British Columbia Adolescent Health Survey Research Articles

Health status and missed care among youth in care in British Columbia, Canada: A population study

PurposeYouth in care (YIC) are a marginalized population with high health care needs and barriers to access, resulting in lifelong health disparities. This study examines the health of Canadian YIC and their engagement with the Canadian health care system on a population level. MethodsData were retrieved from the 2018 British Columbia Adolescent Health Survey, a cross-sectional population survey of Grade 7–12 students (ages 12–19 years) in British Columbia, Canada (n = 38,015). Primary outcomes were self-rated general health and mental health, missed medical care, and missed mental health care among YIC. Secondary outcomes included health care access and gender differences. Multivariate analyses adjusted for age, gender, and food insecurity. ResultsYIC represented 1.9 % of the weighted sample population. Compared to non-YIC, YIC accessed health care more frequently from mental health professionals and youth-focused clinics and less frequently from family physicians. YIC reported worse general health (AOR 1.81 [99 % CI 1.40–2.34]) and mental health (AOR 1.81 [99 % CI 1.42–2.32]) than non-YIC. Adjusted for health status, YIC experienced more missed medical care (AOR 1.96 [99 % CI 1.46–2.62]) but comparable missed mental health care to non-YIC. Significant barriers for YIC included negative health care experiences and transportation. Among YIC, female and non-binary genders also had increased risk for worse health and missed care compared to males. ConclusionsYIC in Canada have inequitably unmet health care needs. Many complex factors contribute to this disparity and its correlation with out-of-home care. Further action is needed to reduce health care barriers for YIC.

Associations between problem technology use, life stress, and self-esteem among high school students

BackgroundAdolescence is a critical period for development, with many risk factors resulting in long-term health consequences, particularly regarding mental health. The purpose of this study was to examine the associations between problem technology use, life stress, and self-esteem in a representative sample of adolescents residing in Ontario, Canada.MethodsSelf-reported data were obtained from a cross-sectional sample of 4,748 students (57.9% females) in grades 9 to 12 (mean age: 15.9 ± 1.3 years) who participated in the 2019 Ontario Student Drug Use and Health Survey. Problem technology use was measured using the 6-item Short Problem Internet Use Test, life stress was assessed using an item from the British Columbia Adolescent Health Survey and self-esteem was assessed using a global measure from the Rosenberg Self-Esteem Scale. Ordinal logistic regression models were adjusted for age, sex, ethnoracial background, subjective socioeconomic status, body mass index z-score, tobacco cigarette smoking, alcohol consumption and cannabis use.ResultsWe found that 18.3% of participants reported symptoms of moderate-to-high problem technology use, although symptoms were more common in females than males (22% vs. 14.7%, respectively). Moderate-to-high problem technology use was associated with 2.04 (95% CI: 1.77–2.35) times higher odds of reporting high life stress and 2.08 (95% CI: 1.76–2.45) times higher odds of reporting low self-esteem compared to all other response options.ConclusionsFindings from this study show that problem technology use is strongly associated with higher life stress and lower self-esteem in adolescents. This study supports the importance of developing and implementing effective strategies that help to mitigate the adverse effects of problem technology use on adolescent mental health.

Racism as a social determinant of health: Link to school-related psychosocial stressors in a population-based sample of African adolescents in Canada.

