The Chinese are one of the fastest-growing ethnic groups in Canada, comprising about four per cent of the population in 2001. Research has consistently found that compared to individuals of European descent, people of Chinese descent have much lower rates of health-seeking behaviours (actions taken in order to maintain or improve health). For example, Chinese women in BC have twice the risk of cervical cancer compared to Euro-Canadian women, mainly because of poor screening behaviours. Culture is believed to be an important factor contributing to low Pap testing rates among Chinese women. By Western standards, traditional Chinese sexual attitudes and behaviours are conservative: sexual activity is strongly discouraged before marriage and it is taboo to talk about sex openly. One way to study culture is to consider what happens when individuals move to a new country and encounter a new culture. Acculturation is the process whereby values of the new culture (Mainstream culture) are incorporated into one’s self-identity and culture of origin (Heritage culture). Recently, a pilot test was conducted among university students investigating the role of acculturation in the relationship between sexuality-related beliefs and behaviours and Pap testing. Among the Chinese women, high Mainstream acculturation was significantly related to more accurate sexual knowledge and better sexual response, and high Heritage acculturation was significantly related to less Pap testing behaviour. Jane Woo is building on the pilot study to further explore these relationships. Following validation that the findings among university students can be extended to women in the general population, she will conduct focus groups to understand women’s experiences related to their sexuality and reproductive health behaviours. A greater understanding of the factors that affect health-seeking behaviours among Chinese women will contribute to the development of more equitable, culturally-sensitive health care services to all Canadians.
Research Pillar: Population Health
Redefining community resilience: community perspectives on the intersection of gender, mental health and adaptive capacity in the context of the Mountain Pine Beetle disaster
Much of British Columbia’s forests have been infested with the mountain pine beetle (MPB), an epidemic that is predicted to result in the loss of more than 80 per cent of the province’s pine forests by 2013. The MPB is also expected to result in the widespread loss of jobs, shifts in traditional resource cultures of affected communities, and an increased risk of forest fires and other natural disasters (e.g. slides, flooding). Gender is recognized as one of the most critical determinants of disaster-related vulnerability. Women and children are disproportionately affected by disasters, reporting higher rates of stress-related health problems (e.g., post-traumatic stress, anxiety, depression), an increased risk of sexual and domestic violence, greater economic marginalization, and substantial increases in their work. They are also less likely to be involved in community-based planning and decision-making processes. Dr. Robin Cox is analyzing individual and collective stressors associated with MPB in four forestry-dependent communities: Barriere/Louis Creek, Clearwater, Quesnel and Wells. She is piloting a community-based research strategy intended to engage affected residents in each community in a series of workshops and focus group interviews. The focus of these events is to identify and elaborate community-based definitions and strategies of resilience that reflect the specific cultural, social, and political contexts of participants. The proposed study will contribute to the development of knowledge around community resilience that integrates a gender perspective, and will lead to the development of policies and procedures that are relevant and responsive to different communities affected by MPB.
Unleashing the research potential of a population-based data system: integrating community-centred, life-course, linked-data, and longitudinal approaches to monitoring child health and development
Early Child Development (ECD) – the development of physical, social-emotional, and language-cognitive capacities in the early years – is recognised as having life-long effects on health, well-being, behaviour, and skill acquisition. Population-based ECD research is essential for understanding the capacity of our future population. British Columbia is at the forefront of population-based research in ECD, thanks to a rich database created by the Human Early Learning Partnership (HELP) at the University of British Columbia. Here, health scientists can access population-based data on children’s health and development, and link these data to other administrative and research databases, such as Statistics Canada’s neighbourhood-level census file. Making use of these state-of-the-art data resources, Dr. Jennifer Lloyd is exploring the pathways of early developmental experiences to later educational outcomes, the relationship between children’s developmental trajectories and their neighbourhoods of residence, and the patterns in which children’s health and development present themselves as gradients when assessed against the socioeconomic characteristics of their residential neighbourhoods.. Lloyd’s research will explore inequalities in children’s developmental trajectories in an unprecedented fashion in British Columbia. In terms of policy and practice, her research stands to influence health delivery systems by providing evidence to guide public health and social policies and program development, and to assist in reducing gaps in existing patterns of children’s development and educational outcomes in British Columbia and beyond.
