One in four people in Canada live with chronic pain. These individuals experience poorer health outcomes, higher healthcare services use, and lower quality of life. Studies show males and females experience pain differently, for example differences in pain sensitivity and pain control. But little is known about pain experiences in people who identify as a sex and gender minority, meaning a person’s sexual orientation or gender identity differs from traditional societal views. Sex and gender minority persons report higher pain and experience unique life stressors (e.g. discrimination), which may lead to worsening of their pain. We aim to study 1) pain experiences and 2) strategies to improve healthcare experiences for individuals who identify as sex and gender minority living with chronic pain by collaborating with patient and public stakeholders to answer these questions. Involving persons who identify as sex and gender minority with chronic pain in research studies is important because it provides them with a voice to offer personal stories and perspectives. Community engagement will help researchers ask the “right questions” and guide research priorities to improve the lives of people who face similar health challenges.
Research Pillar: Population Health
Generating, co-creating, and implementing solutions and supports for older adults with cancer and their caregivers
The number of adults over age 65 in Canada is growing as baby boomers age. Older adults are the most likely to be diagnosed with cancer and likely to have other chronic health conditions. These health conditions may mean increased medications, medical appointments, and/or difficulties getting around, which combine to make the cancer experience more challenging. Older adults may also require help from family or friends to attend their many cancer and other health appointments (family doctor, geriatrics, and other specialists). COVID-19 has created additional challenges for older adults with reports of reduced or limited treatment offerings, and a sudden shift to virtual appointments.
My research responds to ongoing calls to rethink how we provide care for older adults with cancer. Specifically, we will partner with patients, community groups, health system leaders, and clinicians to co-create and implement tools to make cancer management easier for older adults. This work focuses on improving the processes rather than merely supporting individuals to navigate complex systems. This research will have important implications for health systems, clinicians, and researchers, but most significantly for older adults with cancer.
Indigenous community-based health research in British Columbia’s interior
Indigenous health injustices and inequities are formed by colonial structures that are paralleled within health research itself. Therefore, Indigenous health research must re-center Indigenous Peoples approaches, or it risks re-colonization.
Thus, I aim to reframe Indigenous Peoples, cultures, knowledges, and capacities as central to a promising health future. My program of research focuses on three primary community-based health projects, which are guided by Indigenous approaches to health and research with community-partnerships as the foundation. First, in partnership with the Okanagan Nation Alliance, we are working together to frame community data within Sylix Okanagan approaches to health and data. The second project partners with Indigenous Programs and Services at the UBCO campus, to offer a healthy masculinities program for students. The third project brings together a cluster of experts to support urban Indigenous health in collaboration with Metis Centres and Friendship Centers in the Okanagan region.
My research program seeks to promote Indigenous health, health knowledges, capacities, and outcomes in ways that community understand as meaningful, and thereby support Indigenous control of Indigenous health.
Drawing on decolonizing and intersectional research approaches to inform action for health equity and reproductive justice among Indigenous women, Two-Spirit and gender diverse people
Health and social inequities faced by Indigenous women continue be shaped by ongoing systemic colonialism. My research program draws upon Indigenous and decolonizing methods to establish an empirical evidence base to inform interventions and action. Specific objectives include: 1) To draw upon Indigenous methodologies, community and arts-based approaches to understand Indigenous reproductive and maternal health experiences, identifying factors that influence access culturally-safe and trauma informed care; 2)Through intersectional, feminist and decolonial lenses understand how socio-structural factors facilitate or mitigate access to responsive justice systems, identifying community-led and strengths-based responses for Indigenous women who have experienced violence; 3) Examine and evaluate policies and initiatives aimed at addressing the MMIWG calls to justice for marginalized Indigenous women (including women living with HIV and in sex work). Map and innovative strategies and inform evidence-based actions for the development of structural, community-based and Indigenous-led responses; 4)Explore and map marginalized Indigenous women’s primary care experiences using cultural and arts-based methods to inform innovative interventions.
Linking administrative and survey data to examine substance use related diagnoses, hospitalization and mortality among gay, bisexual and other men who have sex with men in Metro Vancouver
Every day, over 400 Canadians are hospitalized because of drug and alcohol-related causes. These admissions are widespread, costly and deadly. This issue is especially problematic in British Columbia (BC) where hospitalizations related to alcohol abuse are highest in the country. Population data consistently highlight that licit and illicit substance use is more common among gay, bisexual and other men who have sex with men (GBM) compared with heterosexual individuals. However, research assessing substance use related mental and behavioral disorders, hospitalizations and mortality is lacking for GBM due to the lack of identifiers for sexual orientation in administrative research. This study links administrative and survey data to examine substance use related outcomes from 2012 to 2020 and compare these rates between GBM and heterosexual males in BC. Further, we will use cohort survey data to examine behavioural and structural factors associated with substance use related disorders, hospitalizations and mortality among GBM in BC. Our results will inform recommendations to improve substance use healthcare for GBM and support reductions in hospitalization costs related to substance.
