This research program aims to tackle the challenge of improving the overall health of the Canadian population, focusing on nutrition. The approach involves using methods from behavioral and data sciences. The study will investigate how small, non-economic encouragements (nudges) and financial incentives can influence people to make healthier and more sustainable food choices over the long term. For example, placing healthy food options prominently at the checkout is a type of nudge. The research involves creating an underlying technological infrastructure, connecting it with data from a grocery store loyalty card program, and analyzing how nudges and economic incentives affect shopping habits over time. The analysis will consider their impacts on total food intake, nutrients consumed, and the environmental impact of food choices. Additionally, the research will examine these influences across different socioeconomic groups to understand and address nutrition disparities. The ultimate aim is to offer practical insights for policymakers and businesses to promote fair, healthy, and sustainable diets.
Research Pillar: Population Health
Investigating the influence of residential green space on cognitive decline and dementia
The global population is aging rapidly. This demographic shift towards an older population poses a major public health challenge and highlights the need to identify strategies to support healthy aging. Prior research has suggested that green space may promote cognitive health, but there are gaps in knowledge that limit the application of findings in planning and policy to optimize health benefits. In this work, we will use long-term data on aging to study the influence of residential green space exposure on cognitive decline and dementia among middle-aged and older adults. We will advance existing knowledge by studying the health impacts of specific green space types and forms of contact, as well as pathways linking green space to health outcomes. We will use these findings to develop and apply an index of green space characteristics that are supportive of healthy cognitive aging that may be used by urban planners to direct the design of greening strategies. We will communicate our research findings to scientists, policy makers, and the public. Our aim is to help guide the creation of urban planning and public health policies that improve population health. This work will help to advance initiatives to support healthy aging.
Consequences of preconception bariatric surgery for fetal size and pathological growth restriction: a linked population registry study.
In Canada, 20-30% of reproductive-aged women suffer from obesity, which increases the chances that they will experience pregnancy complications. Preconception treatment of obesity with bariatric surgery reduces the risks of most pregnancy complications, but it increases the risk of having a baby measured in the smallest 10% (small-for-gestational-age, SGA). However, SGA is a poor indicator of fetal growth restriction (FGR), a condition where growth is impeded by a disease process. This distinction is important as FGR is associated with increased risks of neonatal complications, while most SGA infants are healthy. Whether preconception treatment with bariatric surgery is associated with increased odds of FGR is still unclear.
In this study, we will use a population database to evaluate the association between preconception bariatric surgery and the risk of FGR. Results of this study will be important to examine the balance between risks and benefits of preconception bariatric surgery in clinical care. Results will be diffused through scientific publications and presentations. Educational material, including infographic summaries and courses, will be created to disseminate findings to clinicians and patients.
Impact of COVID-19 pandemic on health care services for hepatitis B
The COVID-19 pandemic led to disruptions in health services. However, impacts of the pandemic on testing and treatment for hepatitis B (HBV) are not well understood, including impacts over the longer term and impacts for people who inject drugs and immigrants from regions where HBV is more common.
This study will investigate the impact of the COVID-19 pandemic and related policies on testing and treatment for HBV from April 2020 to December 2022 in BC. We will look at impacts for the full population of BC and by sex, age, prenatal status, substance use / injection drug use status, and immigration status. We will engage with research users throughout the research process, including immigrant service agency S.U.C.C.E.S.S. and the BC Hepatitis Network.
We anticipate that HBV testing and treatment were reduced in 2020, 2021, and 2022, and impacts were greater among people who inject drugs and immigrants.
The study findings will inform health services and policy related to meeting Canada’s commitment to eliminate HBV as a public health threat by 2030, delivering HBV-related health services during future health system disruptions such as pandemics, and addressing health equity.
Enhancing Canada’s Capacity to Respond to Complex One Health Issues Through Communications and Collaboration
A holistic, collaborative approach that addresses the interconnections of human, animal, and environmental health (‘One Health’) is increasingly recognized as necessary for the management of ongoing and emerging health threats. This requires effective knowledge sharing and communication strategies between government agencies and One Health practitioners (e.g., physicians, veterinarians, and environmental scientists). Using a community-engaged approach, we will describe the scope of One Health issues in two Canadian provinces – British Columbia and Ontario – and review how One Health information is currently shared. Through engagement with a diverse community of stakeholders in academia, government, and practice, we will assess information and policy needs, priorities, and possibilities within local contexts and explore how One Health Communication strategies can be deployed and sustained at a regional level. By combining One Health systems science and communications research, this project will improve our ability and capacity to provide relevant and timely information related to human, animal, and environmental health and mitigate emerging health threats in Canada.
