Background: Indigenous leaders continue to be concerned about high rates of HIV and barriers to H... more Background: Indigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. Objective: This study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population.
Background: Indigenous women involved in survival sex work face multiple layers of discrimination... more Background: Indigenous women involved in survival sex work face multiple layers of discrimination, criminalization and alarming levels of intergenerational and lifetime trauma. This longitudinal study examined historical, structural and interpersonal factors associated with survival sex work involvement among Indigenous women who have used drugs in British Columbia (BC), Canada. Methods: The Cedar Project is an ongoing cohort study involving young Indigenous people who have used illicit drugs in Vancouver and Prince George, BC. Data was collected every 6 months from 2007 to 2016. Generalized linear mixed-effects modeling was used to model survival sex work involvement, defined as exchanging sex for money, drugs, food or shelter in the previous six months. Results: Among 292 participants, 34% reported their family always/often lived by traditional culture and 37% reported their family always/often spoke their traditional language. In contrast, 48% had a parent in residential school and 72% were removed from their biological parents. In total, 55% of women were involved in survival sex work at baseline. In adjusted analyses, those who were single (ARR: 1.91; 95% CI: 1.50-2.35), identified as two-spirit (ARR: 2.16; 95% CI: 1.36-2.91), experienced sexual assault (ARR: 1.90; 95% CI: 1.22-2.58), were denied access to shelter (ARR: 1.71; 95% CI: 1.18-2.28), used crack daily (ARR: 2.85; 95% CI: 2.36-3.31), used injection drugs (ARR: 2.52; 95% CI: 1.98-3.07), and were unable to access substance use treatment (ARR: 1.58; 95% CI: 1.15-2.05) were more likely to be involved in sex work. Conclusion: Indigenous-governed, wellness-based harm-reduction interventions, and structural reforms addressing housing insecurity and normalization of a culture of violence against Indigenous women, especially those involved in survival sex work, are urgently needed in Canada.
Knowledge Creation, Dissemination, and Preservation Studies, 2021
The Cedar Project is an interdisciplinary, community-driven research project responding to the cr... more The Cedar Project is an interdisciplinary, community-driven research project responding to the crises of HIV and Hepatitis C infection and contributing to the healing of young Indigenous people who use or have used drugs. We are a collective membership of Indigenous Elders, health/social service experts, researchers, and non-Indigenous allies. We situate our work in the context of strength, resilience, and rights to self-determination for Indigenous peoples while also acknowledging the ongoing impacts of historical, intergenerational, and current trauma, specifically those related to the child welfare systems. We provide epidemiological and qualitative evidence that reflects Indigenous perspectives of health and wellness. In this paper, we highlight over seventeen years of shared learnings on conducting research with Indigenous communities in a good way. Specifically, we elaborate on four key components of our unique project. First, our paradigm is to build on young Indigenous people's strengths while acknowledging grief and historical trauma. We recognize that Cedar participants are not statistics—they are relatives of Indigenous partners governing this study. Second, our processes are determined by Indigenous governance, led by Elders and rooted in cultural safety. Third, our research ethics are determined by terms of reference created by the Cedar Project Partnership and by embracing guidelines of TCPS and community-based research. Fourth, we are informed by multiple perspectives and research relationships between Elders, partners, students, academics, and research staff. Sharing our learnings with the larger research community can contribute to decolonizing research spaces by centering Indigenous knowledges and privileging Indigenous voice.
Background: Colonization and colonial systems have led to the overrepresentation of Indigenous pe... more Background: Colonization and colonial systems have led to the overrepresentation of Indigenous people im-pacted by substance use and HCV infection in Canada. It is critical to ensure Indigenous people's equitable access to new direct acting antiviral HCV treatments (DAAs). Identifying culturally-safe, healing-centered approaches that support the wellbeing of Indigenous people living with HCV is an essential step toward this goal. We listened to the stories and perspectives of HCV-affected Indigenous people and HCV treatment providers with the aim of providing pragmatic recommendations for decolonizing HCV care. Methods: Forty-five semi-structured interviews were carried out with Indigenous participants affected by HCV from the Cedar Project (n = 20, British Columbia (BC)) and the Canadian Coinfection Cohort (n = 25, BC; Ontario (ON); Saskatchewan (SK)). In addition, 10 HCV treatment providers were interviewed (n = 4 BC, n = 4 ON, n = 2 SK). Interpretive description identified themes to inform clinical approaches and public health HCV care. Themes and related recommendations were validated by Indigenous health experts and Indigenous participants prior to coding and re-contextualization. Results: Taken together, participants' stories and perceptions were interpreted to coalesce into three overarching and interdependent themes representing their recommendations. First: treatment providers must understand and accept colonization as a determinant of health and wellness among HCV-affected Indigenous people, including ongoing cycles of child apprehension and discrimination within the healthcare system. Second: consistently safe attitudes and actions create trust within HCV treatment provider-patient relationships and open opportunities for engagement into care. Third: treatment providers who identify, build, and strengthen circles of care will have greater success engaging HCV-affected Indigenous people who have used drugs into care. Conclusion: There are several pragmatic ways to integrate Truth and Reconciliation as well as Indigenous concepts of whole-person wellness into the HCV cascade of care. By doing so, HCV treatment providers have an opportunity to create greater equity and support long-term wellness of Indigenous patients.
