British Columbia is experiencing a public health emergency and toxic drug crisis. Statistical models help us understand this epidemic, and inform treatment and intervention strategies. An assumption of many existing models is that overdose risk is homogeneous throughout the population, ignoring individual risk factors such as past overdoses, treatment history, or other relevant features commonly available in administrative health data. However, key at-risk groups may be particularly affected by this assumption, as impacts may be underestimated. We propose a method of estimating individual overdose risk which leverages available health data. A number of machine learning models will be compared, with a focus on the mechanisms behind predictions, since a greater understanding of factors contributing to overdose risk can assist in targeting populations most in need of intervention and follow-on care. This work will be the first of its kind in BC. It will directly impact policy by providing a method of accounting for heterogeneity of overdose risk in existing models, improving estimation of intervention effects and forecasting, and practice, by the potential of direct application as a clinical tool in the distribution of care.
Research Pillar: Population Health
Educational pathways for holistic health and transformative social justice in prisons in British Columbia
Federal prisons deprive people of health education, which has adverse health impacts, including truncating opportunities for critical health literacy, agency, social inclusion and holistic health. The majority of people in prison have less than a grade ten education, and opportunities for learning are minimal. Despite evidence that education can support health literacy by increasing self-efficacy and socio-economic opportunities, there is a persistent gap between study findings and testing real-world benefits of formal education in prison. This Participatory Action Research will focus on developing and testing transformative social justice curriculum in two BC prisons, guided by the wisdom of currently and formerly incarcerated people. Anticipated outcomes are increased health literacy, positive identity formation, and improve holistic health. Knowledge mobilization focus on expanding and sustaining curriculum, working towards course accreditation, and work towards national policy change to improve health and education outcomes in prisons.
Climate change and youth mental health and wellbeing: a population-based study and participatory knowledge-to-action project
78% of Canadian youth report that climate change impacts their mental health. This is important because mental ill-health during youth can have significant impacts over the lifetime. At the same time, youth feel powerless in addressing climate change, particularly due to government inaction.
This research seeks to uncover how negative emotions about climate change impact mental health in BC youth and what factors may protect against negative mental health outcomes. This research focuses specifically on factors of agency, for example activism and pro-environmental behaviours. I will use a large data set of more than 250,000 youth to learn about their mental health and climate change concerns. Additionally, I will work with 20 youth and two community-based organizations more closely to co-create a policy-level advocacy program and to understand the role of engaging in activism with regards to participants’ mental health. I believe this project will contribute to fostering the resilience and inter-generational support that youth will need as they take on the challenge of our generations.
Exploring the Intersection of Race, Chronic Pain, Substance Use, and Overdose among People Living with HIV: A Mediation Analysis
As people living with HIV (PLWH) live longer due to effective antiretroviral therapy (ART), new health issues, such as chronic pain, have emerged. Research shows that PLWH with chronic pain may struggle with ART adherence and are at increased risk for substance use disorders and overdoses. However, there is limited knowledge on how chronic pain and overdose are connected in PLWH, especially if substance use disorders mediate this link. This project aims to close this gap. I hypothesize that PLWH who experience chronic pain are more likely to use illicit substances, which in turn increases their risk of substance use disorder and subsequent overdose.
Using data from the Comparative Outcomes and Service Utilization Trends (COAST) study, which includes comprehensive health data on all PLWH in British Columbia, this project will:
Analyze if PLWH with chronic pain are more likely to develop substance use disorders, potentially increasing overdose risk.
Assess whether racialized PLWH face greater overdose risk due to compounded challenges with chronic pain and substance use than White PLWH.
Develop knowledge translation guidelines to improve health outcomes for PLWH experiencing chronic pain and overdose.
Reducing harms associated with ‘before medically advised’ hospital discharge
About 1 in 30 hospital patients leave the hospital before completing their treatment. These are known as ‘before medically advised’ (BMA) discharges. These patients are at a much higher risk of death, being readmitted to the hospital, or suffering from a drug overdose. Despite these risks, there are no established care guidelines for how to manage these patients, many of whom struggle with addictions and homelessness. To address this, the study will first examine whether the proportion of patients with BMA discharge has increased in Canada over the past 16 years. Next, the study will use data from British Columbia to explore whether proactive follow-up by a physician within 7 days of discharge can help reduce the risk of death, readmission, or overdose, compared to not having any follow-up. The goal is to create better care strategies for these vulnerable patients. The results will be shared with hospital staff, administrators, and the public to improve patient care.
