The Road to Recovery Initiative (R2RI): A Prospective Evaluation of a Novel Program for the Delivery and Coordination of Addiction Care in a Canadian Setting

The consequences of substance use have had a devastating impact on British Columbia’s (BC) healthcare system. Since the declaration of the province’s public health emergency in 2016, over 10,000 British Columbians have died from an overdose. The lack of a coordinated addiction treatment system provincially is a significant contributor to BC’s present state. To address this, Providence Health Care is implementing the Road to Recovery Initiative (R2RI), an innovate model of care to address two aspects of BC’s addiction treatment crisis through: 1) increasing access to on-demand addiction care; and 2) reorganizing existing clinical services to support patients at every phase of recovery. The proposed Program of Research seeks to evaluate key health and social outcomes associated with the implementation of R2RI. Participants of this program will be followed for 5 years with data collection focused on: substance use, illness trajectory, community engagement, health care utilization, health risk behaviours, quality of life, overdose, and death. Knowledge gained through this research will identify outcomes associated with the provision of a coordinated addiction treatment system and will inform successful scale-up of this new approach.

Quantifying navigational impairments in preclinical Alzheimer’s disease

Our brain contains a ‘cognitive map’ of the external world that helps us navigate, and encode/retrieve memories. Dementias such as Alzheimer’s Disease (AD) degenerate these regions, causing well-known memory impairments and much less well-understood navigational impairments. My research program seeks to quantify how navigation is impacted in early AD in rodents and humans.

Young and older human participants will navigate a virtual reality maze. We will quantify how their errors in positioning and navigating scale when the complexity of the task is increased. We will perform similar experiments in rats navigating a physical maze, where we can additionally record neural activity. We will then extend the task to participants diagnosed with preclinical AD, and rodent models of AD. We will characterize the behavioural and neural correlates of early progression of AD, with the goal of finding a metric that is predictive of AD-induced cognitive impairment, and its underlying neural mechanisms.

Over 60,000 British Columbians currently live with dementia. A non-invasive and affordable test such as this will allow clinicians to perform early diagnosis, and start approaches that reduce symptoms and improve quality of life.

Innovating health promotion efforts in response to youth tobacco use

Today’s tobacco use landscape has shifted since the introduction of e-cigarettes, which have become highly popular amongst youth. Nicotine addiction, subsequent smoking, and increased heart and lung disease risk are some of the major concerns brought forward within the public health community in relation to e-cigarette use, with youth disproportionately at risk for these detrimental impacts. Compounding this new landscape of tobacco use include socio-environmental factors that impact use, including rapid advances in technologies (e.g., new social media platforms; smartphone applications). As a result, the new generation of tobacco users are not the same as previous generations, and efforts to protect young people from exposure to tobacco smoke and e-cigarette vapor must similarly shift to adapt to this new landscape. I am responding to this need through my program of research, whereby responsive, youth-driven evidence is being harnessed to develop youth-friendly tobacco control resources for delivery on their preferred digital platforms. Ultimately, this research will lead to optimal solutions to curb tobacco use and reduce tobacco-related disease, situating BC as a leader in adapting to tobacco use of today.

Improving health information interventions to foster vaccine confidence and cultural safety of vaccination services

From monkeypox to measles, vaccination is essential to controlling infectious disease. COVID vaccines alone saved approximately 20 million lives in the first year. However, barriers to vaccination—including inaccessibility, lack of confidence in vaccine safety or effectiveness, and distrust in those providing vaccination—threaten our ability to stop epidemics.

My program of research applies unique interdisciplinary expertise in information science and population health to investigate how we can use information to reduce vaccination barriers. Over the next 5 years I will conduct a suite of studies aiming to improve population health interventions focused on vaccine communication and surveillance.

Studying how people use information and how vaccine communication and surveillance affects people in real-life contexts will help us meet needs of co-parents who disagree about child vaccination, people deciding whether to get new vaccines, and members of marginalized groups targeted by vaccination campaigns. It will generate evidence on how technologies can best be used for identifying and sharing information with vaccine hesitant people. Ultimately, this knowledge will improve vaccine uptake and reduce disease burden and inequity.

BC REACH (BC Research on Equitable Adaptation to Climate and Health)

The flood, fire and heat events of 2021 brought the health impacts of climate change into focus for British Columbians. New public health interventions are required to support effective adaptation, but especially for the most impacted population groups. The BC-REACH (BC Research for Equitable Adaptation to Climate and Health) project is a mixed-methods research platform to build evidence on effective and equitable public health adaptation to climate change. The project’s goal is to equip public health practitioners and residents of British Columbia (and beyond) with new evidence and interventions to enhance their preparedness to a variety of climate change-related health risks. Working in partnership with applied health system partners, this research will ultimately lead to the co-development and evaluation of novel programs and policies that have multiple co-benefits for populations that may be more exposed or physiologically sensitive, or lack the capacity to adapt to a changing climate. By centring equity in this analysis, this research will build knowledge and capacity to reduce population-level health inequities by ‘climate proofing’ the future of the health system’s responses to a wide variety of climate and health risks.