This MA thesis examines the decision-making capacity of young women married during
adolescence wi... more This MA thesis examines the decision-making capacity of young women married during adolescence within the context of their sexual and reproductive health in an urban ghetto in the city of Ahmedabad, India. Specifically, the development literature on married female adolescents (MFAs) is characterized by negative health indicators such as higher rates of unwanted pregnancies, reproductive tract infections, sexually transmitted diseases, high infant and maternal mortality and morbidity coupled with the phenomenon of early marriage, poverty and an overall lower social status. The result is a disempowering discourse that constructs and presents them as powerless victims who lack any decision-making capacity and are perpetually oppressed. This research is an effort to move the discussions of “Other third world women” outside the realm of victimization by challenging and destabilizing this disempowering, hegemonic discourse. We must ask what does decision making look like for these women, as exercised within the context of their sexual and reproductive health. This qualitative analysis is informed by primary research through focus groups and semi-structured interviews with young married women, and was conducted with the help of a local NGO, Mahila Patchwork Co-operative Society. The study provides insights on the young married women‟s participation and role in determining their own health outcomes (negative and positive) to better inform programs and services offered by the community NGOs.
Indigenous leaders remain concerned that systemic oppression and culturally unsafe care impede In... more Indigenous leaders remain concerned that systemic oppression and culturally unsafe care impede Indigenous peoples living with HIV from accessing health services that make up the HIV cascade of care. We conducted a systematic review to assess the evidence related to experiences of the HIV care cascade among Indigenous peoples in Australia, Canada, New Zealand, and United States. We identified 93 qualitative and quantitative articles published between 1996 and 2017 reporting primary data on cascade outcomes disaggregated by Indigenous identity. Twelve involved data from Australia, 52 from Canada, 3 from New Zealand and 26 from United States. The majority dealt with HIV testing/diagnosis (50). Relatively few addressed post-diagnosis experiences: linkage (14); retention (20); treatment initiation (21); adherence (23); and viral suppression (24). With the HIV cascade of care increasingly the focus of global, national, and local HIV agendas, it is critical that culturally-safe care for Indigenous peoples is available at all stages.
Background: Indigenous young people, particularly those involved in the child welfare system, tho... more Background: Indigenous young people, particularly those involved in the child welfare system, those entrenched in substance use and those living with HIV or hepatitis C, are dying prematurely. We report mortality rates among young Indigenous people who use drugs in British Columbia and explore predictors of mortality over time. Methods: We analyzed data collected every 6 months between 2003 and 2014 by the Cedar Project, a prospective cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, BC. We calculated age-standardized mortality ratios using Indigenous and Canadian reference populations. We identified predictors of mortality using time-dependent Cox proportional hazard regression. Results: Among 610 participants, 40 died between 2003 and 2014, yielding a mortality rate of 670 per 100 000 person- years. Young Indigenous people who used drugs were 12.9 (95% confidence interval [CI] 9.2–17.5) times more likely to die than all Canadians the same age and were 7.8 (95% CI 5.6–10.6) times more likely to die than Indigenous people with Status in BC. Young women and those using drugs by injection were most affected. The leading causes of death were overdose (n = 15 [38%]), illness (n = 11 [28%]) and suicide (n = 5 [12%]). Predictors of mortality included having hepatitis C at baseline (adjusted hazard ratio [HR] 2.76, 95% CI 1.47–5.16), previous attempted suicide (adjusted HR 1.88, 95% CI 1.01– 3.50) and recent overdose (adjusted HR 2.85, 95% CI 1.00–8.09). Interpretation: Young Indigenous people using drugs in BC are dying at an alarming rate, particularly young women and those using injection drugs. These deaths likely reflect complex intersections of historical and present-day injustices, substance use and barriers to care.
