Using Google Trends to Inform the Population Size Estimation and Spatial Distribution of Gay, Bisexual, and Other Men Who Have Sex With Men: Proof-of-concept Study

Background:We must triangulate data sources to understand best the spatial distribution and population size of marginalized populations to empower public health leaders to address population-specific needs. Existing population size estimation techniques are difficult and limited. Objective:We sought to identify a passive surveillance strategy that utilizes internet and social media to enhance, validate, and triangulate population size estimates of gay, bisexual, and other men who have sex with men (gbMSM). Methods:We explored the Google Trends platform to approximate an estimate of the spatial heterogeneity of the population distribution of gbMSM. This was done by comparing the prevalence of the search term “gay porn” with that of the search term “porn.” Results:Our results suggested that most cities have a gbMSM population size between 2% and 4% of their total population, with large urban centers having higher estimates relative to rural or suburban areas. This represents nearly a double up of population size estimates compared to that found by other methods, which typically find that between 1% and 2% of the total population are gbMSM. We noted that our method was limited by unequal coverage in internet usage across Canada and differences in the frequency of porn use by gender and sexual orientation. Conclusions:We argue that Google Trends estimates may provide, for many public health planning purposes, adequate city-level estimates of gbMSM population size in regions with a high prevalence of internet access and for purposes in which a precise or narrow estimate of the population size is not required. Furthermore, the Google Trends platform does so in less than a minute at no cost, making it extremely timely and cost-effective relative to more precise (and complex) estimates. We also discuss future steps for further validation of this approach

Substance-specific readiness to change among sexual and gender minority men who use crystal methamphetamine

A patient-oriented approach to addressing high levels of polysubstance use among sexual and gender minority men (SGM) who use crystal methamphetamine (CM) requires an understanding of which drugs they would like to change their use of. We examined readiness to change for 24 separate substances. Participants were SGM, aged 18+, living with Canada, who used CM in the past six months that were recruited through advertisements on socio-sexual networking applications. Frequency of use and readiness to change were descriptively analyzed and associations between frequency of use and readiness to change were assessed. Only slightly more than half (53.1%) of CM-using SGM were ready now, soon, or in the future to change substance use. Participants were most ready to change their tobacco, methamphetamine, and barbiturate use. Greater frequency of use was associated with greater readiness to change for all drugs in which daily or almost daily use was common. SGM participants reported high levels of comfort being asked about their substance use from primary care, mental health, and queer-identified health professionals. Interventions addressing multiple and specific substances are needed in health care settings serving SGM who use CM. Screening, brief interventions, and referral to treatment (SBIRT) in these settings may help identify those ready to address their substance use. Harm reduction interventions should offer supports for those not wanting to change their substance use—which includes most SGM for most of the drugs they use

Building common understanding::seeking consensus and defining social prescribing across contexts – a collective commentary on a Delphi study

Social prescribing has become a global phenomenon. A Delphi study was recently conducted with 48 social prescribing experts from 26 countries to establish global agreement on the definition of social prescribing. We refect on the use and utility of the outputs of this work, and where we go from here

La prescription sociale au Canada : la promotion de la santé en action, 50 ans après le rapport Lalonde

RésuméLe rapport Lalonde, publié en 1974 par le ministre canadien de la Santé nationale et du Bien-être social, a fait oeuvre de pionnier en matière de santé publique au Canada en reconnaissant que les déterminants de la santé vont bien au-delà des services de soins de santé. Cinquante ans plus tard, ce numéro spécial de Promotion de la santé et prévention des maladies chroniques au Canada montre comment on peut agir sur les déterminants de la santé en amont au moyen d’une nouvelle intervention appelée « prescription sociale ». La prescription sociale oriente les patients vers des ressources communautaires qui correspondent à leurs priorités personnelles. Elle favorise ainsi un changement de paradigme par lequel l’approche de promotion de la santé n’est plus axée sur les déficits mais sur les forces. La première partie de ce numéro porte sur la croissance rapide de la prescription sociale et ses applications variées au Canada, que ce soit des initiatives ciblant diverses populations ou des interventions privilégiant le contact avec la nature, les arts, l’activité physique ou encore la connectivité sociale. Les contributions d’un large éventail de partenaires (chercheurs, professionnels de la santé et membres de la communauté, etc.) explorent l’adaptabilité de la prescription sociale à différents groupes, soulignent le rôle que jouent la communauté et les expériences vécues dans la recherche et signalent également la nécessité d’un plus grand nombre d’études sur l’efficacité et les résultats de la prescription sociale. Les études de cas présentées prouvent l’existence d’avantages tangibles sur les plans de l’équité en santé et de l’accès aux services sociaux. Ce numéro ne reflète pas seulement la portée et l’incidence actuelles de la prescription sociale au Canada : il jette aussi les bases de son évolution future et de son intégration dans les pratiques de santé en général

