Publications

Citation:

Samji H, Delgado-Ron J, Schonert-Reichl K, Guhn M, Long D, Whitehead J, Gorfinkel L, De Arruda Maluf G Wu J, Kaufmann J, Mari del Casal J, & Maloney J. Development and Validation of the Youth Development Instrument (YDI): A Comprehensive Survey of Adolescent Health and Well-Being. (2025). Children and Youth Services Review 179, 108557. https://doi.org/10.1016/j.childyouth.2025.108557

Abstract

Strengths-based approaches are urgently needed to protect and promote adolescent well-being in the United States and Canada, where adolescent happiness and mental health rank among the lowest of the world’s wealthiest countries. Identifying protective and promotive factors for adolescent well-being is critical for guiding policy, public health, and education sector responses as adolescents face unprecedented challenges. We examined the dimensionality and psychometric properties of the Youth Development Instrument (YDI), a comprehensive survey of adolescent health and well-being within a longitudinal well-being monitoring system. The YDI draws predominantly from existing, validated measures identified as fundamental to adolescent well-being. We describe the survey creation process in consultation with adolescents, interdisciplinary experts, and partners in adolescent development, medicine, policy, psychology, psychiatry, education, and public health. We conducted psychometric analysis of the YDI pilot implementation among 2295 eleventh-grade students across 31 schools in British Columbia, Canada, in 2021. We examined each measure’s dimensionality and relationship with thriving, resilience, and prosocial orientation to assess their construct validity. Exploratory and confirmatory factor analyses demonstrated the uni-dimensionality of each measure. Most measures had good or excellent internal consistency (mean Cronbach’s α: 0.85) and demonstrated moderate or large magnitude correlations to thriving, resilience, and/or prosocial orientation and small correlations with family affluence as hypothesized. Correlation patterns aligned with theoretical literature. The YDI is a comprehensive and psychometrically sound survey of adolescents’ well-being and protective and promotive factors. The YDI’s linkable nature also creates potential for measuring population-level mental health and wellbeing trajectories.

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Citation:

Pirani, Y., Delgado-Ron, J.A., Marinho, P. et al. Frequency of self-reported persistent post-treatment genital hypoesthesia among past antidepressant users: a cross-sectional survey of sexual and gender minority youth in Canada and the US. Soc Psychiatry Psychiatr Epidemiol 60, 1771–1779 (2025). https://doi.org/10.1007/s00127-024-02769-0

Abstract

Persistent post-treatment genital hypoesthesia (PPTGH) is a primary symptom of post-SSRI sexual dysfunction (PSSD), as an iatrogenic syndrome characterized by enduring sexual dysfunction following the discontinuation of some antidepressants. We aimed to estimate the frequency of PPTGH among past users of psychiatric treatments, particularly antidepressants. We used a subsample of UnACoRN, a US/Canada survey of sexual and gender minority youth aged 15 to 29. We included participants with a history of psychiatric drug use. We excluded individuals with genital surgeries or without sexual experience. The analysis involved chi-square tests for initial group comparisons, post hoc tests for multiple comparisons, and logistic regression among those who had stopped taking medication. We exponentiated the regression to estimate the odds of PPTGH by drug type, adjusting for age, sex-assigned-at-birth, hormone treatment, and depression severity in three nested models. 574 of 2179 survey participants reported genital hypoesthesia. They were older and more likely to report male sex assignment at birth, hormonal therapy history, and psychiatric drug history. The frequency of PPTGH among antidepressant users was 13.2% (93/707) compared to 0.9% (1/102) among users of other medications; adjusted odds ratio: 14.2 (95% CI: 2.92 to 257). Antidepressant discontinuation is strongly associated with PPTGH in the US and Canada, where SSRI/SNRI medications account for 80% of antidepressant prescriptions. We call for standardized international warnings and transparent, informed consent. Future research should expand upon our efforts to estimate the risk of PSSD by including all the proposed diagnostic criteria, including documentation of temporal changes in PSSD-related symptoms before and after treatment (3 months).

