Faculty publications - Dalla Lana School of Public Health

Permanent URI for this collectionhttps://hdl.handle.net/1807/67752

This space is provided for the faculty publications from the Dalla Lana School of Public Health (DLSPH).

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Sexual Satisfaction of Midlife Women Living With HIV in Canada: A Prospective Cohort Analysis
(Wolters Kluwer, 2023-08) King, Elizabeth M.; Carter, Allison; Loutfy, Mona; Webster, Kathleen; Muchenje, Marvelous; Murray, Melanie C.M.; de Pokomandy, Alexandra; Ding, Erin; Li, Jenny; Kaida, Angela
Background: Although sexual activity and function decline in older women living with HIV, positive dimensions of sexual health, such as satisfaction, are relatively unexplored. We evaluated the prevalence of sexual satisfaction for midlife women with HIV and assessed its relation to women's physical, mental, and sociostructural experiences. Setting: We studied women in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) over 3 survey waves (2013–2018). Methods: We included women living with HIV aged ≥45 years who reported ever having consensual sex. Sexual satisfaction was assessed using an item from the Sexual Satisfaction Scale for Women and was dichotomized into satisfactory (“completely/very/reasonably satisfactory”) and not satisfactory (“not very/not at all satisfactory”). Probable depression was based on CES-D ≥10. Multivariable logistic regression and fixed effects models determined correlates of sexual satisfaction. Reasons for sexual inactivity and alternate forms of sexual expression were also explored. Results: Among 508 midlife women, 61% were satisfied with their sexual lives at baseline. Women with probable depression had lower odds of sexual satisfaction than those without (aOR: 0.44; 95% CI: 0.27 to 0.71) and worsening depressive symptoms over time were associated with poorer sexual satisfaction (P = 0.001). Increased sexual activity was associated with higher sexual satisfaction (aOR: 2.75; 95% CI: 1.54 to 4.91); however, 51% of women reporting sexual satisfaction were sexually inactive. Sexually inactive women engaged in alternate forms of sexual expression such as self-pleasure (37%) and intimate relationships without sex (13%). Conclusion: Midlife women with HIV have high rates of sexual satisfaction, even in the absence of sexual activity. Depressive symptoms were closely associated with sexual dissatisfaction, alerting providers to the importance of screening for depression and sexual health together.
Unintentional injury deaths among children younger than 5 years of age in India: a nationally representative study
(BMJ Journals, 2011) Jagnoor, Jagnoor; Bassani, Diego G; Keay, Lisa; Ivers, Rebecca Q; Thakur, J S; Gururaj, G; Jha, Prabhat
Objective: To determine the mortality burden associated with unintentional injuries among children younger than 5 years of age in India. Methods: The Registrar General of India conducted verbal autopsy for all deaths occurring in 2001–2003 in a nationally representative sample of over 1.1 million homes. These verbal autopsy reports were coded by two of 130 trained physicians, who independently assigned an ICD-10 code to each death. Discrepancies were resolved through reconciliation and, if necessary, adjudication. The probability of death during the first 5 years of life (per 100 000 live births) was estimated from the 2005 United Nations' population and death estimates for India, to which the proportions of deaths from the mortality study were applied. Results: Unintentional injuries were the sixth leading cause of death among children under 5 years of age. In 2005, unintentional injuries led to 82 000 deaths (99% CI 71 000 to 88 000) among children under 5 years of age, a mortality rate per 100 000 live births (MR) of 302 (99% CI 262 to 323). Mortality was higher in rural areas (MR=339, 99% CI 282 to 351), mostly due to more drowning deaths, than in urban areas (MR=173, 99% CI 120 to 237), where falls were the leading cause of child injury mortality. Conclusion: Unintentional injuries, specifically drowning and falls, lead to substantial mortality in children younger than 5 years of age in India. There is a need for continued monitoring of the injury burden and investigation of risk factors for evidence-based effective injury prevention programmes.
