The present study aimed to examine the association between experienced weight stigma and disordered eating among undergraduate students and alumni in health-related programs, and to examine whether perceived weight status explained disordered eating beyond experienced weight stigma. It was hypothesized that (1) experienced weight stigma would positively correlate with disordered eating scores, and (2) perceived weight status could explain disordered eating behaviours over and above the explanation of experienced weight stigma for cognitive and emotional eating, but not for uncontrolled eating. To test these hypotheses, undergraduate students and alumni enrolled in health-related majors (n = 187) were recruited from a mid-sized university in Ontario, Canada. All participants reported their perceived weight status, and filled out a demographic information sheet, the Three-Factor Eating Questionnaire-18, and the Stigmatizing Situations Inventory-Brief Form questionnaire. Linear regressions and hierarchical regression models were used to analyze these potential relationships. A significant, positive correlation existed between experienced weight stigma and disordered eating among undergraduate students in health-related programs. Additionally, it was found that perceived weight status explained further variance than experienced weight stigma could for cognitive restraint and emotional eating, but not for uncontrolled eating. The findings suggest that health-related undergraduate students do not significantly differ from other groups; however, further research is supported.

This study aims to investigate stressors experienced by racialized sexual orientation and gender identity expression (SOGIE) refugees in Southern Ontario through Meyer’s Minority Stress Theory (MST). Interviews with 10 racialized SOGIE refugees and two service providers living in Ontario, Canada were extracted from a larger study. Participants identified both explicit and implicit stressors in their daily lives, ranging from feelings of isolation and community disconnect, to anticipatory fear of stigma and violence. Consistent with MST’s distinction of distal and proximal stressors, these challenges negatively affected their well-being. Overall, recognizing the unique positionality of racialized SOGIE refugees and finding ways to facilitate positive mental health and well-being is key.

Sexual orientation minorities continue to experience significant health disparities compared to heterosexual counterparts, posited to be due to excessive stigma experienced by these groups, necessitating focus in healthcare delivery. A commonly used framework to describe experiences of stigma is minority stress. This study explores the associations between minority stress factors and primary care outcomes among LGBT2Q + individuals in Canada, from data collected in mid-2020. Using modified Poisson regression and logistic regression, the study examines four key outcomes: attachment to primary care, comfort discussing sexual orientation with a primary care provider (PCP), disclosure of sexual orientation to a PCP, and discussing health concerns related to sexual orientation with a PCP. The results reveal significant associations between higher levels of identity concealment, internalized stigma, and discomfort in disclosing sexual orientation or discussing relevant health issues with a PCP. Higher levels of victimization and discrimination were associated with a lesser likelihood of discomfort and disclosure of sexual orientation. Greater community connectedness was linked to primary care attachment and greater comfort in healthcare settings. Future research should also examine how minority strengths, such as identity pride, can mitigate stress impacts on healthcare access. The findings underscore the need for inclusive policies in healthcare settings, increased medical education, and community-based supports to address the unique health needs of LGBT2Q + individuals.

This rapid review investigated the mental health concerns of sexual orientation and gender identity expression (SOGIE) refugees in Canada. Database searches yielded 365 results across five databases, providing 12 papers for final thematic analysis once inclusion criteria were applied. Three themes emerged: (1) Stigma and discrimination negatively affected mental health and well-being; (2) SOGIE refugees faced challenges accessing services; and (3) the refugee claims process adversely affected well-being. Recommendations to improve SOGIE refugee well-being include implementing culturally safe policies in agencies, life-skills programs, and supportive spaces; promoting inclusivity, interprofessional collaboration between services, and innovative agency outreach to refugees; addressing biases in refugee claims boards and extending the refugee claim eligibility period.

