Chronic obstructive pulmonary disease (COPD), has generally been thought of as a ""man's disease."" However, there has been a substantial increase in the prevalence and mortality of COPD in women recently, with a tripling of the female mortality rate over the past 20 years compared with a stable mortality rate in men over that same time period. The increased prevalence and mortality of COPD in women has been attributed to an increase in smoking rates in women, which began over 50 years ago. Recent studies have shown that women may be more susceptible to the effects of cigarette smoke compared to men. In addition, there is evidence to suggest that a gender bias may exist with respect to diagnosis; specifically, that women may be more likely to be diagnosed with asthma, and men with COPD, regardless of their underlying condition. Furthermore, studies have shown that a smaller proportion of women compared to men are not referred for diagnostic testing for COPD, or do not receive optimal pharmacotherapy. Using data from the BC Linked Health Database and the PharmaNet database, Dr. Pat Camp is conducting an in-depth analysis of the management and health outcomes of COPD in women compared with men. The goals of Dr. Camp's research are designed to identify gender differences with respect to diagnostic test utilization, hospitalization rates and medication usage. Dr. Camp is also investigating what, if any, impact age and region of residence have on diagnostic testing, medications and hospitalizations in people with COPD. The results of Dr. Camp's research will allow for specific messages and targeted interventions to be developed that facilitate better care and improved quality of life of people living with COPD.
Research Pillar: Population Health
The influence of technology on pedestrian safety behaviour
The use of personal electronic devices, such as cell phones and Pods, in everyday situations is a growing safety concern, and there is a common belief that all personal electronic devices threaten pedestrian safety in the same way, that is via distraction. However, recent data indicate that cell phones and iPods influence pedestrian safety behaviours (e.g. looking both ways before crossing a street), in qualitatively different ways, and that cell phones and iPods have different effects on an individual’s behaviour in naturalistic contexts. Building on her earlier research in this area, Sophie Lanthier’s current project will test the hypothesis that cell phone and iPod users are affected differently by these devices: specifically, that cell phone users’ conversations absorb general-purpose attentional resources (i.e. they are distracted from their environment), which increases their likelihood of being in an accident, whereas iPod listeners are not distracted by their music, but rather the music limits auditory input from the environment, rendering them unable to hear unexpected events that could occur after they begin to cross the street. This inability to adapt to a potentially important change in the environment (i.e. a car that has just turned onto the street), could increase an iPod user’s likelihood of being in an accident. This study will help to identify what cues individuals rely on to monitor changes in their environment and how personal electronic devices influence one’s ability to use these cues. With this information firmly in hand, methods to reduce risk in pedestrian behaviours can be undertaken.
Exposure assessment for women’s occupational exposure to carcinogens and other hazardous substances
Studies that have evaluated workplace exposure to hazardous chemicals and associated health outcomes have traditionally focused on men in male dominated jobs such as manufacturing and other heavy industries. Consequently, women weren’t generally included in the earlier studies and the industries in which they worked weren’t regarded as important. This, in turn, negatively affected women’s access to workers’ compensation compared with men, especially with respect to injuries, stress and lung diseases from asbestos. However, the research focus has recently shifted to include the changing role of women in the workplace and subsequent hazardous materials exposure that might adversely affect their health. The CAREX study, currently underway in Canada, is a national surveillance project aimed at estimating the number of Canadians exposed to environmental and workplace carcinogens. Cheryl Peter’s research will augment the CAREX project by looking at how these types of exposures differ between men and women. Her study identifies research gaps in women’s occupational health in general, and industries or jobs where women are more susceptible to exposures or adverse health outcomes specifically. The results of this study will help improve the health of female workers by identifying women at higher risk of exposure to hazardous chemicals, and may also help to prevent future health problems, including cancer. Further, Ms. Peter’s data will inform researchers with respect to improved research methods and recommendations on improvements for future studies, accounting for differences in exposures on the job between men and women.
Evaluation of a Proposed Revision of the HCR-20 Violence Risk Assessment Scheme.
Violence is a serious public health concern. It embodies a considerable societal burden and its individual cost, in terms of both physical and mental health, is enormous, whether it pertains to victims, perpetrators or those close to them. Currently, legal, forensic and psychiatric institutions are confronted with the difficult task of determining whether a specific individual may be at risk of harming others. Violence risk assessments are conducted in order to find a way to reduce or manage that risk, either in the community or within institutions. Because the decisions made by mental health professionals during such assessments have serious consequences, it is essential that the decision-making processes be scientifically and clinically sound. The Historical/Clinical/Risk-Management-20 (HCR-20) represents one of the most researched and established instruments used to assess risk for community and institutional violence in offenders, civil psychiatric patients, forensic psychiatric patients, as well as males and females with mental illness, personality disorder or substance abuse problems. Since the development of the HCR-20 in 1997, a large body of data on its efficacy has been collected, and the authors concluded that some revisions were necessary. Diana Strub’s research involves an evaluation of a subscale of the revised HCR-20 assessment scheme in its entirety on a new sample of 150 individuals (i.e. offenders and mentally disordered offenders), about to be released into the community. Her work has implications for violence risk reduction and management for individuals with mental illness, personality disorders, correctional involvement and/or substance abuse problems. Such violence prevention strategies are expected, in turn, to considerably reduce physical and mental health concerns for those at risk, their victims and those close to them, as well as alleviate some of the burden placed on the health care system.
