly lower prevalence of CMH compared to the general population (62.5% vs 76.1%, p < .001). Evidence of mediation was found for depression (indirect effect = -.19; 95%CI = -.30, -.09, p = .002), anxiety (indirect effect = -.12; 95%CI = -.20, -.05, p = .005), substance use disorder (indirect effect = -.04; 95%CI = -0.07, -.01, p = .016) and social provisions (indirect effect = -.13; 95%CI = -.19, -.07, p < .001). Among those with a history of PDV the odds of CMH were lower among those with lower social support and those with a history of substance use disorder or anxiety. It is important to consider mediators, such as mental health and social support, when addressing the negative outcomes of witnessing PDV.
Adapting and Validating a Scale to Measure Sexual Stigma among Lesbian, Bisexual and Queer Women
(Public Library of Science, 2015) Logie, Carmen; Earnshaw, Valerie
From publisher: Lesbian, bisexual and queer (LBQ) women experience pervasive sexual stigma that harms wellbeing. Stigma is a multi-dimensional construct and includes perceived stigma, awareness of negative attitudes towards one’s group, and enacted stigma, overt experiences of discrimination. Despite its complexity, sexual stigma research has generally explored singular forms of sexual stigma among LBQ women. The study objective was to develop a scale to assess perceived and enacted sexual stigma among LBQ women. We adapted a sexual stigma scale for use with LBQ women. The validation process involved 3 phases. First, we held a focus group where we engaged a purposively selected group of key informants in cognitive interviewing techniques to modify the survey items to enhance relevance to LBQ women. Second, we implemented an internet-based, cross-sectional survey with LBQ women (n=466) in Toronto, Canada. Third, we administered an internet-based survey at baseline and 6-week follow-up with LBQ women in Toronto (n=24) and Calgary (n=20). We conducted an exploratory factor analysis using principal components analysis and descriptive statistics to explore health and demographic correlates of the sexual stigma scale. Analyses yielded one scale with two factors: perceived and enacted sexual stigma. The total scale and subscales demonstrated adequate internal reliability (total scale alpha coefficient: 0.78; perceived sub-scale: 0.70; enacted sub-scale: 0.72), test-retest reliability, and construct validity. Perceived and enacted sexual stigma were associated with higher rates of depressive symptoms and lower self-esteem, social support, and self-rated health scores. Results suggest this sexual stigma scale adapted for LBQ women has good psychometric properties and addresses enacted and perceived stigma dimensions. The overwhelming majority of participants reported experiences of perceived sexual stigma. This underscores the importance of moving beyond a singular focus on discrimination to explore perceptions of social judgment, negative attitudes and social norms.
Adapting stigma mechanism frameworks to explore complex pathways between intersectional stigma and HIV-related health outcomes among women living with HIV in Canada
(Elsevier, 2019-05-02) Logie, Carmen; Williams, Charmaine C; Wang, Ying; Marcus, Natania; Kazemi, Mina; Cioppa, Lynne; Kaida, Angela; Webster, Kath; Beaver, Kerrigan; de Pokomandy, Alexandra; Loutfy, Mona
1. Introduction One-quarter of people living with HIV in Canada are women (Public Health Agency of Canada, 2015), and women living with HIV (WLWH) experience depression and poorer health sequalae disproportionately in comparison with men (Gonzalez et al., 2011). Depression is associated with compromised health outcomes in people living with HIV (PLHIV) (Gonzalez et al., 2011; Wagner et al., 2011), yet the relationship between HIV and depression is complex. Social and structural factors associated with HIV infection such as exposure to violence (Siemieniuk et al., 2013), HIV-related stigma, racism, gender discrimination, and low income (Logie et al., 2013, 2018) may increase WLWH's likelihood of experiencing depression, that in turn influence HIV-related health. Conceptual models offer insight into the complex associations between social, structural, and individual level factors that shape PLHIV's health outcomes. Earnshaw and Chaudoir's (2009) HIV Stigma Framework explains how enacted (experiences of mistreatment), anticipated (expectations of future mistreatment), and internalized (acceptance of negative beliefs regarding PLHIV) HIV-related stigma mechanisms are associated with a range of outcomes, including mental health, social support, and HIV symptoms. Building on this model, Turan et al. (2017) conceptualize how intersectional stigma based on race, class, gender, and sexuality may influence HIV-related stigma, which in turn may influence mechanisms (interpersonal, psychological, mental health, stress) that impact care engagement and ultimately HIV-related health. Kennedy's (2009) psychosocial model of racism and treatment adherence also posits that sociodemographic, environmental, cultural, and racism factors contribute to compromised treatment adherence and ultimately poorer health among racial minorities. We integrate concepts from these frameworks and test pathways from intersectional stigma to HIV-related health outcomes via interpersonal, psychological, mental health, and stress mechanisms among WLWH.