Background. Mental health and wellbeing, including addressing impacts of historical trauma and su... more Background. Mental health and wellbeing, including addressing impacts of historical trauma and substance use among young people, has been identified as a key priority by Indigenous communities and leaders across Canada and globally. Yet, research to understand mental health among young Indigenous people who have used drugs is limited. Aims. To examine longitudinal risk and strengths-based factors associated with psychological distress among young Indigenous people who use drugs. Method. The Cedar Project is an ongoing cohort study involving young Indigenous people who use drugs in Vancouver, Prince George, and Chase, British Columbia, Canada. This study included participants who completed the Symptom Checklist-90-Revised, returned for follow-up between 2010 and 2012, and completed the Childhood Trauma Questionnaire. Adjusted linear mixed-effects models estimated effects of study variables on changes in area T-scores of psychological distress. Results. Of 202 eligible participants, 53% were women and the mean age was 28 years. Among men, childhood maltreatment (emotional abuse, physical abuse, sexual abuse, physical neglect), any drug use, blackouts from drinking, and sex work were associated with increased distress. Among women, childhood maltreatment (emotional abuse, physical abuse, physical neglect), blackouts from drinking, and sexual assault were associated with increased distress, while having attempted to quit using drugs was associated with reduced distress. Marginal associations were observed between speaking their traditional language and living by traditional culture with lower distress among men. Conclusion. Culturally safe mental wellness interventions are urgently needed to address childhood trauma and harmful coping strategies that exacerbate distress among young Indigenous people who use drugs.
lq6u^dm lo uo[plon e st pue polqlqotd ^lssajdxa $ uorssuu€d uauu,$ ]nol4r/rr uo{pnpoldat laqlo lo... more lq6u^dm lo uo[plon e st pue polqlqotd ^lssajdxa $ uorssuu€d uauu,$ ]nol4r/rr uo{pnpoldat laqlo lo butldocoloqd atnllsul qclPasoH cl^lC e !02 O
Objectives: The objectives of this qualitative investigation are two‐fold: (1) to clarify issues ... more Objectives: The objectives of this qualitative investigation are two‐fold: (1) to clarify issues related to measuring simultaneous use in the context of alcohol and cocaine; and (2) to explore the patterns of simultaneous use of cocaine and alcohol, focusing on temporal order, mode of administration, drug form, and drug dose. Methods: In‐depth open‐ended pilot interviews with simultaneous cocaine and alcohol users were conducted at a residential treatment centre in Ontario, Canada (n = 10). The interview transcripts were coded by three coders independently. Analyses of the transcripts were performed to identify emerging themes and to develop conceptual networks of codes. Findings: Respondents focused on the effects of introducing one substance after the other, rather than the combined effects of both alcohol and cocaine. They also discussed the importance of alcohol in relation to different methods of use, with alcohol being more common when cocaine was snorted, rather than injected or smoked. Finally, preliminary results suggest that the temporal order of cocaine or alcohol ingestion is related to differential functions of use. The study highlights the importance of developing better measures of patterns of simultaneous use to describe the complexity of alcohol and cocaine use and its effects.
International Journal for Crime, Justice and Social Democracy, 2014
Abstract
The brutal gang rape of a physiotherapy student in India in December 2012 drew the worl... more Abstract
The brutal gang rape of a physiotherapy student in India in December 2012 drew the world’s attention to the problem of sexual violence against women in that country. Protests and mass public reaction towards the case pressurized the government to respond to the crisis by changing the laws on sexual violence. However, these new laws have not led to a decrease in violence against women (VAW). Is this the result of the failure of the rule of law? Or does it highlight the limitations of law in absence of social change? This paper addresses the need for using law as a key tool in addressing violence against women in India. It recognizes that unless we address the structural and root causes of violence against women, our analysis will be limited. It is important to bridge the creation of new laws, with an analysis that speaks to the role of hypermasculinity, neoliberalism and culture in VAW. If unaddressed, what may result instead are quick fixes, symbolized by the passing of new laws that act as token gestures rather than ones leading to transformative action.
Keywords India; gang‐rape; law; hypermasculinity; political economy;
Abstract The twentieth century saw a paradigm shift in medical education, with acceptance that 'k... more Abstract The twentieth century saw a paradigm shift in medical education, with acceptance that 'knowledge' and 'truth' are contextual, in flux and always evolving. The twenty-first century has seen a greater explosion in computer technology leading to a massive increase in information and an ease of availability, both offering great potential to future research. However, for many decades, there have been voices within the health care system raising an alarm at the lack of evidence to support widespread clinical practice; from these voices, the concept of and need for evidence-based health-care has grown. Parallel to this development has been the emergence of evidence-based medical education; if healthcare is evidence-based, then the training of practitioners who provide this healthcare must equally be evidence-based. Evidence-based medical education involves the systematic collection, synthesis and application of all available evidence, when available, and not just the opinion of experts. This represented a seismic shift from a position of expert based consensus guidance to evidence led guidance for evolving clinical knowledge. The aim of this guide is to provide a practical approach to the development and application of a systematic review in medical education; a valid method used in this guide to seek and substantiate the effects of interventions in medical education.
Background: Indigenous leaders continue to be concerned about high rates of HIV and barriers to H... more Background: Indigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. Objective: This study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population.
