The use of illicit drugs in Canada is associated with substantial, widespread consequences, including high rates of death and health complications among users, and significant social and economic costs to society. Canada has traditionally addressed illicit drug use with law enforcement measures, with prevention and treatment measures playing a secondary role. Recent efforts to reform Canadian drug policy go hand-in-hand with a strong need for expanded research to support the development of effective and evidence-based intervention programs and public health policies. Dr. Benedikt Fischer is examining how to develop more effective public health-oriented prevention, treatment and policy options to reduce the harms of illicit drug use. His research focuses on five main areas: street drug use monitoring; opioid treatment programs; prevention and treatment for hepatitis C among illicit drug users; cannabis control reform; and criminal justice interventions for drug offenders. Dr. Fischer is integrating basic, clinical and social health research and working in collaboration with researchers from across Canada, with an emphasis on issues of national relevance as well as those specific to British Columbia.
Research Location: University of Victoria
Access to care at the end of life: encounters between home care nurses and family caregivers
An important social change of the last quarter century has been a shift in the setting for health care delivery away from institutions — the move from facility-based care to home-based care. In particular, access to palliative home care services has become a major health policy issue in Canada. With an aging population, a growing number of Canadians diagnosed with terminal illness, and almost 90 per cent of Canadians reporting a preference to spend their final days at home, current government policy is pressing for more and better care of the terminally ill in the community. While several conditions are needed to effectively support palliative care at home, two of the most important are the availability of family caregivers (FCGs) and access to services by home care nurses (HCNs). Dr. Kelli Stajduhar is studying the decision-making factors that HCNs take into account when providing specific levels and types of palliative home care nursing services and exploring how the relationships between HCNs and FCGs shape access to care for dying patients. She is interviewing FCGs providing palliative care at home, HCNs and expert clinicians and administrators. Dr. Stajduhar is also observing relationships between HCNs and FCGs to better understand how these interactions affect access to care. Ultimately, results from this research will inform the development of health services, policies and HCNs’ decision making in order to improve access to care for families in palliative care.
Seniors Preventative Health Intervention Program
To assess whether a pharmacist in consultation with family physicians can improve medication management for older patients thus reducing hospital admissions, health services and costs due to inappropriate medication use.
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Puberty, sex and childbirth: Implications of sexual education and early sexual activity on maternal health outcome
As adolescent girls mature into young adults, they experience puberty, menstruation and sexual activity in an environment saturated with information. They learn about social and cultural norms through their social environment, as well as female reproductive health, biological development and sexual health through sexual education. While it is known that many biological and social factors influence women’s health during pregnancy, childbirth and the post-partum period, less is known about the impact of social and cultural factors on reproductive development and health. Moreover, the link between adolescent development and adulthood in this aspect of health is largely unexplored. Adrienne Bonfonti is studying whether girls’ experiences during this early stage of womanhood have lasting implications for their reproductive health. Adrienne is interviewing first-time mothers to learn how their earlier experiences with education, menstruation, physical development and sexual activity affect their experiences and health during pregnancy, childbirth and motherhood. Adrienne’s research should identify which factors have a positive or negative effect on reproductive health outcomes, and what women may be at risk for a turbulent transition into motherhood. This information can be used to improve sexual education or intervention programs for maturing youth in order to further promote healthy development during adolescence and into adulthood.
A place to grow old: past experience and present circumstance as motivation for seniors to migrate or to age-in-place
Nearly 25 percent of Canadians will be 65 or older by 2036. With increasing age, most seniors face the difficult decision of where to live. Jennifer Harvey is studying how seniors’ sense of place, emotional ties and experiences in a community influence their decision to move to a new location or to stay in the same place. She is also studying how support networks differ for seniors who stay in place and those who move. Jennifer is examining the experiences of seniors in two small B.C. communities: Parksville, where almost 31 percent of the population were seniors in 2001, and Qualicum Beach, where 38 percent were seniors. These figures are significantly higher than the provincial average of approximately 13 percent. Results from the research could be used to forecast migration patterns among seniors and improve housing, health and social service policies in communities with aging populations.