In the news

• The New York Times: After antidepressants, a loss of sexuality.

Salway, T., Delgado-Ron J.A., Rich A.J., Dharma, C., Baams L., & Fish, J. (2024). Trends in mental health and smoking disparities between sexual minority and heterosexual adults in Canada, 2003-2020. SSM – Population Health 24, 101697. https://doi.org/10.1016/j.ssmph.2024.101697.

Highlights

• The study, spanning 18 years, represents one of the longest trend analyses among sexual minority adults, covering four different mental health and substance use outcomes, showing persistent disparities across these areas.
• Despite improvements in sexual minority-affirming legislation, policy advances, and societal attitudes, relative disparities in mental health and substance use/misuse either remained the same or increased over this 18-year period.

Press release: Sexual minorities still face more mental health, substance use conditions – SFU study

In the news: The Hamilton Spectator

Downloads:

MacKinnon, K., Jeyabalan, T., Strang, J., Delgado-Ron, J., Lam, J., Gould, W., Cooper, A., & Salway, T., (2024). Discontinuation of gender-affirming medical treatments: Prevalence and associated features in a non-probabilistic sample of transgender and gender-diverse adolescents and young adults in Canada and the United States. Journal of Adolescent Health. https://doi.org/10.1016/j.jadohealth.2024.05.015 [In press].

In the news: New Study Shows Stopping Medical Transition is Not the Same as Detransition

Abstract:

This study investigated the prevalence, correlates, and reasons for discontinuing gender-affirming medical treatment (GAMT) among transgender and gender-diverse adolescents and young adults living in Canada and the United States of America. We used data from an online survey of sexual and gender minority adolescents and young adults aged 15–29 years living in Canada or the United States of America (March–August 2022). The analytic sample was constituted by participants who responded to questions regarding starting and stopping GAMT, as well as reasons for stopping. Correlates of discontinuing GAMT were assessed using univariate logistic regression. The mean age of the analytic sample (N = 3,937) was 21.1 years. Participants were predominantly nonbinary (54.2%) and assigned female at birth (80.8%). 75.5% lived in Canada and 24.5% in the United States of America. Among those who had started GAMT, 121 of 720 (16.8%) reported having ever discontinued treatment. Forty five of 121 (37.2%) who ceased GAMT reported “Yes, but I wish I hadn't.” The most frequently endorsed reasons for discontinuing GAMT were health reasons (37.3%), a change in gender identity (32.0%), and cost (16.0%). Greater age; nonbinary identity, ‘other’ gender identity; diagnosis of or self-identifying as living with schizophrenia; residing in the United States of America (relative to Canada); and endorsing a current Christian identity were associated with discontinuation. Ninety seven of 121 (80.2%) who discontinued GAMT reported a current transgender or gender-diverse identity. Given the dearth of information about the subpopulation who discontinue GAMT, this study advances candidate factors to inform future longitudinal research to better understand the multiple reasons and contexts for stopping GAMT.

Andrade-Rivas, F., Naman, P., Spiegel, J., Henderson, S. Parrott, L., Delgado-Ron J., Echeverri, A. & van den Bosch, M. (2023). Mapping potential population-level pesticide exposures using a modular and scalable geospatial strategy. GeoHealth, 7, e2022GH000775. https://doi.org/10.1029/2022GH000775.

Summary:

Delgado-Ron, J. A., Jeyabalan, T., Watt, S., Black, S., Gumprich, M., & Salway, T. (2023). Sampling Sexual and Gender Minority Youth With UnACoRN (Understanding Affirming Communities, Relationships, and Networks): Lessons From a Web-Based Survey. Journal of Medical Internet Research, 25:e44175. https://doi.org/10.2196/44175

Highlights:

UnACoRN recruited nearly 10,000 SGM youth in the United States and Canada, and the cost per survey was CAD $1.48. Researchers using online recruitment strategies should be aware of the differences in campaign management each website or social media platform offers and be prepared to engage with their framing (content selection and delivery) to correct any imbalances derived from it. Those who focus on SGM populations should consider how 2S/LGBTQ-oriented campaigns might deter participation from cisgender or heterosexual people or SGM people not identifying as 2S/LGBTQ, if relevant to their research design. Finally, those with limited resources may select fewer venues with lower cost per completed survey or that appeal more to their specific audience, if needed.