Influence of co-occurring mental and substance use disorders on the prevalence of problem gambling in Canada
(Wiley, 2008-11) Rush, Brian R; Bassani, Diego G; Urbanoski, Karen A; Castel, Saulo
Context/background: Research has shown that problem gambling (PG) is associated with substance use disorders (SUD) and also with other mental disorders (MD). Nevertheless, evidence about the relative contribution of each type of disorder for the risk of gambling in the population is very limited. Objective: Study the association of SUD, alone and in combination with MD, with the prevalence and severity of PG. Design: Cross-sectional national survey (Canadian Community Health Survey—Mental Health and Well-Being) data collected through a multi-stage stratified cluster design. Setting: Population-based household survey. Participants: This analysis includes data on 36 885 participants (99.7% of the survey sample). Main outcome measures: The prevalence and severity of PG were measured using the Canadian Problem Gambling Index. Prevalence of MD (mood and anxiety disorders) and SUD were defined according to the World Mental Health Survey Initiative Composite International Diagnostic Interview, following definitions of the DSM-IV. Results: Compared to the population, higher prevalence rates of PG are observed when the severity of SUD is higher, but are not impacted by the co-occurrence of MD. For individuals with low risk and moderate risk/problem gambling, the prevalence rate difference (prevalence rate in the subgroup minus prevalence rate in the population) observed among substance dependents was reduced when MD co-occurred (from a prevalence rate difference of 2.5; 99% confidence interval 1.6–3.8 to 1.6; 99% confidence interval 1.2–2.2 for low risk gamblers and from 3.7; 99% confidence interval 1.6–5.5 to 2.9; 99% confidence interval 2.0–4.3 for moderate risk/problem gamblers). Estimates were not statistically different. Conclusions: Prevalence of all levels of PG increased with SUD severity, but the pattern did not appear to be affected by MD co-occurrence. Results suggest particular attention be given to SUD in treatment-seeking clients with co-occurring disorders.
A Collection of Exercises in Advanced Probability Theory: The Solutions Manual of All Even-Numbered Exercises from "A First Look at Rigorous Probability Theory" (2006)
(World Scientific Publishing Co. Ltd., 2020-01-01) Soltanifar, Mohsen; Li, Longhai; Rosenthal, Jeffrey S.
A Collection of Exercises in Advanced Mathematical Statistics: The Solution Manual of All Odd-Numbered Exercises from "Mathematical Statistics" (2000)
(Chapman & Hall/CRC Press LLC, 2018-07-01) Soltanifar, Mohsen; Knight, Keith
Le VIH et le sida au Canada : Une étude nationale - Sommaire
(Centre IRSC en recherche sociale pour la prevention du VIH, 2012-04-16) Calzavara, Liviana; Allman, Dan; Worthington, Catherine; Tyndall, Mark; Adrien, Alix
HIV and AIDS in Canada: A National Survey - Summary Report
(CIHR Social Research Centre in HIV Prevention, 2012-04-16) Calzavara, Liviana; Allman, Dan; Worthington, Catherine; Tyndall, Mark; Adrien, Alix
Modeling microbial growth in carpet dust exposed to diurnal variations in relative humidity using the "Time-of-Wetness" framework
(Wiley, 2020-09) Haines, Sarah R; Siegel, Jeffrey A; Dannemiller, Karen C
Resuspension of microbes in floor dust and subsequent inhalation by human occupants is an important source of human microbial exposure. Microbes in carpet dust grow at elevated levels of relative humidity, but rates of this growth are not well established, especially under changing conditions. The goal of this study was to model fungal growth in carpet dust based on indoor diurnal variations in relative humidity utilizing the time-of-wetness framework. A chamber study was conducted on carpet and dust collected from 19 homes in Ohio, USA and exposed to varying moisture conditions of 50%, 85%, and 100% relative humidity. Fungal growth followed the two activation regime model, while bacterial growth could not be evaluated using the framework. Collection site was a stronger driver of species composition (P = 0.001, R2 = 0.461) than moisture conditions (P = 0.001, R2 = 0.021). Maximum moisture condition was associated with species composition within some individual sites (P = 0.001-0.02, R2 = 0.1-0.33). Aspergillus, Penicillium, and Wallemia were common fungal genera found among samples at elevated moisture conditions. These findings can inform future studies of associations between dampness/mold in homes and health outcomes and allow for prediction of microbial growth in the indoor environment.