BackgroundTrans people face persistent systemic challenges and barriers in healthcare systems. Despite these obstacles, many trans people have had positive healthcare experiences, however little is known regarding their commonalities.AimsThis study aims to better understand factors that influence positive healthcare experiences among trans people.Methods33 longform interviews were conducted with trans individuals, with 29 being used for the final sample. Interviews were recorded, transcribed verbatim, and analyzed using NVIVO 12 software. Thematic analysis was conducted for the coding process with a combination of inductive and deductive approaches used to develop the coding frame.ResultsFour healthcare provider (HCP) characteristics and two patient attributes were identified as promoters of positive healthcare experiences. Positive HCP characteristics included having a provider who was 1) a member of the LGBTQ community, 2) knowledgeable, experienced, and willing to learn about trans health, 3) transparent and empowered patients regarding their medical decisions; and 4) sensitive, accepting, and validating of patients' gender identities. The two patient attributes included: 1) engaging in self-advocacy regarding their care, and 2) being connected to a variety of supportive trans communities, both online and in-person.DiscussionBetter understanding these positive healthcare experiences can help in the development of curricula and policy to facilitate improved quality healthcare for trans people in Canada.

LGBT2Q+ (lesbian, gay, bisexual, transgender, Two-Spirit, queer, plus) Canadians face minority stressors that lead to higher mental health inequalities such as worse self-reported mental health and increased risk of mental health issues when compared to their heterosexual/straight and cisgender counterparts. However, there are within-group (intracategorical) differences within a community as large as LGBT2Q+ peoples. Guided by the Andersen Model of Healthcare Utilization, we sought to explore intracategorical differences in LGBT2Q+ Canadian predisposing, enabling, and need factors in mental health service utilization within the past year. Using data from the 2020 LGBT2Q+ Health Survey (N = 1542), modified Poisson logistic regression found that more polysexual respondents and trans/gender-diverse respondents were more likely to have utilized mental health services within the past year than their gay, lesbian, and cis male counterparts. As well, compared to White respondents, Indigenous respondents were more likely to have utilized mental health services, while other racialized respondents were associated with less utilization. Backwards elimination of Andersen model of healthcare utilization factors predicting mental health service utilization retained two predisposing factors (ethnoracial groups and gender modality) and two need factors (self-reporting living with a mood disorder and self-reporting living with an anxiety disorder). Results suggest that polysexual, trans and gender-diverse, and racialized LGBT2Q+ peoples have an increased need for mental health services due to increased specific minority stressors that cisgender, White, monosexual peoples do not face. Implications for healthcare providers are discussed on how to improve service provision to LGBT2Q+ peoples.

Purpose: Mental health disparities in sexual orientation and/or gender identity and/or expression (SOGIE) minority groups are well-documented, with research consistently showing higher levels of suicidality, even in Canada, considered one of the world's most accepting countries of SOGIE minority groups. Adverse outcomes in these groups are often framed using minority stress theory, with social support frequently studied as an integral buffer to these outcomes. This analysis explores facets of minority stress and social support associated with past-year suicidal ideation and suicide attempts.Methods: A cross-sectional internet survey of SOGIE diverse people in Canada (n = 1542) was conducted. Binary logistic regression calculated bivariate and multivariate factors associated with past-year suicidal ideation and suicide attempts. Backward elimination (retaining sociodemographic factors and self-rated mental health) identified salient minority stress and social support (provisions) factors.Results: Over half (56.72%) of participants had ever thought of dying by suicide, with 24.84% having attempted suicide. During the past year, 26.80% had thought of dying by suicide, with 5.32% having attempted suicide. Victimization events, and guidance (e.g., someone to talk to about important decisions) and attachment (e.g., close relationships providing emotional security) social provision subscales remained salient after backward elimination procedures.Conclusion: Our findings emphasize that a fulsome, multilevel approach considering structural, community, and individual strategies to address overt discrimination, integrating social connections and guidance, is necessary to prevent dying by suicide.

Lesbian, gay, bisexual, and diverse sexual orientation minorities are disproportionately represented in the prevalence of adverse health conditions, even in Canada, suggested as one of the more progressive countries when it comes to social acceptance and human rights protections. This highlights the inclusion of sexual orientation identity as a point of consideration when providers interact with patients and to consider facilitating sexual orientation identity disclosure when accessing health care. This study explored factors associated with different facets of sexual orientation disclosure to primary care providers. A cross-sectional survey of sexual orientation minority participants, 16 years or older, living, working, or residing in Waterloo Region was distributed ( n = 437). Modified Poisson regression methods modelled (a) comfort sharing sexual orientation with their regular primary care provider (RPCP), (b) disclosure of sexual orientation to their RPCP, and (c) talking to their RPCP about health issues related to their sexual orientation. Increasing outness within one’s social network was consistently significant across all three outcomes of comfort, disclosure, and talking about health issues related to sexual orientation. Self-esteem was also identified as salient in comfort and when talking to providers. The authors also observed significant associations between sexual orientation identity and relationship status variables. Findings highlight important factors to consider in discussing and disclosing sexual orientation identity and associated health issues with health care providers. Implications for practice include training new health care providers and providing opportunities for continued education for established providers to ensure appropriate care is provided based on sexual orientation.