Racism is a social determinant of health that links to the health and well-being of racial/ethnic marginalized populations. However, perceived racism among African Canadian adolescents has not been adequately addressed, especially the link between racism and psychosocial stressors in school settings. The aim of the current study was to assess racism and the link to school-related psychosocial stressors in a population-based sample of African Canadian adolescents. Secondary analysis of the population-based 2018 British Columbia Adolescent Health Survey dataset. Logistic regression and generalized linear models tested the link between racism and psychosocial stressors among African Canadian adolescents (n = 942), adjusting for sociodemographic factors. More than 38% of the adolescents reported racism in the year preceding the survey. Regardless of gender and birthplace, and controlling for covariates, those who experienced racism were significantly more likely to report peer victimization, which includes teasing, social exclusion, cyberbullying and sexual harassment, and they felt less safe and connected to their schools compared to those who did not experience racism. With gender and birthplace differences, those who reported racism had higher odds of having been physically assaulted, stayed away from school, reported negative emotional responses and used avoidant behaviours to evade racism. African Canadian adolescents are a visible racialized ethnic group in British Columbia, who are at heightened risk of racism and the associated psychosocial stressors. These findings demonstrate the influences of racism on psychosocial stressors and related emotional responses among African Canadian adolescents. Nurses and other healthcare providers should be cognizant of racism and the psychological impacts when providing care to "at-risk" populations. Promoting positive and inclusive school climates and addressing racism at all levels of the society will foster better social integration, as well as improve the health and academic achievement of African Canadian adolescents. We presented the research and preliminary results of the data analysis to the African community (parents and adolescents who self-identify as African). The African community who attended the gathering corroborated the link between racism and health and reiterated that addressing these psychosocial stressors can promote adolescent health and well-being. The attendees accepted all the variables that we included in the analysis. However, they emphasized the need for more African representation among school staff and teachers to foster trust, feelings of safety and connectedness, and to promote African students' academic achievement and well-being. They stressed the need to train and build the capacities of the school staff and teachers so that they can assist students regardless of race. They emphasized the need to promote cultural awareness and cultural sensitivity among all healthcare providers. We included the recommendations in the appropriate sections of the manuscript.

Trends and Disparities in Suicidality Among Heterosexual and Sexual Minority/Two-Spirit Indigenous Adolescents in Canada

PurposeTo explore trends in sexual orientation group differences in suicidality among Indigenous adolescents and evaluate whether gaps between heterosexual and sexual minority/Two-Spirit adolescents have changed over time. MethodsLeveraging pooled school-based population data from five waves of the British Columbia Adolescent Health Survey (1998–2018), we used age-adjusted logistic regression models, separately for boys and girls, to examine 20-year trends and disparities in past year suicidal ideation and suicide attempts among heterosexual and sexual minority/Two-Spirit Indigenous adolescents (N = 13,788). ResultsSuicidal ideation increased among all sexual orientation groups in 2018 compared to previous survey waves. Suicide attempts spiked for heterosexual girls in 2003, remained stable for heterosexual boys, and decreased for sexual minority/Two-Spirit boys and girls over time. Compared to their heterosexual peers, sexual minority/Two-Spirit boys had higher odds of suicidal ideation since 1998, whereas sexual minority/Two-Spirit girls had higher odds of suicidal ideation since 2003. Sexual minority/Two-Spirit (vs. heterosexual) boys were approximately 4–7 times more likely to attempt suicide since 2008, whereas sexual-minority/Two-Spirit (vs. heterosexual) girls were approximately 3–4 times more likely to attempt suicide since 2003. These gaps in suicidality were persistent across time. DiscussionSexual minority/Two-Spirit Indigenous adolescents are at an elevated risk for suicidality compared to their heterosexual Indigenous peers. While trends of suicidal ideation worsened for all Indigenous adolescents, suicide attempts either lessened or remained stable over time. Greater efforts are needed to help reduce suicidality among Indigenous adolescents in Canada, especially among sexual minority/Two-Spirit young people.

Identifying trans and non-binary youth in population-based school health surveys in western Canada

