First Nations, MĂŠtis, and Inuit Peoples have a right to health. BC laws affirm this right. Settler health systems have not yet fulfilled our obligations. Evidence is clear that Indigenous-specific racism persists across BCâs health system.
But how can we change what we are doing to uphold Indigenous rights and eradicate Indigenous-specific racism? This is the question we get most from our colleagues in population and public health.
Getting at the âhowâ is the focus of a newly created âUnlearning & Undoing White Supremacy and Indigenous-Specific Racism Lab.â
The U&U Lab brings together 3 provincial population and public health organizations: BC Office of the Provincial Health Officer, the BC CDC, and Provincial Health Services Authority-Indigenous Health.
To start our work in a good way, we need to come together to:
1. Undertake territorial protocols with Coast Salish Nations
2. Build relationships
3. Map our vision, grounding principles, and research agenda for the next 5 years
We will host a meeting bringing together representatives from Coast Salish Nations, Indigenous health thought leaders, and settler population and public health leaders to set vision, grounding principles, and research agenda for the U&U Lab.
As society becomes increasingly digital, some people are getting left behind because they may lack access or skills to use the internet or may not trust it. The effects of these âdigital determinantsâ of health (DDoH) may be particularly hard for communities that are already historically marginalized in British Columbia, including those with higher rates of sexually-transmitted and blood-borne infections (STBBI). This topic has not received a lot of attention in STBBI related research, even as related health services are increasingly âdigital-first,â and has only in the past year become a topic important to public health leaders in BC. Through this project we hope to understand this issue better. We will start by holding focus groups with people from these communities (e.g., people with lived experience of incarceration, people living with HIV) and representatives from the community organizations that serve them. From these discussions, we hope to better understand how DDoH affect their lives and how services are provided. We will then review these findings with peers, community organizations, and researchers in a two-day workshop to identify important research questions that will be the focus of future grant applications.
More and more people are using digital tools to get tested for STIs. But we donât know much about how to ensure that the public health benefit of these tools last for a long time. We call this sustainability. In this project, we want to learn how to make the benefit of these tools last. Here is what we will do:
⢠Review existing research to find out what things people think about when they want digital STI tools to be sustainable.
⢠Explore the experiences of digital STI testing programs, like BCâs GetCheckedOnline (GCO) and other similar programs. GCO is a program that lets people get tested for STIs online. We will review program documents. We will also interview the people who run the program and those who work with them. We will document the processes and factors that have made their programs sustainable so far.
⢠Review GCOâs data to see how people use the program. This is important because some people worry that too many people using the program too often might make it hard to keep it going.
Our project will help GCO and other programs like it plan for the future. It will also help us make a plan for how to make these programs sustainable.
The COVID-19 pandemic led to disruptions in health services. However, impacts of the pandemic on testing and treatment for hepatitis B (HBV) are not well understood, including impacts over the longer term and impacts for people who inject drugs and immigrants from regions where HBV is more common.
This study will investigate the impact of the COVID-19 pandemic and related policies on testing and treatment for HBV from April 2020 to December 2022 in BC. We will look at impacts for the full population of BC and by sex, age, prenatal status, substance use / injection drug use status, and immigration status. We will engage with research users throughout the research process, including immigrant service agency S.U.C.C.E.S.S. and the BC Hepatitis Network.
We anticipate that HBV testing and treatment were reduced in 2020, 2021, and 2022, and impacts were greater among people who inject drugs and immigrants.
The study findings will inform health services and policy related to meeting Canadaâs commitment to eliminate HBV as a public health threat by 2030, delivering HBV-related health services during future health system disruptions such as pandemics, and addressing health equity.
This Health System Impact Fellowship is co-funded by ÂCIHR Institute of Population and Public Health (CIHR-IPPH), Michael Smith Health Research BC, and the BC Centre for Disease Control (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.
