Intimate partner violence, which includes psychological, physical and sexual abuse, is a serious social and public health issue. The problem is particularly critical in British Columbia, which consistently has one of the highest rates of abuse of women in Canada. A womanâs risk of partner violence increases during pregnancy, and is associated with increased chance of miscarriage, premature labour, and low birth weight, as well as posttraumatic stress disorder and depression. Health care providers ask all pregnant women about violence as a routine part of their health history. However, a major barrier for caregivers is their lack of knowledge about what action to take after a woman discloses abuse. Little research has been done to determine what steps can be taken to successfully stop the abuse. Dr. Sarah Desmarais is evaluating the effectiveness of a targeted intervention, delivered in the context of primary care, to reduce violence and improve health. She will follow pregnant women â receiving care in a Lower Mainland hospital â who indicate that they have experienced partner violence. The intervention program will be provided by community health nurses and will consist of a variety of information, referral, and resource services (e.g., providing women with telephone numbers for community agencies and assisting women in contacting a women’s shelter and negotiating admission). Following the initial intervention, Desmarais will track pregnancy complications and newborn health. She will also interview women post partum about their health, their intervention experiences, and the incidence of partner violence. This research will inform the development and delivery of partner violence intervention in primary care settings, with an ultimate goal of reducing partner violence and improving women’s and newborn health.
Research Pillar: Population Health
Healthy child development: A multidimensional evaluation of parenting in the context of neighbourhood
Early childhood development (ECD) is a determinant of health and well-being across the lifespan. Recent results show that children’s developmental readiness at school is generally predicted by the socio-economic characteristics of the neighbourhoods in which they live. However, findings also reveal ‘atypical’ neighbourhoods, where neighbourhood socio-economic characteristics appear to have less influence on children’s development. One possibility in understanding these inconsistent findings points to familial and parenting influences on children’s health and development. Among families, parenting is a key factor in the protection, nurturing, and socialization of children, with important implications for developmental health. Parenting may also serve as an indirect pathway through which neighbourhood factors operate on young children’s health and development. Parents have a primary role in either transmitting or buffering neighbourhood influence on children’s development, especially during early childhood when children have quite limited direct exposure to the neighbourhood. Dr. Anat Zaidman-Zait is developing a multidimensional measure of parent-child interactions and will examine parenting in the context of the neighbourhood environment. Specifically, she will study parents of preschoolers from diverse neighbourhoods across BC, collecting information on parenting, neighbourhood socio-economic characteristics, parents’ perceptions of their neighbourhood, family demographic characteristics, and family and parents’ psychosocial functioning. Zaidman-Zaitâs research promises to highlight processes through which families who are exposed to different conditions remain resilient and are able to successfully support the healthy early development of their children.
Spatial epidemiology of trauma: understanding and preventing injury through geographic analysis
Over the course of the last two decades, the notion that health and well-being is tied to societal and environmental circumstances that may overlap and intersect with important elements of individual experiences has been widely utilized as a means of characterizing the inequitable distribution of a wide range of health outcomes, including injuries. Importantly, the population health perspective model is transforming how we understand the complex interaction between the environment and injuries, and tailoring prevention and policy responses to address the inequitable distribution of their occurrence. Yet, there are currently no frameworks in place for how we quantify the interconnectivity between social, environmental, and geographical determinants of injury and building evidence that highlights the underlying relationship between all three factors with injuries. Addressing the ecological and geographical questions regarding this complex interaction entails integrating the current injury prevention models with the tools and analysis functions of geographic information systems (GIS). GIS are widely recognized as essential tools in public health promotion and surveillance as they allow for the integration of multiple data sources and the visual and spatial analysis of health data in relation to locations, distances, or proximities. GIS can increase our understanding of current population access to emergency medical services, the extent that injuries âclusterâ in certain areas and among certain population groups, as well as help researchers better understand and locate the links between people and their environments that may either reduce or increase injury risk. Nathaniel is currently applying GIS in a number of research areas in order to determine where important systems elements might be augmented to improve population access to critical care, for identifying incidence patterns that might have gone under noticed had they not been examined using GIS, as well as how this technology might be used to help researchers more accurately target prevention efforts to reach communities in-need. This research will help structure ongoing injury prevention efforts in British Columbia as well as provide future researchers with a number of frameworks for using GIS to improve our understanding of the societal, environmental, and geographic factors associated with injury.