Background: Indigenous women involved in survival sex work face multiple layers of discrimination... more Background: Indigenous women involved in survival sex work face multiple layers of discrimination, criminalization and alarming levels of intergenerational and lifetime trauma. This longitudinal study examined historical, structural and interpersonal factors associated with survival sex work involvement among Indigenous women who have used drugs in British Columbia (BC), Canada. Methods: The Cedar Project is an ongoing cohort study involving young Indigenous people who have used illicit drugs in Vancouver and Prince George, BC. Data was collected every 6 months from 2007 to 2016. Generalized linear mixed-effects modeling was used to model survival sex work involvement, defined as exchanging sex for money, drugs, food or shelter in the previous six months. Results: Among 292 participants, 34% reported their family always/often lived by traditional culture and 37% reported their family always/often spoke their traditional language. In contrast, 48% had a parent in residential school and 72% were removed from their biological parents. In total, 55% of women were involved in survival sex work at baseline. In adjusted analyses, those who were single (ARR: 1.91; 95% CI: 1.50-2.35), identified as two-spirit (ARR: 2.16; 95% CI: 1.36-2.91), experienced sexual assault (ARR: 1.90; 95% CI: 1.22-2.58), were denied access to shelter (ARR: 1.71; 95% CI: 1.18-2.28), used crack daily (ARR: 2.85; 95% CI: 2.36-3.31), used injection drugs (ARR: 2.52; 95% CI: 1.98-3.07), and were unable to access substance use treatment (ARR: 1.58; 95% CI: 1.15-2.05) were more likely to be involved in sex work. Conclusion: Indigenous-governed, wellness-based harm-reduction interventions, and structural reforms addressing housing insecurity and normalization of a culture of violence against Indigenous women, especially those involved in survival sex work, are urgently needed in Canada.
Knowledge Creation, Dissemination, and Preservation Studies, 2021
The Cedar Project is an interdisciplinary, community-driven research project responding to the cr... more The Cedar Project is an interdisciplinary, community-driven research project responding to the crises of HIV and Hepatitis C infection and contributing to the healing of young Indigenous people who use or have used drugs. We are a collective membership of Indigenous Elders, health/social service experts, researchers, and non-Indigenous allies. We situate our work in the context of strength, resilience, and rights to self-determination for Indigenous peoples while also acknowledging the ongoing impacts of historical, intergenerational, and current trauma, specifically those related to the child welfare systems. We provide epidemiological and qualitative evidence that reflects Indigenous perspectives of health and wellness. In this paper, we highlight over seventeen years of shared learnings on conducting research with Indigenous communities in a good way. Specifically, we elaborate on four key components of our unique project. First, our paradigm is to build on young Indigenous people's strengths while acknowledging grief and historical trauma. We recognize that Cedar participants are not statistics—they are relatives of Indigenous partners governing this study. Second, our processes are determined by Indigenous governance, led by Elders and rooted in cultural safety. Third, our research ethics are determined by terms of reference created by the Cedar Project Partnership and by embracing guidelines of TCPS and community-based research. Fourth, we are informed by multiple perspectives and research relationships between Elders, partners, students, academics, and research staff. Sharing our learnings with the larger research community can contribute to decolonizing research spaces by centering Indigenous knowledges and privileging Indigenous voice.
Background: Colonization and colonial systems have led to the overrepresentation of Indigenous pe... more Background: Colonization and colonial systems have led to the overrepresentation of Indigenous people im-pacted by substance use and HCV infection in Canada. It is critical to ensure Indigenous people's equitable access to new direct acting antiviral HCV treatments (DAAs). Identifying culturally-safe, healing-centered approaches that support the wellbeing of Indigenous people living with HCV is an essential step toward this goal. We listened to the stories and perspectives of HCV-affected Indigenous people and HCV treatment providers with the aim of providing pragmatic recommendations for decolonizing HCV care. Methods: Forty-five semi-structured interviews were carried out with Indigenous participants affected by HCV from the Cedar Project (n = 20, British Columbia (BC)) and the Canadian Coinfection Cohort (n = 25, BC; Ontario (ON); Saskatchewan (SK)). In addition, 10 HCV treatment providers were interviewed (n = 4 BC, n = 4 ON, n = 2 SK). Interpretive description identified themes to inform clinical approaches and public health HCV care. Themes and related recommendations were validated by Indigenous health experts and Indigenous participants prior to coding and re-contextualization. Results: Taken together, participants' stories and perceptions were interpreted to coalesce into three overarching and interdependent themes representing their recommendations. First: treatment providers must understand and accept colonization as a determinant of health and wellness among HCV-affected Indigenous people, including ongoing cycles of child apprehension and discrimination within the healthcare system. Second: consistently safe attitudes and actions create trust within HCV treatment provider-patient relationships and open opportunities for engagement into care. Third: treatment providers who identify, build, and strengthen circles of care will have greater success engaging HCV-affected Indigenous people who have used drugs into care. Conclusion: There are several pragmatic ways to integrate Truth and Reconciliation as well as Indigenous concepts of whole-person wellness into the HCV cascade of care. By doing so, HCV treatment providers have an opportunity to create greater equity and support long-term wellness of Indigenous patients.