The illicit drug overdose crisis in North America has had a profound impact on individuals, families and communities, often leading to premature loss of life and lowering of life expectancy. Since 2016, British Columbia (BC) has been experiencing an epidemic of toxic drug supply leading to a large increase in the number of drug overdose events and related deaths. Coronavirus disease 2019 (COVID-19) and measures taken to limit the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, have directly and indirectly disrupted access to healthcare and social services worldwide, including harm reduction and social support services. Since the beginning of the COVID-19 pandemic, BC witnessed large increases in drug overdose related deaths, with 2021 being the deadliest year. This requires scaling up of existing interventions and introducing new, targeted interventions to address the overdose crisis. The level and type of response is also affected by the perception of the population towards health issues and debate on intervention options. The information available on social media could help decision makers understand the public discourse about opioid use and intervention options. In this project, the overall aim is to understand public perceptions and discourse related to overdose in social media using Artificial Intelligence (AI) methods and techniques to inform the overdose response.
Source: CIHR Funding Decisions Database
End of Award Update – December 2024
Results
1. We identified five predominant themes in Long COVID conversations:
- Long COVID in People, Including Children, in the Context of Vaccination – Focused on objective perspectives such as research, monitoring, experiences, and news items highlighting the significant impact of Long COVID symptoms in adults and children, including the potential benefits of vaccination in reducing Long COVID risk.
- Duration and Suffering Associated with Long COVID – Captures the subjective experiences of suffering and frustration associated with Long COVID, emphasizing the prolonged duration of symptoms.
- Persistent Symptoms of Long COVID – Focuses on the persistent symptoms of Long COVID, highlighting both formal and informal advocacy and awareness-raising efforts.
- Need for Research on Long COVID Treatment – Represents calls to address the plight of individuals with Long COVID, either by researchers or governments, expressing frustration over neglect and ongoing symptoms.
- Measuring Long COVID Symptoms –Discusses the large number of people affected by or projected to be affected by Long COVID symptoms, along with associated societal impacts.
2. Sentiment Trends:
- Dynamic Emotional Responses: Our sentiment analysis revealed fluctuations in positive, negative, and neutral sentiments over the months, corresponding to significant events and announcements related to Long COVID.
- Regional Variations: Different regions exhibited unique sentiment trends, reflecting varying public concerns and levels of awareness.
3. Regional Comparisons:
- Canada and Europe: Higher prevalence of discussions about personal experiences and research on Long COVID.
- United States: More diverse and sometimes less clear topics, with notable discussions around government policies and advocacy efforts.
4. Publications:
- Journal Publication Available: Monthly Variations in Long COVID Discourse on Twitter – Full Paper
- Upcoming Publication: A second paper detailing the comparative analysis of topic evolution and sentiment trends across the regions is currently being prepared for submission and will be available soon.
Impact
Our project has made significant contributions to understanding public perceptions and sentiments surrounding Long COVID, with several immediate impacts:
- Enhanced Public Health Monitoring: By mapping Long COVID discourse on Twitter, our research provides valuable insights into public concerns, misinformation, and areas requiring attention. This enables health authorities to tailor their communication strategies more effectively.
- Informed Policy Development: Insights into public sentiment regarding government policies and advocacy efforts have informed policymakers about the effectiveness and reception of their initiatives, guiding future policy adjustments to better address Long COVID challenges.
- Awareness and Advocacy: The identification of themes related to research needs and advocacy highlights the growing demand for increased support and resources for individuals affected by Long COVID, prompting organizations to prioritize Long COVID in their agendas.
- Academic Contributions: Our study advances the methodology of analyzing health-related social media discourse by integrating Contextualized Topic Modeling and Large Language Models, offering a robust framework for future research in similar domains.
Potential Influence
Looking ahead, our research holds substantial potential to shape future health strategies and interventions both locally and globally:
- Enhanced Surveillance Systems: Integrating social media analysis into public health surveillance can provide real-time insights, enabling quicker responses to emerging public concerns about Long COVID.
- Targeted Public Health Campaigns: Understanding regional sentiment and topic prevalence allows for the creation of personalized and effective public health campaigns that address specific local needs and misconceptions.
- Global Health Strategies: By comparing discourse across multiple regions, our findings can contribute to international collaborations aimed at managing and mitigating Long COVID on a global scale.
- Improved Patient Support: Insights into the experiences and persistent symptoms of Long COVID can inform the development of targeted support programs and resources for affected individuals.