Nourishing Inclusion: Integrating Two-Spirit, Trans, and Queer Communities into Food Security Solutions in British Columbia
In BC, one in five families compromises nutrition, skips meals, or goes days without eating. Since 2005, public health data have tracked those repeatedly at risk of food insecurity, such as lone mothers, Indigenous and Black individuals, and those on social assistance. Rex, a transmale in his late 20s, shared during a dissertation interview that after coming out as trans he lost his job, father, partner, and faced mounting costs, saying, “so far everyone I am telling is leaving me.” Stories like Rex’s and other Two-Spirit, trans, and queer individuals remain absent from food security data due to historic stigma. This project remedies this through partnerships with the Community-based Research Centre (CBRC), BC Centre for Disease Control (BCCDC), UVic, UBC, YorkU, Saige Community Food Share, and Ribbon Community to include 2S/LGBTQIA+ communities in food security data. Using survey data from CBRC’s Our Health and Statistics Canada alongside interviews, we will analyze predictors, barriers, and facilitators of queer food security in BC. We will collaborate with health authorities to redesign health equity and food security indicators to promote the visibility of diverse queer communities and engender more equitable health systems.
Urban environments to support healthy cognitive aging
Cognitive functioning impacts older adults’ wellbeing, quality of life, and ability to live independently. As the proportion of people over 65 increases, and urban populations grow, it is important to ensure that everyday environments support healthy cognitive aging. Urban environmental factors are known to influence cognitive health or decline, but practical tools to assess neighborhood environmental supportiveness for brain health are lacking.
This project will develop an index of environmental factors that support healthy cognitive aging, for ages 65+. From frameworks for healthy aging, expert consultation, and location-based environmental measures, an index will be developed and mapped across Canadian and US cities. Links between index scores at participant home locations and measures of cognitive function will be examined, using data from the Canadian Longitudinal Study of Aging, and Health and Retirement Study.
This research will advance knowledge of urban exposures and cognitive functioning in later life. The index will allow assessment of everyday local exposures linked to cognitive aging and enable evaluation of equitable access to urban environments that support healthy cognition.
Building Capacity for Research Partnerships: A Health Learning System Approach
People with SCI often struggle to find research that reflects their needs. One way to improve this is through research partnerships, where researchers and people with lived experience work together. However, many researchers do not have the training or support to build strong partnerships, and research institutions do not have systems in place to make engagement easier. This project will help change that by developing a long-term support system for research partnerships at ICORD. The first step is launching a training course to help researchers and trainees learn how to work meaningfully with partners. I will also work with ICORD’s Meaningful Engagement Committee to create ways for the institution to better track, support, and strengthen partnerships over time. Finally, I will connect with other SCI research institutions to see how this approach can be adapted beyond ICORD. This work will help make research partnerships more effective, ensuring SCI research is relevant, useful, and impactful for the people it is meant to serve.
Novel STI Care and Prevention for Group Sex Communities
Group sex is an important health phenomenon, with an estimated one-in-ten people engaging in group sex at some point in their life. Group sex can be a source of pleasure and belonging but may increase risk of sexually transmitted infections (STIs). Despite its estimated prevalence, there has been little research on STI prevention and care among people who have group sex. Most group sex research has been done outside Canada and has focused only on men who have sex with men, excluding other sexualities and genders. My goal is to improve the STI outcomes for people who have group sex in Canada and beyond. My research focuses on 1) community-based knowledge around what makes group sex uniquely risky when it comes to STIs, 2) what STI prevention strategies people use during group sex and how effective they are, and 3) the barriers that healthcare providers face in providing STI care to people having group sex. Based on my findings, I will work closely with group sex community members to develop educational materials and support resources to improve STI prevention and care. Ultimately, I hope to reduce STIs and their negative impact on the health of this diverse stigmatized population.
Equitable health measurements to inform age-friendly community initiatives in diverse populations
The Age-Friendly BC initiative was initiated in 2007 to make communities (e.g., cities and towns) better for older adults. Improvements in programs and environments for older adults has been a major part of this effort. Surveys are a valuable tool for assessing the well-being of older adults in these communities. However, people from different backgrounds (e.g., gender, culture, age) might understand and answer survey questions differently. This project aims to understand differences in how people interpret survey questions and explore ways to adjust survey scores for these differences, with the objective of providing an accurate picture of older adults’ well-being. Communities can be designed to be fair to everyone if we acknowledge different ways in which people think about their well-being. We will work with older adults and policymakers from the beginning to the end of the project. They will help us create an analysis plan and understand findings. We will also work with them to figure out the best way to share what we find.