To address immigrant health disparities, timely evidence-informed, equity-based, and community-engaged policy solutions are urgently needed. In this project we will be using population-based analyses and mixed methods contextual analyses to explicate preventable health inequities experienced by immigrant communities in Canada. Our consultation with BC, AB, and ON migrant community partners, the national CIHR Youth Health Advisory, and other groups have identified two main priority areas: mental health (all ages) and sexual health (youth), along with food insecurity, discrimination, and other social determinants of health that can influence these priority health issues. Large-scale, regularly repeating health surveys in Canada create the opportunity to identify trends in health disparities among migrant populations. We will be conducting 20 years trends in sexual and mental health outcomes among migrant youth in Western Canada. We will work on identifying correlates and social determinants that help explain health inequities in sexual and mental health for migrant youth populations, especially for LGBTQ+ migrant youth, racialized migrant youth, and refugee youth in particular. Additionally, we will identify health disparities among homestay student compared to their migrant peers.

Leads: Elizabeth Saewyc (University of British Columbia), and Josephine Wong (Toronto Metropolitan University)
Co-Investigator: Abdul-Fatawu Abdulai, Assistant Professor, School of Nursing
Project Manager: Monica Rana
SARAVYC Team: Mauricio Coronel Villalobos, Helen Okoye, Marie Louise Umwangange, Daniel Ji, Yeshvi Mehta
Funded by: Canada First Research Excellence Fund

The project will adapt Girl2Girl (a text messaging-based teen prevention pregnancy program (TPP) program designed for cisgender sexual minority girls) to create #TranscendentHealth, a gender inclusive TPP for transgender boys. The adaptation will build upon our prior success of Girl2Girl by updating the content so that it addresses the important social and structural influences of the sexual behavior of gender-diverse youth, including significant social stressors, discrimination, and rejection. Acknowledging the importance of primary (universal) prevention, both sexually experienced and inexperienced youth will be included.

Specifically, the project aims to:

Aim 1: With ongoing feedback from transgender boys, adapt Girl2Girl for gender inclusivity
Aim 2: Test the resulting adaptation, named #TranscendentHealth, in a national RCT of trans boys 14-18 years of age.

Principal Investigators: Michelle Ybarra, Elizabeth Saewyc
Research Team: Monica Rana, Adi Ferrara and Jimmy Chokmeesuk

This study is an evaluation of the substance use, mental health, and wrap-around care provided to marginalized young people by the non-profit organization Dan’s Legacy.

Principal Investigator: Elizabeth Saewyc
Research Team: Monica Rana, Yeshvi Mehta
Funded by: Health Canada

Beginning in 2016 in British Columbia (BC), a program called Sexual Orientation and Gender Identity (SOGI) 1 2 3 was implemented in BC’s elementary and secondary schools, with the goal of creating safe and inclusive environments for students of all genders and sexual orientations. This program is therefore the first of its kind in Canada, and seeks to address the health gap between sexual minority students and their heterosexual peers. The program was created by the ARC Foundation, in collaboration with the BC Teachers’ Federation, the BC Ministry of Education, University of British Columbia’s Faculty of Education, and several local and national LGBTQ2S+ organizations.

Given that SOGI 1 2 3 has only been active for up to five years in BC schools, there has been little research conducted on the program and its effect on the health of sexual minority students. In 2017, the BC Centre for Disease Control (BCCDC) commissioned an academic study of SOGI 1 2 3’s pilot year, which found that the program was already having a positive impact on student mental health, bullying and harassment, and school climate. However, given that this study focused on the pilot year of the program, it’s insights were limited to nine school districts and could not look at the program’s impact over multiple years. This study will build off of the findings from this initial study and aim to evaluate SOGI 1 2 3 as a program, now that it has been implemented for five years. Hence, this study will seek to evaluate both the program’s implementation in elementary and secondary schools, and its efficacy in improving the health, wellbeing, and safety of sexual minority students and their heterosexual peers.