Adults’ responses to bullying: the victimized youth’s perspectives
(Taylor & Francis, 2019-07-25) Bjereld, Ylva; Daneback, Kristian; Mishna, Faye
Children are generally encouraged to tell adults about bullying. Although telling can be effective in ending bullying, adults do not necessarily respond in a way that is helpful. Previous research has rarely included victims’ own thoughts and feelings regarding what adult actions and reactions are experienced as positive and helpful, and which are experienced as negative and unhelpful in managing bullying situations. This paper reports on interviews with bullied youth, with the overall aims of describing adults’ responses to bullying from the victimized youth’s perspectives and discussing how the youth experienced these responses. The analysis comprised grounded theory, emphasizing the victimized youth’s points of view. When adults became aware of bullying, they responded in three ways; verbal, physical or avoiding/ignoring. Responses that included increasing adult presence were typically experienced as helpful, as were responses whereby the youth felt adults listened without blaming the victim for the bullying or, listened without excusing the behaviour of the youth that bullied. No response was depicted by the participants as unambiguously helpful although when adults avoided or ignored the bullying it was never helpful.
Adverse childhood experiences and binge-eating disorder in early adolescents
(BioMed Central, 2022-11-16) Chu, Jonathan; Raney, Julia H; Ganson, Kyle T; Wu, Kelsey; Rupanagunta, Ananya; Testa, Alexander; Jackson, Dylan B; Murray, Stuart B; Nagata, Jason M
Background: Adverse childhood experiences (ACEs) are common and linked to negative health outcomes. Previous studies have found associations between ACEs and binge-eating disorder (BED), though they have mainly focused on adults and use cross-sectional data. The objective of this study was to examine the associations between ACEs and BED in a large, national cohort of 9–14-year-old early adolescents in the US. Methods: We analyzed prospective cohort data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,145, 2016–2020). Logistic regression analyses were used to determine the associations between self-reported ACEs and BED based on the Kiddie Schedule for Affective Disorders and Schizophrenia at two-year follow-up, adjusting for sex, race/ethnicity, baseline household income, parental education, site, and baseline binge-eating disorder. Results: In the sample, (49% female, 46% racial/ethnic minority), 82.8% of adolescents reported at least one ACE and 1.2% had a diagnosis of BED at two-year follow-up. The mean number of ACEs was higher in those with a diagnosis of BED compared to those without (2.6 ± 0.14 vs 1.7 ± 0.02). The association between number of ACEs and BED in general had a dose–response relationship. One ACE (adjusted odds ratio [aOR] 3.48, 95% confidence interval [CI] 1.11–10.89), two ACEs (aOR 3.88, 95% CI 1.28–11.74), and three or more ACEs (aOR 8.94, 95% CI 3.01–26.54) were all associated with higher odds of BED at two-year follow-up. When stratified by types of ACEs, history of household mental illness (aOR 2.18, 95% 1.31–3.63), household violence (aOR 2.43, 95% CI 1.42–4.15), and criminal household member (aOR 2.14, 95% CI 1.23–3.73) were most associated with BED at two-year follow-up. Conclusions: Children and adolescents who have experienced ACEs, particularly household challenges, have higher odds of developing BED. Clinicians may consider screening for ACEs and providing trauma-focused care when evaluating patients for BED.