Impact of Residential HVAC Filters on Particle Concentration and Exposure
(2020-06) Zhang, Yizhi; Siegel, Jeffrey A.; Civil Engineering
Filters in heating, ventilating, and air conditioning (HVAC) systems can improve indoor air quality. In North America, residential air cleaning is usually done by recirculating indoor air through a filter. In this work, I explored two methods of assessing the impacts of HVAC filters in residences. The first method was through examining year-long PM measurements in 20 Toronto homes where different types of filters were installed. I found no evidence that higher efficiency filters reduced long-term exposure to PM. The second method was by studying the particle size distribution of filter dust. I explored the possibility of size separating filter dust to gain more information on smaller particles. One major challenge is the sticky nature of filter dust makes both the separation and mixing (with water for size analysis) processes difficult. Despite the caveats, these findings suggest that both methods are promising and can provide useful information for future studies.
A call for caution in use of pertussis vaccine effectiveness studies to estimate waning immunity: A Canadian Immunization Research Network Study
(Oxford Academic, 2020-05-08) Crowcroft, Natasha S; Schwartz, Kevin L; Savage, Rachel D; Chen, Cynthia; Johnson, Caitlin; Li, Ye; Marchand-Austin, Alex; Bolotin, Shelly; Deeks, Shelley L; Jamieson, Frances B; Drews, Steven J; Russell, Margaret L; Svenson, Lawrence W; Simmonds, Kimberley; Righolt, Christiaan H; Bell, Christopher; Mahmud, Salaheddin M; Kwong, Jeffrey C
Background: Vaccine effectiveness (VE) studies provide essential evidence on waning vaccine-derived immunity, a major threat to pertussis control. We evaluated how study design affects estimates by comparing two case-control studies conducted in Ontario, Canada. Methods: We compared results from a test-negative design (TND) with a frequency-matched design (FMD) case-control study using pertussis cases from 2005-15. In the first study, we identified test-negative controls from the public health laboratory that diagnosed cases and in the second, randomly selected controls from patients attending the same physicians that reported cases, frequency-matched on age and year. We compared characteristics of cases and controls using standardized differences. Results: In both designs, VE estimates for the early years post-immunization were consistent with clinical trials (TND 84%, FMD 89% at 1-3 years post-vaccination), but diverged as time since last vaccination increased (TND 41% and FMD 74% by 8 years post-vaccination). Overall, we observed lower VE and faster waning in the TND than the FMD. In the TND but not the FMD, controls differed from cases in important confounders, being younger, having more comorbidities and higher healthcare use. Differences between the controls of each design were greater than differences between cases. TND controls were more likely to be unvaccinated or incomplete vaccinated than FMD controls (p<0.001). Conclusions: The FMD adjusted better for healthcare-seeking behaviour than the TND. Duration of protection from pertussis vaccines is unclear because estimates vary by study design. Caution should be exercised by experts, researchers and decision-makers when evaluating evidence on optimal timing of boosters.
Poverty in lesbian, gay, bisexual, transgender, queer, and two-spirit (LGBTQ2S+) populations in Canada: an intersectional review of the literature
(Policy Press, 2020-02) Kia, Hannah; MacKay, Jenna; Ross, Lori E.; Robinson, Margaret
Despite the prominence of poverty in lesbian, gay, bisexual, transgender, queer, twospirit, and other sexual and gender minorities (LGBTQ2S+) in Canada, studies that centre the material conditions of these groups as sites of inquiry remain scant. Accordingly, in this paper we present an intersectional narrative review of the limited Canadian literature on LGBTQ2S+ poverty. We examine 39 studies, published between 2000 and 2018, that report Canadian data on poverty in LGBTQ2S+ youth, older adults, racial minorities, and Indigenous groups. We highlight intersectional differences reflected across these axes of social location, and consider research, policy, and practice implications of our analysis.
