Socio-Ecological Model of Health
In the 1970s, Urie Bronfenbrenner presented a conceptual model called the socio-ecological model (Kilanowski, 2017). Human development is highlighted through this conceptual model (Kilanowski, 2017). In the 1980s, a theory was made from this conceptual model (Kilanowski, 2017). There are different systems influencing an individual as per Bronfenbrenner’s initial theory (Kilanowski, 2017). Political, social, physical, community, group and individual elements interact to influence health according to the socio-ecological model (Agency for Toxic Substances and Disease Registry, 2015). The socio-ecological model consists of variations (Poux, 2017). A four-level hierarchy is adopted by CDC (Poux, 2017). For purposes of this blog post, I will be referring to the five-level hierarchy adopted by UNICEF (Poux, 2017). “The socio-ecological framework is a multilevel conceptualization of health that includes intrapersonal, interpersonal, organizational, environmental, and public policy factors” (Scarneo et al., 2019, pp. 356-360). Individual characteristics and biology must be understood at the start of analysis (Agency for Toxic Substances and Disease Registry, 2015). Income and education illustrate examples of intrapersonal factors at play (Agency for Toxic Substances and Disease Registry, 2015). Relationships become critical at the interpersonal level (Lumen Learning, n.d.). Behavior can be impacted by relatives, a spouse, and/or friends (Agency for Toxic Substances and Disease Registry, 2015). Experiences are shaped by members who are a part of a person’s social circle (Agency for Toxic Substances and Disease Registry, 2015). Rules and regulations dictating behavior are enforced by organizations such as schools and workplaces at the organizational level (Lumen Learning, n.d.; Poux, 2017). Organizational collaboration is vital at the community level (Lumen Learning, n.d. ; Poux, 2017). “These associations include businesses and functions of the “built environment,” such as parks” (Poux, 2017, p.1). Customs and behaviors are shaped through community structures (Poux, 2017). The socioecological framework consists of public policy at the last and broadest level ( Lumen Learning, n.d. ; Poux, 2017 ). At this stage, global, national, and local policies are crucial (Poux, 2017). At-risk populations can benefit from consideration of the socio-ecological model of health (Poux, 2017). Sustainable solutions can be achieved via the socio-ecological model to target a vast array of health issues ( Lumen Learning, n.d. ; Poux, 2017).
Figure 1.
Socioecological Model, 2013
Note. Source of image: https://www.ahrq.gov/prevention/resources/chronic-care/clinical-community-relationships-measures-atlas/ccrm-atlas3.html
Sexually Transmitted Infections (STIs) and Blood-Borne Infections amongst Ontarian Youth
I have chosen to apply the socio-ecological model of health to address the health issue of sexually transmitted infections and blood-borne infections amongst Ontarian youth. “Sexually transmitted infections (STIs) are caused by microorganisms such as viruses or bacteria that are transmitted through sexual contact, particularly vaginal, oral or anal sex” (Public Health Ontario, 2022, By Diseases & Conditions section, By Infectious Diseases section, By Sexually Transmitted Infections section, lines. 1-2). For example, Chlamydia trachomatis bacteria gives a person chlamydia, and the Herpes Simplex Virus gives a person Herpes (Provincial Health Services Authority, 2022). Anal, oral and vaginal sex are the main ways that a person acquires an STI such as chlamydia and gonorrhea (Provincial Health Services Authority, 2022). The sharing of sex toys can cause chlamydia and gonorrhea (Provincial Health Services Authority,2022). Anal and vaginal sex can transmit HIV (Provincial Health Services Authority, 2022). Oral sex can also transmit HIV under certain circumstances (Provincial Health Services Authority, 2022). Skin-to-skin contact can also spread STIs such as herpes and syphilis (Provincial Health Services Authority, 2022). Contact with infected blood can transmit HIV, Hepatitis B and Hepatitis C infections (Minnesota Department of Health, 2022; Public Health Ontario, 2022). HIV/AIDS does not have a cure or vaccine (Minnesota Department of Health, 2022). The immune system is severely compromised in a case of HIV where treatment is not taken (Minnesota Department of Health, 2022). Moreover, certain cancers and infections can be triggered by HIV (Minnesota Department of Health, 2022). Therefore, prevention efforts include testing (Centres for Disease Control and Prevention, 2020). Needle and/or syringe sharing can spread infected blood (Minnesota Department of Health, 2022). In