Adverse Childhood Experiences and Cardiovascular Risk among Young Adults: Findings from the 2019 Behavioral Risk Factor Surveillance System
(MDPI, 2022-09-16) Jackson, Dylan B; Testa, Alexander; Woodward, Krista P; Qureshi, Farah; Ganson, Kyle T; Nagata, Jason M
Background: Heart disease is the fourth leading cause of death for young adults aged 18–34 in the United States. Recent research suggests that adverse childhood experiences (ACEs) may shape cardiovascular health and its proximate antecedents. In the current study, we draw on a contemporary, national sample to examine the association between ACEs and cardiovascular health among young adults in the United States, as well as potential mediating pathways. Methods: The present study uses data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) to examine associations between ACEs and cardiovascular risk, as well as the role of cumulative disadvantage and poor mental health in these associations. Results: Findings indicate that young adults who have experienced a greater number of ACEs have a higher likelihood of having moderate to high cardiovascular risk compared to those who have zero or few reported ACEs. Moreover, both poor mental health and cumulative disadvantage explain a significant proportion of this association. Conclusions: The present findings suggest that young adulthood is an appropriate age for deploying prevention efforts related to cardiovascular risk, particularly for young adults reporting high levels of ACEs.
Adverse childhood experiences and prescription opioid use during pregnancy: an analysis of the North and South Dakota PRAMS, 2019-2020
(Springer Nature, 2023-08-23) Testa, Alexander; Jacobs, Benjamin; Zhang, Lixia; Jackson, Dylan B; Ganson, Kyle T; Nagata, Jason M
Objectives This study assesses the association between adverse childhood experiences (ACEs) and prescription opioid use during pregnancy. Methods This study uses data on 2,999 individuals from the 2019 and 2020 Pregnancy Risk Assessment Monitoring System (PRAMS) from North Dakota and South Dakota. The relationship between ACEs and prescription opioid use during pregnancy is examined using multiple logistic regression. Results The prevalence of prescription opioid use increases alongside more ACE exposure. Compared to those with no ACEs, recent mothers with three or more ACEs have a 2.4 greater odds of prescription opioid use during pregnancy (aOR [adjusted odds ratio] = 2.437; 95% CI [confidence interval] = 1.319, 4.503). Conclusion Exposure to three or more ACEs are associated with a higherrisk of prescription opioid use during pregnancy. Additional research is needed better understand the mechanisms that link ACEs and prescription opioid use during pregnancy, as well as how to best support those with ACEs exposure in a trauma-informed manner to reduce the risk of substance use.
Adverse childhood experiences and sipping alcohol in U.S. Children: Findings from the Adolescent Brain Cognitive Development study
(Elsevier, 2023-04) Nagata, Jason M; Smith, Natalia; Sajjad, Omar M; Zamora, Gabriel; Raney, Julia H; Ganson, Kyle T; Testa, Alexander; Vittinghoff, Eric; Jackson, Dylan B
The objective of this study was to explore the relationship between accumulating adverse childhood experiences (ACEs) and sipping alcohol in a large, nationwide sample of 9-to-10-year-old U.S. children. We analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study (2016-2018). Of 10,853 children (49.1 % female), 23.4 % reported ever sipping alcohol. A greater ACE score was associated with a higher risk of sipping alcohol. Having 4 or more ACEs placed children at 1.27 times the risk (95 % CI 1.11-1.45) of sipping alcohol compared to children with no ACEs. Among the nine distinct ACEs examined, household violence (Risk Ratio [RR] = 1.13, 95 % CI 1.04-1.22) and household alcohol abuse (RR = 1.14, 95 % CI 1.05-1.22) were associated with sipping alcohol during childhood. Our findings indicate a need for increased clinical attention to alcohol sipping among ACE-exposed children.
Adverse childhood experiences, gender, and HIV risk behaviors: Results from a population-based sample
(Elsevier, 2016-12) Fang, Lin; Chuang, Deng-Min; Lee, Yookyong
Recent HIV research suggested assessing adverse childhood experiences (ACEs) as contributing factors of HIV risk behaviors. However, studies often focused on a single type of adverse experience and very few utilized population-based data. This population study examined the associations between ACE (individual and cumulative ACE score) and HIV risk behaviors. We analyzed the 2012 Behavioral Risk Factor Surveillance Survey (BRFSS) from 5 states. The sample consisted of 39,434 adults. Eight types of ACEs that included different types of child abuse and household dysfunctions before the age of 18 were measured. A cumulative score of ACEs was also computed. Logistic regression estimated of the association between ACEs and HIV risk behaviors using odds ratio (OR) with 95% confidence intervals (CIs) for males and females separately. We found that ACEs were positively associated with HIV risk behaviors overall, but the associations differed between males and females in a few instances. While the cumulative ACE score was associated with HIV risk behaviors in a stepwise manner, the pattern varied by gender. For males, the odds of HIV risk increased at a significant level as long as they experienced one ACE, whereas for females, the odds did not increase until they experienced three or more ACEs. Future research should further investigate the gender-specific associations between ACEs and HIV risk behaviors. As childhood adversities are prevalent among general population, and such experiences are associated with increased risk behaviors for HIV transmission, service providers can benefit from the principles of trauma-informed practice.
