In reaction to air pollutants, asthmatics may experience an “”asthma exacerbation”” characterized by the narrowing of their airways. This may lead to a shortness of breath that may require urgent medical attention. One source of air pollution associated with asthma exacerbations is diesel exhaust. How and why diesel exhaust causes exacerbations is unclear, but one hypothesis is that it causes “”oxidative stress””, which is damage to cells and body tissues due to certain chemical characteristics. Ongoing exposure to traffic-related air pollution can also result in new asthma in previously healthy individuals. Dr. Christopher Carlsten is working to understand how different air pollutants, particularly diesel exhaust, influence asthma. He is trying to determine whether diesel exhaust creates oxidative stress, and, if so, if that stress is responsible for airway narrowing in human asthmatics. In his laboratory, diesel exhaust is generated in concentrations typically found in mining operations or in busy bus terminals. Volunteer subjects inhale the exhaust for two hours – a short exposure time has no permanent effects but does produce mild, temporary changes – and changes in oxidative stress and airway narrowing are measured. In some subjects, other typical environmental allergens such as tree and grass pollen are added to see if they worsen the effect of diesel exhaust. In addition to this work, Dr. Carlsten and colleagues are following a group of more than 20,000 children from birth to see how their exposure to such pollution may lead to new asthma. Dr. Carlsten’s research will lead to a better understanding of diesel exhaust-related airways disease and will lead to measures to protect Canadians exposed to traffic-related pollution. This research aims to inform recommendations for or against changes in fuel composition and/or personal measures to bolster anti-oxidant levels. Dr. Carlsten’s work to understand the effects of air pollution on asthma development should inform interventions regarding pollutant exposure in children.
Research Pillar: Population Health
Towards evidence-based public health for sex workers in British Columbia
Youth and women working in Vancouver’s sex industry are among the most marginalized and vulnerable in Canadian society. The persistently high rates of health-related issues, violence, and mortality among sex workers, both in Canada and globally, highlights a desperate need for renewed public health interventions targeting the reduction of harms in this industry. Dr. Kate Shannon is working to investigate the different factors influencing the health and safety of youth and women working in the sex industry in Vancouver. Her team is studying the social (violence, work conditions) and structural (laws, regulations, urban renewal) contexts of sexually transmitted infection (STI) in this population. Specifically, her team is examining the different factors that influence the worker’s negotiating power during transactions and how this influences the risk of HIV/STI acquisition. Her research will involve the study and long-term follow-up of two groups of women: (1) 500 existing and new adult women working in both the street and indoor sex industry; and (2) 250 female youth aged 14 to 20 years who have exchanged sex for money, drugs, gifts, shelter, or other commodities in the previous 30 days. By evaluating and integrating different types of data, including individual mapping and neighborhood environment data (including violence and housing) from publicly available sources, she hopes to identify policies and harm-reducing interventions for this population. This study is among the first prospective studies of sex work in North America. Dr. Shannon’s team possesses a wealth of expertise in observational and intervention research, policy, and sex work. They are uniquely positioned to conduct this study, which aims to directly improve the health of some of the most marginalized youth and women in Canadian society.