This MA thesis examines the decision-making capacity of young women married during
adolescence wi... more This MA thesis examines the decision-making capacity of young women married during adolescence within the context of their sexual and reproductive health in an urban ghetto in the city of Ahmedabad, India. Specifically, the development literature on married female adolescents (MFAs) is characterized by negative health indicators such as higher rates of unwanted pregnancies, reproductive tract infections, sexually transmitted diseases, high infant and maternal mortality and morbidity coupled with the phenomenon of early marriage, poverty and an overall lower social status. The result is a disempowering discourse that constructs and presents them as powerless victims who lack any decision-making capacity and are perpetually oppressed. This research is an effort to move the discussions of “Other third world women” outside the realm of victimization by challenging and destabilizing this disempowering, hegemonic discourse. We must ask what does decision making look like for these women, as exercised within the context of their sexual and reproductive health. This qualitative analysis is informed by primary research through focus groups and semi-structured interviews with young married women, and was conducted with the help of a local NGO, Mahila Patchwork Co-operative Society. The study provides insights on the young married women‟s participation and role in determining their own health outcomes (negative and positive) to better inform programs and services offered by the community NGOs.
Indigenous leaders remain concerned that systemic oppression and culturally unsafe care impede In... more Indigenous leaders remain concerned that systemic oppression and culturally unsafe care impede Indigenous peoples living with HIV from accessing health services that make up the HIV cascade of care. We conducted a systematic review to assess the evidence related to experiences of the HIV care cascade among Indigenous peoples in Australia, Canada, New Zealand, and United States. We identified 93 qualitative and quantitative articles published between 1996 and 2017 reporting primary data on cascade outcomes disaggregated by Indigenous identity. Twelve involved data from Australia, 52 from Canada, 3 from New Zealand and 26 from United States. The majority dealt with HIV testing/diagnosis (50). Relatively few addressed post-diagnosis experiences: linkage (14); retention (20); treatment initiation (21); adherence (23); and viral suppression (24). With the HIV cascade of care increasingly the focus of global, national, and local HIV agendas, it is critical that culturally-safe care for Indigenous peoples is available at all stages.
Background: Indigenous young people, particularly those involved in the child welfare system, tho... more Background: Indigenous young people, particularly those involved in the child welfare system, those entrenched in substance use and those living with HIV or hepatitis C, are dying prematurely. We report mortality rates among young Indigenous people who use drugs in British Columbia and explore predictors of mortality over time. Methods: We analyzed data collected every 6 months between 2003 and 2014 by the Cedar Project, a prospective cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, BC. We calculated age-standardized mortality ratios using Indigenous and Canadian reference populations. We identified predictors of mortality using time-dependent Cox proportional hazard regression. Results: Among 610 participants, 40 died between 2003 and 2014, yielding a mortality rate of 670 per 100 000 person- years. Young Indigenous people who used drugs were 12.9 (95% confidence interval [CI] 9.2–17.5) times more likely to die than all Canadians the same age and were 7.8 (95% CI 5.6–10.6) times more likely to die than Indigenous people with Status in BC. Young women and those using drugs by injection were most affected. The leading causes of death were overdose (n = 15 [38%]), illness (n = 11 [28%]) and suicide (n = 5 [12%]). Predictors of mortality included having hepatitis C at baseline (adjusted hazard ratio [HR] 2.76, 95% CI 1.47–5.16), previous attempted suicide (adjusted HR 1.88, 95% CI 1.01– 3.50) and recent overdose (adjusted HR 2.85, 95% CI 1.00–8.09). Interpretation: Young Indigenous people using drugs in BC are dying at an alarming rate, particularly young women and those using injection drugs. These deaths likely reflect complex intersections of historical and present-day injustices, substance use and barriers to care.
Background. Mental health and wellbeing, including addressing impacts of historical trauma and su... more Background. Mental health and wellbeing, including addressing impacts of historical trauma and substance use among young people, has been identified as a key priority by Indigenous communities and leaders across Canada and globally. Yet, research to understand mental health among young Indigenous people who have used drugs is limited. Aims. To examine longitudinal risk and strengths-based factors associated with psychological distress among young Indigenous people who use drugs. Method. The Cedar Project is an ongoing cohort study involving young Indigenous people who use drugs in Vancouver, Prince George, and Chase, British Columbia, Canada. This study included participants who completed the Symptom Checklist-90-Revised, returned for follow-up between 2010 and 2012, and completed the Childhood Trauma Questionnaire. Adjusted linear mixed-effects models estimated effects of study variables on changes in area T-scores of psychological distress. Results. Of 202 eligible participants, 53% were women and the mean age was 28 years. Among men, childhood maltreatment (emotional abuse, physical abuse, sexual abuse, physical neglect), any drug use, blackouts from drinking, and sex work were associated with increased distress. Among women, childhood maltreatment (emotional abuse, physical abuse, physical neglect), blackouts from drinking, and sexual assault were associated with increased distress, while having attempted to quit using drugs was associated with reduced distress. Marginal associations were observed between speaking their traditional language and living by traditional culture with lower distress among men. Conclusion. Culturally safe mental wellness interventions are urgently needed to address childhood trauma and harmful coping strategies that exacerbate distress among young Indigenous people who use drugs.