Social prescribing in Canada: health promotion in action, 50 years after the Lalonde report

AbstractThe Lalonde report, published in 1974 by the Canadian Minister of National Health and Welfare, broke ground for public health in Canada by acknowledging that the determinants of health are much broader than health care services. Fifty years later, this special issue of Health Promotion and Chronic Disease Prevention in Canada charts a clear path towards addressing upstream determinants of health through an emerging intervention called “social prescribing.” Social prescribing connects patients with community resources tailored to their individual priorities, fostering a paradigm shift from a deficitbased to a strengths-based approach in health promotion. Part 1 of this issue covers the rapid growth and diverse applications of social prescribing across Canada, with targeted initiatives for various populations and interventions ranging from nature and arts to physical activity and social connectivity. Contributions from a wide range of partners, including researchers, health professionals and community members, explore the adaptability of social prescribing for different groups, underscore the role of community and lived experiences in research, and call for more studies on social prescribing’s effectiveness and outcomes. Highlighted case studies demonstrate tangible benefits in health equity and access to social services. This issue not only reflects the current scope and impact of social prescribing in Canada but also sets the stage for its future development and integration into broader health practices

The role of vaccine status homophily in the COVID-19 pandemic: a cross-sectional survey with modelling

Abstract Background Vaccine homophily describes non-heterogeneous vaccine uptake within contact networks. This study was performed to determine observable patterns of vaccine homophily, as well as the impact of vaccine homophily on disease transmission within and between vaccination groups under conditions of high and low vaccine efficacy. Methods Residents of British Columbia, Canada, aged ≥ 16 years, were recruited via online advertisements between February and March 2022, and provided information about vaccination status, perceived vaccination status of household and non-household contacts, compliance with COVID-19 prevention guidelines, and history of COVID-19. A deterministic mathematical model was used to assess transmission dynamics between vaccine status groups under conditions of high and low vaccine efficacy. Results Vaccine homophily was observed among those with 0, 2, or 3 doses of the vaccine. Greater homophily was observed among those who had more doses of the vaccine (p < 0.0001). Those with fewer vaccine doses had larger contact networks (p < 0.0001), were more likely to report prior COVID-19 (p < 0.0001), and reported lower compliance with COVID-19 prevention guidelines (p < 0.0001). Mathematical modelling showed that vaccine homophily plays a considerable role in epidemic growth under conditions of high and low vaccine efficacy. Furthermore, vaccine homophily contributes to a high force of infection among unvaccinated individuals under conditions of high vaccine efficacy, as well as to an elevated force of infection from unvaccinated to suboptimally vaccinated individuals under conditions of low vaccine efficacy. Interpretation The uneven uptake of COVID-19 vaccines and the nature of the contact network in the population play important roles in shaping COVID-19 transmission dynamics

Patterns of online and offline connectedness among gay, bisexual, and other men who have sex with men