addition, sexual contact can transmit blood-borne infections (Public Health Ontario, 2022). Other bodily fluids can contain blood-borne infections (Public Health Ontario, 2022). For example, breast milk, anal fluids and pre-ejaculate can spread HIV (Provincial Health Services Authority, 2022). Newborns can acquire STIs and blood-borne infections if the mother is infected (Minnesota Department of Health, 2022; Public Health Ontario, 2022). Breastfeeding, birth, and pregnancy allows this acquisition (Minnesota Department of Health, 2022; Public Health Ontario, 2022). Within Canada, a concern within the public health realm is the topic of STIs (Allen & Macdonald, 2014) Some people may not be aware that they are infected, making testing and protection critical (Mayo Clinic, 2022). There has been a rise amongst youth with respect to gonorrhea, syphilis and chlamydia cases (Allen & Macdonald, 2014). In those younger than 30, cases of chlamydia in Canada totaled to 76.1% in 2018 (Government of Canada, 2021). 37.8% was the total for infectious syphilis, and gonorrhea cases totaled to 56.3% (Government of Canada, 2021). Newborn health, reproductive health and quality of life are all negatively affected by these infections (Government of Canada, 2021). Liver damage and infections can arise from blood-borne infections such as hepatitis C virus and hepatitis B virus (National Library of Medicine, 2022). In addition, the risk of acquiring cancer and/or HIV can increase when living with an STI infection (Government of Canada, 2021). It is therefore important for STI treatment, diagnosis, prevention and awareness to be adequately addressed through public health interventions (Government of Canada, 2021). STDs should be reduced via practical solutions (Lumen Learning, n.d.) As such, a feasible approach is obtained via the socio-ecological model (Lumen Learning, n.d.; Poux, 2017). “Risky sexual behavior in adolescence is commonly characterized in the literature by early age of sexual initiation and greater number of sexual partners” (Pflieger, 2013, pp.903-909).
(Department of Health) WA Health, 2020)
(XO Safety, 2020)
Application of the Socio-Ecological Model of Health
Individual/Intrapersonal Level
Knowledge and skills are critical at the individual level of the socio-ecological model of health (Lumen Learning, n.d.). Disease severity and susceptibility are better understood via knowledge (Lumen Learning, n.d.). Decisions and attitudes can be adjusted with the knowledge that youth develop, and the skills they attain (Lumen Learning, n.d.). In Ontario, youth can access sex education via programs and workshops available through Planned Parenthood (Planned Parenthood, 2022). For example, STI and HIV prevention are addressed via the PEAK program (Planned Parenthood, 2022). In the Planned Parenthood Toronto youth clinic, sexual health support is offered to youth by youth peer educators (Planned Parenthood, 2022). Informed decisions can then be made through the skills and knowledge gained (Planned Parenthood, 2022). There are also many online resources such as Public Health Ontario’s website and the Region of Peel’s website which provides information about STIs and blood-borne pathogens (Public Health Ontario, 2022; Region of Peel, 2022). Personally, I also find it useful to visit the Mississauga Central Library when I require information on a topic of interest or concern. Peel Public Health provides a helpline where you can chat with a public health nurse to address sexual health inquiries (Region of Peel, 2022). Health history, income, education, gender, and age are a part of the individual level of the socio-ecological framework (Agency for Toxic Substances and Disease Registry, 2015; Muchimba, 2019). Perceptions, beliefs, attitudes and awareness are also a part of the individual level of the socioecological framework (Muchimba, 2019). Sexual behaviour depends upon all of these factors (Muchimba, 2019). A few findings relative to the individual level of the socio-ecological model of health can be retained from research. Firstly, it is evident that multiple sex partners are prominent amongst the male gender (Kann et al., 2015; Muchimba, 2019; Vasilenko & Lanza, 2014 ). In addition, condom usage protection is less prevalent amongst men (Calsyn et al., 2013; Muchimba, 2019). “Homeless youth are more likely to engage in high-risk behaviors, including inconsistent condom use, multiple sex partners, survival sex, and alcohol/drug use, putting them at increased sexually transmitted disease (STD) risk” (Caccamo et al., 2017, pp.466-476). Hepatitis C is transmitted via crack pipe sharing (Cheng et al., 2014). A study found drug use and homelessness to be associated with crack pipe sharing amongst street youth in