This Health System Impact Fellowship is co-funded by CIHR, Michael Smith Health Research BC, and the BC Centre for Disease Control (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.
COVID-19 and pandemic response measures implemented to limit its spread have resulted in various indirect health impacts due to the disruption of many preventative, diagnostic, and management services. The extent of their impacts on the diabetes care cascade are not known. South Asians, representing 25 percent of the visible minorities have highest burden of Type 2 diabetes. Higher incidence of COVID-19 was reported in neighborhood areas with higher density of South Asian population in British Columbia (BC) and Ontario. However, it is not known if diabetes care cascade among South Asians was impacted more than other population groups.
We aim to assess: a) The impact of COVID-19 pandemic on the diabetes care cascade, b) Differential impact in South Asians vs other population groups; c) Patient/provider perceptions of disruption of services.
We will use BC COVID-19 Cohort which integrates daily COVID-19 lab tests, case follow-up data, COVID-19 immunizations, hospital and ICU admissions, with demographic, healthcare utilization datasets (medical visits, hospital admissions, emergency room visits, dispensed prescription drugs) Chronic Disease Registry and socioeconomic data and data from BC SPEAK Survey. We will construct care cascade in pre-pandemic years and pandemic/post pandemic years and apply a combination of epidemiological and statistical techniques to investigate the stated aims. We will gather qualitative data based on interviews with diabetes patients and care providers to provide context and inform interventions to prevent further disruptions and optimize care.
This project will characterize the extent of disruption in services across diabetes care cascade and will identify characteristics of population most affected. We will provide evidence on disparities experienced by South Asians and identify strategies to mitigate the impacts of the COVID-19 pandemic or future similar health emergencies for individuals with diabetes.
Source: CIHR Funding Decisions Database
This Health System Impact Fellowship is co-funded by CIHR, Michael Smith Health Research BC, and the BC Centre for Disease Control (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.
Multimorbidity is when an individual has two or more chronic diseases. But, behind this simple definition lies a complex phenomenon. Chronic diseases interact, and their combined health impacts can be greater than predicted by their individual impacts. Multimorbidity accumulates with age and affects the majority of senior citizens in Canada. For these seniors, multimorbidity increases health complications; including dementia, severe complications from COVID-19, and susceptibility to heat and climate events.
The BC Centre for Disease Control’s mandate is to provide accurate, timely and actionable health intelligence about population well-being and its determinants to decision makers in BC. This project follows this mandate, to improve knowledge of multimorbidity across BC. Multimorbidity is a huge challenge for our health care system because of its complexity. There are countless possible disease combinations, each with unique interactive effects on health. For this reason, most previous research has indexed multimorbidity by a simple count of the number of co-occurring diseases. But this approach loses granularity in understanding the nature of disease combinations.
Our goal is to use data clustering analyses to identify patterns of co-occurring diseases across the BC population and create a multimorbidity disease cluster index. We will apply this cluster index to measure how common different clustered disease combinations are across BC, and how different disease clusters relate to negative health outcomes. Finally, we will measure how disease clusters vary by sociodemographic variables like age, sex and gender, and socioeconomic status.
This project will enhance the ability of BC health authorities to identify opportunities for public health planning around multimorbidity, with knowledge of specific disease combinations and their sociodemographic context. Our project output will lay the foundation for enhanced population health surveillance and monitoring in BC.
Source: CIHR Funding Decisions Database
Twelve percent of all dental antibiotic prescriptions in BC are for clindamycin, a drug with considerable risk of adverse effects compared with alternatives. Good dental outcomes are achieved with much lower use of that drug in Australia (5 percent), and the UK (0.5 percent). Prescribing clindamycin endangers patient safety due to higher rates of Clostridium difficile infections, increases the risk of resistance, and should only be used when no better option is available. Audit and feedback interventions have decreased antibiotic prescribing rates in various settings, but experience with its use in dental prescribing is limited. Further, there is growing evidence that strategies informed by behavioral theory may be more effective and should be explored. Focus groups will provide an understanding of the current challenges in dental prescribing and test the responses on audit and feedback as well as the planned and alternative behavioral interventions. This would enable tailoring the audit and feedback according to the dentists’ needs making the intervention more relevant to the receivers and more effective.