The effects of inconsistency on everyday activities of Alzheimer’s disease
Studies have shown that people with Alzheimer’s disease are more inconsistent, compared to healthy older adults, on cognitive tasks (e.g., memory, reaction time). Research in this area has measured fluctuations in performance on multiple occasions over short periods of time. What is not clear is how these inconsistencies affect people’s daily lives. Various factors — including cognitive, visual and perceptual abilities, language and speed of processing — influence functional abilities. Catherine Burton is studying the impact of inconsistent cognitive performance on ability to perform everyday activities, such as managing finances and taking medications. Her research could help characterize the neural systems required for particular cognitive processes, which would assist in identifying people most at risk and in need of support.
Family environment and mental health of youth from biological and adoptive families
Research suggests the family environment plays an important role in youth health and development. For example, youth exposed to more coercive forms of discipline, higher family stress, and less parental care seem to be at higher risk of developing alcohol problems. However, other research suggests genetic factors may influence both risk behaviours and family factors, such as parenting. Ming Ao is studying both biological and adoptive families to determine if the family environment influences mental health and risk behaviours in youth. Ming is assessing how family environment affects young people’s emotional well-being, social skills and competence. The findings from this study could improve understanding of family influence on youth mental health and be used to develop youth health services for biological and adoptive families.
Structural studies of clinically-relevant protein-carbohydrate interactions
Thanks to new scientific methods, including use of high-speed computers, the search for ways to diagnose, treat and cure disease has changed greatly in the last 50 years. While chance discoveries are still important, new technology allows researchers to systematically probe the molecular nature of disease-causing organisms and the medicines being developed to treat them. X-ray crystallography is a technique to determine the three-dimensional structure of crystallized molecules. Dr. Stephen Evans is using the technique to study the interactions between proteins (such as antibodies and enzymes) with carbohydrates to learn about the atomic structure of these molecules. In one project Dr. Evans is investigating the antibodies responsible for inherited immunity to learn how the body reacts to new and emerging diseases. In another project he is investigating how a protein molecule can mimic a carbohydrate and be used to vaccinate patients against their own cancer. He is also examining how enzymes can be used to make new carbohydrates that can, in turn, be used as new medicines. Finally, Dr. Evans is developing a new version of his SETOR molecular graphics software that will enable researchers to reduce complicated molecular structures to simplified illustrations.
Social determinants of health and their impact on post partum morbidity among midwifery, physician and obstetrician clients in British Columbia
After giving birth, some women have difficulty adjusting to their new role as a mother. Some problems can be attributed to injuries from childbirth, while others, such as depression, fatigue and long-term pain, are not as easily understood. Using questionnaires and face-to-face interviews, Dr. Rachel Westfall is investigating how women’s income, education and support networks affect their recovery from pregnancy and childbirth and the adjustment to being a parent. Dr. Westfall is also looking at the different types of post-partum care available in BC — including midwifery, general physician care and obstetrician care — to assess how some approaches may meet women’s needs better than others. Results from the research could be used to improve post-partum care and the transition to motherhood for BC women.
Game on: diminishing risks for depressive symptoms in early adolescence through positive involvement in team sports
In early adolescence, both girls and boys report increases in levels of depression. However, by late adolescence the rates of depression among girls are double those found among boys. Research shows that boys and girls’ perceptions about athletic competence (how good they are at sports), social acceptance (how popular they are among peers), and body dissatisfaction (negative feelings about their bodies) are strong predictors of depression. Since girls tend to report lower levels of athletic competence, participate in sports at lower rates, and report higher levels of body dissatisfaction than boys, they may be at greater risk for depression. Erin Boone is examining whether positive involvement in team sports increases perceptions of athletic competence and social acceptance, and helps to diminish body dissatisfaction among both girls and boys. The study will be among the first to assess the mechanisms that link positive team sports involvement to diminished risks for depression in adolescence. Findings will outline the mental health benefits associated with team sports involvement and highlight the need to sustain adolescents’ interest and participation in sports.