Principal Investigator: Dr. Elizabeth Saewyc

Research Team:
Monica Rana, Managing Director, SARAVYC, School of Nursing, UBC
Mauricio Villalobos Coronel, Research Associate, SARAVYC, School of Nursing, UBC
Ley Fraser, Research Assistant, SARAVYC, School of Nursing, UBC

Reaching street-involved and homeless youth (SIY) and enabling them to make use of the many evidence-based HIV prevention and treatment interventions like antiretrovirals (ART) is critical to achieving the global goal declared by the United Nations of zero new infections and zero HIV deaths by 2030. Canadian sites (London, Toronto, Vancouver) and Kenyan sites (Pioneer and Kitale) all have many underserved SIY who bear a high burden of uncontrolled HIV. This study proposes to adapt and scale-up a peer-based intervention among SIY in these centres to increase uptake of HIV prevention, testing, and treatment as needed.

The objectives of the phase 1 of the study are:
Objective 1: Evaluate and explore the acceptability and appropriateness of the Peer Navigator (PN) intervention from the perspectives of SIY, healthcare providers, and community stakeholders.

Objective 2: Characterize the adaptations needed in the intervention in and across the local contexts and to describe community-informed enhancements needed to make the intervention work well in each setting in terms of linkage to HIV services.

Principal Investigator: Dr. Alex Abramovich (Toronto)

Principal Investigator (Vancouver Site): Dr. Elizabeth Saewyc

Co-Investigators: Dr. Abe Oudshoorn (London, Ontario), Dr. David Ayuku (Huruma, Kenya)

Research Team (Vancouver Site):
Dr. Monica Rana, Managing Director, SARAVYC, School of Nursing, UBC
Dr. Adi Ferrara, Postdoctoral Research Fellow, SARAVYC, School of Nursing, UBC

Funded by: CIHR “Adapting and scaling up “Peer Navigators” to targeted populations of street-involved youth in Canada and Kenya to increase linkage to HIV prevention, testing, and treatment”

Fostering healthy relationships among LGBTQ2S+ youth in British Columbia

Gender-based violence disproportionately affects people who identify as LGBTQ2S+ and gender non-conforming individuals. Trend analyses of the province-wide BC Adolescent Health Survey tell us that lesbian, gay, or bisexual youth are three to six times more likely to experience dating violence than their straight peers. In addition, our Canadian Trans Youth Health Survey finds trans and non-binary youth report even higher rates of dating violence.

Adolescence is a key time to provide young people with the knowledge and skills to develop healthy relationships that are free from violence and abuse. SARAVYC has partnered with the McCreary Centre Society and their Youth Research Academy to develop, implement, and evaluate a healthy relationship intervention with LGBTQ2S+ youth for LGBTQ2S+ youth in British Columbia.

Objectives

Develop and facilitate education modules

In collaboration with youth, we will develop education modules focused on preventing dating violence for LGBTQ2S+ adolescents. We will pilot the intervention across British Columbia, meeting queer youth in the spaces they tend to frequent— Gender Sexuality Alliance Clubs (GSAs) and LGBTQ2S+ youth community groups. We will then scale up across the country.

The proposed intervention, developed with LGBTQ2S+ youth for LGBTQ2S+ youth, incorporating trauma-informed and culturally safe approaches, should help foster healthier relationships, prevent or reduce dating violence, and in turn, reduce the health inequities faced by LGBTQ2S+ youth as a result of stigma and trauma.

At the completion of these modules, participants will:

• Have greater awareness of dating violence in LGBTQ2S+ relationships
• Be able to identify both dating violence behaviours and healthy relationships
• Experience role playing conflict management and learn effective strategies in relationships
• Define strategies for being effective bystanders and supportive friends to peers in violent dating relationships

Evaluate intervention

We will conduct surveys to evaluate the intervention and its impact on knowledge, motivation to change attitudes, and influence on behaviours that support healthy relationships.

Identify barriers

By interviewing teachers, counselors, and facilitators, we will identify barriers and improvements to support a country-wide intervention. Without these learned lessons, the most effective intervention is limited.