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Gumprich, M., Watt, S., Black, S., Jeyabalan, T., Delgado-Ron, J., & Salway, T. (2024). Nonbinary youth and young adult experiences in organized team sports in Canada. International Journal of LGBTQ+ Youth Studies, 1–20. https://doi.org/10.1080/29968992.2024.2421208 [In press].

Related content: Gumprich M & Hare N. The Canadian non-binary youth in sport report. 2023.

Abstract:

Research concerning sexual and gender minority inclusion in sport has primarily focused on cisgender and binary transgender participants. Participation in organized team sport among nonbinary people is understudied. The goal of this study was to identify the barriers nonbinary people face to entering and remaining in organized team sports in Canada. The Understanding Affirming Communities, Relationships and Networks Study surveyed 6495 15-29-year-olds in Canada, including 2513 nonbinary (encompassing genderqueer, agender, third gender and trans nonbinary) and 1929 cisgender respondents. A smaller proportion of nonbinary respondents (11%) participated in team sport compared to cisgender respondents (18%) (p = 0.001). More nonbinary respondents (62%) have played a sport and then stopped compared to cisgender respondents (57%) (p = 0.0008). The most commonly reported reason nonbinary people felt unsafe in sport was discriminatory comments, with >50% witnessing homophobic, transphobic, and/or sexist comments. Structural and policy changes by organizers, administrators, and coaches can support the inclusion of nonbinary people in organized team sports.

Citation:

Lowik, A.J., Delgado-Ron, J. A., Khonina, M., & Salway, T. (2025). Measuring Gender Modality: Comparing Strategies and Methods from the UnACoRN Youth Survey. Psychology of Sexual Orientation and Gender Diversity. [In-press]. https://doi.org/10.1037/sgd0000817

Abstract

Gender modality is the relationship between someone’s current gender identity and the sex/gender they were assigned. Measuring gender modality conveys that research welcomes minoritized respondents and allows for gender modality-specific disaggregation and analyses. This article explores the variability of responses across several measures of gender modality, including a stand-alone question about trans experience, a two-step method where gender identity and assignment are compared for concordance, and an intersex-inclusive method. Understanding Affirming Communities, Relationships & Networks was an online survey of 9,052 predominantly sexual and gender minority youth aged 15–29 from Canada and the United States conducted in 2022. Respondents were asked about their sex/gender assignment, intersex status, trans experience, and current gender identity, and these measures were used to categorize participants as cisgender or transgender. Using a single measure of trans experience, 48.7% of respondents were categorized as trans, 39.5% as cis, and 11.9% were unsure. Using a two-step method, 50% were categorized as trans, 33% as cis, and 16.2% as uncategorizable due to uncertainty or declined gender identity and/or sex/gender assignment. When intersex/endosex status was considered in tandem with the two-step method, respondents were classified as intersex trans (1.2%), endosex trans (41.4%), intersex cis (0.9%), and endosex cis (30.3%), with disproportionate uncertainty regarding intersex status among trans respondents. Gender modality categorization has inherent variability, dependent upon how it is measured. There is no single best approach, and researchers should carefully consider the associated dis/advantages, be transparent about their choices, and acknowledge the implications for analysis and generalizability of findings.

