The ongoing overdose and drug toxicity crisis in North America has contributed momentum to the em... more The ongoing overdose and drug toxicity crisis in North America has contributed momentum to the emergence of safer supply prescribing and programs in Canada as a means of providing an alternative to the highly volatile unregulated drug supply. The implementation and scale-up of safer supply have been met with a vocal reaction on the part of news media commentators, conservative politicians, recovery industry representatives, and some prominent addiction medicine physicians. This reaction has largely converged around several narratives, based on unsubstantiated claims and anecdotal evidence, alleging that safer supply programs are generating a "new opioid epidemic", reflecting an emerging alignment among key institutional and political actors. Employing situational analysis method, and drawing on the policy studies and social science scholarship on moral panics, this essay examines news media coverage from January to July 2023, bringing this into dialogue with other existing empirical sources on safer supply (e.g. Coroner's reports, program evaluations, debates among experts in medical journals). We employ eight previously established criteria delineating moral panics to critically appraise public dialogue regarding safer supply, diverted medication, and claims of increased youth initiation to drug use and youth overdose. In detailing the emergence of a moral panic regarding safer supply, we trace historic continuities with earlier drug scares in Canadian history mobilized as tools of racialized poverty governance, as well as previous backlashes towards healthcare interventions for people who use drugs (PWUD). The essay assesses the claims of moral entrepreneurs against the current landscape of opioid use, diversion, and overdose among youth, notes the key role played by medical expertise in this and previous moral panics, and identifies what the convergence of these narratives materialize for PWUD and healthcare access, as well as the broader policy responses such narratives activate.
Community-based models of cannabis cultivation, distribution, and consumption—such as cannabis cl... more Community-based models of cannabis cultivation, distribution, and consumption—such as cannabis clubs—have been documented across Europe, North America, South America, and New Zealand since the 1990s. For the most part, these models have a history of operating outside existing legislation and regulations. Jurisdictions that have legalized cannabis have approached community-based models in opposite ways (eliminate vs. regulate). Canada legalizing cannabis has resulted in more stringent enforcement and concerted efforts to close these models despite documented health and social benefits. This paper presents a case study of the Victoria Cannabis Buyers Club (VCBC) and its consumption space—The Box. We conducted a survey of VCBC members to explore four domains: demographics, cannabis consumption, access to and use of The Box, and the impact of its temporary closure due to COVID-19. From the survey data ( n = 104), descriptive statistics were generated and three conceptual avenues were id...
Food insecurity is widely documented among people living with HIV (PLWH) worldwide, and it presen... more Food insecurity is widely documented among people living with HIV (PLWH) worldwide, and it presents significant challenges across the spectrum of HIV care and support. In North America, the prevalence of food insecurity among PLWH exceeds 50%. In the province of British Columbia (BC), it exceeds 65%. It comes as no surprise that food has become an essential tool in supporting and engaging with PLWH. Over the past decade, however, a shift has taken place, and food has become an incentive to boost uptake and outcomes of prevention, testing, treatment, and support. To explore this practice, we drew on a qualitative case study of incentives in the care and support of PLWH. This paper presents the findings of a targeted analysis of interviews (N = 25) that discuss food incentives and explores two main themes that shed light on this practice: (1) Using food to engage versus to incentivize and (2) Food is more beneficial and more ethical. Providers perceived food more positively than other incentives, despite the goal remaining somewhat the same. Incentives, such as cash or gift cards, were considered ethically problematic and less helpful (and potentially harmful), whereas food addressed a basic need and felt more ethical.
IntroductionDespite the development of safe and highly efficacious COVID-19 vaccines, extensive b... more IntroductionDespite the development of safe and highly efficacious COVID-19 vaccines, extensive barriers to vaccine deployment and uptake threaten the effectiveness of vaccines in controlling the pandemic. Notably, marginalization produces structural and social inequalities that render certain populations disproportionately vulnerable to COVID-19 incidence, morbidity, and mortality, and less likely to be vaccinated. The purpose of this scoping review is to provide a comprehensive overview of definitions/conceptualizations, elements, and determinants of COVID-19 vaccine hesitancy among marginalized populations in the U.S. and Canada.Materials and MethodsThe proposed scoping review follows the framework outlined by Arksey and O’Malley, and further developed by the Joanna Briggs Institute. It will comply with reporting guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The overall research question is: What...
