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

Specifically, the project aims to:

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

Principal Investigators: Dr. Michelle Ybarra, Dr. Elizabeth Saewyc

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

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

Principal Investigator: Dr. Elizabeth Saewyc

Research Team:
Shannon Srivastava, Research Assistant, SARAVYC, School of Nursing, UBC

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

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

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

Principal Investigator: Dr. Alex Abramovich (Toronto)

Principal Investigator (Vancouver Site): Dr. Elizabeth Saewyc

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

Research Team (Vancouver Site):
Dr. Monica Rana, Managing Director, SARAVYC, School of Nursing, UBC
Shannon Srivastava, Research Assistant, SARAVYC, School of Nursing, UBC
James Sinclair, Research Assistant, SARAVYC, School of Nursing, UBC

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

The aim of this study is to pilot test the effect of a short, discussion-led social cognitive intervention on homophobic language use, descriptive norms, injunctive norms, and attitudes towards using homophobic language. The intervention will be delivered by professional rugby union players to teenage rugby union teams.

British Columbia Rugby (BC Rugby) wants to challenge the use of homophobic language in Rugby and will be initiating the intervention, in which the selected team members (ambassadors) from the BC Rugby teams will be trained to challenge homophobia in their team culture. The current study will be a pilot study to explore the effect of the intervention using surveys and qualitative focus groups. We will be specifically observing the intervention, providing support to ambassadors, and examining the effect of the intervention to help BC Rugby to scale this intervention to all the clubs in the future.

Principal Investigator: Dr. Elizabeth Saewyc

Co-Investigators: Annie Smith, McCreary Centre Society, Executive Director; Dr. Richard Pringle, Monash University

Research Team:
Shannon Millar, Project Coordinator, SARAVYC
Shams Al-anzi, Research Assistant, SARAVYC
Emily Gee, Research Assistant, SARAVYC
Katie Horton, Research Assistant, McCreary Centre Society
Dr. Erik Denison, Postdoctoral Fellow, Monash University

Funded by: CIHR (Foundation Scheme) “Improving health equity for LGBTQ youth in Canada and globally: addressing the role of families and culture”

Partnering with BC Rugby

Sexual minority youth in British Columbia (BC) feel less supported by parents now than their sexual minority peers did in 1998, especially by fathers. There are few interventions designed for families, and almost all are group-based approaches in urban centres, with limited evaluation of their outcomes. Studies have shown the effectiveness of on-line and text-messaging approaches in sustaining health behaviour change, including by our research team, and such interventions can bypass barriers and access issues for parents and youth, even in rural areas (e.g., privacy, transportation, competing life demands, lack of available local professionals). However, studies of text-messaging interventions for sexual minority youth, while conducted in the United States by our team, have not been implemented in Canada, nor for parents. Further, there is very little research on how well families support rural sexual minority youth, or those from various ethnocultural and immigrant backgrounds, or if these youth face even greater health inequities due to the intersection of racism and stigma. There is no research on the extent to which protective factors like family connectedness buffer the effects of stigma for different ethnic groups of sexual minority youth in Canada and globally.

Although research has provided some direction about what lesbian, gay, bisexual, transgender, queer, Two Spirit, and other (LGBTQ/2S+) youth need from their parents to thrive, such as warmth, care and closeness, we have limited knowledge of the stressors and barriers parents face in supporting their youth and parents’ strategies for managing those stressors and barriers. 

Our research will identify culturally specific knowledge to create new, culturally relevant family and youth interventions, to improve their health and reduce the health disparities sexual minority youth face. These interventions will seek to effectively reach youth and their parents in rural as well as in urban areas, among diverse cultural groups, in order to improve support, health knowledge, and motivation for healthy coping.

The objectives of this study are:

• To understand the experience of parents of LGBTQ/2S+ youth in response to disclosure of their sexual orientation or gender identity.

• To identify and understand the stressors and barriers parents face within their communities and extended families in supporting their LGBTQ/2S+ youth, and parents’ strategies for navigating those stressors and barriers.
• To understand the role of collectivist and cultural communities on parental support of LGBTQ/2S+ youth.
• To gather feedback on developing interventions to support parents of LGBTQ/2S+ youth.

Principal Investigator: Dr. Elizabeth Saewyc

Co-Investigators: 

Dr. Sheila Marshall, Professor, School of Social Work, UBC
Dr. Chichun Lin, Assistant Professor, Marriage and Family Therapy Program, Faculty of Education, University of Winnipeg
Dr. Monica Rana, Managing Director, SARAVYC, School of Nursing, UBC
Shannon Millar, Research Assistant, SARAVYC, School of Nursing, UBC

Funded by: CIHR (Foundation Scheme) & SSHRC

Fostering healthy relationships among LGBTQ2S+ youth in British Columbia

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

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

Objectives

Develop and facilitate education modules

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

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

At the completion of these modules, participants will:

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

Evaluate intervention

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

Identify barriers

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

Measure Impact

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

Deliverables

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

Our team

SARAVYC

The SARAVYC team is led by:

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

McCreary Centre Society

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

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

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

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

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

Principal investigator: Dr. Elizabeth Saewyc

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

Funded by: Canadian Institutes of Health Research

Most of the sexual orientation research done on adolescents originates from the US and only a small number of publications come from other countries. For instance, there have been some recent publications from Turkey and Northern Ireland, but very little research published from African countries or the Middle East. The existence of LGBTQ2S communities has sometimes been phrased as a cultural specific phenomenon of the western world- this project aims to determine if that is the case.

The main research objective of this project is to find evidence of global estimates of adolescent sexual minorities. This will be achieved by conducting a systematic review of the available evidence of the estimates of the LGBTQ adolescent population around the world.

Principal Investigator: Dr. Elizabeth Saewyc

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

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

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

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

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

Principal Investigator: Dr. Elizabeth Saewyc

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

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