According to Statistics Canada, Canadian adolescents are more likely than any other age group to commit violent crimes. This violence has enormous costs, including the suffering of victims, the fears experienced within a community and financial costs to taxpayers. A significant effect is the reduced opportunity for these youth who commit violent crimes. Researchers have recently identified mental illness as a possible contributing factor for youth violence. While most teenagers with mental illness are not violent, rates of violence appear higher in this group. Currently, researchers do not have a clear understanding of which mental illnesses increase youths’ risk and why. Dr. Jodi Viljoen will advance this understanding by providing health professionals and society in general with information about key relationships between youth violence and specific mental illnesses. Viljoen will interview 200 adolescent offenders in the community. The youths’ mental health symptoms, social context (e.g., peers), protective factors (e.g., supportive relationships with adults), and violent behaviour will be assessed regularly for a one-year period based on the following: structured interviews with youth and their caretakers, clinician rating scales, self-reporting questionnaires, and justice and mental health records. Her analyses will carefully examine the role of youths’ strengths and social context in predicting violence, as well as possible gender and ethnic differences in links between mental illness and youth violence. By identifying core risk factors and treatment needs in adolescent offenders with mental health issues, her research will help inform the development of effective strategies to prevent and treat violent behaviour in this critical age group, and will also advance BC as a premier centre in youth violence research and training.
Research Pillar: Population Health
Health and the Work Environment: A Program of Research for the Surveillance and Epidemiology of Workplace Injury and Illness and the Evaluation of Workplace Policies and Procedures to Protect and the …
Health Issue: Conditions in the work environment for many occupations involve hazards to health that reduce the well-being, working capacity and even the life span of working individuals. In 2005, three BC workers per 100 had a work-related injury or illness serious enough to require medical attention and time off work.
Objective: The objective of the research program on Health and the Work Environment is to provide evidence for primary and secondary prevention of work-related illness, injury and disability in order to advance the health of British Columbians. It spans three interconnected themes of a) research data development and surveillance of work-related injuries, illnesses and exposures, b) occupational epidemiology of risk factors associated with work-related injury and illness, and c) policy and program (intervention) evaluation to reduce work-related disability.
Work Plan and Innovation: The research data development and surveillance theme involves the merging of health databases with employment characteristics and work exposure data to map injury/illness rates and exposure groups and identify high risk groups in BC by occupation and industry. To our knowledge, this will be the only population-based occupational research database of its kind in Canada.
The occupational epidemiology theme involves a study of BC firefighters and the relationship between heart disease and exposure to smoke, carbon monoxide, or physical stress; and a study of BC workers in heavy industry and the relationship between back injury and exposure to heavy lifting, awkward postures, or vibration. The innovation of both of these studies involves novel job exposure assessment techniques.
The intervention theme includes an investigation of the effect of compensation procedures to reduce wait time (surgical fee incentive and private clinic surgeries) on return to work and re-injury for workers with musculoskeletal injuries; and a study to investigate if an early intervention program improves return to work or risk of long term disability for health care workers who are off work for 5 days with depression. These two projects provide unique opportunities to inform debates on a) health service delivery models in Canada for musculoskeletal conditions (the predominant source of disability) and b) early interventions for mental illness (the fastest rising source of disability).
Social Determinants of Rural and Northern Community Health
Research has increasingly linked the health of individuals to the integrity of a community’s social fabric, the extent to which residents in a community trust each other and participate in community activities, and on the networks of communication and exchange between community members. However, little research on this “”social capital”” has been conducted in British Columbia. Yet, communities in British Columbia are facing an accelerated pace of structural change due to the effects of globalization, changes over the past 15 years in health and welfare systems, and industrial restructuring. It is imperative, particularly in the Central and Northern Interior of the province, where an unprecedented eco-economic crisis is unfolding due to the pine-beetle infestation, that the impacts of these changes in community structure and functioning and, in turn, their impacts on social capital and the health and the health and educational status of children and adolescents are investigated in a way that may lead to amelioration. Building on the foundation of over a decade of work on the social determinants of workplace and community health and a recently awarded New Emerging Team grant to investigate the social determinants of community health in British Columbia, this program of research will further methodological developments in community health research while strengthening the base for community health research at the University of Victoria, in BC, nationally, and internationally. Given that many other communities in Canada, as well as in other nations, similar challenges, the knowledge, conclusions, and recommendations arising from this program of research will be applicable in other jurisdictions.