lq6u^dm lo uo[plon e st pue polqlqotd ^lssajdxa $ uorssuu€d uauu,$ ]nol4r/rr uo{pnpoldat laqlo lo... more lq6u^dm lo uo[plon e st pue polqlqotd ^lssajdxa $ uorssuu€d uauu,$ ]nol4r/rr uo{pnpoldat laqlo lo butldocoloqd atnllsul qclPasoH cl^lC e !02 O
Objectives: The objectives of this qualitative investigation are two‐fold: (1) to clarify issues ... more Objectives: The objectives of this qualitative investigation are two‐fold: (1) to clarify issues related to measuring simultaneous use in the context of alcohol and cocaine; and (2) to explore the patterns of simultaneous use of cocaine and alcohol, focusing on temporal order, mode of administration, drug form, and drug dose. Methods: In‐depth open‐ended pilot interviews with simultaneous cocaine and alcohol users were conducted at a residential treatment centre in Ontario, Canada (n = 10). The interview transcripts were coded by three coders independently. Analyses of the transcripts were performed to identify emerging themes and to develop conceptual networks of codes. Findings: Respondents focused on the effects of introducing one substance after the other, rather than the combined effects of both alcohol and cocaine. They also discussed the importance of alcohol in relation to different methods of use, with alcohol being more common when cocaine was snorted, rather than injected or smoked. Finally, preliminary results suggest that the temporal order of cocaine or alcohol ingestion is related to differential functions of use. The study highlights the importance of developing better measures of patterns of simultaneous use to describe the complexity of alcohol and cocaine use and its effects.
International Journal for Crime, Justice and Social Democracy, 2014
Abstract
The brutal gang rape of a physiotherapy student in India in December 2012 drew the worl... more Abstract
The brutal gang rape of a physiotherapy student in India in December 2012 drew the world’s attention to the problem of sexual violence against women in that country. Protests and mass public reaction towards the case pressurized the government to respond to the crisis by changing the laws on sexual violence. However, these new laws have not led to a decrease in violence against women (VAW). Is this the result of the failure of the rule of law? Or does it highlight the limitations of law in absence of social change? This paper addresses the need for using law as a key tool in addressing violence against women in India. It recognizes that unless we address the structural and root causes of violence against women, our analysis will be limited. It is important to bridge the creation of new laws, with an analysis that speaks to the role of hypermasculinity, neoliberalism and culture in VAW. If unaddressed, what may result instead are quick fixes, symbolized by the passing of new laws that act as token gestures rather than ones leading to transformative action.
Keywords India; gang‐rape; law; hypermasculinity; political economy;
Abstract The twentieth century saw a paradigm shift in medical education, with acceptance that 'k... more Abstract The twentieth century saw a paradigm shift in medical education, with acceptance that 'knowledge' and 'truth' are contextual, in flux and always evolving. The twenty-first century has seen a greater explosion in computer technology leading to a massive increase in information and an ease of availability, both offering great potential to future research. However, for many decades, there have been voices within the health care system raising an alarm at the lack of evidence to support widespread clinical practice; from these voices, the concept of and need for evidence-based health-care has grown. Parallel to this development has been the emergence of evidence-based medical education; if healthcare is evidence-based, then the training of practitioners who provide this healthcare must equally be evidence-based. Evidence-based medical education involves the systematic collection, synthesis and application of all available evidence, when available, and not just the opinion of experts. This represented a seismic shift from a position of expert based consensus guidance to evidence led guidance for evolving clinical knowledge. The aim of this guide is to provide a practical approach to the development and application of a systematic review in medical education; a valid method used in this guide to seek and substantiate the effects of interventions in medical education.
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Papers by Richa Sharma
adolescence within the context of their sexual and reproductive health in an urban ghetto in the city of Ahmedabad, India. Specifically, the development literature on married female adolescents (MFAs) is characterized by negative health indicators such as higher rates of unwanted pregnancies, reproductive tract infections, sexually transmitted diseases, high infant and maternal mortality and morbidity coupled with the phenomenon of early marriage, poverty and an overall lower social status. The result is a disempowering discourse that constructs and presents them as powerless victims who lack any decision-making capacity and are perpetually oppressed. This research is an effort to move the discussions of “Other third world women” outside the realm of victimization by challenging and destabilizing this disempowering, hegemonic discourse. We must ask what does decision making look like for these women, as exercised within the context of their sexual and reproductive health. This qualitative analysis is informed by primary research through focus groups and semi-structured interviews with young married women, and was conducted with the help of a local NGO, Mahila Patchwork Co-operative Society. The study provides insights on the young married women‟s participation and role in determining their own health outcomes (negative and positive) to better inform programs and services offered by the community NGOs.
