Factors associated with the use of psychedelics, ketamine and MDMA among sexual and gender minority youths in Canada: a machine learning analysis

BACKGROUND

Substance use is increasing among sexual and gender minority youth (SGMY). This increase may be due to changes in social norms and socialisation, or due to SGMY exploring the potential therapeutic value of drugs such as psychedelics. We identified predictors of psychedelics, MDMA and ketamine use.

METHODS

Data were obtained from 1414 SGMY participants who completed the ongoing longitudinal 2SLGBTQ+ Tobacco Project in Canada between November 2020 to January 2021. We examined the association between 80 potential features (including sociodemographic factors, mental health-related factors and substance use-related factors) with the use of psychedelics, MDMA and ketamine in the past year. Random forest classifier was used to identify the predictors most associated with reported use of these drugs.

RESULTS

18.1% of participants have used psychedelics in the past year; 21.9% used at least one of the three drugs. Cannabis and cocaine use were the predictors most strongly associated with any of these drugs, while cannabis, but not cocaine use, was the one most associated with psychedelic use. Other mental health and 2SLGBTQ+ stigma-related factors were also associated with the use of these drugs.

CONCLUSION

The use of psychedelics, MDMA and ketamine among 2SLGBTQ+ individuals appeared to be largely driven by those who used them together with other drugs. Depression scores also appeared in the top 10 factors associated with these illicit drugs, suggesting that there were individuals who may benefit from the potential therapeutic value of these drugs. These characteristics should be further investigated in future studies.

Correlates of wanting to seek help for mental health and substance use concerns by sexual and gender minority young adults during the COVID-19 pandemic: A machine learning analysis

The COVID-19 pandemic has worsened the mental health and substance use challenges among many people who are Two Spirit, lesbian, gay, bisexual, transgender, queer, questioning, and intersex (2SLGBTQI+). We aimed to identify the important correlates and their effects on the predicted likelihood of wanting to seek help among 2SLGBTQI+ young adults for mental health or substance use concerns during the pandemic. A cross-sectional survey was conducted in 2020-2021 among 2SLGBTQI+ young adults aged 16-29 living in two Canadian provinces (Ontario and Quebec). Among 1414 participants, 77% (n = 1089) wanted to seek help for their mental health or substance use concerns during the pandemic, out of these, 69.8% (n = 760) reported delay in accessing care. We built a random forest (RF) model to predict the status of wanting to seek help, which achieved moderately high performance with an area under the receiver operating characteristic curve (AUC) of 0.85. The top 10 correlates of wanting to seek help were worsening mental health, age, stigma and discrimination, and adverse childhood experiences. The interactions of adequate housing with certain sexual orientations, gender identities and mental health challenges were found to increase the likelihood of wanting to seek help. We built another RF model for predicting risk of delay in accessing care among participants who wanted to seek help (n = 1089). The model identified a similar set of top 10 correlates of delay in accessing care but lacked adequate performance (AUC 0.61). These findings can direct future research and targeted prevention measures to reduce health disparities for 2SLGBTQI+ young adults.

Correlates of past year suicidal thoughts among sexual and gender minority young adults: A machine learning analysis

Sexual and gender minority populations are at elevated risk of experiencing suicidal thoughts and attempting suicide. The COVID-19 pandemic exacerbated mental health and substance use challenges among this population. We aimed to examine the relative importance and effects of intersectional factors and strong interactions associated with the risk of suicidal thoughts among Canadian lesbian, gay, bisexual, transgender, queer, questioning, intersex and Two Spirit (LGBTQI2S+) young adults. A cross-sectional online survey was conducted among LGBTQI2S + participants aged 16-29 years living in two Canadian provinces (Ontario, Quebec). Among 1414 participants (mean age 21.90 years), 61% (n = 857) participants reported suicidal thoughts in last 12 months. We built a random forest model to predict the risk of having past year suicidal thoughts, which achieved high performance with an area under the receiver operating characteristic curve (AUC) of 0.84. The top 10 correlates identified were: seeking help from health professionals for mental health or substance use issues since the start of the pandemic, current self-rated mental health status, insulted by parents or adults in childhood, ever heard that being identifying as LGBTQI2S+ is not normal, age in years, past week feeling depressed, lifetime diagnosis of mental illness, lifetime diagnosis of depressive disorder, past week feeling sad, ever pretended to be straight or cisgender to be accepted. The increase in the risk of suicidal thoughts for those having mental health challenges or facing minority stressors is more pronounced in those living in urban areas or being unemployed than those living in rural areas or being employed.