Evaluating the impact of pharmaceutical interventions to reduce overdose among people with criminal justice system involvement in British Columbia
People with criminal justice system involvement (i.e. who have been to prison for a criminal offence) are more likely to use drugs like heroin and methamphetamine compared to the general population. People who use drugs also are at higher risk of negative outcomes like overdose and more rapid or frequent return to prison. Efforts to address overdose, both in prisons and in the community, have been focused on providing treatment for people who use opioids (e.g. heroin, fentanyl). This alone may not be sufficient to reduce overdose risk, particularly among people who use other substances (e.g. cocaine, alcohol) in addition to opioids. In March 2020, in the context of COVID-19, the British Columbia (BC) Ministry of Health provided new Risk Mitigation Guidance (RMG) for doctors, permitting them to prescribe opioids, stimulants, benzodiazepines, and alcohol withdrawal management medications to people at risk of overdose. In this study, I will evaluate whether the RMG has reduced overdose and return to prison among people with criminal justice system involvement in BC. This study will highlight gaps in substance use services in BC, and will inform evidence-based services that can help to reduce overdose in prison and community.
Addressing emerging health system priorities in cervical cancer prevention: determining optimal strategies for human papillomavirus test-based primary screening
Cervical cancer remains a significant women’s health issue in Canada even after the introduction of cytology screens (i.e. Pap smears) in 1949, which resulted in a reduction of cases. It is frequently diagnosed in young women, who are embedded in careers, raising families, or still planning to conceive. Treatment can affect women’s ability to work, care for families and cause infertility, and survival rate is often low. It is thus vital to improve preventative screening programs using recent testing innovations. Testing for human papillomavirus (HPV) is more effective than cytology, but it is not yet used in BC. HPV FOr CerviCAL Cancer (FOCAL) was a trial investigating HPV testing. Participants were followed for ten years post-trial through linkage to the BC Cervix Screening Program to create the FOCAL-DECADE cohort. We will use data from this cohort to compare long-term rates of cervical precancer between those who received cytology or HPV testing, expecting significantly reduced rates in the HPV group. These results will inform decision-makers, like the provincial screening program, of best screening practices (e.g. screen interval), aiding transition to HPV-based testing programs, thus helping reduce cervical cancer across BC.
Immigrants, work and health: Evaluation of services to reduce inequities
Work is a marker of successful integration for immigrants to Canada. While we know much about the health outcomes and employment patterns of immigrants within the Canadian context, less is known about the impact of work on health, in particular on work disability experiences. Emerging evidence suggests that immigrants take longer to return to work following a work injury/illness compared to Canadian-born workers. Provision of employment-related and rehabilitation services are meant to provide access to safe work and minimize work disability but, this has not been examined in immigrant populations. Using a unique research opportunity that will merge immigration data with 1) workers’ compensation and medical services data; and 2) settlement service use for the working population of British Columbia, the purpose of this study is to examine the impact of rehabilitation and employment-related services on work and work disability experiences of immigrants compared to Canadian-born workers, along the continuum from injury to rehabilitation to return to work and income earning. Evidence of different experiences and effectiveness of services can inform best practices and reduce health inequities for all workers, including immigrants.
Honouring all our relations: Advancing health and wellness of uncounted Indigenous peoples in BC through addressing gaps in population health and wellness reporting
Reporting on population health is important to monitor trends, identify priorities, and track progress to address inequities. All Indigenous peoples have the right to be counted. Yet, over 88,000 Indigenous people in British Columbia (BC) who do not have ‘Status’ under the Indian Act or are not registered with Metis Nation BC are currently ‘uncounted’ in population health reporting.
Responsibility for reporting on health of BC residents lies with the Office of the Provincial Health Officer, including collaborative reporting on health of diverse Indigenous peoples in BC. Currently, there is no process to report on health of uncounted Indigenous peoples. Gaps include: lack of formal relationships with those representing uncounted Indigenous peoples; no way of identifying this population in BC health data; absence of research frameworks reflecting uncounted Indigenous peoples’ perspectives; and no implementation plan for province-wide surveillance involving uncounted Indigenous peoples.
This study aims to support health of uncounted Indigenous peoples in BC by addressing current gaps in population health reporting, through partnerships that uphold Indigenous self-determination, decision-making and perspectives of health and wellness.
Exploring mechanisms, pathways, and mitigation strategies to prevent loneliness, social isolation, and their deleterious health impacts
We experience hunger so we eat, thirst so we drink, tiredness so we sleep, and loneliness so we find social connection. Social needs are fundamental to humans and when we are lonely the body’s central stress response system is dysregulated. As a result, our capacity to manage stress, inflammation, and energy reserves is reduced. The end result: lonely people live shorter and sicker lives.
In the wake of COVID-19, which itself manifested in an era of already increasing social isolation, it has never been more important to study loneliness. Yet, while a robust literature base has examined loneliness in older adults, we still know very little about what we can do to respond to experiences of loneliness across the life-course. This is particularly true in marginalized populations, such as gay, bisexual, and other men who have sex with men (gbMSM), who are especially vulnerable to social exclusion and related stressors, but they also exhibit unique coping strategies that may buffer these effects.
My research will help us better understand the epidemiology of loneliness among gbMSM in order to prevent its deleterious effects on these individuals, their communities, and the broader population in the wake of COVID-19.