Vancouver (Cheng et al., 2014). To minimize risky behaviour, homeless youth should be a target for health services (Cheng et al., 2014). Canadian street youth are affected by HIV (Rapid Response Service, 2014). Amongst this group, 0.2-1.9% is the range of HIV prevalence (Rapid Response Service, 2014). A Longitudinal Study of Adolescent Health involved White, Hispanic, and Black young females (Pflieger et al., 2013). The study found evidence of “risky sexual partners, inconsistent condom use, and early age of sexual initiation” (Pflieger et al., 2013, pp. 903-909). The STI risk was found to be high amongst Hispanics and Blacks (Pflieger et al., 2013). This study illustrates a need for adolescents to be a focus of STI prevention efforts (Pflieger et al., 2013).
Interpersonal Level
Relationships become critical at the interpersonal level of the socio-ecological framework (Lumen Learning, n.d.). Sexual behavior is influenced by family, intimate partners, and friends (Agency for Toxic Substances & Disease Registry, 2015). To connect with others, many teens turn to social media (Mayo Clinic, 2022). Social media platforms are used by 97% of 13–to 17-year-olds (Mayo Clinic, 2022). STDs may be triggered by casual sex through the use of social apps according to health officials (Enomoto et al., 2017) This is because meeting new people becomes easier via social apps and dating sites (Enomoto et al., 2017). Examples include Facebook and Tinder (Enomoto et al., 2017). Sexual health can be promoted via social media tools (Gabbaron & Wynn, 2016). Sexual health promotion with social media was found in 51 publications (Gabbaron & Wynn, 2016). STD and blood-borne infection prevention can be topics of discussion between children and parents at the interpersonal level (Lumen Learning, n.d.). In addition, regular health screening should be encouraged by parents (Lumen Learning, n.d.). Because youth tend to make their own decisions sometimes, initiative should be taken by parents to provide condoms (Lumen Learning, n.d.). The topics of sex, development and relationships in discussion pose challenges to parents (Advocates for Youth, 2022). Embarrassment can arise, and/or information may be lacking (Advocates for Youth, 2022). Birth control and abstinence were not addressed by parents who had teenage boys and teenage girls according to a recent survey (Advocates for Youth, 2022). Communication between children and parents can be developed via programs (Advocates for Youth, 2022). In Ontario, this development can occur through programs such as Facing Your Fears and Triple P provided by Strides Toronto (Strides Toronto, 2022). Safe sex practices and behaviors are adhered to with the presence of strong communication systems between children and parents (Harris et al., 2013; Muchimba 2019). “In a meta-analysis of 58 studies conducted in 15 countries, Van de Bongardt, Reitz, Sandfort, and Deković (2015) showed that adolescents were more likely to be sexually active themselves if they felt that their peers were more sexually active, more approving of having sex, and exerted more pressure on them to be sexually active” (Muchimba, 2019, pp.1-14; Van de Bongardt et al., 2014)
Organization Level
The responsibility of STD and blood-borne infection prevention falls on organizations such as workplaces and schools at the organizational level of the socio-ecological framework (Lumen learning, n.d.). Youth in Canadian schools receive sex education as part of the curriculum (Levin & Hammock, 2020). Disease prevention, pregnancy, relationships, and sexual expression are some broad topics discussed at these class sessions (Levin & Hammock, 2020). School clinic condom supply can contribute to safe sex practice amongst youth (Lumen Learning, n.d.). At the University of Toronto, free safe sex supplies such as condoms are provided by the Sexual Education Center (University of Toronto, 2022). STI treatment and testing is provided at no cost through Region of Peel Healthy Sexuality Clinics (Region of Peel, 2022). In addition, free condoms are also made available at these clinics (Region of Peel, 2022). Immunization and counseling services can be offered by organizations to promote sexual health (Lumen Learning, n.d.). Counseling on relationships and sexuality is provided by Crossways Sexual Health Clinic in Toronto (Sexual Health Ontario, 2022). HPV and Hepatitis B vaccines are given in school clinics in Ontario (Eastern Ontario Health Unit, 2022). Young workers should have access to insurance plans for automatic use if their job is affected by an STI and/or blood-borne infection (Lumen Learning, n.d.). In Ontario, disability benefits are provided by some employers if work is affected due to illness (Aaron Waxman Associates, 2020).