Place and experiences of risk among young drug users in downtown Vancouver
Illicit drug use is associated with severe harms and immense social suffering among youth. Previous ethnographic work has shown how social-structural and cultural processes present within specific urban locales intersect to push young people who engage in drug use towards ‘risk’, until it becomes difficult or impossible for them to avoid transitioning into increasingly ‘risky’ behaviours. However, there have been relatively few in-depth investigations of drug-using contexts or ‘scenes’ that focus exclusively on the meanings, understandings and everyday lived experiences of young drug users themselves. Danya Fast’s research explores young people’s understandings of the social-structural and physical landscapes of the downtown Vancouver drug scene, and how various locales (e.g. neighbourhoods, alleyways, service locations, residences), shape experiences of ‘safety’ and ‘risk’ among drug-using youth. Her approach emphasizes the influence of place on health, where place is understood to encompass both physical and social spaces. An important goal of this research will be the identification of elements in the physical and social environment that shape risk and structural interventions that alter context and, by consequence, facilitate safer spaces for work, rest and recreation for youth. Ms. Fast’s project will result in a more comprehensive and culturally sensitive account of young drug users’ everyday experiences in the context of the downtown Vancouver drug scene, and will also be used to inform ongoing epidemiological research with drug-using youth. Moreover, Ms. Fast’s project will contribute to the development of an ongoing ethno-epidemiological research program that has been identified as an important emergent area within Human Immunodeficiency Virus research, due to its unique ability to inform the development of interventions designed to reduce drug-related harms.
Bayesian Adjustment for Unmeasured Environmental Confounding
Studies in environmental epidemiology are often concerned with understanding the health effects of environmental exposure in various forms. Because these studies are, by nature, observational, it is often difficult to make valid statistical conclusions. Additional complications arise from the presence of confounding variables, which relate to both the exposure and health effect, and hence complicate the relationship. Traditionally these confounders are controlled for by including them as explanatory variables in a statistical model. Bias-free conclusions become much more difficult, however, when some confounders are unmeasured or inadequately measured. A wide variety of environmental epidemiology studies have suffered from this problem, including, for instance, estimating the association between air pollution and mortality, between magnesium levels in drinking water and mortality from acute myocardial infarction, and between ethnicity, income and limiting long-term illness. The focus of Luke Bornn’s research is the development of a coherent, unified framework for modeling environmental risk exposure in the presence of unmeasured confounding. His model will account for spatial dependencies between adjacent geographical groups as well as other factors that are important for these studies, such as ecological bias and pure specification bias. His hypothesis is that by accounting for spatial dependence and unmeasured confounding under a comprehensive and unified framework, the risk estimates will more accurately estimate the true exposure risk and provide more appropriate estimates of the corresponding uncertainty. By developing a model through simulations, analytic results and application to real data sets, Mr. Bornn’s research will create a model that is both practical and useable for environmental epidemiology practitioners.
Investigating the effects of social, cultural, demographic, and socio-economic factors on developmental health and education trajectories of children in British Columbia
In BC, child poverty has reached 22 percent (First Call, 2008), the highest provincial rate within Canada. BC is characterized by its ethno-cultural diversity, with 20 percent of all children having recently immigrated, and more than 50 percent of children in some urban school districts having English as their second language. Furthermore, BC has been affected by rapid economic, environmental and demographic changes. An understanding of how personal and contextual factors are associated with developmental patterns of resilience and vulnerability among the different communities and subpopulations of BC is important. More specifically, it is critical to identify to what degree developmental needs and strengths differ from one context and subpopulation to another, and in which ways these differences in needs and strengths are associated with the cultural and socio-economic characteristics of those different communities and subpopulations.
Dr. Guhn's research draws from a unique, population-level linked database that provides an unprecedented opportunity to examine the social determinants of developmental health and education of children in BC. By utilizing population-level data on health and education outcomes for 40,000 children, and data on socio-economic and demographic characteristics for all of the 478 neighbourhoods in BC, Dr. Guhn will provide a detailed analysis of how social, cultural, demographic, and socio-economic factors are jointly related to health and education trajectories of children in BC. His findings have important implications for further developmental health research as well as for practices and policies in health and education. Furthermore, his data will inform practitioners and policy makers in health and education with respect to the process of adapting health and education service delivery according to characteristics that are specific to particular subpopulations and communities.