Abstract Background Most research about gender-diverse adolescents is with clinical samples, skewing population estimates of health and risk. With trans youth estimated at around 0.5% of the population and no reliable measures, school health surveys have not asked gender diversity items. In 2018, the British Columbia Adolescent Health Survey (BCAHS) in Canada trialled measures to differentiate cisgender, trans, and non-binary youth, to capture a representative picture of health for gender-diverse young people. Methods The 2018 BCAHS is a stratified random survey of 2,175 classrooms of grades 7-12 (ages 12-19) in 58/60 school districts province-wide (N = 38,015). Two measures asked about sex assigned at birth and current gender identity, combined to identify cisgender boys and girls, trans boys, trans girls, non-binary and questioning youth. We examined patterns of missingness by demographics. Results Overall, nearly 99% of youth responded to both items, with very low missing (0.5% for sex, 0.8% gender identity) with no differences by school or district, or by age. Missing responses were higher among international students and English language learners but still low (1.1%). Youth living in foster care or with a disability or chronic condition also had higher odds of skipping both items, but the highest missing was only 3.7% among youth with FASD. Overall, 48.9% identified as cis girls, 48.6% as cis boys, 0.13% as trans girls, 0.33% trans boys, 0.75% non-binary, and 1.28% as not sure (479 trans/non-binary, and 484 unsure). Preliminary analyses show positive assets also support gender diverse youth well-being. Conclusions A two-step measure of gender identity is feasible for adolescents as young as 12 years old in large scale school surveys, with very low missing responses in western Canada. Although <1% identified as trans, in large samples stable estimates for population comparisons are possible. Future studies should pilot gender identity measures in other nations/languages.

8.O. Workshop: Developmental assets and resilience in gender minority youth: Towards a balanced research agenda

Abstract Since the late 1990s, health inequalities among sexual and gender minority (SGM) youth have been increasingly recognised and investigated. However, most studies have been conducted in North America, while the research landscape in Europe is bleak. Gender minority (e.g. transgender, non-binary, genderqueer and genderfluid) youth receive even less attention than their sexual minority peers (e.g. those identifying as lesbian, gay and bisexual). A growing number of researchers recognise that the studies so far have concentrated on the disproportionate burden SGM youth face across various health outcomes. This maintains a discourse depicting SGM young people as ‘victims' and ‘at risk'. This individualistic approach is problematic because it often fails to consider macro-level determinants of these health inequalities, including societal attitudes towards SGM individuals; processes of structural stigma; lack of visibility and positive role models; and erasure of SGM identities. There is evidence that many SGM youth live happy and balanced lives and have developed resilience in face of adversities. There are developmental assets and positive features associated with being an SGM young person, for instance ‘coming out growth' and a sense of authenticity; support from family and peers; sense of belonging and connectedness to LGBTI+ communities; and civic engagement and community work. We argue that future research should consider these and other developmental assets and positive factors and embrace them in their design. This does not mean that risk factors or existing health inequalities and their determinants (e.g. structural stigma and minority stress) should be downplayed or minimised. A balanced approach is needed, which strives to also understand the empowering factors that contribute to SGM youth resilience, and developmental ‘assets' which help them to grow and flourish. This workshop will present work of key researchers in the area of gender minority youth research in Europe and North America, including findings from evidence synthesis, methodological developments and concrete evidence on developmental assets. The first presentation by Elena Vaughan et al. will showcase a two-phased landscape and knowledge gap study which synthesises European research with SGM youth. Concepcion Moreno-Maldonado et al. will present evidence on how community engagement among gender minority youth in Spain is associated with health-related quality of life. Ashley Taylor et al. will introduce findings from the Canadian Trans Youth Health Survey on the importance of having positive role models for gender minority young people. In the final presentation, Elizabeth M. Saewyc will showcase how gender minority youth were identified in the British Columbia Adolescent Health Survey. Following the presentations, we look forward to discussing the findings and future perspectives on health research with gender minority youth with attendees. Key messages Research on gender minority youth has largely concentrated on risk factors and maintained a ‘victim’ discourse, while developmental assets and sources of resilience receive less attention. Researchers from Europe and North America present evidence on the positive aspects of gender minority young people’s lives and argue for a more balanced perspective for future studies.

Community lives of adolescents across multiple special needs: Discrimination, community belonging, trusted people, leisure activities, and friends.