This study examined patterns of connectedness among 774 sexually-active gay, bisexual, and other men who have sex with men (GBM), aged ≥ 16 years, recruited using respondent-driven sampling in Metro Vancouver. Latent class analysis examined patterns of connectedness including: attendance at gay venues/events (i.e., bars/clubs, community groups, pride parades), social time spent with GBM, use of online social and sex seeking apps/websites, and consumption of gay media. Multinomial regression identified correlates of class membership. A three-class LCA solution was specified: Class 1 “Socialites” (38.8%) were highly connected across all indicators. Class 2 “Traditionalists” (25.7%) were moderately connected, with little app/website-use. Class 3 “Techies” (35.4%) had high online connectedness and relatively lower in-person connectedness. In multivariable modelling, Socialites had higher collectivism than Traditionalists, who had higher collectivism than Techies. Socialites also had higher annual incomes than other classes. Techies were more likely than Traditionalists to report recent serodiscordant or unknown condomless anal sex and HIV risk management practices (e.g., ask their partner’s HIV status, get tested for HIV). Traditionalists on the other hand were less likely to practice HIV risk management and had lower HIV/AIDS stigma scores than Socialites. Further, Traditionalists were older, more likely to be partnered, and reported fewer male sex partners than men in other groups. These findings highlight how patterns of connectedness relate to GBM’s risk management

Can the combination of TasP and PrEP eliminate HIV among MSM in British Columbia, Canada?

Introduction: In British Columbia (BC), the HIV epidemic continues to disproportionally affect the gay, bisexual and other men who have sex with men (MSM). In this study, we aimed to evaluate how Treatment as Prevention (TasP) and pre-exposure prophylaxis (PrEP), if used in combination, could lead to HIV elimination in BC among MSM. Methods: Considering the heterogeneity in HIV transmission risk, we developed a compartmental model stratified by age and risk-taking behaviour for the HIV epidemic among MSM in BC, informed by clinical, behavioural and epidemiological data. Key outcome measures included the World Health Organization (WHO) threshold for disease elimination as a public health concern and the effective reproduction number (Re). Model interventions focused on the optimization of different TasP and PrEP components. Sensitivity analysis was done to evaluate the impact of sexual mixing patterns, PrEP effectiveness and increasing risk-taking behaviour. Results: The incidence rate was estimated to be 1.2 (0.9–1.9) per 1000 susceptible MSM under the Status Quo scenario by the end of 2029. Optimizing all aspects of TasP and the simultaneous provision of PrEP to high-risk MSM resulted in an HIV incidence rate as low as 0.4 (0.3–0.6) per 1000 susceptible MSM, and an Re as low as 0.7 (0.6–0.9), indicating that disease elimination was possible when TasP and PrEP were combined. Provision of PrEP to younger MSM or high-risk and younger MSM resulted in a similar HIV incidence rate, but an Re with credible intervals that crossed one. Conclusion: Further optimizing all aspects of TasP and prioritizing PrEP to high-risk MSM can achieve the goal of disease elimination in BC. These results should inform public health policy development and intervention programs that address the HIV epidemic in BC and in other similar settings where MSM are disproportionately affected

Escape expectancies and sexualized substance use among gay, bisexual, and other men who have sex with men

McKirnan’s Cognitive Escape Theory (1996) is often characterized by the hypothesis that drugs are used during sex by gay, bisexual, and other men who have sex with men (gbMSM) to relieve internal cognitive conflict over safe-sex norms and sexual desire. We examined how McKirnan’s Cognitive Escape Scale (CES) is related to other widely used constructs relevant to sexualized substance use with hopes of better situating the theory within the evolving landscape of HIV-prevention. Associations between CES and trait anxiety, depression, treatment optimism, sexual altruism, sexual sensation seeking, and self-perceived risk for HIV transmission/acquisition were tested. Mediation analyses tested whether associated psychological measures mediated the effect of CES on the proportion of events in which participants reported co-occurrent substance use and condomless anal sex. Results indicated that CES is associated with higher sexual sensation seeking, treatment optimism, trait anxiety, and perceived likelihood of HIV transmission/ acquisition. Mediation analyses suggest that CES is related to but operates independently of treatment optimism, sensation seeking, and trait anxiety. Nevertheless, the intersection of HIV- related worries and substance use expectancies are clearly more nuanced than is widely reported is discussions on cognitive escap