Prenatal exposures to PBDEs and PFCs: Sources of exposure, thyroid effects, and neurodevelopmental effects in children
Polybrominated diphenyl ethers (PBDEs) and perfluorocarbons (PFC) are chemicals that are used as flame retardants and surfactants in a wide variety of consumer products. In animal studies, both chemical groups have been shown to have toxic effects on the thyroid and have the potential to affect fetal brain development. A small but growing body of evidence suggests similar thyroid effects may occur in humans; however, the links between these chemicals and thyroid disruption in early pregnancy, the most critical window of exposure, are still unclear. The specific effects of prenatal PBDE and PFC exposures on neurodevelopment in humans are largely unknown. Disturbingly, both chemicals are present in the blood of the entire Canadian population, including children and newborns, and the most important sources of these chemicals are poorly understood. The post-doctoral research of Dr. Glenys Webster will help fill these gaps by 1) identifying the main sources of PBDEs in maternal blood, 2) exploring whether maternal PBDE levels are associated with maternal thyroid hormone levels in early pregnancy, a time when thyroid hormones play a critical role in fetal brain development, and 3) examining the relationships between maternal PBDE and PFC levels and neurodevelopmental outcomes in one- to three-year-old children, as measured by cognition, motor function and behavior. Dr. Webster’s work will use data from two existing pregnancy cohorts in Vancouver and Cincinnati, and will link the sources of chemical exposure to chemical levels in blood to maternal thyroid effects to child neurodevelopmental effects, all within the same study populations. Understanding the public health implications of population-wide exposures to PBDEs and PFCs will provide key information for ongoing risk assessment and risk management strategies in Canada and will support the development of effective chemical regulation policies to protect public health.
Impact of structural and environmental factors on risk for HIV/sexually transmitted infections and barriers to accessing prevention, treatment and care among women involved in sex work
Sex workers in Vancouver have been found to be highly vulnerable to a variety of negative health and safety outcomes, including high rates of occupational and historical violence, a high prevalence of HIV (approximately 25 percent within street-based sex workers in Vancouver), and limited access and use of health services. In order to mitigate some of the HIV and sexually transmitted infection (STI) risk in this population, researchers at the Gender and Sexual Health Initiative at the BC Centre for Excellence in HIV/AIDS are looking into understanding some of the larger structural and environmental determinants of HIV/STI risk. Dr. Kathleen Deering is studying a sample of sex workers in Metropolitan Vancouver to investigate the intersecting relationships between different social, environmental and structural factors, such as the availability and access to health services, neighbourhood of residence, and locations and venues of sex work. She will be measuring health and safety outcomes of these women (such as HIV/STI risks, including inconsistent condom use, number of sex partners and sex partnering patterns, and occupational and intimate partner violence) and the geographic distribution of these outcomes over time. This project will access data from a five-year longitudinal cohort of women in sex work in Vancouver, including 500 women and 250 youth sex workers who are 14 to 24 years of age. Participants will fill out a detailed survey and be asked to provide blood and urine samples for HIV and STI testing at the start and every six months for the five-year duration of the study. Dr. Deering will be using these data, combined with social epidemiology methods and Geographic Information Systems (GIS) mapping technology to help understand how social, structural and environmental factors impact risk patterns for HIV/STI and health services use and access. She will also be exploring the use of complex adaptive systems approaches as a novel and key methodological/analytical approach for examining multiple intersecting levels of risk. The results of this research will lead to important recommendations relating to changes in public health policy and the development of effective safer-environment interventions to improve the health and safety of women in sex work in Canadian settings. Results will be communicated to community members, the local and provincial government, and the study population through ongoing partnerships.
Investigating the relationship between residential stability, physical and mental health, and quality of life in homeless and vulnerably housed individuals: A multi-site longitudinal study
An increasingly large number of individuals are facing homelessness and inadequate housing (i.e. living in a shelter, on the street or other places not intended for human habitation) in Canada. Annually, it is estimated that 150,000 to 300,000 individuals experience homelessness across the country. In addition, a much larger number of individuals are vulnerably housed (i.e. individuals with low or moderate income who spend more than 50 percent of their income on housing and are at risk of becoming homeless). Housing is a significant determinant of health. Compared to the general population, homeless and vulnerably housed individuals (HVHIs) have been found to be at a substantially increased risk for physical and mental illness, substance use, injuries, assaults and mortality. Furthermore, HVHIs are socially marginalized and frequently experience barriers to health care and social services. Dr. Anne Gadermann will be examining the dynamics of homelessness and housing vulnerability over time, risk and protective factors associated with onset and exiting of homelessness, and whether changes in housing status are associated with changes in physical and mental health status and quality of life. To conduct her research, Dr. Gadermann will be analyzing data from the Health and Housing in Transition study, a longitudinal multi-site cohort study of HVHIs. In this study, a representative sample of more than 1,100 HVHIs has been interviewed annually over a three-year period in Vancouver, Ottawa and Toronto. At each time point, the interview surveys assessed a wide number of variables, including demographic characteristics, housing history and quality of living conditions, physical and mental health status, family history, substance use problems, quality of life, social support, risk behaviours, health care and social service utilization, contact with the legal system, and life events. Furthermore, the interview data have been linked to health insurance databases to provide information on respondents’ health care utilization. Given the increase of homelessness and vulnerable housing in Canada, there is a greater need and demand for research evidence that can complement and expand existing policies, services and programs. The proposed research project is uniquely situated to provide such research evidence, and a special focus will be given to the dissemination of the findings in order to maximize the impact of the research findings on public policies, services and programs related to housing and health.