We sought to gain insights into the community lives, experiences, and activities of adolescents across multiple categories of special needs. Specifically, we: explored the particular aspects of their lives adolescents felt elicited discrimination; determined whether adolescents feel a sense of community belongingness, as well as the categories of people whom adolescents approach when help is needed; and detailed the leisure activities respondents undertake and with which frequency, in addition to the quantity of friendships they have.We performed assorted descriptive analyses of the McCreary Centre Society's 2013 British Columbia Adolescent Health Survey (BCAHS) database.We found tremendous variation in the survey responses of adolescents, both within and between special needs categories, highlighting the importance of such exploratory analyses.This paper provides inductive population-based evidence to inform theories about the community lives of adolescents with special needs, as well as to guide programs and policies targeting such youth.

92 Substance Use of Adolescents across Multiple Categories of Health Conditions and/or Disabilities: A Population-Based Study

Abstract Background Substance use among adolescents with health conditions and disabilities is an important issue in public health and pediatrics that warrants further study. Existing research typically investigates one type of health condition and/or disability, which limits understanding of how substance use is similar or different across various sub-groups. By including multiple sub-groups and adolescents who report no conditions, the results of our research could be used to inform targeted interventions and supports. Objectives The purpose of this study was to investigate substance use among adolescents across multiple categories of health conditions and/or disabilities using data from the 2013 British Columbia Adolescent Health Survey (BCAHS) (see Table 1). The research objectives were: 1) to determine the number of (categories of) substances used by survey respondents; 2) to investigate the occurrence (frequency) of respondents’ substance use; 3) to explore the consequences of their substance use; and 4) to ascertain the reasons for their substance use. Design/Methods This was a secondary analysis of data from the 2013 British Columbia Adolescent Health Survey, which is quinquennially administered by the McCreary Centre Society. The BCAHS is a large-scale survey designed to capture information about adolescents’ physical and emotional health, and about factors that can influence health during adolescence and in later life. The study population consisted of a total provincial weighted N = 251,641 of adolescents from 56 (of 59) school districts who attended Grade 7 to Grade 12 in the 2012/2013 school year. We performed a series of descriptive statistical analyses on the person-level database, including frequencies and cross-tabulations. Statistical analyses were conducted using the Complex Samples module of IBM SPSS Statistics, Version 24 (IBM Corp, 2016), which facilitates the computation of statistics and standard errors from complex sample designs while adjusting for the complex cluster-stratified sampling method and weighted data by integrating sample designs into survey analysis. Results The results indicated great diversity, both within and between categories of health conditions and/or disabilities. In particular, we found that youth in three categories: those with mental or emotional needs, those with behavioural needs, and those with two or more conditions were i) using the greatest number of (categories of) substances, ii) using substances most frequently, and iii) were experiencing the most severe consequences as a result of substance use. Conclusion Clearly there is a need for greater access to mental health supports, including assessment and treatment, for adolescents. Further, given that youth with two or more conditions were also more likely to engage in substance use, there is a need for complex care programs to support this sub-group. Lastly, as adolescents are approaching the transition from pediatrics to adult healthcare services, substance use programming that bridges these developmental stages is needed.

The link between LGBTQ-supportive communities, progressive political climate, and suicidality among sexual minority adolescents in Canada