Methods: We analyzed data collected every 6 months between 2003 and 2014 by the Cedar Project, a prospective cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, BC. We calculated age-standardized mortality ratios using Indigenous and Canadian reference populations. We identified predictors of mortality using time-dependent Cox proportional hazard regression.
Results: Among 610 participants, 40 died between 2003 and 2014, yielding a mortality rate of 670 per 100 000 person- years. Young Indigenous people who used drugs were 12.9 (95% confidence interval [CI] 9.2–17.5) times more likely to die than all Canadians the same age and were 7.8 (95% CI 5.6–10.6) times more likely to die than Indigenous people with Status in BC. Young women and those using drugs by injection were most affected. The leading causes of death were overdose (n = 15 [38%]), illness (n = 11 [28%]) and suicide (n = 5 [12%]). Predictors of mortality included having hepatitis C at baseline (adjusted hazard ratio [HR] 2.76, 95% CI 1.47–5.16), previous attempted suicide (adjusted HR 1.88, 95% CI 1.01– 3.50) and recent overdose (adjusted HR 2.85, 95% CI 1.00–8.09).
Interpretation: Young Indigenous people using drugs in BC are dying at an alarming rate, particularly young women and those using injection drugs. These deaths likely reflect complex intersections of historical and present-day injustices, substance use and barriers to care.
Aims. To examine longitudinal risk and strengths-based factors associated with psychological distress among young Indigenous people who use drugs.
Method. The Cedar Project is an ongoing cohort study involving young Indigenous people who use drugs in Vancouver, Prince George, and Chase, British Columbia, Canada. This study included participants who completed the Symptom Checklist-90-Revised, returned for follow-up between 2010 and 2012, and completed the Childhood Trauma Questionnaire. Adjusted linear mixed-effects models estimated effects of study variables on changes in area T-scores of psychological distress.
Results. Of 202 eligible participants, 53% were women and the mean age was 28 years. Among men, childhood maltreatment (emotional abuse, physical abuse, sexual abuse, physical neglect), any drug use, blackouts from drinking, and sex work were associated with increased distress. Among women, childhood maltreatment (emotional abuse, physical abuse, physical neglect), blackouts from drinking, and sexual assault were associated with increased distress, while having attempted to quit using drugs was associated with reduced distress. Marginal associations were observed between speaking their traditional language and living by traditional culture with lower distress among men.
Conclusion. Culturally safe mental wellness interventions are urgently needed to address childhood trauma and harmful coping strategies that exacerbate distress among young Indigenous people who use drugs.
Methods: In‐depth open‐ended pilot interviews with simultaneous cocaine and alcohol users were conducted at a residential treatment centre in Ontario, Canada (n = 10). The interview transcripts were coded by three coders independently. Analyses of the transcripts were performed to identify emerging themes and to develop conceptual networks of codes.
Findings: Respondents focused on the effects of introducing one substance after the other, rather than the combined effects of both alcohol and cocaine. They also discussed the importance of alcohol in relation to different methods of use, with alcohol being more common when cocaine was snorted, rather than injected or smoked. Finally, preliminary results suggest that the temporal order of cocaine or alcohol ingestion is related to differential functions of use. The study highlights the importance of developing better measures of patterns of simultaneous use to describe the complexity of alcohol and cocaine use and its effects.
The brutal gang rape of a physiotherapy student in India in December 2012 drew the world’s attention to the problem of sexual violence against women in that country. Protests and mass public reaction towards the case pressurized the government to respond to the crisis by changing the laws on sexual violence. However, these new laws have not led to a decrease in violence against women (VAW). Is this the result of the failure of the rule of law? Or does it highlight the limitations of law in absence of social change? This paper addresses the need for using law as a key tool in addressing violence against women in India. It recognizes that unless we address the structural and root causes of violence against women, our analysis will be limited. It is important to bridge the creation of new laws, with an analysis that speaks to the role of hypermasculinity, neoliberalism and culture in VAW. If unaddressed, what may result instead are quick fixes, symbolized by the passing of new laws that act as token gestures rather than ones leading to transformative action.