Optimizing the impact of antiretroviral treatment as an HIV prevention intervention in marginalized populations
The introduction in the mid-1990s of highly active antiretroviral therapy (HAART) helped HIV become a manageable disease in industrialized settings such as Canada. Mortality and morbidity associated with HIV have been dramatically reduced with the increased use of these drug regimens and are associated with reduced transmission probability of HIV within sexual relationships. It has been proposed that HAART be integrated into HIV-prevention activities as a means of helping curb epidemic growth. Evaluating the impact of HAART is complex. For example, while the effect of reduced symptoms and increased lifespan is beneficial to the individual, modelling studies have shown that unless infectiousness of individuals is sufficiently reduced by antiretrovirals, the negative impact of an increased incubation period (leading to increased number of opportunities for transmitting infection and a larger population of transmitters) can actually increase how fast the infection spreads. Using mathemathical modelling methods, Kathleen Deering is comparing the impacts of HAART in Vancouver (where HIV-infected individuals have free access to treatment), and in southwest India (where only about 10 per cent of HIV-infected people have access). Her studies, which consider infection biology, behavioural and demographic characteristics of the population, and the spread of infection over time, will be used to compare different treatment strategies for HAART, and to project disease outcomes. Deeringâs research will provide evidence for developing HIV treatment and care recommendations that will help maximize the effectiveness of HAART among marginalized groups in Canada and India.
An investigation of the impact of crystal methamphetamine use on sexual and injection-related risk behaviour among street youth and injection drug users in Vancouver
Illicit drug use is a major public health concern in British Columbia, most notably the high rates of HIV and Hepatitis C transmission among injection drug users. Additionally, in Vancouver and elsewhere in British Columbia, there is concern regarding escalating rates of crystal methamphetamine (CM) use. The prevalence of CM use is rising internationally, and has been associated with unsafe sexual and injecting practices among specific subpopulations at risk for HIV. However, the potential associations between CM use and sexual and injection-related risk behaviour among marginalized populations in Vancouver have not been thoroughly investigated. Brandon Marshall was previously funded by MSFHR for his Masterâs work studying the interactions between drug use and sexual risk behaviour among street youth in Vancouver. He is now continuing his examination of a number of social, environmental, and structural factors that predict frequent CM use and subsequent health-related harms among young injection drug users. He hypothesizes that social disadvantage, impoverished living conditions, frequent exposure to law enforcement, and poor access to health and harm reduction services will be associated with higher frequency and intensity of CM use. This research will help inform evidence-based public health policy and interventions for marginalized populations. Marshallâs findings may be used to develop strategies that seek to reduce the harms associated with CM use, prevent further transmission of HIV and Hepatitis C, and provide better support for youth and injection drug users who are already infected.
Early mother-infant interaction and infant mental health
The quality of the mother-infant relationship early in infancy forms a foundation for infantsâ subsequent social and emotional development. In particular, mothersâ sensitive responses to behavioural and emotional cues help their infants develop a sense of self and help them regulate their emotions. Attachment â or the bond between infants and their caregivers â is a developmental achievement in the first year of life that is essential for healthy physical and psychological growth. Studies have shown that insecurely-attached infants are at risk for a range of negative developmental outcomes. Nancy Mcquaid was funded by MSFHR for her early PhD work into the relationship between attachment and infant mental health. She is continuing this longitudinal investigation among a community sample of mothers and their infants. Mcquaidâs research is now evaluating whether maternal responsiveness and infant social expectations observed at four months are related to subsequent infant mental health at 12 and 30 months of age. She is also assessing the impact of mother and infant temperament to healthy developmental outcomes. Mcquaidâs research will contribute to our understanding of healthy infant development and will help develop means of intervention for infants who are at risk for developmental emotional and interactive disturbances, such as infants of mothers with postpartum depression and low birth weight infants.
Social support groups as a means to enhance the health literacy status of ESL-speaking immigrant women
Health literacy is defined as the ability to read and comprehend prescription bottles, appointment slips, and other essential health-related materials, or the capacity to obtain, interpret and understand basic health information and services needed to make appropriate health decisions. Inadequate health literacy increases a personâs risk of dying of chronic and communicable diseases, and directly affects the ability to follow physician instructions, to understand disease-related information, and to understand health care rights. In particular, immigrant women may struggle to understand health information. On average, they have lower literacy rates than immigrant men and they also have significantly lower literacy levels than the Canadian-born population. There is a social dimension to health literacy, but no study to date has investigated whether or how social support can moderate the effects of health literacy on individual health and health service use. Laura Nimmon is partnering with an immigrant society in BC to implement a community health education program that fosters social relationships for ESL-speaking immigrant women and builds on their health literacy levels. She is creating a pilot program that will educate research participants about health information and guide them to act as community health advisors to their peers, mentoring other immigrant women to participate in healthy choices and activities. Nimmonâs research aims to improve understanding about how peer-based social support groups might enhance the health literacy status of immigrant women and alleviate the adverse health consequences of low health literacy.