Despite supportive structural changes to reduce stigma towards lesbian, gay, and bisexual, transgender, queer, and questioning (LGBTQ) Canadian residents, sexual minority youth still face disparities compared to heterosexual peers. We aimed to characterize LGBTQ-supportive environments and political climates, and examine their links to suicidal behavior among sexual minority adolescents in western Canada. Data were from the 2013 British Columbia Adolescent Health Survey, a cluster-stratified random cross-sectional survey of public school students in BC, Canada; We sampled 2678 self-identified LGB and mostly heterosexual students (69% girls) from 274 schools, representing an estimated provincial population of 24,624 sexual minority students in weighted models. Student reports of past-year suicidal ideation, suicidal attempts, and self-harm behaviors were merged with community-level data assessing diverse aspects of LGBTQ-supportive resources and progressive political climates in communities surrounding the schools. Adjusted multilevel models showed that for sexual minority adolescent girls, higher community LGBTQ-supportiveness predicted marginally significant lower suicidal ideation (aOR = 0.94, 95% CI [0.88, 1.01]) and suicidal attempts (aOR = 0.91, 95% CI [0.83, 1.00]) and significantly lower self-harm behaviors (aOR = 0.91, 95% CI [0.85, 0.98]). Further, progressive political climates predicted marginally significant lower suicidal ideation (aOR = 0.89, 95% CI [0.78, 1.02]) and significantly lower self-harm behaviors (aOR = 0.87, 95% CI [0.77, 0.99]). For sexual minority adolescent boys, no community-level variables were associated with suicidal behavior in adjusted models. Thus, LGBTQ-supportive communities and progressive political climates appear to be protective against suicidal behavior among sexual minority adolescent girls, but not sexual minority adolescent boys.

Associations Between Community-Level LGBTQ-Supportive Factors and Substance Use Among Sexual Minority Adolescents

Purpose: Using representative school-based data and community-level primary data, we investigated how environmental factors (e.g., school and community climate) might be protective against substance use behaviors among a vulnerable population of adolescents. Methods: We analyzed a sample of 2678 sexual minority adolescents using a combination of student-level data (British Columbia Adolescent Health Survey) and primary community-level data (assessing lesbian, gay, bisexual, transgender, and queer [LGBTQ]-specific community and school environments). Using multilevel logistic regression models, we examined associations between lifetime substance use (alcohol, illegal drugs, marijuana, nonmedical use of prescription drugs, and smoking) and community-level predictors (community and school LGBTQ supportiveness). Results: Above and beyond student characteristics (e.g., age and years living in Canada), sexual minority adolescents residing in communities with more LGBTQ supports (i.e., more supportive climates) had lower odds of lifetime illegal drug use (for boys and girls), marijuana use (for girls), and smoking (for girls). Specifically, in communities with more frequent LGBTQ events (such as Pride events), the odds of substance use among sexual minority adolescents living in those communities was lower compared with their counterparts living in communities with fewer LGBTQ supports. Conclusions: The availability of LGBTQ community-level organizations, events, and programs may serve as protective factors for substance use among sexual minority adolescents. In particular, LGBTQ-supportive community factors were negatively associated with substance use, which has important implications for our investment in community programs, laws, and organizations that advance the visibility and rights of LGBTQ people.

Worsening Perceptions of Family Connectedness and Parent Support for Lesbian, Gay, and Bisexual Adolescents.

Lesbian, gay, and bisexual (LGB) adolescents often report compromised relations with their families. Given the recent changes in societal attitudes toward LGB individuals, in respect to rights for marriage and other legal statuses, we explore whether or not there has been a change in how LGB and heterosexual adolescents perceive their family relations over time. Using the British Columbia Adolescent Health Survey from British Columbia, Canada (N = 99,373; M age = 14.8), we investigated the trends and disparities in family connectedness and mother/father support in four data sets from 1998 to 2013. We found that while levels of perceived family connectedness and parent support have increased for heterosexual adolescents since 1998, the same increases were not found for LGB adolescents. Among LGB participants, levels of perceived connectedness/support generally decreased in each survey waves, especially among females. Alarmingly, significant disparities in these perceptions remained for LGB youth over time. Our findings have implications for supportive interventions focused on LGB adolescents and their families and in particular, the role of father support.

Smoking behaviours among heterosexual and sexual minority youth? Findings from 15 years of provincially representative data.