Team members: Sade Stenlund (BCCDC); Fawziah Lalji (UBC – Faculty of Pharmaceutical Sciences); Clifford Pau (UBC – Faculty of Dentistry); Mamun Abdullah (BCCDC); Nick Smith (BCCDC); Max Xie (BCCDC); Lynsey Hamilton (BCCDC); Kirstin Appelt (Sauder School of Business); Dana Stanley (UBC – Therapeutics Initiative); Anat Fisher (UBC Therapeutics Initiative); Sophie Y. Wang (University of Hamburg).
BC is facing dual public health emergencies of COVID-19 and a public health emergency of overdose, first declared in 2016. New interventions have been introduced to reduce overdose in BC, including efforts to decriminalize drug possession and the introduction of pharmaceutical alternatives to the toxic drug supply, known as “Risk Mitigation Guidance” (RMG) prescribing. RMG allows physicians to prescribe pharmaceutical medications (e.g. opioids, stimulants) to people at risk of overdose. While provincial evaluations of pharmaceutical alternatives are ongoing, little is known about the impact of these interventions on people who have been incarcerated, who face a disproportionate burden of overdose risk and mortality in BC, particularly in the weeks immediately following release from correctional institutions.
We aim to address this knowledge gap by convening a Peer Advisory Group of people with lived and living experience of substance use and incarceration. The group will advise on how data sources created in response to the 2016 public health emergency (BC-ODC) can be used to investigate interventions to reduce overdose, with attention to the unique and context-specific overdose risks faced by people who have been incarcerated.
Team members: Ana Becerra (BC Centre for Disease Control); Helen Brown (UBC); Jane Buxton (BC Centre for Disease Control); Ruth Elwood Martin (UBC); Kurt Lock (BC Centre for Disease Control); Tonia Nicholls (UBC); Erin Wilson (University of Northern British Columbia); Chloe Xavier (BC Centre for Disease Control); Sofia Bartlett (BC Centre for Disease Control); Cameron Geddes (UBC); Heather Palis (BC Centre for Disease Control); Marnie Scow (UBC); Chas Coutlee (Indian Residential School Survivors Society); Nicholas Crier (UBCâs Transformative Health and Justice Cluster); Jade Hoffman (Prince George Urban Aboriginal Justice Society); Patrick Keating (UBCâs Transformative Health and Justice Cluster ); Jenny McDougall (BC Centre for Disease Control); Rick Meier (Coalition of Substance Users of the North); Elder Roberta Price (UBCâs Transformative Health and Justice Cluster); Glenn Young (Unlocking the Gates Services Society); Pam Young (Unlocking the Gates Services Society); Andrew Ivsins (Ministry of Mental Health and Addictions); Carrie McCully (BC Corrections); Angus Monaghan (BC Mental Health and Substance Use Services); Justine Patterson (BC Mental Health and Substance Use Services); Kathryn Proudfoot (BC Mental Health and Substance Use Services); Vijay Seethpathy (BC Mental Health and Substance Use Services)
People with criminal justice system involvement (i.e. who have been to prison for a criminal offence) are more likely to use drugs like heroin and methamphetamine compared to the general population. People who use drugs also are at higher risk of negative outcomes like overdose and more rapid or frequent return to prison. Efforts to address overdose, both in prisons and in the community, have been focused on providing treatment for people who use opioids (e.g. heroin, fentanyl). This alone may not be sufficient to reduce overdose risk, particularly among people who use other substances (e.g. cocaine, alcohol) in addition to opioids. In March 2020, in the context of COVID-19, the British Columbia (BC) Ministry of Health provided new Risk Mitigation Guidance (RMG) for doctors, permitting them to prescribe opioids, stimulants, benzodiazepines, and alcohol withdrawal management medications to people at risk of overdose. In this study, I will evaluate whether the RMG has reduced overdose and return to prison among people with criminal justice system involvement in BC. This study will highlight gaps in substance use services in BC, and will inform evidence-based services that can help to reduce overdose in prison and community.