Machine Learning Applications in Mental Health and Substance Use Research Among the LGBTQ2S+ Population: Scoping Review

BACKGROUND

A high risk of mental health or substance addiction issues among sexual and gender minority populations may have more nuanced characteristics that may not be easily discovered by traditional statistical methods.

OBJECTIVE

This review aims to identify literature studies that used machine learning (ML) to investigate mental health or substance use concerns among the lesbian, gay, bisexual, transgender, queer or questioning, and two-spirit (LGBTQ2S+) population and direct future research in this field.

METHODS

The MEDLINE, Embase, PubMed, CINAHL Plus, PsycINFO, IEEE Xplore, and Summon databases were searched from November to December 2020. We included original studies that used ML to explore mental health or substance use among the LGBTQ2S+ population and excluded studies of genomics and pharmacokinetics. Two independent reviewers reviewed all papers and extracted data on general study findings, model development, and discussion of the study findings.

RESULTS

We included 11 studies in this review, of which 81% (9/11) were on mental health and 18% (2/11) were on substance use concerns. All studies were published within the last 2 years, and most were conducted in the United States. Among mutually nonexclusive population categories, sexual minority men were the most commonly studied subgroup (5/11, 45%), whereas sexual minority women were studied the least (2/11, 18%). Studies were categorized into 3 major domains: web content analysis (6/11, 54%), prediction modeling (4/11, 36%), and imaging studies (1/11, 9%).

CONCLUSIONS

ML is a promising tool for capturing and analyzing hidden data on mental health and substance use concerns among the LGBTQ2S+ population. In addition to conducting more research on sexual minority women, different mental health and substance use problems, as well as outcomes and future research should explore newer environments, data sources, and intersections with various social determinants of health.

Is vaping cessation like smoking cessation? A qualitative study exploring the responses of youth and young adults who vape e-cigarettes

INTRODUCTION

Young people are now seeking help to quit vaping. However, little is known about vaping cessation. To bridge the gap between the current state of research and the urgent need for interventions, practitioners have drawn upon smoking cessation models under the assumption that vaping and smoking are fairly similar. In this study, we sought to understand the nature and extent to which vaping is similar to smoking in order to inform the development of vaping cessation interventions for young people.

METHODS

Seven focus groups were conducted between November 2019 and February 2020 among youth (ages 16-18) and young adults (ages 19-29) living in the Greater Toronto Area who self-identified as e-cigarette vapers and expressed interest in vaping cessation (n = 41). Focus groups were audio recorded, transcribed verbatim, and analyzed using thematic analysis methods.

RESULTS

Perceived similarities between vaping and smoking emerged from participant narratives: three themes relating to barriers to quitting (social benefits, stress reduction, sensory and behavioural gratification), and three relating to reasons for quitting (financial loss, industry influence, dependence). However, there were also perceived differences that emerged: three themes relating to barriers to quitting vaping (enjoyment of flavours, convenience and discreetness, lack of self-awareness of vaping behaviours), and two relating to reasons for quitting vaping (lack of trusted information, perceived social acceptability).

CONCLUSIONS

Although there is significant overlap between vaping and smoking, understanding perceived differences in barriers to quitting and reasons for quitting is critical to advancing vaping cessation research and practice among young people.

Preterm delivery among Inuit women in the Baffin Region of the Canadian Arctic

OBJECTIVE

To evaluate the rate and causes of preterm (before 37 weeks gestation) and very preterm (before 32 weeks gestation) delivery among a population of Inuit living in Canada.

STUDY DESIGN

Three-year retrospective cross-sectional review of charts for patients delivering in the Baffin Region of Canada.