Citation:

Card, K., & Delgado-Ron J.A. (2025). Do Rural-Urban Differences in Social Environments Act as Barriers to Social Wellbeing? A Cross-Sectional Study. Urban Science  9(7), 248; https://doi.org/10.3390/urbansci9070248

Abstract

Loneliness and social isolation are pressing public health concerns, prompting interest in how rural and urban environments shape social wellbeing. However, evidence remains mixed—perhaps because loneliness is a distal psychological outcome with complex, trait-like stability. To address this, we examined geographic variation in upstream patterns of social activity using data from the 2023 Canadian Social Connection Survey (N = 1556). The principal component analysis identified five domains of social behavior, which we analyzed using multivariable regression and supplemented with a series of sensitivity and stratified analyses. Our findings suggest that while broad differences across rural and urban geographies are modest, specific domains of behavior show some variation. For example, residents in rural areas reported lower casual social interaction (b = −0.19, p = 0.019) but similar or even greater engagement in intimate and supportive behaviors. Emotional loneliness was slightly lower in small towns (b = −0.17, p = 0.029), indicating possible protective effects of some smaller community contexts. While the overall structure of social behavior was not invariant across settings, general patterns of engagement appeared largely resilient to geographic differences. These findings underscore the importance of place-sensitive strategies that respond to specific forms of social behavior affected by geography while avoiding overgeneralized assumptions about rural–urban disparities.

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Núñez-González S, Delgado-Ron JA, Simancas-Racines D. Tendencias y análisis espacio-temporal de la mortalidad por diabetes mellitus en Ecuador, 2001-2016 [Trends and space-time analysis of mortality due to diabetes mellitus in Ecuador, 2001-2016]. Revista Cubana de Salud Pública. 2020 Jun 28;46:e1314.

Highlights: Mortality by diabetes mellitus in Ecuador significantly increased in most age groups and provinces during the period 2001-2016. The provinces of Santa Elena, Guayas, Manabí, Los Ríos, and Santo Domingo accumulated the biggest number of deaths due to this cause. This forces decision-makers to address the design and implementation of health policies that allow for improving the registration systems for adequate epidemiological surveillance.

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Núñez-González, S., Lara-Vinueza, A. G., Gault, C., & Delgado-Ron, J. A. (2018). Trends and spatial patterns of suicide among adolescent in Ecuador, 1997-2016. Clinical Practice and Epidemiology in Mental Health: CP & EMH, 14(1), 283-292. doi:10.2174/1745017901814010283

Núñez-González S, Delgado-Ron JA, Gault C, Simancas-Racines D. Trends and spatial patterns of oral cancer mortality in Ecuador, 2001–2016. International Journal of Dentistry. 2018 Jul 2;2018.

Abstract:

The aims of this study were to describe the temporal trend of oral cancer from 2001 to 2016 and to analyze the space and space-time clusters of high mortality due to oral cancer in Ecuador from 2011 to 2016. Methods. The present study is a mixed ecological study; the time trends were obtained using a Joinpoint regression model, space-time scan statistics was used to identify high-risk clusters, and Global Moran I index was calculated. Results. In Ecuador, between 2001 and 2016, OC caused a total of 1,025 deaths. Crude mortality rates significantly increased, with an APC (annual percentage change) of 2.7% (p = 0.009). The age-standardized mortality rate did not significantly increase (APC: 1.73%; p = 0.08). The most likely cluster was detected in 2015, included 20 cantons. The second cluster included 38 cantons, in the years 2014 to 2016. The Global Moran I index for the study period showed a negative spatial autocorrelation (−0.067; p = 0.37). Conclusion. Mortality due to oral cancer in Ecuador significantly increased over the 16-year study period, the young groups being the most affected. Ecuadorian provinces present high variability in types of oral cancer and cancer rates.

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Delgado-Ron JA, Whitehead J, Kaufmann J, Wu J, De Arruda Maluf G, Dhaliwal H, Coelho J, Toulany A, & Samji H. (2026). Gender and sexual orientation differences in the relationship between social media use and disordered eating: results from a serial cross-sectional youth survey from 2022 to 2024. Journal of Adolescent Health 78(1), 110-118. https://doi.org/10.1016/j.jadohealth.2025.08.022

Summary

This study identified a dose-response association between social media use and disordered eating (DE) among youth. It found a disproportionate risk among girls and transgender and gender-expansive youth and highlighted the potential effect of social media bans across intersecting identities of sexual orientation and gender identity.