It is well-known that trans and non-binary individuals experience worse health outcomes due to experiences of violence and discrimination. For this reason, accessible healthcare for trans and non-binary people is crucial. There is a lack of Canadian literature on the experiences of non-binary people within the healthcare system. This study sought to understand barriers to healthcare among non-binary people living in a mid-sized urban/rural region of Canada. Interviews were conducted between November 2019 to March 2020 with 12 non-binary individuals assigned female at birth, living in Waterloo Region, Ontario, Canada, as a part of a larger qualitative study exploring experiences within the community, healthcare and employment. Three broad themes were developed: erasure, barriers to access to healthcare, and assessing whether (or not) to come out. Sub-themes included institutional erasure, informational erasure, general healthcare barriers, medical transition healthcare barriers, anticipated discrimination, and assessing safety. Policy and institutional changes are needed to increase the safety and accessibility of healthcare services to non-binary individuals.

Transgender (trans) individuals experience disproportionately high rates of discrimination and social exclusion which negatively impacts their health and well-being. However, a recent focus on social inclusion has revealed the protective effect that community engagement can have on trans individuals’ well-being. The purpose of this study was to investigate the sources and perceptions of community inclusion among trans people and to better understand how a feeling of connectedness can lead to elevated well-being. Thirty-three trans individuals living in a mid-sized urban and rural region of Southern Ontario, Canada were interviewed for a larger study focused on experiences of discrimination. Using NVivo 12, a thematic analysis on perceptions of community inclusion was conducted involving 22 participants from the larger study. Primary sources of community inclusion among trans individuals were in-person trans events, trans groups, and online forums. All three sources led to enhanced well-being by fostering feelings of acceptance, belonging, and safety. Our study supports a need to prioritize these sources as supportive outlets to promote the positive well-being of trans individuals.

In 2006/2007, the Toronto Teen Survey investigated barriers and facilitators to youth (ages 13 to 18+) access to sexual health services. The results of the surveys were presented to 13 focus groups of 80 service providers (SPs) from 55 agencies around the Greater Toronto Area. Funding and resource allocation were seen as primary barriers to providing adequate sexual health promotion and services. Coding and analysis of focus group transcripts identified two primary categories of concern: (1) Distribution and Amount of Resources (including lack of funding, length of funding agreements, and increased competition for scarce financial resources among service providing organizations and agencies); and (2) Resources for Specific Services (including peer education, translation services, and targeting specific populations of youth). SPs recommendations for change included: approachable staff; school-based outreach; increased accessibility and visibility; peer-to-peer outreach; increased and constant funding; and sharing and partnerships among SPs. Implications for the improvement of youth sexual health services and promotion are discussed.

Social media has become increasingly integrated into the lives of students for the past decade; however, the public health restrictions associated with the COVID-19 pandemic have led to a sharp increase in social media use in a short period of time. The purpose of this study was to investigate the effects of social media use on university students during the COVID-19 pandemic. Fifteen students from a mid-sized Canadian city were interviewed to share their experiences with social media during the COVID-19 pandemic. Purposive sampling was conducted to gather a diverse sample of participants, including individuals of various ages, gender and sexual identities, and ethnicities. Thematic analysis on the 15 interviews was completed using NVivo (version 12). Participants experienced both advantages and disadvantages associated with social media use. Ease of communication and stress relief were acknowledged as the strongest benefits. Social comparison, loneliness, development of bad habits, and lack of focus were cited as major disadvantages to social media use during the pandemic. Cost-benefit analysis of social media was common, and participants expressed the importance of using social media with moderation, balance, and awareness. Our study indicates that the focus on health with respect to the pandemic should not be solely based on physical health, rather the potential mental health risks associated with social media use during the pandemic should be recognized and addressed by healthcare providers.