Bridging the Gaps: A One Health Communications Framework for Mobilizing Knowledge at the Nexus of Human, Animal, and Environmental Health

Health is connected and collective. Connections across species and geographies promote the spread of infectious diseases. Collectively, humans, animals, and environments face shared health threats like climate change. This concept of ‘One Health’ is a valuable lens through which to identify actions that support a healthy world. Yet, One Health’s major strength is also its largest challenge as it relies on bridging disciplinary silos — veterinarians and doctors, policy makers and public health practitioners, scientists, and the public. My community-engaged research explores a framework for mobilizing information at this nexus of health. Working with policy makers, health practitioners, and communities, I will identify communication structures that can be deployed at regional scales and across sectors. By understanding community knowledge and perceptions of three One Health issues (chronic wasting disease, avian influenza virus, and rat-associated diseases), I will resolve how health messages can be strengthened to promote public participation in disease surveillance programs. Engaging with knowledge users at all levels will help to improve data collection, monitoring, and inform government decision making and timely action.

The SLeep solUtions to proMote Better Early childhood Relationships (SLUMBER) Program: Helping families optimize infant mental health by supporting sleep health in early childhood

Most parents struggle with their baby’s sleep in the first year. Severe and persistent sleep difficulties can harm parent-child relationships and infant and parental mental health. Parental education, individual consultations, and/or group sessions can help parents improve their baby’s sleep but parents are often overwhelmed with rigid or conflicting advice. Canadian families are diverse, and what works for one may not work for others. For example, a family may be impacted by depression, poverty, or both, and these intersecting factors will affect what educational content and delivery will work best. The SLeep solUtions to proMote Better Early childhood Relationships (SLUMBER) program will give families options to meet their specific needs to get everyone sleeping better. Each part of the program will be designed in partnership with parents. We will develop groups of program options (portfolios) and test them to see who, how, and why they help. This personalized approach will prevent and/or lessen sleep problems with the added benefit of supporting parent-infant relationships and infant mental health. Having a baby is stressful, and this research will support sleep as a foundational pillar of family mental health and well-being.

Supporting Mental Health in Adolescents and their Parents: Using Developmental Science to Refine and Promote the Uptake of a Local Community Intervention

Stressors encountered in daily life such as family conflicts contribute to the risk of experiencing mental health issues such as anxiety. Conflicts between parents and their children increase in adolescence, but research has focused primarily on its mental health implications for adolescents and not also parents. Parents of adolescents go through their own developmental transitions (e.g., midlife) that bring significant stressors with them. Therefore, both parental and adolescent developmental status and mental health need to be understood to help families develop healthy communication and conflict skills, which may benefit the mental health of both individuals. We need to identify which types of emotion patterns are associated with increased risks, or protection from, the development of mental health issues in response to stressors. We aim to identify parent-adolescent emotion dynamics in the context of stress that are associated with both parents’ and adolescents’ anxiety. The primary impact will be to refine an existing community-based intervention for parents of anxious adolescents and to promote its accessibility by involving families and counsellors in the redevelopment process.

Mucus-directed therapeutics to prevent and treat chronic microbiota-dependent diseases of the gut

The colon is teeming with life, not just due to our own cells, but also due to a rich and diverse community of microbes. Remarkably, this community is a virtual organ, helping to digest food and fight inflammation. Unfortunately, this “organ” can malfunction and cause chronic diseases like inflammatory bowel disease (IBD), which affects thousands of Canadians. How to promote the benefits and prevent the harmful activities of our microbiota is a central question. One major factor is gut mucus, a sugar-rich gel-like layer that surrounds the microbiota to act as a barrier to prevent their invasion. This mucus layer is defective in IBD. The objective of my research is to develop new ways to capture the protective power of human mucus to prevent and cure IBD. To do this I will use a new approach my lab developed to extract and purify human mucus to test its protective abilities in mouse models of IBD. We will also learn how microbes control mucus production so we can target these pathways in patients. Last we will use human colon cells to generate a “mucus factory” that can produce mucus with enhanced protective properties. The results of this research will illuminate new paths to restore healthy host-bacteria relationships in IBD.

Co-Developing a Learning Health System with People with Lived/Living Experience of Substance Use: a response to the toxic drug poisoning crisis

Walk With Me was developed by Dr. Karsten and her research team throughout the past four years with intent to combat stigma and create systems change in relation to the toxic drug poisoning crisis – a public health emergency that has enacted more deaths in BC than suicides, car accidents and homicides combined. This team has been working in Vancouver Island communities of various sizes, and within Island Health acute care facilities, to better understand the ways in which the drug poisoning crisis is impacting communities and systems. Through deep listening, peer engagement and leadership, and collaborative design, the team has developed recommendations designed to close service gaps and reduce stigma. In the summer of 2022, Island Health released its first Harm Reduction Policy. Stemming from this release is an opportunity to deepen this existing partnership, through the co-creation of a Harm Reduction Learning Health System. This system, developed through patient/peer insights and leadership, and alongside clinicians, management and staff, will enable Island Health to respond effectively to a rapidly-evolving public health crisis.