RESULTS

There were 938 births over the study period; 95% to Inuit women. Inuit women had a preterm delivery rate of 18.2% and a very preterm delivery rate of 2.4%, more than twice the Canadian national average. Sociodemographic risk factors for preterm delivery including substance use, young age, single marital status, and poor nutrition, occurred more frequently among Inuit women compared to non-Inuit women, but were not independently associated with prematurity. Known medical and obstetrical risk factors were associated with preterm delivery among Inuit women; history of prior preterm delivery, multiple pregnancy, placenta previa, poor weight gain and vaginal bleeding after 20 weeks gestation. Hospitalization rates and infant mortality were higher among preterm infants. The most common indication for hospitalization was respiratory infection (51.1%) followed by other infection (15.8%).

CONCLUSION

Inuit women had preterm and very preterm delivery rates more than twice the Canadian national average. Preterm delivery was associated with several medical risk factors and resulted in significant increases in infant hospitalization and mortality.

Disparities in tobacco use by sexual orientation among high school students

OBJECTIVE

This study examined whether cigarette use is associated with sexual orientation among high school students.

METHODS

Data were from a 2012 cross-sectional survey of 5994 students in grades 9, 10 and 12 attending public schools in Atlantic Canada. Multilevel logistic regression analysis was used to examine differences in cigarette use by sexual orientation.

RESULTS

Lesbian, gay and bisexual adolescents (LGB) reported higher prevalence (22%) of daily cigarette use compared with heterosexuals (11%). Multilevel logistic regression analysis, controlling for standard covariates, found that LGB adolescents were more likely to be daily smokers than non-LGB adolescents (odds ratio 2.00, 95% confidence interval 1.50-2.68). Bisexual adolescents were at least twice more likely to be a smoker compared with heterosexual adolescents.

CONCLUSIONS

Prevalence of cigarette use was significantly higher among LGB adolescent students. Our results join a growing body of evidence indicating that sexual minorities are at heightened risk of tobacco use. Smoking cessation measures that specifically target this group may be beneficial given that there is no one size fits all approach.

Australian and Pacific contributions to the genetic diversity of Norfolk Island feral chickens

Background

Norfolk Island has a population of feral chickens which could be the result of domestic stock introduced onto the island by British settlers in 1788. However, there is ongoing debate about their origins because multiple human arrivals to the island may have brought chickens with them. Here we investigate the genetic origins of these feral chickens by sequencing their mitochondrial control region. We infer their phylogenetic relationships using a large dataset of novel sequences from Australian mainland domestic chickens and published sequences from around the world.

Results

Eleven control region haplotypes were found among the Norfolk Island feral and Australian mainland domestic chickens. Six of the Norfolk Island haplotypes fall within haplogroup E, but given the worldwide distribution of this haplogroup, the putative European origin of these chickens requires further investigation. One haplotype common among Norfolk Island and Australian samples belonged to a subgroup of haplogroup D, which appears to be restricted to chickens from Indonesia, Vanuatu and Guam.

Conclusions

Our data show that at least two mitochondrial DNA haplogroups (D and E) have contributed to the genetic make-up of Norfolk Island feral chickens. In addition, we have provided insights into the discrete geographical distribution and diversity of the chicken haplogroup D. In view of the worldwide interest in the characterisation of poultry resources, further assessment of chicken populations of Island Southeast Asia and the Pacific region is warranted.

An overview of practice facilitation programs in Canada: current perspectives and future directions

Practice facilitation has proven to be effective in improving the quality of primary care. A practice facilitator is a health professional, usually external to the practice, who regularly visits the practice to provide support in change management that targets improvements in the delivery of care. Our environmental scan shows that several initiatives across Canada utilize practice facilitation as a quality improvement method; however, many are conducted in isolation as there is a lack of coordinated effort, knowledge translation and dissemination in this field across the country. We recommend that investments be made in capacity building, knowledge exchange and facilitator training, and that partnership building be considered a priority in this field.

Survey of consumer and non-consumer mental health service providers on assertive community treatment teams in Ontario

Reflecting the increasing trend of consumers as providers in mental health services, the standards for Assertive Community Treatment (ACT) teams in Ontario, Canada require the hiring of at least 0.5 full-time equivalent consumer as a service provider. Through a mail-out survey, we explored how the consumer position has been integrated into these ACT teams. It was found that despite some variation in the roles and degree of integration of the consumers on these teams, consumers were generally well-incorporated team members with equal or better job satisfaction as compared to other employees.