Community Level
Organizational partnerships are critical at the community level (Lumen Learning, n.d.). Community sexual health can be promoted through collaboration between organizations (Lumen Learning, n.d.). A school at which sex education is taught by nurses working at a local hospital illustrates this concept (Lumen Learning, n.d.). Non-profit community agencies receive free condoms via Toronto Public Health (City of Toronto, 2022). Community groups can take part in interactive workshops (City of Toronto, 2022). HIV prevention, STI prevention, harm reduction and reproductive health are some broad topics addressed at these workshops (City of Toronto, 2022). Workshops are led by sexual health promoters working for Toronto Public Health (City of Toronto, 2022). In Peel Region, community sexual health is promoted via Peel Public Health's Healthy Sexuality Program (Region of Peel, 2022). In Mississauga, Caledon and Brampton healthy sexuality clinics are made available via the program (Region of Peel, 2022). Sexual health information and community outreach is provided by the program (Region of Peel, 2022). Behaviour is impacted by community settings (Centres for Disease Control and Prevention, 2022; Muchimba, 2019). In youth, studies show negative impacts to sexual health where substance use, hunger, and violence are prevalent (Ford & Browning, 2014; Muchimba, 2019). Studies show sexual behaviour to be less risky where crime, unemployment and poverty are minimal (Carlson et al., 2014; Muchimba, 2019) School connectedness is identified in research as a part of the community level of the socio-ecological framework (Muchimba, 2019). Risky sexual behaviors are avoided when students feel cared for at school (Langille et al., 2014; Muchima, 2019; Shneyderman & Schwartz, 2012).
Public Policy Level
STI prevention is in the hands of governing authorities at the public policy level (Lumen Learning, n.d.) In comparison to the other levels, many individuals are impacted by the public policy level (Lumen Learning, n.d.). Thus, it is the broadest level (Poux, 2017). This level consists of global, national, and local policies. (Poux, 2017). Hiding an STI such as HIV from a sex partner is a crime in Canada (Campenella, 2017). Under the Canadian Criminal Code, sexual assault charges can be laid (Campenella, 2017). I believe that strict laws in society are more effective due to fear of severe consequences that could alter one’s life. According to "the criminal code of Canada, the age of consent for non-exploitative sexual activity is 16 years. For exploitative sexual activity the age of consent is 18 years” (Bellemare, 2008, p.475). With this legislation, sexual exploitation amongst children is prevented, and sexual predators are not able to be exposed to youth (Bellemare, 2008). STD transmission is researched by various agencies in Canada (Lumen Learning, n.d.). At the provincial level, a diverse range of health-related topics are addressed by researchers working for Public Health Ontario (Public Health Ontario, 2022). Such topics include blood-borne infections and harm reduction (Public Health Ontario, 2022). Health promotion and disease prevention are addressed at the federal level by the Public Health Agency of Canada (Public Health Agency of Canada, 2022). Youth sexual health and substance use are addressed by the Public Health Agency of Canada (Public Health Agency of Canada, 2022). The Health Protection and Promotion Act sets Ontario Public Health Standards (Ministry of Health and Long-Term Care, 2019). Counseling, treatment, diagnosis, monitoring and screening of blood-borne infections and sexually transmitted infections are addressed via protocols in the standards (Ministry of Health and Long-Term Care, 2019). Guidelines, protocols and standards must be adhered to by Boards of Health (Ministry of Health and Long-Term Care, 2019). Safe sex practice, healthy sexuality and STBBIs management and prevention are addressed in protocols (Ministry of Health and Long-Term Care, 2019). Under Ontario’s Health Protection and Promotion Act, it is necessary for AIDS management and prevention to be addressed via programs and services (Health Protection and Promotion Act, 1990).