Canadian Institutes of Health Research and McMaster University's Labarge Optimal Aging Initia... more Canadian Institutes of Health Research and McMaster University's Labarge Optimal Aging Initiative
BACKGROUND Supervised consumption services (SCS) prevent drug related harms for people who use dr... more BACKGROUND Supervised consumption services (SCS) prevent drug related harms for people who use drugs (PWUD) and often require a feasibility study before implementation. While there is a growing feasibility study literature, it has not been synthesized for use by researchers and SCS planners. We conducted a scoping review of feasibility studies reporting on preferred SCS design characteristics, staffing models and ancillary services. MATERIALS AND METHODS We searched academic databases and grey literature sources with key terms related to SCS and feasibility studies. Team members reviewed search results and included feasibility studies with findings relevant to SCS design, staff, or ancillary services. The research methods and findings from included studies regarding design elements were charted, collated, and reported. RESULTS The search yielded 1347 results; 26 met eligibility criteria for review. Most reported preferences for SCS location, hours and wait times. Few reported preferences for security, space allocation by type of drug use, and onsite opioid prescribing. PWUD generally preferred aligning design elements with the goal of harm reduction for clients while other stakeholders valued treatment as a goal. Specific considerations varied by implementation context. CONCLUSIONS These results can be used by SCS planners and researchers to help resolve implementation concerns and improve uptake among PWUD, which is critical during an overdose crisis. Future feasibility studies should ask about design preferences that may be significant to uptake but are not commonly covered in studies. These should also explore how context influences preferences to develop an evidence-based framework for context-specific design decisions.
The objective of this study was to document the sexual behaviour of an ethnoculturally diverse sa... more The objective of this study was to document the sexual behaviour of an ethnoculturally diverse sample of 1,200 urban youth and to assess the association of their experience of 11 behaviours with such factors as age, gender, immigration, race, religion, location of sexual education and sexual orientation. Grouping of these behaviours into three "risk" categories also permitted a similar assessment based on the "highest" risk category that youth had experienced. The descriptive and statistical findings in relation to race, religion, immigration status, and sexual orientation provide a basis for strengthening sexual health programming for urban youth. They also highlight the need to pay close attention to issues of vulnerability and stereotyping when reflecting on who is and is not engaging in various sexual behaviours.
ABSTRACT This study utilized data from the Toronto Teen Survey to examine the sexual health topic... more ABSTRACT This study utilized data from the Toronto Teen Survey to examine the sexual health topics that respondents had received information about and the topics they did or did not want to learn more about. Given the diverse sample of youth participating in the study, we placed particular emphasis in the current analysis on associations between religious affiliation and having received information on eight different sexual health topics, and the desire to learn more about the same topics. Overall, there were few associations of religious affiliation with either topics youth had received information about or with topics they wanted to learn more. Protestant youth were more likely than those with no religious affiliation to have received information about sexually transmitted infections. Muslim youth were less likely to express a desire to learn more about sexual health than those identifying no religion. Gender and age differences in sexual health topics that youth had received information about and topics they wanted to learn more about were also examined. Copyright 2010 by the Sex Information and Education Council of Canada
The ongoing overdose and drug toxicity crisis in North America has contributed momentum to the em... more The ongoing overdose and drug toxicity crisis in North America has contributed momentum to the emergence of safer supply prescribing and programs in Canada as a means of providing an alternative to the highly volatile unregulated drug supply. The implementation and scale-up of safer supply have been met with a vocal reaction on the part of news media commentators, conservative politicians, recovery industry representatives, and some prominent addiction medicine physicians. This reaction has largely converged around several narratives, based on unsubstantiated claims and anecdotal evidence, alleging that safer supply programs are generating a "new opioid epidemic", reflecting an emerging alignment among key institutional and political actors. Employing situational analysis method, and drawing on the policy studies and social science scholarship on moral panics, this essay examines news media coverage from January to July 2023, bringing this into dialogue with other existing empirical sources on safer supply (e.g. Coroner's reports, program evaluations, debates among experts in medical journals). We employ eight previously established criteria delineating moral panics to critically appraise public dialogue regarding safer supply, diverted medication, and claims of increased youth initiation to drug use and youth overdose. In detailing the emergence of a moral panic regarding safer supply, we trace historic continuities with earlier drug scares in Canadian history mobilized as tools of racialized poverty governance, as well as previous backlashes towards healthcare interventions for people who use drugs (PWUD). The essay assesses the claims of moral entrepreneurs against the current landscape of opioid use, diversion, and overdose among youth, notes the key role played by medical expertise in this and previous moral panics, and identifies what the convergence of these narratives materialize for PWUD and healthcare access, as well as the broader policy responses such narratives activate.