Keywords
India; gang‐rape; law; hypermasculinity; political economy;
adolescence within the context of their sexual and reproductive health in an urban ghetto in the city of Ahmedabad, India. Specifically, the development literature on married female adolescents (MFAs) is characterized by negative health indicators such as higher rates of unwanted pregnancies, reproductive tract infections, sexually transmitted diseases, high infant and maternal mortality and morbidity coupled with the phenomenon of early marriage, poverty and an overall lower social status. The result is a disempowering discourse that constructs and presents them as powerless victims who lack any decision-making capacity and are perpetually oppressed. This research is an effort to move the discussions of “Other third world women” outside the realm of victimization by challenging and destabilizing this disempowering, hegemonic discourse. We must ask what does decision making look like for these women, as exercised within the context of their sexual and reproductive health. This qualitative analysis is informed by primary research through focus groups and semi-structured interviews with young married women, and was conducted with the help of a local NGO, Mahila Patchwork Co-operative Society. The study provides insights on the young married women‟s participation and role in determining their own health outcomes (negative and positive) to better inform programs and services offered by the community NGOs.
Methods: We analyzed data collected every 6 months between 2003 and 2014 by the Cedar Project, a prospective cohort study involving young Indigenous people who use illicit drugs in Vancouver and Prince George, BC. We calculated age-standardized mortality ratios using Indigenous and Canadian reference populations. We identified predictors of mortality using time-dependent Cox proportional hazard regression.
Results: Among 610 participants, 40 died between 2003 and 2014, yielding a mortality rate of 670 per 100 000 person- years. Young Indigenous people who used drugs were 12.9 (95% confidence interval [CI] 9.2–17.5) times more likely to die than all Canadians the same age and were 7.8 (95% CI 5.6–10.6) times more likely to die than Indigenous people with Status in BC. Young women and those using drugs by injection were most affected. The leading causes of death were overdose (n = 15 [38%]), illness (n = 11 [28%]) and suicide (n = 5 [12%]). Predictors of mortality included having hepatitis C at baseline (adjusted hazard ratio [HR] 2.76, 95% CI 1.47–5.16), previous attempted suicide (adjusted HR 1.88, 95% CI 1.01– 3.50) and recent overdose (adjusted HR 2.85, 95% CI 1.00–8.09).
Interpretation: Young Indigenous people using drugs in BC are dying at an alarming rate, particularly young women and those using injection drugs. These deaths likely reflect complex intersections of historical and present-day injustices, substance use and barriers to care.
Aims. To examine longitudinal risk and strengths-based factors associated with psychological distress among young Indigenous people who use drugs.
Method. The Cedar Project is an ongoing cohort study involving young Indigenous people who use drugs in Vancouver, Prince George, and Chase, British Columbia, Canada. This study included participants who completed the Symptom Checklist-90-Revised, returned for follow-up between 2010 and 2012, and completed the Childhood Trauma Questionnaire. Adjusted linear mixed-effects models estimated effects of study variables on changes in area T-scores of psychological distress.
Results. Of 202 eligible participants, 53% were women and the mean age was 28 years. Among men, childhood maltreatment (emotional abuse, physical abuse, sexual abuse, physical neglect), any drug use, blackouts from drinking, and sex work were associated with increased distress. Among women, childhood maltreatment (emotional abuse, physical abuse, physical neglect), blackouts from drinking, and sexual assault were associated with increased distress, while having attempted to quit using drugs was associated with reduced distress. Marginal associations were observed between speaking their traditional language and living by traditional culture with lower distress among men.
Conclusion. Culturally safe mental wellness interventions are urgently needed to address childhood trauma and harmful coping strategies that exacerbate distress among young Indigenous people who use drugs.
Methods: In‐depth open‐ended pilot interviews with simultaneous cocaine and alcohol users were conducted at a residential treatment centre in Ontario, Canada (n = 10). The interview transcripts were coded by three coders independently. Analyses of the transcripts were performed to identify emerging themes and to develop conceptual networks of codes.
Findings: Respondents focused on the effects of introducing one substance after the other, rather than the combined effects of both alcohol and cocaine. They also discussed the importance of alcohol in relation to different methods of use, with alcohol being more common when cocaine was snorted, rather than injected or smoked. Finally, preliminary results suggest that the temporal order of cocaine or alcohol ingestion is related to differential functions of use. The study highlights the importance of developing better measures of patterns of simultaneous use to describe the complexity of alcohol and cocaine use and its effects.
The brutal gang rape of a physiotherapy student in India in December 2012 drew the world’s attention to the problem of sexual violence against women in that country. Protests and mass public reaction towards the case pressurized the government to respond to the crisis by changing the laws on sexual violence. However, these new laws have not led to a decrease in violence against women (VAW). Is this the result of the failure of the rule of law? Or does it highlight the limitations of law in absence of social change? This paper addresses the need for using law as a key tool in addressing violence against women in India. It recognizes that unless we address the structural and root causes of violence against women, our analysis will be limited. It is important to bridge the creation of new laws, with an analysis that speaks to the role of hypermasculinity, neoliberalism and culture in VAW. If unaddressed, what may result instead are quick fixes, symbolized by the passing of new laws that act as token gestures rather than ones leading to transformative action.
Keywords
India; gang‐rape; law; hypermasculinity; political economy;