Considerations for community engagement when conducting clinical trials during infectious disease emergencies in West Africa
(2019) Folayan, Morenike Oluwatoyin; Allman, Dan; Haire, Bridget; Yakubu, Aminu; Afolabi, Muhammed O; Cooper, Joseph
Community engagement in research, including public health related research, is acknowledged as an ethical imperative. While medical care and public health action take priority over research during infectious disease outbreaks, research is still required in order to learn from epidemic responses. The World Health Organisation developed a guide for community engagement during infectious disease epidemics called the Good Participatory Practice for Trials of Emerging (and Re-emerging) Pathogens that are Likely to Cause Severe Outbreaks in the Near Future and for which Few or No Medical Counter-Measures Exist (GPP-EP). This paper identified priorities for community engagement for research conducted during infectious disease outbreaks drawing on discussions held with a purposive sample of bioethicists, social scientists, researchers, policy makers and laypersons who work with ethics committees in West Africa. These perspectives were considered in the light of the GPP-EP, which adds further depth and dimension to discussions on community engagement frameworks. It concludes that there is no presumptive justification for the exclusion of communities in the design, implementation and monitoring of clinical trials conducted during an infectious disease outbreak. Engagement that facilitates collaboration rather than partnership between researchers and the community during epidemics is acceptable.
Articulating connections between the harm-reduction paradigm and the marginalisation of people who use illicit drugs
(2016-07) Souleymanov, Rusty; Allman, Dan
In this paper, we argue for the importance of unsettling dominant narratives in the current terrain of harm-reduction policy, practice and research. To accomplish this, we trace the historical developments regarding the Human Immunodeficiency Virus (HIV), the Hepatitis C Virus (HCV) and harm-reduction policies and practice. We argue that multiple historical junctures rather than single causes of social exclusion engender the processes of marginalisation, propelled by social movements, institutional interests, state legislation, community practices, neo-liberalism and governmentality techniques. We analyse interests (activist, lay expert, institutional and state) in the harm-reduction field, and consider conceptualisations of risk, pleasure, stigma, social control and exclusionary moral identities. Based on our review of the literature, this paper provides recommendations for social workers and others delivering health and social care interested in the fields of substance use, HIV prevention and harm reduction.
Introduction to the Culture, Health & Sexuality Virtual Special Issue on sex, sexuality and sex work
(2016-12) Allman, Dan; Ditmore, Melissa Hope
This article provides an editorial introduction to a virtual special issue on sex work and prostitution. It offers a brief history of sex work studies as published in the journal Culture, Health & Sexuality; reflects on the breadth and scope of papers the journal has published; considers the contribution of the journal's papers to the wellbeing and sexuality of people who sell sex; and envisions future areas of inquiry for sex work studies. As authors, we identify major themes within the journal's archive, including activism, agency, context, discourse, hazard, health, legalisation, love, place, power, race, relationships, stigma and vulnerabilities. In particular, we reflect on how HIV has created an environment in which issues of culture, health and sexuality have come to be disentangled from the moral agendas of earlier years. As a venue for the dissemination of a reinvigorated scholarship, Culture, Health & Sexuality provides a platform for a community of often like-minded, rigorous thinkers, to provide new and established perspectives, methods and voices and to present important developments in studies of sex, sexuality and sex work.