Community-based models of cannabis cultivation, distribution, and consumption—such as cannabis cl... more Community-based models of cannabis cultivation, distribution, and consumption—such as cannabis clubs—have been documented across Europe, North America, South America, and New Zealand since the 1990s. For the most part, these models have a history of operating outside existing legislation and regulations. Jurisdictions that have legalized cannabis have approached community-based models in opposite ways (eliminate vs. regulate). Canada legalizing cannabis has resulted in more stringent enforcement and concerted efforts to close these models despite documented health and social benefits. This paper presents a case study of the Victoria Cannabis Buyers Club (VCBC) and its consumption space—The Box. We conducted a survey of VCBC members to explore four domains: demographics, cannabis consumption, access to and use of The Box, and the impact of its temporary closure due to COVID-19. From the survey data ( n = 104), descriptive statistics were generated and three conceptual avenues were id...
Food insecurity is widely documented among people living with HIV (PLWH) worldwide, and it presen... more Food insecurity is widely documented among people living with HIV (PLWH) worldwide, and it presents significant challenges across the spectrum of HIV care and support. In North America, the prevalence of food insecurity among PLWH exceeds 50%. In the province of British Columbia (BC), it exceeds 65%. It comes as no surprise that food has become an essential tool in supporting and engaging with PLWH. Over the past decade, however, a shift has taken place, and food has become an incentive to boost uptake and outcomes of prevention, testing, treatment, and support. To explore this practice, we drew on a qualitative case study of incentives in the care and support of PLWH. This paper presents the findings of a targeted analysis of interviews (N = 25) that discuss food incentives and explores two main themes that shed light on this practice: (1) Using food to engage versus to incentivize and (2) Food is more beneficial and more ethical. Providers perceived food more positively than other incentives, despite the goal remaining somewhat the same. Incentives, such as cash or gift cards, were considered ethically problematic and less helpful (and potentially harmful), whereas food addressed a basic need and felt more ethical.
IntroductionDespite the development of safe and highly efficacious COVID-19 vaccines, extensive b... more IntroductionDespite the development of safe and highly efficacious COVID-19 vaccines, extensive barriers to vaccine deployment and uptake threaten the effectiveness of vaccines in controlling the pandemic. Notably, marginalization produces structural and social inequalities that render certain populations disproportionately vulnerable to COVID-19 incidence, morbidity, and mortality, and less likely to be vaccinated. The purpose of this scoping review is to provide a comprehensive overview of definitions/conceptualizations, elements, and determinants of COVID-19 vaccine hesitancy among marginalized populations in the U.S. and Canada.Materials and MethodsThe proposed scoping review follows the framework outlined by Arksey and O’Malley, and further developed by the Joanna Briggs Institute. It will comply with reporting guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The overall research question is: What...