Transformational teaching and physical activity adherence among adolescents: From measurement and prediction to intervention
Physical inactivity in adolescence has been linked to a vast array of physical and mental health problems that extend across the lifespan. Canadian adolescents are required to undertake regular physical education as part of their school curriculum, guided by physical education teachers. However, more than half of adolescents are considered not sufficiently active to meet international guidelines for optimal growth and development. In workplace settings, “transformational leadership” is exemplified by business leaders whose behaviours and interactions inspire employees to reach new heights of work performance and self confidence. Transformational leaders inspire, energize and intellectually stimulate their followers. Training programs in business and military settings have also shown that people in leadership positions can successfully acquire and develop these behaviours.
Exercise and health psychologist Dr. Mark Beauchamp is taking this leadership model out of the workplace and applying it to school physical education and health promotion settings. He’s studying whether training physical education teachers in transformational leadership can positively affect the attitudes and behaviours of their students around adopting and maintaining physical activity. If this approach is proved effective, this research could be used to help develop evidence-based initiatives (across Canada and beyond) that inspire a greater proportion of adolescents to become and stay physically active.
Protective factors associated with preventing injection drug use initiation among at-risk youth in Vancouver, British Columbia
Street youth â 15- to 24-year-olds without a permanent residence â are at considerable risk for acquiring HIV and hepatitis C due to participation in high-risk activities such as injection drug use (IDU) and sex trade work. In comparison to their older counterparts, street youth who use injection drugs are at greater risk for blood-borne infections because of their lack of experience: they are more likely to share needles and other drug equipment, and they are more likely to initially require a friend or acquaintance to inject them, decreasing their control over the use of clean equipment. In addition to the risk for HIV and hepatitis C infection, initiation of IDU at a young age is associated with participation in sex trade work, binge drug use events, criminal activity, and long term injection drug use. While most research concerned with IDU in street youth populations examines high-risk behaviours for HIV and hepatitis C infection, few studies have investigated factors that prevent street youth from initiating IDU. Catharine Chambersâ research aims to determine why certain street youth are resilient to IDU initiation and, for those youth who have experimented with injection drugs, why they initiated IDU and what can potentially prevent them from transitioning into regular users. She hypothesizes that stable relationships with primary caregivers, social support networks separate from the street community, and absence of criminal activity may provide resilience from IDU initiation. Chambersâ findings will inform the development and implementation of prevention programs to reduce initiation of injection drug use among Vancouver’s street youth. Ultimately, this could reduce the prevalence of blood-borne infections, HIV and hepatitis C, in these high-risk groups.
Investigating syringe-sharing among at-risk youth, and analyzing coverage of and access to youth-targeted needle exchange programs
Street youth often carry a heavy burden: trauma, sexual and physical violence, lack of education, homelessness, and mental illness all contribute to the difficulties that many young street people face. Studies have shown that street youth are also one of the groups at most risk of progressing from non-injection drug use to injection drug use, including crystal methamphetamine use. Because they often engage in high-risk sexual activities and drug use, street youth are also particularly susceptible to being infected with and spreading blood-borne diseases like HIV and Hepatitis C. Young women in this group, some of whom are involved in the sex trade, are at particularly high risk of contracting these diseases. Health authorities in Vancouver have recognized this problem and responded by expanding and decentralizing needle exchange programs that target street youth. However, little is currently known about the effect that these programs have had on the risk behaviours and drug use patterns of street-based youth. Given that street youth who inject are often hard to reach, there are concerns that this population may not have adequate access to critical HIV prevention programs such as needle exchange. Daniel Werb is investigating the factors associated with syringe sharing among street youth, such as crystal methamphetamine use, unstable housing, involvement in sex trade work, historical sexual abuse, and depression. He will also investigate the reach of youth-oriented needle exchange programs in Vancouver and determine their effectiveness in harm reduction. Werbâs findings will help health authorities understand this at-risk population better, and contribute to the development of effective programs that support the health of street youth who inject drugs.