In-situ Measurement of Ventilation and Impacts of Filtration on IEQ and Energy use of Residential Buildings
(2019-11) Alavy Ghahfarrokhy, Seyed Masih; Siegel, Jeffrey A; Civil Engineering
Indoor environmental quality (IEQ) impacts of filters in residential HVAC systems is a strong function of many HVAC system- and building-specific parameters. Furthermore, the energy consequences of filters can be important, and the magnitude and the sign of these energy impacts are system-specific as well. These system- and building-specific parameters can vary not only over different residential buildings, but also over the lifetime of a filter in a given building. A primary building-specific parameter that varies greatly over time is outdoor ventilation air change rate (ACR). ACR is not only an important particle removal mechanism, and a source of variations in filter IEQ performance, but it also is an important contributor to energy use in buildings. This work first critically reviews the existing literature on filtration and then presents an integrated evaluation of the overall IEQ and energy performance of higher efficiency residential filters. It also further develops the understanding of how ACR varies over time and how it influences filtration performance in residences. Yearlong measurement results from particle removal performance analysis of four different high efficiency filters placed in 21 residences in Toronto, Ontario showed that there was more variation in filter performance between the same filter in different homes than there was between different filters in the same home. In addition, increasing system runtime (ontime fraction) could also lead to higher particle removal impacts of filters. Study of energy consequences of the same filters in the same homes showed that fan energy consequences of high efficiency filters are negligible and because HVAC runtimes were generally low (median = 9.6%) in this sample of homes, the difference between energy consumption of different types of motor fans at typical runtimes was small (less than 10 kWh per month). Yearlong ACR measurements showed that ACR is a temporally dynamic parameter with timescales of minutes that varies considerably over long-term periods (e.g., geometric mean = 0.47/h, geometric standard deviation = 3.44 in one of the residences studied). Overall, this dissertation provides new methods and data for assessing the ventilation performance and impacts of filtration on IEQ and energy use of residential buildings.
Economic Predictors of Household Food Insecurity in Canadian Metropolitan Areas
(Taylor and Francis, 2016-01-12) Sriram, Urshila; Tarasuk, Valerie
In Canada, household food insecurity is largely an urban problem, but there is little understanding of how the conditions in urban areas influence households[#x02019] vulnerability. The present study used data on 42 355 households from the 2011[#x02013]2012 Canadian Community Health Survey to examine the influence of local area economic characteristics on household food insecurity in 20 census metropolitan areas. Substantial variability in food insecurity rates was observed across metropolitan areas, with part of this variation being attributed to differences in costs of living. Higher area-level shelter costs were associated with elevated household food insecurity risk, independent of household sociodemographic characteristics. This finding suggests that strategies to ensure affordable housing can mitigate the burden of household food insecurity at a local level.
Prioritization of the essentials in the spending patterns of Canadian households experiencing food insecurity
(Cambridge University Press, 2018-03-21) Fafard St-Germain, Andrée-Anne; Tarasuk, Valerie
Objective: Food insecurity is a potent determinant of health and indicator of material deprivation in many affluent countries. Food insecurity is associated with compromises in food and housing expenditures, but how it relates to other expenditures is unknown. The present study described households' resource allocation over a 12-month period by food insecurity status. Design: Expenditure data from the 2010 Survey of Household Spending were aggregated into four categories (basic needs, other necessities, discretionary, investments/assets) and ten sub-categories (food, clothing, housing, transportation, household/personal care, health/education, leisure, miscellaneous, personal insurance/pension, durables/assets). A four-level food insecurity status was created using the adult-specific items of the Household Food Security Survey Module. Mean dollars spent and budget share by food insecurity status were estimated with generalized linear models adjusted first for household size and composition, and subsequently for after-tax income quartiles. Setting: Canada. Subjects: Population-based sample of households from the ten provinces (n 9050). Results: Food-secure households had higher mean total expenditures than marginally, moderately and severely food-insecure households (P-trend <0·0001). As severity of food insecurity increased, households spent less on all categories and sub-categories, except transportation, but they allocated a larger budget share to basic needs and smaller shares to discretionary spending and investments/assets. The downward trends for dollars spent on basic needs and other necessities became non-significant after accounting for income, but the upward trend in the budget shares for basic needs persisted. Conclusions: The spending patterns of food-insecure households suggest that they prioritized essential needs above all else.