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In the news:

Delgado-Ron, J. A., & Andrade-Rivas, F. (2023). Unwanted or mistimed pregnancy and developmental issues in Ecuadorian children aged 3 to 5: a doubly robust estimate using data from the National Health and Nutrition Survey 2018. Maternal and Child Health Journal 27, 1672–1682. https://doi.org/10.1007/s10995-023-03713-5

Highlights:

Delgado-Ron, J. A., Jeyabalan, T., Watt, S., & Salway, T. (2024). Mitigating invalid data bias in the estimation of sexual orientation disparities in a survey of youth in US and Canada. Child Development [In press]. https://doi.org/10.1111/cdev.14111

Abstract:

The current commentary explored the applicability of the methods described in “Mitigating invalid and mischievous survey responses: A registered report examining risk disparities between heterosexual and lesbian, gay, bisexual, or questioning youth” by Dr. Joseph Cimpian and colleagues to explore sexual orientation disparities in preexisting data from a nonprobability sample. Understanding Affirming Communities, Relationships, and Networks was a study of mostly White (77.4%) 9674 sexual and gender-minoritized youth aged 15–29 from the US and Canada. The influence of invalid data on the prevalence ratios of four health outcomes was assessed. The methods yielded similar effects to the original paper. The accuracy varied by outcome prevalence and was robust to misspecification of the model. Therefore, the applicability of this method to preexisting data seems feasible.

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• Delgado-Ron, J.A., López-Jaramillo, P. & Karim, M.E. (2023). Adding nuance to dietary prescriptions: does sodium reduction benefit people already losing weight? J Hum Hypertension 37, 584–585 (2023). https://doi.org/10.1038/s41371-023-00820-2

Goodyear T, Delgado-Ron, J.A., Ashley F, Knight R, & Salway T. (2023). Sexual orientation and gender identity and expression change efforts and suicidality: Evidence, challenges, and future research directions. LGBT Health 10, 5 (339–343). https://doi.org/10.1089/lgbt.2022.0359

Abstract:

Sexual orientation and gender identity and expression change efforts (SOGIECE) aim to deny or suppress nonheterosexual and transgender identities. SOGIECE, including “conversion practices,” are controversial and remain prevalent despite contemporary legislative bans and denouncement of these harmful practices from numerous health professional organizations. Recent work has questioned the validity of epidemiological studies associating SOGIECE with suicidal thoughts and suicide attempts. This perspective article addresses such critiques, arguing that the balance of available evidence indicates SOGIECE contributes to suicidality while proposing methods to better account for structural context and the multitude of factors that may explain both SOGIECE attendance and suicidality.

Delgado-Ron JA, Adhikari B, Van den Bosch M, Dummer T, Hong A, Sandhu J, Demlow E, Hu Y, Frank LD. Community design and hypertension: Walkability and park access relationships with cardiovascular health. International Journal of Hygiene and Environmental Health. 2021 Aug 1;237:113820.

Summary:

Citation:

Smith, J., Tiwana, M. H., Murage, A., Samji, H., Morgan, R., Delgado-Ron, J.A. (2024). Moral distress related to paid and unpaid care among healthcare workers during the COVID-19 pandemic. PLOS ONE 19(9): e0310132. https://doi.org/10.1371/journal.pone.0310132

Abstract:

While there is growing literature on the experiences of healthcare workers and those providing unpaid care during COVID-19, little research considers the interaction between these two sectors of the care economy. We administered a moral distress survey to healthcare workers in Canada in 2022, collecting data on both paid and unpaid care. There were no significant differences in the proportion of participants providing unpaid care by gender, with both genders equally affected by certain responsibilities such as reduced contact with family/loved ones. However, men were significantly more distressed about specific unpaid care responsibilities. Unpaid care was not significantly associated with differences in intention to leave work. At work, women were significantly more concerned about patients unable to see family, while men were distressed by others mistreating COVID patients. This study enhances understanding of paid and unpaid care relationships, particularly during crises, and proposes an innovative method for assessing unpaid care burdens.