Urban renewal, drug related disorder and displacement: implications for health and HIV risk behaviour among injection drug using populations
It is estimated that 269,000 Canadians have injected drugs in the past year; statistics reveal that almost 20 per cent of all newly-recorded HIV infections are associated with injection drug use. High risk behaviours associated with injection drug use have made injection drug user populations especially vulnerable to HIV infection. This is particularly evident in Vancouver’s Downtown Eastside, which has experienced an explosive HIV epidemic among local injection drug users. For several years, this neighbourhood has felt the effects of new developments squeezing out older, low-income housing. This ongoing revitalization of Canada’s poorest postal code will soon be coupled with the upcoming 2010 Olympics. It is also expected that targeted policy interventions will be initiated to reduce the appearance of public disorder, particularly open illicit drug scenes. The implications for current residents are significant. The coming years have the potential to bring a massive displacement of injection drug users out of the Downtown Eastside, away from where most of their health and social services are currently situated. Kora DeBeck is monitoring how public policy changes related to urban revitalization affect risky behaviours and health among injection drug users. She is analyzing data from established cohort studies, which currently follow more than 2,000 injection drug users. Not only will DeBeck’s work help local policy makers respond to changing health service needs within Vancouver, it will also inform other cities experiencing similar urban transitions.
Ambient air pollution, residential traffic noise, and cardiovascular disease in British Columbia
Cardiovascular disease is the leading cause of death worldwide and accounts for approximately one-third of deaths across BC and Canada. Growing evidence has shown that air pollution and residential traffic noise are associated with cardiovascular disease. Chronic exposure to air pollution may induce and accelerate atherosclerosis, and environmental noise pollution is associated with hypertension. Previous studies have not clarified the independent effects of noise exposure and the joint effects of both ambient air pollution and residential traffic noise on the risk of cardiovascular events. Wenqi Gan is investigating if British Columbians exposed to higher levels of air pollution and residential traffic noise have an increased risk of cardiovascular events such as heart attacks, and whether this effect is greater among older age groups and individuals with other existing health conditions. Using air quality monitoring data , calculated environmental noise levels, as well as cardiovascularhospitalization and death records in Metro Vancouver, his study will follow more than half a million residents aged 45-85 over five years. Advanced statistical methods will be used to analyze the relationship between air pollution and noise exposure levels and the risk of cardiovascular events. Gan’s study will help identify the impacts of multiple environmental exposures on the risk of cardiovascular events and will also provide important evidence to support environmental policy making about air pollution, urban design, and transportation planning.
Combined analyses of the environmental risk factors for Lung Cancer in British Columbia and the resulting burden from particulate air pollution, arsenic and radon exposures
Every year, approximately 2,200 British Columbians die of lung cancer and an additional 2,700 are diagnosed with the disease. While tobacco smoke is the primary cause of lung cancer in BC, approximately 25 per cent of lung cancer cases are not attributable to smoking. In fact, lung cancer in non-smokers accounts for the seventh leading cause of cancer death. Studies have found that environmental factors increase the risk of lung cancer in both smokers and non-smokers, including exposure to particulate air pollution, residential radon (a radioactive gas that leeches from soil and building materials), and arsenic in drinking water. These three exposures are widespread throughout BC and affect a large percentage of the population. However, no study has been conducted that determines how many, where and to what levels the BC population is exposed to these environmental carcinogens, or the risks posed to lung cancer development and the resulting burden on lung cancer in BC. Perry Hystad is creating current and historical provincial exposure models for particulate air pollution, radon and arsenic. These results are linked with provincial lung cancer data collected by the National Enhanced Cancer Surveillance System. His research will include exposure assessment, epidemiological analysis and burden of disease calculations. Hystad’s findings will shed light on the risks posed by these environmental carcinogens across BC. Ultimately, this work could help identify potentially susceptible populations and contribute to the development of prevention measures.
Evaluating changes in the social, sexual, and drug-using networks of men who have sex with men (MSM) following testing and an enhanced prevention intervention for acute HIV infection: Applying social …
The primary purpose of this research is to provide insight into how to reduce the rising rate of HIV infection among men who have sex with men (MSM) in Canada. The number of HIV infections in Canada continues to rise annually, with MSM accounting for a disproportionate number of these new infections. Evidence now suggests that individuals are highly infectious during the early stage of HIV infection, and these individuals are responsible for generating 11 to 40% of new infections annually. Indentifying individuals as soon as possible after acquiring HIV infection and providing a risk reduction intervention is necessary to curtail this HIV epidemic among MSM. Traditional HIV antibody testing is unable to detect HIV during this early infective stage; a new technology (nucleic acid amplification test-NAAT) that can identify early HIV infection has recently become available and will be used in this study. Traditional epidemiologic methods have focused on individual-level risk factors (e.g. number of sexual partners, condom use) but these have failed to fully explain transmission dynamics or control epidemic growth. Social network analysis (SNA) is a methodology that considers relationships, and interactions among those with varying risk characteristics in the social context. SNA is increasingly being applied to infectious disease epidemiology and research suggests this is a useful approach to the study of HIV transmission dynamics. MSM who acquire HIV are likely to belong to social, sexual, and drug-using networks whose members have similar risk behaviours. We hypothesize that early HIV detection and risk reduction interventions targeting these individuals, and their networks, will reduce the transmission of HIV. This research will employ SNA to examine and describe the social, sexual, and drug-using networks of MSM diagnosed with early HIV infection using NAAT. Network information will be used to identify networks containing high levels of risk behaviour and networks with a high incidence of early HIV infection. An enhanced prevention intervention will be developed with MSM community participation and implemented among individuals within the network who are engaging in high risk behaviour, and who are prominent in the network. In addition, SNA will be used to evaluate how the networks change over time (post-intervention) considering network structure, sexual mixing patterns, rate of partner change, risk behaviour, and to determine forward HIV transmission events.