Aesthetics of Social Work: Governing Risky Spaces and Youth Subjects through Techniques of Visuality
(2012-11) Crath, Rory ; Williams, Charmaine ; Social Work
In the wake of a rescaling of national state welfare responsibilities, urban centres, like the city of Toronto, have become new governance sightlines for managing the deleterious effects of a globalised restructuring of capitalist economies. Toronto is now trafficking its multicultural and “creative city” flare in regional and global markets to secure capital investment necessary to float its newly acquired fiscal responsibilities, including welfare and social services provisioning. And a host of local private-public partnerships have appeared as “shadow state” actors to assist in the suturing of disenfranchised communities to the operative logics of neo-liberal governance and globalised city aspirations. Social welfare and urban studies literature has not been attentive to the increasing reliance on visuality and the “aesthetic” more broadly in securing these desired social and economic outcomes. My ethnographically based dissertation picks up this analytical slack by inciting a two-fold intervention: First, I hone in on the efficacious properties of visual images produced within 3 different social policy spaces and their presumed roles in constituting the domains of social interaction and production. This analysis illustrates that different policy crafting experts understand the “aesthetic” as a remunerative technology of governance - for regulating the problematics of socio-economic and racialised difference, and for mediating rifts in the social fabric as fallout from welfare retrenchment. Second, I examine the ways in which certain normativised aesthetic sensibilities connected to neoliberal urbanism serve as both a calculative resource for re-defining certain spaces and subjects as problematic and thus controllable, and an interpellative mechanism for assembling moralized subjects around the dictates of responsibility and (self) empowerment. The dissertation argues that although these aesthetic governance strategies are resulting in a depoliticisation of communities, and a moralised segregation of compliant and non-compliant subjects played out along racialised /economic lines, there exists a level of disruption transpiring in the spaces of policy implementation. In situ attention to these disruptions, layered with a reflexive analytical restaging of these events and a critical analysis of deployed governance strategies are proposed as a grounding for social work, research and social policy praxis.
AFFIRM Online: Utilising an Affirmative Cognitive–Behavioural Digital Intervention to Improve Mental Health, Access, and Engagement among LGBTQA+ Youth and Young Adults
(2021-02-05) Craig, Shelley L.; Leung, Vivian W. Y.; Pascoe, Rachael; Pang, Nelson; Iacono, Gio; Austin, Ashley; Dillon, Frank
Digital mental health interventions may enable access to care for LGBTQA+ youth and young adults that face significant threats to their wellbeing. This study describes the preliminary efficacy of AFFIRM Online, an eight-session manualised affirmative cognitive behavioural group intervention delivered synchronously. Participants (M_age = 21.17; SD = 4.52) had a range of sexual (e.g., queer, lesbian, pansexual) and gender (e.g., non-binary, transgender, cisgender woman) identities. Compared to a waitlist control (n = 50), AFFIRM Online participants (n = 46) experienced significantly reduced depression (b = −5.30, p = 0.005, d = 0.60) and improved appraisal of stress as a challenge (b = 0.51, p = 0.005, d = 0.60) and having the resources to meet those challenges (b = 0.27, p = 0.059, d = 0.39) as well active coping (b = 0.36, p = 0.012, d = 0.54), emotional support (b = 0.38, p = 0.017, d = 0.51), instrumental support (b = 0.58, p < 0.001, d = 0.77), positive framing (b = 0.34, p = 0.046, d = 0.42), and planning (b = 0.41, p = 0.024, d = 0.49). Participants reported high acceptability. This study highlights the potential of digital interventions to impact LGBTQA+ youth mental health and explores the feasibility of digital mental health to support access and engagement of youth with a range of identities and needs (e.g., pandemic, lack of transportation, rural locations). Findings have implications for the design and delivery of digital interventions for marginalised youth and young adults.

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