An Examination of the Risks and Health Needs of Adolescents and Young Adults with FASD in the Criminal Justice System.
Fetal alcohol spectrum disorder (FASD) is an umbrella term referring to a range of permanent deficits that occur in a developing fetus as a result of exposure to alcohol during pregnancy. FASD is the leading cause of developmental disability among Canadian children and is identified as a major public health concern in Canada. Individuals with FASD experience high rates of health related problems, including serious mental illness and substance use, homelessness, violence and victimization. In BC, the government has committed to the important goal of providing individuals living with FASD the support needed to reach their full potential in healthy and safe communities. To assist in achieving this goal, the province has called for more research to inform treatment efforts in general health and justice settings. Kaitlyn McLachlan’s research speaks to that need by providing a knowledge base specific to the risks and health needs of youth diagnosed with FASD in the justice system. The overall purpose of this study is to improve health outcomes for justice-involved youth with FASD, in part, by developing a knowledge-base about offending patterns and salient risk indicators in youth with FASD. The project will be based in BC and parallel data collection efforts will be made in additional provinces so that reliable conclusions can be made about this population. The information from this study can be used to inform the targets and timing of interventions and improve clinicians’ recommendations about risk, risk management and interventions. The knowledge gathered about mental health and substance use problems will also be crucial in determining the types of community-based services youth with FASD require outside the justice system in order to maintain good health.
Job accommodations: Perspectives from people with bipolar disorder
Bipolar Affective Disorder (BD), also known as ‘manic depression,’ is a chronic, often recurrent condition that affects more than half a million Canadians. It is characterized by changes in mood and behaviour, which range from elevated, euphoric and irritable (mania), to sad, withdrawn and hopeless (depression). While symptoms such as depression and euphoria can be controlled to some degree by medications, they can still result in significant challenges for individuals living with the disorder. Several studies have shown an association between BD and impairment in social roles such as work. Notably, people with BD rate work as the role most important to their quality of life, and the ability to maintain financial independence and contribute to the social fabric of our world is tied to how people work. Consequently, satisfactory employment is associated with improved health outcomes. However, the ability of people with BD to engage in work varies widely. Symptom recovery from an episode of BD occurs before functional and occupational recovery, which suggests factors beyond clinical symptoms can influence a person’s capacity for employment. In her research, Sandra Hale is exploring both formal and informal job accommodations with a view to improving employment outcomes for people with BD. Formal accommodations are defined as changes made to job structure and/or demands, documented by employers, disability management or vocational rehabilitation services. Informal accommodations are defined by the person with BD to address workplace issues or job demands. The results of Ms. Hale’s project will be shared with health care providers and mental health organizations and may help inform policy promoting access to information about job accommodation for people with BD.
