Research Pillar: Population Health

Smoking is the major cause of preventable death in Canada, accounting for more than 45,000 premature deaths per year and 30 per cent of all cancer deaths. Most smokers begin to smoke as teenagers, and tobacco advertising and promotion are among the main motivators for tobacco use, especially in youth. Currently, tobacco companies are spending the majority of their marketing dollars in retail stores, compared to any other advertising venue. Since most teenagers shop at convenience stores at least once a week, adolescents are routinely exposed to tobacco advertising. Little research has examined the extent and impact of these “Point of Purchase” (POP) activities in Canada. Helen Hsu is studying the links between smoking prevalence among youth and environmental influences, including POP advertising, pricing, signage and retail locations. She is using Geographic Information System technology to gather and analyze social-demographic, economic and geographic information. Her work could help explain the impact of tobacco industry activities on adolescent tobacco use across Canada, and provide insight into the effectiveness of tobacco control strategies in schools and communities. This information will be useful for setting public health policies and developing tobacco control programs.

The well-being of health care workers and a healthy work environment are critical components of an effective health care system. According to the Workers’ Compensation Board of BC approximately 40% of all violence related claims come from health care workers. In a survey of St. Paul’s Hospital in Vancouver, 66% of employees had experienced physical assault in the previous year. Despite the increasing recognition of the severity and impact of violence in the workplace, there have been few studies that have investigated the impact of workplace strategies and interventions that mitigate violence in the workforce. Rakel Kling is examining the overall effectiveness of a violence-reduction intervention in the health care industry. Her research is specifically investigating the rate of violence-related incidents among health care workers at Vancouver General Hospital (VGH) over a five year period and examining the differences in rates by year and unit type. She is also examining whether there is a reduction in healthcare worker injuries as a result of the implementation of a new patient risk assessment system. Results from Rakel’s research will help guide policy and program decisions surrounding violence prevention measures at VGH and ultimately other hospitals and health care facilities in the province.

By age three, 80 percent of children in North America have experienced a middle ear infection, or otitis media. Symptoms include ear discharge, pain, fever, vomiting and diarrhea. This condition is the number one reason for young children to visit their doctor. Consequently, otitis media has high health care costs and is thought to contribute to overconsumption of antibiotics. The identification of preventable risk factors will aid in reducing the incidence of this common childhood disease, and the associated costs to our health care system. Known risk factors for otitis media include recent respiratory infection, age, gender, race, season, non-initiation of breast feeding, familial history, daycare enrolment, and exposure to passive smoking. Outdoor air pollution has been hypothesized as a risk factor. Elaina MacIntyre is conducting the first study in North America to investigate whether exposure to air pollution from industrial, traffic and residential woodburning sources is linked to the incidence of otitis media in children under 2 years of age. She is examining the health records of 60,000 children in British Columbia born between 1999 and 2000 to see if episodes of increased residential air pollution correspond with increased rates of diagnosis for otitis media. If a link is found, Elaina will analyze the cost of cases attributable to air pollution.

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common mental disorders in children. Three to five per cent of elementary school-aged children are diagnosed with ADHD, which is often accompanied by other learning disabilities or disorders. Children with ADHD display persistent inattentive, hyperactive and impulsive behaviours that are inappropriate for their age. Research shows medication and behavioral treatments can be effective in treating ADHD. However, little research has examined the factors that influence parents’ acceptance of and adherence to these treatments. Treatment adherence is an issue, especially among Asian-Canadian families. Janet Mah is investigating cultural variations in parents’ attitudes towards mental health disorders such as ADHD. She is comparing how parents’ expectations for child behaviour affect treatment choices in Asian-Canadian and Caucasian families. Janet will assess whether Asian-Canadian parents are less likely to attribute problem behaviour to medical causes, and more likely to feel a sense of stigma about mental health problems, compared to Caucasian parents. This research could help clinicians improve cultural sensitivity in mental health services to better reach the under-served population of Asian-Canadian families.

Mounting evidence indicates that taking care of a spouse with a chronic disease increases the caregiver’s vulnerability to psychological and physical illness. Caregivers report poorer health and use medications for physical problems more than non-caregivers, and they are 63 percent more likely to die over a five-year period than non-caregivers. Little is known about the ways caregiving affects health and well being. However, it has been observed that some individuals adapt successfully to the role of caregiver, despite the multitude of social, economic, and personal demands it places on them. This variability in caregiver well-being suggests that there are important individual differences in responding to stressful situations. Teresa Marin is analyzing the daily impact of expressing or suppressing emotions on the mental and physical health of spouses caring for cancer patients. While a caregiver may routinely control negative feelings to avoid upsetting the spouse, research suggests that chronic suppression of negative emotions may increase distress in the long run, because it can limit communication and support within and outside of the marital relationship. Teresa believes that strategies for dealing with negative emotions may be an important link between the day-to-day demands of caregiving and long-term health. By determining how emotional and coping behaviours affect well being, clinical interventions can be designed to foster healthy adjustment among caregivers.

Urban residents are exposed to air pollution from motor vehicles every day. Research suggests that elevated exposure to air pollution may contribute to the development of respiratory and cardiovascular disease, particularly in the elderly and children, and to adverse pregnancy outcomes. Exposure levels depend on how much pollution is in the environment, where people live, and their daily activities. For example, high levels of air pollution around urban homes near busy streets have been linked to low birth weight babies and preterm births. Elizabeth Nethery is specifically looking at the levels and effect of air pollution exposure on pregnant women in urban centres. While air pollution studies generally use computer models based on neighbourhood monitoring stations and home location to estimate individual exposures, Elizabeth is the first person to evaluate the accuracy of these estimates for pregnant women by comparing predicted to actual exposures. The results will provide more accurate information on the air pollution levels pregnant women inhale, and could lead to regulatory strategies, health protection measures, and policies to improve the health of women, children and the general population.