References
Aaron Waxman Associates. (2020). A closer look at short-term disability benefits in ontario.
https://www.awaxmanlaw.ca/disability/std-guide
Advocates for Youth. (2022). Parent-child communication programs.
https://www.advocatesforyouth.org/resources/fact-sheets/parent-child-communication-programs/
Agency for Healthcare Research and Quality. (2013). Socioecological model. [Image]. United
States.https://www.pinterest.ca/pin/496662665136614410/
Agency for Toxic Substances and Disease Registry. (2015). The social ecological model of
health.
http://www.atsdr.cdc.gov/communityengagement/pce_models.html#:~:text+The%20so
cial
Allen, U. D., MacDonald, N. E. (2014). Sexually transmitted infections in adolescents:
Maximizing opportunities for optimal care. Paediatrics & Child Health, 19(8), 429–433. https://doi.org/10.1093/pch/19.8.429
Bellemare, S. (2008). Age of consent for sexual activity in Canada. Paediatrics & Child Health,
13(6), 475.
https://doi.org/10.1093/pch/13.6.475
Caccamo, A., Kachur, R., & Williams, S. P. (2017). Narrative Review. Sexually Transmitted
Diseases, 44(8),
466–476. https://doi.org/10.1097/olq.0000000000000633
Calsyn, D. A., Peavy, M., Wells, E. A., Campbell, A. N. C., Hatch-Maillette, M. A., Greenfield,
S. F., & Tross, S. (2013). Differences between Men and Women in Condom Use,
Attitudes, and Skills in Substance Abuse Treatment Seekers. The American Journal on
Addictions, 22(2), 150–157.
https://doi.org/10.1111/j.1521-0391.2013.00312.x
Campenella, E. (2017). Have an STI? What you’re legally obligated to disclose.
https://globalnews.ca/news/3796984/have-an-sti-what-youre-legally-obligated-to-
Canadian Peadiatric Society. (2019). Diagnosis and management of sexually transmitted
infections in
adolescents. https://cps.ca/documents/position/sexually-transmitted-infections
Carlson, D. L., McNulty, T. L., Bellair, P. E., & Watts, S. (2014). Neighborhoods and
Racial/Ethnic Disparities in Adolescent Sexual Risk Behavior. Journal of Youth and
Adolescence, 43(9), 1536–
1549. https://doi.org/10.1007/s10964-013-0052-0
Centers for Disease Control and Prevention. (2020). Hiv prevention works.
https://www.cdc.gov/hiv/policies/hip/works.html
Centres for Disease Control and Prevention. (2022). The social-ecological model: A
framework for prevention. https://www.cdc.gov/violenceprevention/about/social-
ecologicalmodel.html
Cheng, T., Wood, E., Nguyen, P., Montaner, J., Kerr, T., & DeBeck, K. (2014). Crack Pipe
Sharing Among Street-Involved Youth in a Canadian Setting. Drug Alcohol Rev, 34 (3),
https://onlinelibrary.wiley.com/doi/10.1111/dar.12180
City of Toronto. (2022). Sexual Health Promotion. https://www.toronto.ca/community-
people/health-wellness-care/health-programs-advice/sexual-health-promotion/
(Department of Health) WA Health. (2020, Feb 6). What is an STI? [Video]. Youtube.