Individual and jurisdictional factors associated with voluntary HIV testing in Canada: Results of a national survey, 2011
(2015) Worthington, Catherine A; Calzavara, Liviana M; White, Samantha J; Allman, Dan; Tyndall, Mark W
Objective: HIV testing remains a central strategy for HIV prevention for its ability to link those who test positive to treatment and support. In Canada, national guidelines have recently changed as part of standard primary care to recommend voluntary HIV testing for those aged 16-64 years. Using results from a nationally representative survey, we examined individual and jurisdictional factors associated with voluntary testing. Methods: A total of 2,139 participants were sampled using a regionally stratified, two-stage recruitment process. English or French interviews (by phone or online) were conducted during May 2011. Voluntary testing was defined as testing at least once for reasons other than blood donation, insurance purposes, immigration screening or research participation. Weighted logistic regression analysis (including socio-demographic, sexual activity, HIV/AIDS knowledge and jurisdictional factors of HIV prevalence and anonymous testing availability) were conducted for the overall sample, and stratified by sex. Results: Twenty-nine percent (29%) of survey participants reported at least one lifetime voluntary HIV test. For the full-sample model, the following were associated with increased odds of testing: age <60 years, female sex, sexual minority status, perceived HIV knowledge, casual sex partner in previous year, and living in a higher-prevalence jurisdiction. For men, the strongest factor related to testing was sexual minority status (OR = 5.15, p < 0.001); for women, it was having a casual sex partner in the previous year (OR = 2.57, p = 0.001). For both men and women, residing in a jurisdiction with lower HIV prevalence decreased odds of testing. Discussion: Sex differences should be considered when designing interventions to increase testing uptake. Jurisdictional factors, including HIV prevalence and testing modality, should be investigated further.
Clinical trials as an industry and an employer of labour
(2011) Folayan, Morenike O; Allman, Dan
To produce drugs, clinical trials depend upon the labour of volunteer participants. For ethical reasons, participants are described as volunteers because to position them otherwise could be considered undue inducement. By using a labour market perspective, we argue that clinical trial participants may be understood as workers. Ethical guidelines argue that remuneration for ‘work done’ by participants in research may result in coercion: research participants will feel obliged to remain in a research trial despite any discomfort and distress simply because of remunerations received. However, we suggest that monetary benefits – in the form of wages – for research participants are no more coercive than the existing and accepted level of inducement. In our commentary, we review clinical trial conduct as it has evolved over the past two decades, the changing investments in this multi-million dollar industry, the ways in which beneficiaries and benefits are conceptualized and how these framings fall short. While it is acknowledged that framing research participants as labourers through the payment of wages has the potential to entrench inequities, we argue that it opens space to consider ways to link global health to the economic empowerment of individuals. Recognizing volunteers not as participants but as ‘workers’ has the capacity to widen the discourses on bioethics as a relevant and powerful counterweight to the injustices of the world today.
Challenges for the sexual health and social acceptance of men who have sex with men in Nigeria
(2007) Allman, Dan; Adebajo, Sylvia; Myers, Ted; Odumuye, Oludare; Ogunsola, Sade
Little research exists regarding men who have sex with men and sexual risk in Nigeria. Prior to the implementation of a targeted HIV/STI prevalence study, structured focus groups incorporating anonymous questionnaires were conducted with members of this population in secure locations in Nigeria. A purposive sample of men was recruited by word-of-mouth. Five focus groups were conducted with a total of 58 men. Mean age was 27 years (range 16-58); 60% had post-secondary education; 56% were employed full or part-time; 83% were Christian; 16% were Muslim; 66% self-identified as bisexual; 31% as homosexual. Participants' experiences were diverse, with ethnic, religious and class distinctions strongly structuring sexual expression. Same-sex community networks were hidden, with social activities taking place in non-commercial, private venues. Socially ostracized by culture, religion, and political will, the risks embodied within same-sex activity are high. For Nigeria--a nation culturally rich and religiously devout--the implications for public health policy are complex. However, these research findings suggest that immediate action is vital to mitigate the impacts of HIV and other STIs.

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