Sexual identity disparities in smoking behaviours are well established; however, there is limited research on whether these disparities have diminished as the social and political landscape has changed for lesbian, gay and bisexual people. Thus, we examined changes in prevalence and sexual identity disparities in three smoking behaviours among Canadian adolescents from 1998 to 2013. Data are from the provincially representative British Columbia Adolescent Health Survey (N = 99 373). Using sex-stratified, age-adjusted logistic regression models, we estimated: (i) trends in lifetime cigarette use, early onset, and past 30-day use for heterosexual and three subgroups of sexual minority (i.e. mostly heterosexual, bisexual and gay/lesbian) youth; (ii) sexual identity disparities in these cigarette-related behaviours within each survey year (1998, 2003, 2008, 2013); and (iii) whether the size of the disparity has changed from 1998 to 2013. Smoking has declined for all youth from 1998 to 2013, although less consistently for sexual minority youth. Within-year disparity estimates indicated elevated prevalence of cigarette use for sexual minority compared to heterosexual youth, particularly among females. Trends in sexual identity and smoking behaviours indicated that the degree of differences between heterosexual and sexual minority youth have remained stable or, in some cases, widened. Heterosexual and sexual minority youth differences widened for early onset among sexual minority boys and lifetime and past 30-day use for sexual minority girls. Efforts to prevent smoking behaviours among youth should continue. Tailored preventive strategies for sexual minority youth might help address existing disparities.

A Media-Based School Intervention to Reduce Sexual Orientation Prejudice and Its Relationship to Discrimination, Bullying, and the Mental Health of Lesbian, Gay, and Bisexual Adolescents in Western Canada: A Population-Based Evaluation.

School interventions to address sexual orientation discrimination can be important tools for fostering inclusive school climate, and improving student wellbeing. In this study, we empirically evaluated a film-based intervention, Out in Schools, designed to reduce sexual orientation prejudice and foster inclusive school attitudes. Our evaluation mapped data about Out in Schools presentations onto student data from the random cluster-stratified, province-wide 2013 British Columbia Adolescent Health Survey (BCAHS) as well as potential confounding variables of Gay-Straight Alliance clubs (GSAs) and inclusive school policies. Outcome measures included past year sexual orientation discrimination, bullying, suicidal ideation, and school connectedness among lesbian, gay, and bisexual (LGB) and heterosexual (HET) students in grades 8 through 12 (ages 13 to 18; unweighted N = 21,075, weighted/scaled N = 184,821). Analyses used complex samples logistic regression, adjusted for sample design, conducted separately by gender and orientation. We found Out in Schools presentations were associated with reduced odds of LGB students experiencing discrimination, and both LGB and HET girl students being bullied or considering suicide, and increased levels of school connectedness, even after controlling for GSAs and policies. Out in Schools appears to have an additive contribution to reducing orientation prejudice and improving LGB and heterosexual student wellbeing within schools.

Ten-Year Trends in Physical Dating Violence Victimization Among Adolescent Boys and Girls in British Columbia, Canada.

Physical dating violence (PDV) victimization among adolescents is a serious global problem. Although knowledge of trends in PDV victimization can help guide programming and health policies, little research has examined whether the prevalence of PDV victimization has increased, decreased, or remained stable over time among non-U.S.-based samples of youth. In addition, few studies have directly tested whether disparities in PDV victimization between boys and girls have narrowed, widened, or remained unchanged in recent years. To address these gaps, we used school-based data from the British Columbia Adolescent Health Survey (BC AHS) of 2003, 2008, and 2013 (n boys = 18,441 and n girls = 17,459) to examine 10-year trends in PDV victimization. We also tested whether trends differed across self-reported sex. Data from the 2003 to 2013 BC AHS revealed that recent PDV victimization rates had significantly decreased among youth overall (5.9%-5.0%) and boys (8.0%-5.8%), but not girls (5.3%-4.2%). Although boys had steeper declines than girls in PDV victimization rates, year-by-sex interactions indicate that the sex gap in PDV victimization had not significantly narrowed. Moreover, rates of PDV victimization over the 10-year period indicated significantly higher rates of PDV victimization among boys compared with girls. Despite positive declines in recent rates of PDV victimization among youth, important differences in rates of PDV victimization between boys and girls remain. These findings underscore the need for greater attention to sex differences in research and programming and health policies to reduce PDV victimization and the sex disparities therein.