Canadian Institutes of Health Research and McMaster University's Labarge Optimal Aging Initia... more Canadian Institutes of Health Research and McMaster University's Labarge Optimal Aging Initiative
BACKGROUND Supervised consumption services (SCS) prevent drug related harms for people who use dr... more BACKGROUND Supervised consumption services (SCS) prevent drug related harms for people who use drugs (PWUD) and often require a feasibility study before implementation. While there is a growing feasibility study literature, it has not been synthesized for use by researchers and SCS planners. We conducted a scoping review of feasibility studies reporting on preferred SCS design characteristics, staffing models and ancillary services. MATERIALS AND METHODS We searched academic databases and grey literature sources with key terms related to SCS and feasibility studies. Team members reviewed search results and included feasibility studies with findings relevant to SCS design, staff, or ancillary services. The research methods and findings from included studies regarding design elements were charted, collated, and reported. RESULTS The search yielded 1347 results; 26 met eligibility criteria for review. Most reported preferences for SCS location, hours and wait times. Few reported preferences for security, space allocation by type of drug use, and onsite opioid prescribing. PWUD generally preferred aligning design elements with the goal of harm reduction for clients while other stakeholders valued treatment as a goal. Specific considerations varied by implementation context. CONCLUSIONS These results can be used by SCS planners and researchers to help resolve implementation concerns and improve uptake among PWUD, which is critical during an overdose crisis. Future feasibility studies should ask about design preferences that may be significant to uptake but are not commonly covered in studies. These should also explore how context influences preferences to develop an evidence-based framework for context-specific design decisions.
The objective of this study was to document the sexual behaviour of an ethnoculturally diverse sa... more The objective of this study was to document the sexual behaviour of an ethnoculturally diverse sample of 1,200 urban youth and to assess the association of their experience of 11 behaviours with such factors as age, gender, immigration, race, religion, location of sexual education and sexual orientation. Grouping of these behaviours into three "risk" categories also permitted a similar assessment based on the "highest" risk category that youth had experienced. The descriptive and statistical findings in relation to race, religion, immigration status, and sexual orientation provide a basis for strengthening sexual health programming for urban youth. They also highlight the need to pay close attention to issues of vulnerability and stereotyping when reflecting on who is and is not engaging in various sexual behaviours.
ABSTRACT This study utilized data from the Toronto Teen Survey to examine the sexual health topic... more ABSTRACT This study utilized data from the Toronto Teen Survey to examine the sexual health topics that respondents had received information about and the topics they did or did not want to learn more about. Given the diverse sample of youth participating in the study, we placed particular emphasis in the current analysis on associations between religious affiliation and having received information on eight different sexual health topics, and the desire to learn more about the same topics. Overall, there were few associations of religious affiliation with either topics youth had received information about or with topics they wanted to learn more. Protestant youth were more likely than those with no religious affiliation to have received information about sexually transmitted infections. Muslim youth were less likely to express a desire to learn more about sexual health than those identifying no religion. Gender and age differences in sexual health topics that youth had received information about and topics they wanted to learn more about were also examined. Copyright 2010 by the Sex Information and Education Council of Canada
Adrian Guta, Sarah Flicker, Robb Travers, Sarah Switzer, Dario Kuzmanovic, Eleanor Maticka-Tyndal... more Adrian Guta, Sarah Flicker, Robb Travers, Sarah Switzer, Dario Kuzmanovic, Eleanor Maticka-Tyndale, Patricia O’Campo , Sarena D. Seifer, Ciann Wilson Improving the Accessibility of Research Ethics Boards for HIV Community-Based Research in Canada.(2014) HIV CBR Ethics Brief #3: Managing Multiple Roles and Boundaries. Improving the Accessibility of Research Ethics Boards for HIV Community-Based Research in Canada. Toronto, ON.
Switzer, S., Strike, C., Guta, A., Chan Carusone (2018). Community-based research in an HIV hospi... more Switzer, S., Strike, C., Guta, A., Chan Carusone (2018). Community-based research in an HIV hospital: issues of confidentiality in working between research and clinical care. In Sarah Banks & Mary Brydon-Miller (Eds). Ethics in participatory research for health and social well-being. Routledge: London.
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Papers by Adrian Guta