Primary health care services provided by nurse practitioners and family physicians in shared practice

BACKGROUND

Collaborative practice involving nurse practitioners (NPs) and family physicians (FPs) is undergoing a renaissance in Canada. However, it is not understood what services are delivered by FPs and NPs working collaboratively. One objective of this study was to determine what primary health care services are provided to patients by NPs and FPs working in the same rural practice setting.

METHODS

Baseline data from 2 rural Ontario primary care practices that participated in a pilot study of an outreach intervention to improve structured collaborative practice between NPs and FPs were analyzed to compare service provision by NPs and FPs. A total of 2 NPs and 4 FPs participated in data collection for 400 unique patient encounters over a 2-month period; the data included reasons for the visit, services provided during the visit and recommendations for further care. Indices of service delivery and descriptive statistics were generated to compare service provision by NPs and FPs.

RESULTS

We analzyed data from a total of 122 encounters involving NPs and 278 involving FPs. The most frequent reason for visiting an NP was to undergo a periodic health examination (27% of reasons for visit), whereas the most frequent reason for visiting an FP was cardiovascular disease other than hypertension (8%). Delivery of health promotion services was similar for NPs and FPs (11.3 v. 10.0 instances per full-time equivalent [FTE]). Delivery of curative services was lower for NPs than for FPs (18.8 v. 29.3 instances per FTE), as was provision of rehabilitative services (15.0 v. 63.7 instances per FTE). In contrast, NPs provided more services related to disease prevention (78.8 v. 55.7 instances per FTE) and more supportive services (43.8 v. 33.7 instances per FTE) than FPs. Of the 173 referrals made during encounters with FPs, follow-up with an FP was recommended in 132 (76%) cases and with an NP in 3 (2%). Of the 79 referrals made during encounters with NPs, follow-up with an NP was recommended in 47 (59%) cases and with an FP in 13 (16%) (p < 0.001).

INTERPRETATION

For the practices in this study NPs were underutilized with regard to curative and rehabilitative care. Referral patterns indicate little evidence of bidirectional referral (a measure of shared care). Explanations for the findings include medicolegal issues related to shared responsibility, lack of interdisciplinary education and lack of familiarity with the scope of NP practice.

Fat-related dietary behaviour: behavioural science concepts for public health practice

Despite being central to Canadian health objectives, reduction in fat consumption remains a difficult health target to reach. Strong epidemiological data associate high dietary fat intake with cardiovascular disease (CVD). There has been considerable interest in applying concepts from psychosocial models of behaviour change to enhance the effectiveness of CVD prevention programs. This review suggests that the determinants of fat-related dietary behaviours can be integrated within a comprehensive model useful to public health practice. The Transtheoretical Model (TTM) is suggested as an organizing framework for variables empirically related to diet. The TTM holds that dietary change occurs through successive stages, defined according to people's readiness to adopt new behaviours. Furthermore, readiness to change can be explained by variables that are amenable to public health interventions. The integration of important variables within the TTM framework may prove helpful in designing, implementing and evaluating effective dietary change intervention programs in the community.

Health promotion activities in Quebec hospitals: a comparison of DSC and non-DSC hospitals

In the early 1970s, public health units were introduced to 32 Quebec hospitals. One of the reasons for introducing public health to hospitals was the beneficial influence this new structure, called "Département de santé communautaire" (DSC), was expected to have on the development of health promotion and prevention activities in the hospital. This study compared 19 DSC hospitals with 19 non-DSC hospitals that were matched for mission, size and location. The data came from a larger survey which had been conducted by the Canadian Hospital Association in Canadian hospitals in 1985. According to our results, DSC hospitals differed from their non-DSC counterparts mainly on dimensions related to their public health mandate (e.g. community programs, advocacy). They did not differ greatly on dimensions related to other health promotion and prevention activities within the hospital (e.g. inpatient and outpatient care, employees). These results suggest that while hospitals have not created organizational obstacles to the achievement of public health activities by DSCs, DSCs did not have the expected impact on hospitals.