Lesbian, gay, bisexual, and transgender (LGBT) youth require appropriate, effective, and accessible sexual health services. Sexual minority youth living in large urban, multicultural cities have a complex range of service needs. As part of the Toronto Teen Survey, focus groups were conducted with 80 service providers from 55 agencies in the Greater Toronto Area to elicit their input concerning the changing service needs of LGBT youth, their increasing complexity as a client group, and obstacles to working effectively with them. Issues that arose in the focus groups included addressing the needs of LGBT youth across a large city that includes suburban areas, the need to address the specific service needs of transgender youth, and the intersection of racial and ethno-cultural diversity with sexual orientation. Service provider recommendations focused on the need for improved education and training and policy change at the agency level.

HIV testing and diagnosis are the gateway into treatment and eventual viral suppression. With gay, bisexual, and other men who have sex with men (GBMSM) persistently over-representing new HIV diagnoses in Canada, combined with the evolving nature of community social connection, an exploration of factors associated with recent HIV testing is warranted. As most studies of GBMSM rely on samples obtained from larger metropolitan regions, examining HIV testing from an under-researched region is necessary. With data collected from an online survey of LGBTQ+ persons 16 or older living, working, or residing in the Region of Waterloo, Ontario, Canada, we used multinomial logistic regression to explore socio-demographic, behavioural, and psychosocial factors associated with recent HIV testing for GBMSM. In the final multivariate multinomial logistic regression model: sense of belonging was associated with more recently testing, as was having an increasing proportion of LGBT friends, app use to find sex partners in the past 12 months, access to the local AIDS service organization, and general sense of belonging to local community, among other. This analysis highlights the continued importance of enabling and need factors when accessing testing, and suggests areas for further testing promotion in physical and virtual spaces frequented by GBMSM.

LGBTQ+ (lesbian, gay, bisexual, transgender, queer, plus) people, compared to their heterosexual and/or cisgender (non-transgender) counterparts, are more likely to be discriminated against based on their gender or sexual identities. Drawing on data from The OutLook Study in Waterloo Region, Ontario, Canada this paper examines discrimination and social support among high school and post-secondary students, and how they are related to self-esteem. We found that transgender students in high school reported significantly higher levels of direct transphobia and of victimization compared to transgender post-secondary students. We found indirect homophobia and indirect transphobia had a significant adverse relationship to self-esteem. Further, social support from friends was related to higher self-esteem for cisgender LGBQ students, but not for transgender students. These findings have the potential to inform school-based policies and mental health interventions in support of improved wellbeing for LGBTQ + students.

The current understanding of sexual consent negotiation is grounded in research conducted with heterosexual populations, and little is understood about how non-heterosexual men (bisexual, bi-curious, two-spirited, other) navigate these processes. A sample of 251 heterosexual men and 313 non-heterosexual men participated in an online survey where they were asked to respond to an open-ended question that addressed their perceptions of the differences between how heterosexual and non-heterosexual men negotiate sexual consent. Participants were recruited through social media (i.e. Facebook, Twitter), Amazon's Mechanical Turk, and via the distribution of flyers/posters. The sample consisted of men from Canada, the United States, and Western Europe. Basic demographic information was gathered along with self-identified sexual orientation. Four main themes were derived through the thematic analysis of responses:understanding of sexual interactions, understanding of sexual script, unique challenges, and the universality of sexual consent. Findings provide initial insight into some of the perceived differences and barrier both non-heterosexual and heterosexual men face in negotiating sexual consent and highlight some of the entrenched heteronormative beliefs that both heterosexual and non-heterosexual men endorse. Results can serve to inform social interactions, education, and policymaking.