Measure Impact

Using BC Adolescent Health Survey (BCAHS) data from before and after the intervention, we will measure potential shifts in dating violence behavior among LGBTQ2S+ youth.

Deliverables

• An online, downloadable manual (available in English and French)
• Train the Trainer workshops throughout British Columbia
• Infographics about the intervention and its outcomes (available in French and English)
• Peer-reviewed papers
• Pre and post-intervention surveys and interviews

Our team

SARAVYC

The SARAVYC team is led by:

• Dr. Elizabeth Saewyc, Executive Director
• Dr. Mauricio Colonel Villalobos, Post Doctoral Fellow
• Dr. Monica Rana, Project Manager
• Quantitative and qualitative graduate research assistant

McCreary Centre Society

McCreary Centre Society (MCS) is a non-government, not-for-profit committed to improving the health of BC youth through research, evaluation and community based projects. Our vision is that all youth are supported to be healthy and connected. MCS has extensive experience coordinating youth engagement in research projects relevant to youth in British Columbia. The MCS team is led by:

• Annie Smith, Executive Director
• McCreary Centre facilitators
• Youth Research Academy

SARAVYC has developed an innovative, award-winning method of studying site-level longitudinal effects of population health interventions (SLEPHI) that can be applied to site-level research in any field.

Using the SLEPHI method, SARAVYC is evaluating recent and previous British Columbia Adolescent Health Surveys to explore the impact of GSAs (Gay Straight Alliances or Gender Sexuality Alliances). Our study into their impact on student health, found that GSAs make schools safer not only for LGBTQ2S+ students, but for all students. The research also revealed that the longer a GSA exists, the safer students feel.

Our goal now, is to use the SLEPHI method to explore other impacts of GSAs, including specific outcomes among ethnic minority LGB youth, and how GSAs effect school connectedness, bullying, and suicide.

Principal investigator: Dr. Elizabeth Saewyc

Co-authors: Gu Li, Amery D. Wu, Sheila K. Marshall, Ryan J. Watson, Jones K. Adjei, Minjeong Park, Mauricio Coronel Villalobos

Funded by: Canadian Institutes of Health Research

Research shows that although lesbian, gay, and bisexual (LGB) youth have poorer mental and physical health outcomes compared to their heterosexual peers, school-connectedness and supportive and caring relationships with their families have a positive impact on their health. However, little is known about how health outcomes differ for LGB youth of various ethnocultural backgrounds, or how sexual orientation might affect relationships between parents and children from different ethnocultural groups. To address this gap, we will be analyzing data from the BC Adolescent Health Survey to: (1) identify differences in health outcomes and trends between heterosexual and LGB youth from Indigenous, East Asian, and South Asian ethnocultural backgrounds; and (2) document the roles of families and schools in health outcomes within these groups.

Advisory committees (composed of youth, family members, health professionals, teachers, counselors and other community members) are being recruited for each of the ethnocultural groups. These committees will inform our study’s analyses, as well as the resulting knowledge translation materials and activities (e.g., pamphlets, presentations, infographics). Findings will be shared in academic journal articles and community reports, and will inform future culturally-respectful health promotion activities for LGB youth from diverse ethnocultural backgrounds.

This project is the Core of our 7 year Canadian Institutes of Health Foundation Grant, “Improving health equity for LGBTQ youth in Canada and globally: Addressing the role of families and culture”.

Principal Investigator: Dr. Elizabeth Saewyc

Co-Investigators: Dr. Terryann Clark, Dr. Hélène Frohard-Dourlent, Emmanuelle Godeau, Lorraine Grieves, Dr. András Költő, Dr. Jennifer Kryworuchko, Dr. Sheila Marshall, Dan Metzger, Dr. Colleen Poon, Dr. Stephen Russell, Dr. Hilary Rose, Annie Smith, Dr. Jaimie Veale, Dr. Jennifer Wolowic, Dr. Michele Ybarra

Funded by: CIHR (Foundation Scheme) under the grant, “Improving health equity for LGBTQ youth in Canada and globally: Addressing the role of families and culture”, 2017-2024