https://www.youtube.com/watch?v=vYtV_Hf29RE
Eastern Ontario Health Unit. (2022). Immunization requirements for children in school.
https://eohu.ca/en/my-health/immunization-requirements-for-children-in-school
Enomoto, C., Noor, S., Widner, B. (2017). Is Social Media to Blame for the Sharp Rise in
STDs? Social Sciences,6 (3), 78. https://doi.org/10.3390/socsci6030078
Ford, J. L., & Browning, C. R. (2014). Neighborhoods and Infectious Disease Risk: Acquisition
of Chlamydia during the Transition to Young Adulthood. Journal of Urban Health, 91(1),
136–150.
https://doi.org/10.1007/s11524-013-9792-0
Gabarron, E., & Wynn, R. (2016). Use of social media for sexual health promotion: a scoping
review. Global Health Action, 9(1), 32193. https://doi.org/10.3402/gha.v9.32193
Government of Canada. (2021). Report on sexually transmitted infections in canada, 2018.
conditions/report-sexually-transmitted-infections-canada-2018.html
Harris, A. L., Sutherland, M. A., & Hutchinson, M. K. (2013). Parental Influences of Sexual Risk
Among Urban African American Adolescent Males. Journal of Nursing Scholarship,
45(2), 141–150.
https://doi.org/10.1111/jnu.12016
Health Protection and Promotion Act, 7 RSO §§ 2-9 (1990).
https://www.ontario.ca/laws/statute/90h07
Kann, L., Mcmanus, M., Harris, A.W., Shanklin, L.S., Flint, H.K., Hawkins, J., Queen, B., Lowry,
R., Olsen, O’M. E., Chyen, D., Whittle, L., Thornton, J., Lim, C., Yamakawa, Y., Brener, N.,
Zaza, S. (2015). Youth Risk Behaviour Surveillance- United States, 2015. Morbidity and
Mortality Weekly Report, 65 (6), 1-168.
https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2015/ss6506_updated.pdf
Kilanowski, J. F. (2017). Breadth of the socio-ecological model. Journal of Agromedicine,
22(4), 295-297.
https://doi.org/10.1080/1059924x.2017.1358971
Langille, D. B., Asbridge, M., Azagba, S., Flowerdew, G., Rasic, D., & Cragg, A. (2014). Sex
Differences in Associations of School Connectedness With Adolescent Sexual Risk-
Taking in Nova Scotia, Canada. Journal of School Health, 84(6), 387–395.
https://doi.org/10.1111/josh.12161
Levin, D. S., & Hammock, A. C. (2020). School context and content in Canadian sex
education. The Canadian Journal of Human Sexuality, 29 (3), 323-338.
https://doi.org/10.3138/cjhs.2019-0046
Lumen Learning. (n.d.). Core Principles of the Ecological Model.
https://courses.lumenlearning.com/suny-buffalo-
environmentalhealth/chapter/core-principles-of-the-ecological-model/
Mayo Clinic. (2022). STD testing: What’s right for you? https://www.mayoclinic.org/diseases-
conditions/sexually-transmitted-diseases-stds/in-depth/std-testing/art-20046019
Mayo Clinic. (2022). Teens and social media use: what’s the impact?
https://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-depth/teens-
and-social-media-use/art-20474437#:~:text=Social%20media%20is%20a%20big,%2C%20Facebook%2C%20Instagram%20or%20Snapchat
Ministry of Health and Long-Term Care. (2019). Sexual health and sexually transmitted/
blood-borne
infections prevention and control protocol, 2019.
https://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Sexual_Health_STIBBI_Protocol_2019_en.pdf
Minnesota Department of Health. (2022). Sexually transmitted diseases (STDs).
https://www.health.state.mn.us/diseases/stds/index.html#:~:text=Some%20STDs%2C%20such%20as%20hepatitis,birth%2C%20or%20through%20breast%20feeding.