Community screening and intervention for high-risk oral premalignancies
Worldwide there are over 300,000 new cases of oral cancer each year with half of these cases dying of the disease; mainly because of late diagnosis. As such, the advanced widespread disease often requires complex and disfiguring treatment, consequently with a huge impact on the quality of life of the patients, at the same time adding stress to the health care system. It is important to prevent and identify the disease at early stages.
In BC, a particular high-risk medically underserved community resides in Vancouver Downtown Eastside (DTES), the location of one of Canada's poorest neighborhood. Residents in this community are at high risk for oral cancer because many are heavy smokers and regular consumers of alcohol, which are the established risk factors for oral cancers. Further aggravating the problem is that many are having complicated immune status; additionally, poor nutrition and oral hygiene and a limited access to dental and medical care.
There is an urgent need to reach this high-risk population to make sure these individuals are equally served. Moreover, a screening program targeted toward such a high-risk community could effectively decrease the suffering and fatal impact attributable to oral cancer. The key focus of my research is to work within high-risk communities to develop a screening strategy targeted towards the hard-to-reach underserved populations where the need is greatest.
The main objective of this study is to establish current research activity in the study of oral cancer and precancers within the context of community-based clinics in a high-risk population in Vancouver. The activities involve: 1) to establish the first oral cancer screening clinic in a high-risk community in BC, 2) to incorporate and evaluate several new visualization tools and molecular markers for the identification of high-risk OPL and early cancer, and 3) to understand the biology of infection and inflammation to OPLs and its role in cancer formation in a high risk community. This work meets the main objectives of the National Cancer Agency, Canada in prevention and early detection of cancers.
The British Columbia Adolescent Substance Use Survey
The use of tobacco, alcohol and marijuana by teenagers continues to pose a significant threat to the health of many young Canadians. Recent national surveys indicate that 18 per cent of Canadian teens smoke tobacco daily or occasionally and one-third of all teens have tried marijuana more than once, with about eight per cent of teens using it at least once a week. Just over 44 per cent of teens reported drinking one to three times each month, with an additional 17 per cent of teens aged 15 to 17 drinking one to three times a week or more. Despite extensive prevention efforts, the use of these substances appears to have become a somewhat normalized part of adolescence. The goal of Dr. Richardson’s program of research is to improve our understanding of why adolescents are using these substances, and in so doing, facilitate the development of more effective interventions. For example, Dr. Richardson will be using an internet-based web survey to collect information every six months from a large group of adolescents to examine how the influence of known risk factors for substance use, such as peer influences and psychological characteristics related to risk taking, change as the students’ progress through high school. Dr. Richardson hopes this research will enable researchers to identify specific longitudinal patterns (i.e., trajectories) of alcohol, tobacco and marijuana use and examine how the influence of known risk factors change as adolescents progress through the secondary school system. In addition to improving our understanding of the different patterns of substance use, this research will contribute to the development of individually tailored prevention and harm reduction interventions that can be delivered over the internet.
Improving youth sexual health in British Columbia
In spite of prevention programs that target risky sexual behaviours in youth, many BC teens continue to experience serious health and social problems related to sexually transmitted infections (STIs) and unplanned pregnancies. While untreated STIs can lead to pelvic inflammatory disease, infertility and increased risk of HIV, early maternal age can result in decreased future educational and employment opportunities for young mothers. As a Scholar, Dr. Jean Shoveller investigated the factors that play a role in the increased incidence of teen pregnancy and STIs among rural and remote BC communities. Now, Dr. Shoveller is working to reduce gaps in public health interventions related to youth sexual health by focusing on policy and program intervention research related to the health and social impacts of STIs and unwanted pregnancies amongst youth. Dr. Shoveller’s research will integrate participatory approaches to research (where youth are directly involved in the planning and implementation of research projects) with an analytical framework that examines how features of youth’s social contexts (e.g., gender, place, culture) affect youth’s sexual lives. Also, data that illustrate how context affects young people’s sexual health will be mapped to reveal how strengths and weaknesses in the health, education and social service systems affect youth’s sexual health. This research will provide researchers with new tools that can be used in new and unique participatory research opportunities that actively involve youth in research into this complex and sensitive topic and will provide public health policy makers and program planners with information to help inform decisions regarding improving and promoting youth sexual health.