Are alcohol‐related disparities between sexual minority and heterosexual youth decreasing?

Although sexual orientation-related alcohol use disparities are well established, researchers have not identified whether disparities are diminishing as societal attitudes towards lesbian/gay and bisexual (LGB) people become more accepting. We examined changes in four alcohol-related disparities between heterosexual and LGB youth from 1998 to 2013 by (1) estimating the prevalence of these behaviors; (2) estimating disparities in alcohol-related outcomes between heterosexual and LGB youth within each wave year; and (3) testing whether the degree of difference in alcohol-related disparities between heterosexual and LGB youth has changed. Logistic regression models and year×sexual orientation interactions with repeated, cross-sectional, provincially representative data. British Columbia, Canada. Students (ages 12-19) from the 1998 (n=22 858), 2003 (n=29 323), 2008 (n=25 254) and 2013 (n=21 938) British Columbia Adolescent Health Survey (total n=99 373, 48.7% male, mean age=14.84). We modeled age-adjusted differences in life-time alcohol use, age of onset, past 30-day drinking and past 30-day heavy episodic drinking between heterosexual and three subgroups of sexual minority youth (i.e. mostly heterosexual, bisexual and lesbian/gay). Generally, alcohol use declined for all youth, although less so among LGB youth [average adjusted odds ratio (aOR)=0.58 and aOR=0.53 for heterosexual males and females and aOR=0.71 and aOR=0.57 for sexual minority males and females, respectively). Within-year comparisons demonstrated elevated rates of alcohol use among LGB compared with heterosexual youth for each of the four survey years, especially among females. Findings indicate few changes over time; however, results show an increase in risky alcohol use from 1998 to 2013 among mostly heterosexual (aOR=1.58 for life-time alcohol use, aOR=1.58 for 30-day alcohol use and aOR=1.34 for 30-day heavy episodic drinking), and bisexual (aOR=1.95 for life-time alcohol use) females. Despite the general decline in the prevalence of alcohol use among young people in Canada since 1998, lesbian/gay and bisexual youth in Canada continue to show elevated rates of alcohol use compared with heterosexual youth.

Mental Health Disparities Among Canadian Transgender Youth

PurposeThis study documented the prevalence of mental health problems among transgender youth in Canada and made comparisons with population-based studies. This study also compared gender identity subgroups and age subgroups (14–18 and 19–25). MethodsA nonprobability sample of 923 transgender youth from Canada completed an online survey. Participants were recruited through community organizations, health care settings, social media, and researchers' networks. Mental health measures were drawn from the British Columbia Adolescent Health Survey and the Canadian Community Health Survey. ResultsTransgender youth had a higher risk of reporting psychological distress, self-harm, major depressive episodes, and suicide. For example, 65% of transgender 14- to 18-year olds seriously considered suicide in the past year compared with 13% in the British Columbia Adolescent Health Survey, and only a quarter of participants reported their mental health was good or excellent. Transgender boys/men and nonbinary youth were most likely to report self-harm and overall mental health remained stable across age subgroups. ConclusionsAlthough a notable minority of transgender youth did not report negative health outcomes, this study shows the mental health disparities faced by transgender youth in Canada are considerable.

Prevalence of pregnancy involvement among Canadian transgender youth and its relation to mental health, sexual health, and gender identity

ABSTRACTWhile little research has been conducted into the reproductive experiences of transgender people, available evidence suggests that like cisgender people, most transgender people endorse a desire for these experiences. This study explores the pregnancy experiences and related health factors among transgender and gender diverse 14 to 25 year olds using a national Canadian sample (N = 923). Results indicated that 26 (5%) transgender youth reported a pregnancy experience in the past and the prevalence among 14- to 18-year-olds was comparable to population-based estimates using the same question in the British Columbia Adolescent Health Survey. Transgender youth with a history of pregnancy involvement reported a diverse range of gender identities, and this group did not differ from the remainder of the sample on general mental health, social supports, and living in felt gender. This group did report over six times greater likelihood of having been diagnosed with a sexually transmitted infection by a doctor (19%), but they did not differ in reported contraception use during last sexual intercourse. These findings suggest that pregnancy involvement is an issue that should not be overlooked by health professionals working with transgender youth and that this group has particular sexual health needs.