Reproductive trends among HIV-positive women in British Columbia's HAART era: Examining the interplay between pregnancy, antiretroviral adherence, and HIV disease progression
A growing proportion of new HIV infections, both locally and globally, are among women of childbearing age, and heterosexual contact is an increasingly important risk of HIV transmission. While it is clear that HIV-positive women continue to desire children, become pregnant, and give birth after knowing their HIV-positive status, the reproductive health concerns and rights of people living with and/or affected by HIV have received little attention. Highly active antiretroviral therapy (HAART), the standard of HIV treatment in BC, is reducing the health risks and barriers to reproduction for people living with HIV. With appropriate adherence to treatment, HAART increases life expectancy, decreases morbidity, and dramatically reduces the risks of HIV transmission from mother-to-child and to sero-discordant sexual partners. Angela Kaida’s research seeks to describe the reproductive trends of HIV-positive women in BC’s “”HAART era”” (roughly 1996 and onwards) and to investigate the complex interplay between pregnancy, antiretroviral adherence, and HIV disease progression. Owing to the structure of HIV-related services and population-level data capture methods, BC provides an entirely unique and highly valuable environment in which to investigate critical questions related to HIV, HAART, and pregnancy. Notably, no other jurisdiction in the world has published population level findings on this topic. This research will provide evidence to guide the development of effective and responsive reproductive and sexual health services and policies for HIV-positive women in BC and beyond. These services are intended to support the rights of HIV positive women to be sexually active and achieve their fertility goals, while minimizing associated risks to maternal, fetal, and partner health. The findings will contribute vital information to the development of provincial, national, and international guidelines that support reproductive decision making among HIV-affected couples and inform the use of antiretroviral therapy during pregnancy.
Polysubstance use: psychosocial functions of combined use of alcohol and psychostimulants
Much of the research that informs current understandings of drug and alcohol use and addictive behaviour is based on studies that concentrate on a single substance type. This narrow focus is in distinct contrast to actual patterns of use and related harms: most Canadians with substance use problems use more than one substance (polysubstance use), often on the same occasion, and their behaviours and health outcomes may be strongly shaped by this combination. Health policies and programs are usually developed, implemented and evaluated one substance or behaviour at a time, without consideration of possible consequences for other substance use and addiction outcomes. In the current research literature there is a lack of information regarding polysubstance use. This includes when, in what order, and in what quantities people use substances, why they choose to use simultaneously, and the risk behaviours (e.g. sexual behaviour, spending behaviours) associated with simultaneous polysubstance use. Kristina Brache is exploring the patterns of use, the settings and the motivations associated with combined use of alcohol and psychostimulants (cocaine, amphetamines). She is conducting a series of in-depth interviews and self-administered surveys of 150-200 substance-using individuals in a treatment setting. Understanding the use of multiple substances can inform prevention and intervention strategies to reduce harm or risk to individuals using multiple substances. Ultimately, this research could improve health and health delivery systems by informing policy, programs and treatment about combined drug use in this population of interest.
Exposure to asbestos in the slums of a sub-population of migrant ship dismantlers in Bangladesh
“Shipbreaking” is the dismantling and recycling of obsolete vessels, their hulls and superstructures. In Bangladesh, this work is carried out on beaches. Salvaged items are resold in local markets and workers and their families live in adjacent slums. Ships often contain hazardous substances such as polychlorinated biphenyls, heavy metals and asbestos, which are all recognized carcinogens. Most work is done without adequate training or protection, and there is high potential for exposures to toxic materials in the shipyards, shops and the community itself. According to the International Labour Organization, shipbreaking is one of the world’s most dangerous occupations. On average, one worker dies every week; the long-term consequences of mortality due to cancer and other chronic illnesses are unknown. Few studies have been performed in Bangladesh on the environmental impact of dismantling ships, the health of shipbreakers, or the impact on the surrounding community and maritime environment. Working in collaboration with local university and non-governmental organization researchers, Midori Courtice is measuring the concentration of asbestos in workers’ living quarters, in shops selling salvaged items, and in areas downwind of ship-dismantling operations. She will interview people about their knowledge, attitudes and practices with respect to their handling of, and hazards associated with, asbestos. Courtice’s findings will be made available to the participants and the local community, and her recommendations could inform local workshops on hazards and reducing risk. Her work will also provide the basis to approach policy makers and strengthen the link between research and policy, to raise awareness of personal health and safety among workers, and to build local capacity for future research on sustainable solutions related to the shipbreaking industry.