Understanding the influence of early childhood sexual trauma and resiliency on health outcomes among young Aboriginal people who use drugs in British Columbia
Recent research has determined that young Aboriginal people who have been sexually abused and who use drugs are at greater risk of several negative health outcomes including Human Immunodeficiency Virus (HIV), infection. It is now well recognized that building resiliency is fundamental to the success of traditional Aboriginal health care practices and that cultural buffers may moderate vulnerability. There are a number of aspects to building resilience including attending to the mind, the body, the emotions and the spirit and, notably, there may be gender and age-related differences in resilience dynamics. Consequently, focused research is required to develop practical theories of resiliency and targeted interventions that will address trauma and facilitate stress coping among Aboriginal young people. To that end, Margo Pearce is investigating specific questions about the role that historical trauma and protective factors have with respect to vulnerability to HIV and hepatitis C (HCV) among young Aboriginal people in BC. She is utilizing existing data from the Cedar Project, an ongoing initiative funded by the Canadian Institutes of Health Research that monitors HIV and HCV risk among 600-1000 young indigenous people aged 14-30 who use injection and non-injection drugs. She is analyzing gender differences in health outcomes over time related to early childhood trauma amongst the Project participants. Ms. Pearce’s work will provide a better understanding of the protective factors that prevent specific adverse health outcomes among young Aboriginal men and women. Furthermore, it will address trauma and protective factors from a global public health policy perspective.
Population trend in fertility drug use and its impact on birth outcomes.
The trend towards delayed childbearing has accelerated in recent decades, and as a result more women find it difficult to become pregnant. Consequently, the use of fertility drugs and assisted reproductive techniques, such as in-vitro-fertilization, has increased. The most profound population effect of these fertility treatments is an increase in multiple births (twins, triplets and higher order multiples), and recent data from Statistics Canada show a continued increase in these types of births. Unfortunately, this unintended increase in multiple births carries a considerably higher risk of pregnancy complications and adverse outcomes in newborns, and therefore carries implications for public health. While evidence suggests that use of fertility drugs is the most significant contributor to multiple pregnancies, identifying the proportion of births that result from the use of fertility drugs alone remains challenging. Further, there is little current information in Canada regarding the temporal trend in fertility drug use and the number of women who currently use these treatments. And, little is known about the impact of fertility drugs alone (without any invasive procedure). Dr. Sarka Lisonkova’s research will provide much needed information on pregnancy and perinatal outcomes including multiple pregnancies, congenital anomalies, miscarriages and pregnancy terminations, stillbirths, preterm births and neonatal deaths among women who did and did not use fertility drugs. By utilizing systematically collected population-based pharmaceutical and health related data available in BC she can identify the trend in fertility drug use among BC women between 1996 and 2006, as well as the maternal age distribution and demographic characteristics of those women. This information is important and timely, and the results will not only inform the women who have difficulty becoming pregnant about potential risks associated with fertility drugs, but also provide useful information to health services planners and administrators.
An ethno-epidemiological investigation of social and environmental contexts of HIV vulnerability among injection drug users
Outside of Africa, an estimated two-thirds of new Human Immunodeficiency virus (HIV), infections are believed to occur among people who inject illicit drugs. While an urgent need exists for tailored interventions to address HIV risk behaviour within vulnerable groups such as adult injection drug users (IDU), there are major knowledge gaps that must first be addressed if interventions are to be successful. Innovative approaches to examine how participation in particular social contexts and environments foster vulnerability to HIV are crucial to the development of effective intervention strategies among highly vulnerable populations of IDUs. William Small is conducting research to address this need using ethnographic methods to develop empirical information regarding transitions into particular high-risk social contexts, including drug markets and sex trade activities. Specifically, his research focuses on the risk environments in two different geographical settings, Vancouver, Canada and Sydney, Australia. The results will provide critical insight regarding how participation in these high-risk settings influences HIV risks as well as an individual’s ability to engage in risk reduction in the context of injection drug use. The information will be integrated with findings from ongoing epidemiological studies in the same locales to test socially-oriented hypotheses regarding the relationship between HIV vulnerabilities and particular social contexts. Ultimately, the findings from Mr. Smalls’ research will help advance the study of HIV risks among IDUs, and inform the development of social and community interventions designed to reduce HIV transmission.