Gay, bisexual, and other men who have sex with men (GBMSM) remain most disproportionately affected by HIV in Canada. HIV- related sexual risk behaviours have been linked to high HIV risk among GBMSM, but prior research has not focused on knowledge of viral load, and the risk it presents for HIV acquisition. The purpose of this study was to explore the relationship between HIV-related sexual risk behaviour and knowledge of viral load among GBMSM. A cross-sectional survey was conducted using a convenience sample of individuals age 16 and older who self-identified as LGBTQ and lived, worked, or resided in the Waterloo region, an urban-rural area in southwestern Ontario ( N = 526). Responses were analyzed from those identifying as GBMSM ( N = 269). Logistic regression models were created to explore sociodemographic, outness, social support, and HIV-related sexual risk variables associated with knowledge of viral load. Multivariable regression models were built to explore the same associations while controlling for confounders. HIV risk was not associated with knowledge of viral load in bivariate or multivariable analyses. Point estimates for low/negligible (odds ratio [OR] 1.10; 95% CI 0.46–2.51) and high risk (OR 1.88; 95% CI 0.68–5.20) suggest trends of higher knowledge with increased HIV risk. Men who engage in sexual risk behaviour may have increased sexual health literacy and awareness of biomedical interventions (e.g., pre-exposure prophylaxis, or PrEP) that reduce HIV risk. Policies are needed that promote acceptance of sexual orientation, improve awareness and access to PrEP, and ensure optimal delivery of HIV education to at-risk groups prior to engagement in higher risk activities.

PURPOSE:The experiences of African, Caribbean and Black (ACB) Canadians are seldom explored in the Canadian context. Family physicians act as a gateway to the rest of the healthcare system and are necessary to provide proper patient care. However, Canada's history with colonialism may impact the socio-cultural context in which patients receive care.METHOD:41 participants from Waterloo Region, Ontario, were engaged in eight focus groups to discuss their experiences in the healthcare system. Data were analysed following thematic analysis.RESULTS:Style of care, racism and discrimination and a lack of cultural competence hindered access. oor Inadequate cultural competence was attributed to western and biomedical approaches, poor understanding of patients' context, physicians failing to address specific health concerns, and racism and discrimination. Participants highlighted that the two facilitators to care were having an ACB family physician and fostering positive relationships with physicians.CONCLUSION:Participants predominantly expressed dissatisfaction in physicians' approaches to care, which were compounded by experiences of racism and discrimination. Findings demonstrate how ACB patients are marginalized and excluded from the healthcare syste Iimplications for better access to care included utilizing community healthcare centres, increasing physicians' capacity around culturally inclusive care, and increasing access to ACB physicians.

Background Relationships between primary care providers (PCP) and trans patients remain important, necessitating discussions about gender identity, health and their intersections. Methods Using an online survey, we explored socio-demographic and psycho-social factors associated with: (1) disclosing gender identity; (2) discussing gender identity-related health issues; and (3) comfort sharing gender identity with PCPs, among trans people (n = 112) over 16 years of age, sampled in Waterloo, Ontario, Canada. Bivariate and multivariate methods using modified Poisson regression generated effect estimates. Results Age, birth presumed gender, employment status, family support, and transphobia were significantly associated with disclosing gender identity, discussing gender identity-related health issues, and comfortability sharing gender identity with PCPs. Conclusion Increasing PCPs’ knowledge of trans-related health issues is stressed to improve access and quality for trans patients.

Purpose: Even in cases of medical emergency, mistreatment and negative experiences in life or in medical settings can deter trans patients from seeking necessary care. The purpose of this study was to identify factors associated with trans persons' emergency department (ED) avoidance in the mixed urban-rural Region of Waterloo, Ontario, Canada. Methods: The OutLook Study was a community-based partnership that created an online, cross-sectional questionnaire for lesbian, gay, bisexual, transgender, and other sexual and gender minority community members. Participants in this analysis were 16 years of age or older, lived, worked, or attended school in Waterloo Region, and identified as trans (n=112). Binary logistic regression was used to test associations between sociodemographic, resilience, and risk variables, and ED avoidance. Sociodemographic variables statistically significant at p<0.05 at the bivariate level were included as controls to explore different combinations of resilience and risk factor in multivariable models. Results: Participants reporting complete or partially complete medical transitions were more likely to report ED avoidance, compared to those who had not initiated medical transition. Elevated transphobia was associated with greater likelihood of avoidance. However, increasing levels of social support decreased the likelihood of avoidance. In multivariable models, social support, support from a special person, and transphobia were always significant, regardless of controlled variables. Conclusion: Transphobia—enacted in the contexts of everyday life and health care—can deter patients from seeking care. Patient-centered care requires careful attention to trans identity and health needs, especially in emergency settings. In the absence of structural changes, providers can take steps to mitigate the erasure and discrimination trans patients experience and anticipate when accessing EDs.