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Citation:

Delgado-Ron, J. A., Tiwana, M., Murage, A., Morgan, R., Purewal, S., & Smith, J. (2024). Moral distress, coping mechanisms, and turnover intent among healthcare providers in British Columbia: a race and gender-based analysis. BMC Health Services Research 24, 925. https://doi.org/10.1186/s12913-024-11377-2

Abstract:

Smith J, Tiwana MH, Samji H, Morgan R, Purewal S, Delgado-Ron JA. An Intersectional Analysis of Moral Distress and Intention to Leave Employment Among Long-Term Care Providers in British Columbia. J Aging Health. 2023 Nov 9:8982643231212981. doi: 10.1177/08982643231212981. Epub ahead of print. PMID: 37943505.

Abstract:

In this study, we aimed to explore the relationship between intersectional inequities and moral distress among those working in Long-Term Care (LTC) in British Columbia, Canada. Methods: This was a cross-sectional and retrospective study. We assessed the moral distress of 1678 respondents using a modified Moral Distress Scale and an equivalent distress mitigation score at the intersections of gender and racial/ethnic identity. Then, we explored which worker attributes were more predictive of intention to leave work. Results: We found notable differences in experiences of moral distress across intersecting identities, including high moral distress scores among Indigenous men and women and white women. Significant differences in mitigation scores were also found by intersectional identities. Discussion: Moral distress was the most important predictor of intention to leave work. The differences across racial and gender identity groups suggest the need for tailored interventions to address moral distress among LTC providers.

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Cevallos JV, Montalvo A, Martínez R, Palma R, Delgado-Ron JA. Resistencia bacteriana en infecciones hospitalarias y adquiridas y su relación con hábitos de prescripción de antibióticos [Bacterial resistance in hospital- and community-acquired infections and its relationship with antibiotic prescription habits]. Tsafiqui-Revista Científica en Ciencias Sociales. 2012 Dec 1(3):7-19.

Summary: We applied a survey to 68% of the medical personnel registered at "Hospital Pablo Arturo Suárez" in Quito-Ecuador, to ask about (a) identify the sources of information and support for antibiotic prescription, (b) understand the habits of empirical antibiotic prescription, (c) investigate the degree of knowledge about bacterial resistance surveillance and studies, and (d) establish whether there is a relationship between the choice of empirical antibiotic prescription and the resistance profiles of 1498 strains isolated in the hospital's laboratory.

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Okpani AI, Barker S, Lockhart K, Grant J, Delgado-Ron JA, Zungu M, Naicker N, Ehrlich R, Yassi A. A mixed-methods study of risk factors and experiences of healthcare workers tested for the novel coronavirus in Canada. J Occup Environ Med 64(9):p e559-e566. 2022 Sept. doi: 10.1097/JOM.0000000000002614. PMID: 35704778.

The aims of this study were to investigate occupational and non–work-related risk factors of coronavirus disease 2019 among health care workers (HCWs) in Vancouver Coastal Health, British Columbia, Canada, and to examine how HCWs described their experiences. Methods: Matched case-control study using data from online and phone questionnaires with optional open-ended questions completed by HCWs who sought severe acute respiratory syndrome coronavirus 2 testing between March 2020 and March 2021. Conditional logistic regression and thematic analysis were utilized. Results: Providing direct care to coronavirus disease 2019 patients during the intermediate cohort period (aOR: 1.90; 95% confidence interval, 1.04 to 3.46) and community exposure to a known case in the late cohort period (aOR: 3.595%; confidence interval, 1.86 to 6.83) were associated with higher infection odds. Suboptimal communication, mental stress, and situations perceived as unsafe were common sources of dissatisfaction. Conclusions: Varying levels of risk between occupational groups call for wider targeting of infection prevention measures. Strategies for mitigating community exposure and supporting HCW resilience are required.