Molecular Pathways Linking Socioeconomic Status, Stress Experiences, and Asthma Severity in Children
About three million Canadians have asthma, a chronic disease of the airways that causes shortness of breath, tightness in the chest, coughing, and wheezing. The prevalence of asthma among children in the developed world has been rapidly increasing, with up to one in four urban children affected. Research shows that stressful life experiences as well as low socioeconomic status have been linked to poor asthma outcomes in children. To date, few studies have examined the common underlying molecular mechanisms behind these links. Dr. Jutta Wolf is investigating how these two variables — stress experiences and socioeconomic status (SES) — can biologically influence asthma symptoms. Stress can cause immune cells to produce more “cytokine” molecules. Cytokines are proteins that stimulate or inhibit the activity of immune cells, which can aggravate asthma symptoms. Stress is also associated with the release of the hormone cortisol. Jutta is examining whether cortisol is incapable of suppressing a molecule called NF-kappa B, which causes immune cells to produce more cytokines in asthma patients, exacerbating their symptoms. This research could help care providers identify early signs of worsening asthma in children, so their condition can be better managed.
Cognitive, emotional, and behavioural implications of vicarious trauma
Everyone is exposed to stressors in their personal and work lives. How people evaluate and deal with these stressors determines how well they cope, which has implications for their immediate and long term health. Stress can also be less direct, the result of witnessing severe trauma suffered by others, such as the 9/11 attacks on the World Trade Center in New York and London subway attacks in 2005. Research has shown this “vicarious trauma” can also have a substantial impact on health, from post-traumatic stress disorder to depression and persistent worry. Rajiv Jhangiani is studying how individuals react when exposed to trauma indirectly. He is examining how people process information, react emotionally, and make decisions during their exposure to vicarious trauma. Jhangiani is assessing how certain factors influence this reaction and ability to cope, such as identifying with victims, the degree of uncertainty about the situation, information overload, and resilience. This information will help identify how individuals and health and social service providers can support healthy ways of coping with vicarious trauma.
Understanding the Day-to-Day Process of Stress and Coping Among Both Individuals with Spinal Cord Injury and Their Primary Emotional Support Providers: Effects on Health, Mood, Functional Ability, and …
Approximately 4 percent of Canadian children are diagnosed with Attention–Deficit/Hyperactivity Disorder. Their symptoms pose significant coping challenges for the child as well as for the parents and are often comorbid with other mental health problems. Indeed, the greatest impairment appears to occur in families of children who have not only ADHD, but also comorbid disorders. However, family factors associated with disorders comorbid with ADHD have received relatively little attention in past studies, with most studies focusing on comorbid oppositional or conduct problems, and few studies examining comorbid anxiety disorders in children with ADHD. Sharon Lee is studying parenting practices associated with childhood ADHD and co-occuring anxiety disorders, She will be comparing parent-child interactions in children with ADHD and comorbid anxiety, children with each disorder alone, and a control group. Analyses will examine how parental responsiveness relates to child comorbid anxiety over and above parental levels of anxiety. This research will help us to understand how parenting style may be related to comorbid anxiety in children with ADHD and such knowledge will be useful in tailoring the empirically-supported parenting interventions used for childhood ADHD to more fully account for the presence of comorbid anxiety.
Exposure to Residential Air Pollution and Diagnosis of Acute Otitis Media During the First Two Years of Life in British Columbia, Canada
Middle ear infection, or otitis media, affects up to 80 per cent of children in North America and is the leading reason children under three visit the doctor, take antibiotics, or have surgery. The costs associated with doctors’ visits, prescriptions and parental work leave are considerable. Elaina MacIntyre is continuing her earlier MSFHR-funded research investigating whether exposure to air pollution increases the risk of middle ear infection in children. The condition is a common complication of upper respiratory tract infections. Since air pollutants irritate the upper respiratory tract, it’s plausible they could play a role in middle ear infections. Recent studies in Europe have found an association between living in areas with high air pollution and the incidence of middle ear infection, but this relationship has not been previously examined in North America. MacIntyre is conducting the first North American study to analyze whether this type of infection is linked to exposure to air pollution from industry, traffic and wood burning sources. Results of her study could be useful in assessing the public health impact and health care costs of middle ear infections, and in helping reduce the incidence through strategies to prevent or limit environmental exposure of young children to environmental conditions that contribute to the development of these infections.