Breaking the cycle of peer victimization and maladaptive outcomes among adolescents: building strength through parent, peer, and teacher emotional support
Peer victimization — the experience of being a target of a peer’s hurtful teasing and aggressive behaviour — has major implications for adolescents’ mental health. It’s estimated that 15 to 27 per cent of adolescents are victimized by their peers and approximately 10 per cent of students face severe or chronic victimization by peers. Chronic and frequent victimization experiences can lead to increased levels of depression and anxiety among victimized adolescents and put them at risk for becoming more aggressive over time. Breaking the cycle of peer victimization is a priority; however less is known about the protective factors that will reduce levels of harmful outcomes associated with peer victimization. Rachel Yeung is investigating the associations between peer victimization and emotional and behavioural problems among adolescents across a four-year period. She is examining whether emotional support from parents, peers and teachers can moderate and protect against these harmful outcomes. Yeung will use data taken from a longitudinal Healthy Youth Survey, which followed 664 adolescents in an urban community via individual interviews. Yeung’s findings can support the importance of building existing support systems and fostering new relationships with parents, peers and teachers to prevent long term and negative mental health problems associated with peer victimization. This will also provide a basis for the development of effective prevention programs that aim to break the cycle of peer victimization and its harmful outcomes among older adolescents.
New Perspectives on Gender, Diversity, and Health Policy, Planning, and Services
The primary methods for identifying and responding to differences between men and women in the health context are gender-based and gender-sex-based analyses (GBA/GSBA). While these approaches are intended to consider diversity within each group, they do not always capture how gender interacts with other factors such as race/ethnicity, socio-economic status, sexual orientation, geography, ability and age. Not taking these factors into account in health planning, implementation and research can result in real economic and human costs for health care consumers. These include lost opportunities, ill health, suffering and perhaps overall, an ineffective and inequitable health care system. A key challenge facing researchers and policy makers is how to move beyond singular variables (e.g. gender) to understand the complex dynamics at play between gender and health. Dr. Olena Hankivsky is examining how GBA and GSBA are applied in health planning, services and policy in Canada, Sweden, the UK, Australia and the Ukraine. She is exploring innovative improvements for analyzing gender and diversity in a health context. In particular, Hankivsky is conducting a gender and diversity analysis of the most recent health reform initiative in British Columbia — The Conversation on Health. The findings could contribute to developing policy tools and interventions that will improve the effectiveness and efficiency of health services and programs for vulnerable and marginalized populations in BC, Canada, and internationally.
Community Learning Centres: A Model of Community Engagement in Health, Education & Training
There are disproportionately high rates of poor health among First Nations populations in comparison to the general Canadian population. A contributing factor is the limited access many geographically-isolated rural and remote First Nations communities have to health information. Dr. Sandra Jarvis-Selinger is focusing on a new and innovative approach supporting community access to health information. This approach involves the formation of Community Learning Centres (CLCs) in four communities located in the Ktunaxa Nation in southeastern BC. A CLC is both a physical and a virtual space for community members to access Internet-linked computers and web-based resources developed according to community-defined health priorities. Health information is created by and for community members and is both accessed at and disseminated via CLCs through information and communication technologies. Community engagement is the cornerstone of this project, with due emphasis placed on community input and governance, local health priorities and inclusion of traditional medicine, language and knowledge. Dr. Jarvis-Selinger is conducting a program evaluation to determine the effectiveness and sustainability of the CLC design and implementation. The evaluation is being co-developed with each community in order to match the communities’ needs, workflow, schedule and style of participation. This research will increase our understanding of how to successfully and sustainably: 1) support community-university partnerships; 2) improve community wellness; 3) expand access to and awareness of community health resources; and 4) increase employment opportunities through technical, research and interpersonal skills training. Overall, this research promises to make a meaningful contribution to the domain of First Nations community health through the use of technology.