Muchimba, M. (2019). Social- Ecological Predictors of Sexual Risk Behaviour Among Young
Adults. Journal of Social, Behavioural, and Health Sciences, 13(1), 1-14.
https://doi.org/10.5590/JSBHS.2019.13.1.01
National Library of Medicine. (2022). Bloodborne pathogens. Medline Plus.
https://medlineplus.gov/ency/patientinstructions/000453.htm#:~:text=Germs%20that%20can%
20have%20a,cause%20infections%20and%20liver%20damage.
Pflieger, J. C., Cook, E. C., Niccolai, L. M., & Connell, C. M. (2013). Racial/Ethnic Differences
in Patterns of Sexual Risk Behavior and Rates of Sexually Transmitted Infections Among Female Young Adults. American Journal of Public Health, 103(5), 903–909.
https://doi.org/10.2105/AJPH.2012.301005
Planned Parenthood. (2022). Programs.
https://ppt.on.ca/programs/
Poux, S. (2017, Aug 5). Social-ecological model offers new approach to public health. The
Borgen Project. https://borgenproject.org/social-ecological-model/
Provincial Health Services Authority. (2022). Sexually transmitted infections (STIs).
http://www.bccdc.ca/health-info/diseases-conditions/sexually-transmitted-infections-(stis)
Public Health Agency of Canada. (2022). Public Health Agency of Canada.
https://www.canada.ca/en/public-health.html
Public Health Ontario. (2022). Blood borne
infections. https://www.publichealthontario.ca/en/Diseases-and-Conditions/Infectious-Diseases/Blood-Borne-Infections
Public Health Ontario. (2022). Our researchers.
https://www.publichealthontario.ca/en/About/Research/Our-Researchers
Public Health Ontario. (2022). Sexually Transmitted Infections (STIs).
https://www.publichealthontario.ca/en/Diseases-and-Conditions/Infectious-Diseases/Sexually-Transmitted-Infections
Rapid Response Service. (2014). Hiv prevalence and testing among street-involved youth in
ontario.
https://www.ohtn.on.ca/wp-content/uploads/2016/12/RR81-HIV-Prevalence-Street-Youth.pdf
Region of Peel. (2022). Clinic Services.
https://www.peelregion.ca/health/sexuality/clinics/cli-services.htm
Region of Peel. (2022). Sexually Transmitted Infections (STI).
https://www.peelregion.ca/health/sexuality/sti/
Sexual Health Ontario. (2022). Crossways Sexual Health Clinic.
https://sexualhealthontario.ca/en/clinic/27306
Scarneo, S. E., Kerr, Z. Y., Kroshus, E., Register-Mihalik, J. K., Hosokawa, Y., Stearns, R. L.,
DiStefano, L. J., & Casa, D. J. (2019). The Socioecological Framework: A Multifaceted Approach to Preventing Sport-Related Deaths in High School Sports. Journal of Athletic Training, 54(4), 356–360.
https://doi.org/10.4085/1062-6050-173-18
Shneyderman, Y., & Schwartz, S. J. (2012). Contextual and Intrapersonal Predictors of
Adolescent Risky Sexual Behavior and Outcomes. Health Education & Behavior, 40(4), 400–414. https://doi.org/10.1177/1090198112447800
Strides Toronto. (2022). Programs & Services. https://stridestoronto.ca/programs/#parenting
University of Toronto. (2022). Our regular safer sex supplies. Sexual Education Centre.
Van de Bongardt, D., Reitz, E., Sandfort, T., & Deković, M. (2014). A Meta-Analysis of the
Relations Between Three Types of Peer Norms and Adolescent Sexual Behavior.
Personality and Social Psychology Review, 19(3), 203–234.
Vasilenko, S. A., & Lanza, S. T. (2014). Predictors of Multiple Sexual Partners From
Adolescence Through
Young Adulthood. Journal of Adolescent Health, 55(4), 491–497. https://doi.org/10.1016/j.jadohealth.2013.12.025
XO Safety. (2020, Sep 30). What are bloodborne pathogens? [Video]. Youtube.
https://www.youtube.com/watch?v=Ut88LjqwDOM
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