Acculturation, Gender, and Mental Health of Southeast Asian Immigrant Youth in Canada

The relationships between mental health, protective factors and acculturation among Southeast Asian youth were examined in this study using a gender-based analysis. Population-based data from the 2008 British Columbia Adolescent Health Survey were used to examine differences in extreme stress and despair by acculturation. Associations between emotional distress and hypothesized protective factors were examined using logistic regression. Stratified analyses were performed to assess gender-related differences. Recent immigrant youth reported higher odds of emotional distress. Family connectedness and school connectedness were linked to lower odds of extreme stress and despair among girls. Family connectedness was associated with lower odds of extreme stress and despair among boys. Higher cultural connectedness was associated with lower odds of despair among boys but with higher odds of extreme stress among girls. Findings are discussed in relation to acculturation and gender-based patterns in protective factors for mental health among Southeast Asian immigrant youth.

Associations between the school food environment, student consumption and body mass index of Canadian adolescents

BackgroundIncreasing attention has been paid to the school food environment as a strategy to reduce childhood obesity. The purpose of this study was to examine associations between the school food environment, students’ dietary intake, and obesity in British Columbia (BC), Canada.MethodsIn 2007/08, principal responses about the school environment (N = 174) were linked to grades 7-12 students (N = 11,385) from corresponding schools, who participated in the BC Adolescent Health Survey. Hierarchical mixed-effect regression analyses examined the association between the school food environment and student’s intake of sugar-sweetened beverages (SSBs), food consumption, and body mass index. Analyses controlled for school setting, neighborhood education level and student’s age and sex.ResultsSchool availability of SSBs was positively associated with moderate (Odds Ratio (OR) = 1.15, 95% Confidence Interval (CI) = 1.02-1.30) and high (OR = 1.43, 95% CI = 1.13-1.80) SSB intake as were less healthful school nutrition guidelines for moderate SSB consumers only (OR = 0.65, 95% CI = 0.48-0.88). Availability of SSBs at school and its consumption were positively associated with student obesity (OR = 1.50, 95% CI = 1.12-2.01 and OR = 1.66, 95% CI = 1.19-2.34, respectively) but not with overweight. In contrast, consumption of less healthful food was positively associated with overweight (OR = 1.03, 95% CI = 1.01-1.06).ConclusionsThe results of this study provide further evidence to support the important role of schools in shaping adolescents’ dietary habits. Availability and consumption of SSBs, but not less healthful foods, at school were associated with higher adolescent obesity highlighting that other environments also contribute to adolescent obesity.

Population-level evaluation of school-based interventions to prevent problem substance use among gay, lesbian and bisexual adolescents in Canada

ObjectiveThis study examined whether students' odds of recent substance use were lower in the presence of gay-straight alliances or explicit anti-homophobia policy that had been established at their school recently, or at least 3years prior. MethodsWe analyzed a population-based sample of students in grades 8 through 12 from the British Columbia Adolescent Health Survey of 2008 (weighted N=21,708). We used multi-nomial logistic regressions to test the hypothesized effects of gay-straight alliances and policies on substance use outcomes for lesbian, gay and bisexual students, and heterosexual students separately. ResultsResults indicated that gay-straight alliances and anti-homophobic bullying policies were linked to significantly lower odds of some but not all types of recent risky alcohol use, and past-year harms from alcohol or drug use, but almost exclusively in schools where the policies or gay-straight alliances had been established for at least 3years; and among lesbian, gay and bisexual adolescents, only for girls. ConclusionsOur findings suggest that these school-based strategies (gay-straight alliances and anti-homophobia policies) to reduce homophobia and foster school inclusion may be beneficial in reducing problem alcohol use among all students, not just sexual minority students.