Understanding the health and social harms of drug re-criminalization within the context of homelessness
Drug criminalization is associated with a range of poor health outcomes, such as overdose. Without access to adequate housing, people who use drugs (PWUD) experiencing homelessness are more likely to use drugs in public, and thus are among the most impacted by criminalization. Recent changes to BC’s decriminalization policy re-criminalizing drug use in most public spaces (e.g., parks, sidewalks in front of buildings) will likely have significant implications for the health and wellbeing of unhoused PWUD. This study will examine how emerging re-criminalization impacts health outcomes, including overdose, for unhoused PWUD, and will develop novel approaches to community-based research in rapidly changing policy contexts. Research activities include interviews with unhoused PWUD and outreach service providers, observation in community settings, and analysis of text sources (e.g., policy guidance, press releases) to fully understand topic scope. By understanding the dynamic relationship between drug re-criminalization and overdose vulnerability for people experiencing homelessness, this research will generate ideas to guide future drug policy in BC, and that are scalable and adaptable to other settings pursuing drug policy reform.
Innovating health promotion efforts in response to youth tobacco use
Today’s tobacco use landscape has shifted since the introduction of e-cigarettes, which have become highly popular amongst youth. Nicotine addiction, subsequent smoking, and increased heart and lung disease risk are some of the major concerns brought forward within the public health community in relation to e-cigarette use, with youth disproportionately at risk for these detrimental impacts. Compounding this new landscape of tobacco use include socio-environmental factors that impact use, including rapid advances in technologies (e.g., new social media platforms; smartphone applications). As a result, the new generation of tobacco users are not the same as previous generations, and efforts to protect young people from exposure to tobacco smoke and e-cigarette vapor must similarly shift to adapt to this new landscape. I am responding to this need through my program of research, whereby responsive, youth-driven evidence is being harnessed to develop youth-friendly tobacco control resources for delivery on their preferred digital platforms. Ultimately, this research will lead to optimal solutions to curb tobacco use and reduce tobacco-related disease, situating BC as a leader in adapting to tobacco use of today.
Improving health information interventions to foster vaccine confidence and cultural safety of vaccination services
From monkeypox to measles, vaccination is essential to controlling infectious disease. COVID vaccines alone saved approximately 20 million lives in the first year. However, barriers to vaccination—including inaccessibility, lack of confidence in vaccine safety or effectiveness, and distrust in those providing vaccination—threaten our ability to stop epidemics.
My program of research applies unique interdisciplinary expertise in information science and population health to investigate how we can use information to reduce vaccination barriers. Over the next 5 years I will conduct a suite of studies aiming to improve population health interventions focused on vaccine communication and surveillance.
Studying how people use information and how vaccine communication and surveillance affects people in real-life contexts will help us meet needs of co-parents who disagree about child vaccination, people deciding whether to get new vaccines, and members of marginalized groups targeted by vaccination campaigns. It will generate evidence on how technologies can best be used for identifying and sharing information with vaccine hesitant people. Ultimately, this knowledge will improve vaccine uptake and reduce disease burden and inequity.
BC REACH (BC Research on Equitable Adaptation to Climate and Health)
The flood, fire and heat events of 2021 brought the health impacts of climate change into focus for British Columbians. New public health interventions are required to support effective adaptation, but especially for the most impacted population groups. The BC-REACH (BC Research for Equitable Adaptation to Climate and Health) project is a mixed-methods research platform to build evidence on effective and equitable public health adaptation to climate change. The project’s goal is to equip public health practitioners and residents of British Columbia (and beyond) with new evidence and interventions to enhance their preparedness to a variety of climate change-related health risks. Working in partnership with applied health system partners, this research will ultimately lead to the co-development and evaluation of novel programs and policies that have multiple co-benefits for populations that may be more exposed or physiologically sensitive, or lack the capacity to adapt to a changing climate. By centring equity in this analysis, this research will build knowledge and capacity to reduce population-level health inequities by ‘climate proofing’ the future of the health system’s responses to a wide variety of climate and health risks.
Bridging the Gaps: A One Health Communications Framework for Mobilizing Knowledge at the Nexus of Human, Animal, and Environmental Health
Health is connected and collective. Connections across species and geographies promote the spread of infectious diseases. Collectively, humans, animals, and environments face shared health threats like climate change. This concept of ‘One Health’ is a valuable lens through which to identify actions that support a healthy world. Yet, One Health’s major strength is also its largest challenge as it relies on bridging disciplinary silos — veterinarians and doctors, policy makers and public health practitioners, scientists, and the public. My community-engaged research explores a framework for mobilizing information at this nexus of health. Working with policy makers, health practitioners, and communities, I will identify communication structures that can be deployed at regional scales and across sectors. By understanding community knowledge and perceptions of three One Health issues (chronic wasting disease, avian influenza virus, and rat-associated diseases), I will resolve how health messages can be strengthened to promote public participation in disease surveillance programs. Engaging with knowledge users at all levels will help to improve data collection, monitoring, and inform government decision making and timely action.