Drug use, poverty, homelessness and sexually transmitted diseases (STDs) such as HIV are endemic in Vancouver’s Downtown Eastside. Melanie Rusch believes that improving the sexual health of marginalized populations is important for curbing the spread of STDs. She is studying a large sample of people who live in the Downtown Eastside to determine how behaviour patterns among these vulnerable populations affect sexual health. Her first aim is to study how different drugs and combinations of drugs affect sexual behaviours and STD rates. This includes estimating the impact of needle use, as opposed to sexual contact, on STD rates. Melanie’s second goal is to estimate STD rates of a group of women living in the Downtown Eastside. Melanie is investigating how their knowledge of STDs, exposure to outreach programs, and feelings of stigma affect use of health care services. Results of this research could be used to better define high-risk groups, identify barriers to accessing care, and tailor interventions to improve health of vulnerable populations.
Research Pillar: Population Health
HIV, STIs and massage parlour workers: application of social network analysis and mathematical modeling to assess the potential for disease propagation
Studies on the spread of sexually transmitted infections (STIs) and HIV usually focus on individual risk factors such as the number of partners and condom use. But these factors do not fully explain epidemics. Social Network Analysis, a new approach, looks at how relationships between people in defined groups affect risk of disease spread. Valencia Remple is using this approach to conduct a sexual health survey of women who work in massage parlours. As part of the study, trained peer outreach workers are conducting in-depth interviews with workers to obtain information about their sexual behaviour, histories of STIs and the characteristics of their sexual partners. She is also measuring factors known to influence the spread of STIs, such as bridging. Bridging occurs when people in one defined group have sexual contact with members of different groups, which could introduce infections into previously uninfected populations. The results of this research could be used to develop targeted health services for this vulnerable and hidden population.
Stigma, risk and protective factors among vulnerable youth
Adolescence is a time of promise, when major physical, cognitive and relational transitions launch the development to adulthood. But stigmatization in communities and schools can derail this process for certain teens. Teens who are more likely to be stigmatized include youth on the streets; those in foster care or custody; sexually abused youth; gay, lesbian, bisexual and transgendered youth; and indigenous and ethnic minority adolescents. As a result of being stigmatized, these youth are at greater risk for health problems such as drug abuse, HIV infection and teen pregnancy. As part of an international study taking place in Canada, New Zealand and the US, Dr. Elizabeth Saewyc is examining behaviours and environments that stigmatize youth in schools. Dr. Saewyc is studying the links between stigma and risk behaviours, and exploring protective factors that can reduce these risks and build resilience among youth. The findings will be shared with groups of teens and youth workers in the three countries to gather their ideas for reducing stigma, creating safer schools, and preventing substance use and risky sexual behaviours in culturally meaningful ways. The research could lead to interventions to reduce or prevent stigma, to help youth cope with stigma, and to foster healthy development among vulnerable young people.
Community, culture and health
Dr. Cindy Patton has conducted a series of studies on knowledge transfer from medical experts to clinicians, media, policymakers and the public. In dramatic and exceptional cases, this exchange happens almost directly. The media’s extensive reporting on health emergencies involving SARS (Severe Acute Respiratory Syndrome) and BSE (Bovine Spongiform Encephalopathy or Mad Cow Disease) created demand from health consumers for more medical research, changes in public health policy, and reassurance about their risk for these conditions. But more often medical research filters down through clinicians and advocacy groups, who translate complex information for consumers and advocate for their medical needs. In addition, government policy makers must sort through information from researchers and citizens to adapt health policies and resources to changing medical needs. Dr. Patton is examining existing methods and systems for exchanging information in various settings—clinics, research centres and global information networks. The research could be used to create better channels for transferring specialized medical information. Dr. Patton is also developing training programs for researchers and the public to help improve their understanding of how to efficiently transfer knowledge from medical experts to people affected by health issues.
Behaviour of the newborn infant in response to pain, distress and caregiving influences
Recent evidence suggests newborn infants are more sensitive to pain and stress than older children and adults. The level of sensitivity may be especially acute for newborns who are at-risk for developmental problems due to prenatal exposure to pain, antidepressants or illicit drugs. Studies suggest that early exposure to pain and stress leads to changes in the newborn’s brain circuitry, and may increase vulnerability to abnormal behaviour and development. This has led to a search for better ways to understand and recognize infant pain and measure the effects of pain treatment. Dr. Fay Warnock is investigating the actions and interactions of healthy and at-risk infants. The research involves confirming a comprehensive list of behaviour associated with newborn distress, and comparing the actions of healthy and at-risk newborns during and after routine diaper change and heel lancing, a common procedure for obtaining a blood sample to screen infants for metabolic errors. She is also linking newborn behaviour with changes in facial action and heart rate. The research will further develop measures of newborn pain, improve understanding of how caregivers can help alleviate pain, and lead to protocols for preventing, assessing and treating newborn pain.
Game on: diminishing risks for depressive symptoms in early adolescence through positive involvement in team sports
In early adolescence, both girls and boys report increases in levels of depression. However, by late adolescence the rates of depression among girls are double those found among boys. Research shows that boys and girls’ perceptions about athletic competence (how good they are at sports), social acceptance (how popular they are among peers), and body dissatisfaction (negative feelings about their bodies) are strong predictors of depression. Since girls tend to report lower levels of athletic competence, participate in sports at lower rates, and report higher levels of body dissatisfaction than boys, they may be at greater risk for depression. Erin Boone is examining whether positive involvement in team sports increases perceptions of athletic competence and social acceptance, and helps to diminish body dissatisfaction among both girls and boys. The study will be among the first to assess the mechanisms that link positive team sports involvement to diminished risks for depression in adolescence. Findings will outline the mental health benefits associated with team sports involvement and highlight the need to sustain adolescents’ interest and participation in sports.
Risk-benefit tradeoffs: A community-based risk assessment of sulfuric emissions from five Canadian petroleum refineries producing reduced sulfur gasoline
In 1999, the federal government announced that oil companies will need to reduce the sulfur content of gasoline from 360 parts per million (ppm) to 30 ppm by January 2005. As a result, refineries across the country will be required to remove more sulfur from the crude oil they process, possibly resulting in higher concentrations of sulfur in their stack emissions. While this regulation is intended to protect Canadians from harmful compounds in tailpipe exhaust, communities close to oil refineries may be exposed to higher concentrations of those same compounds. Using air pollution and population data from five major Canadian refinery communities, Sarah Henderson is assessing the potential for sulfuric emissions from refineries to affect public health, and is determining how federal gas regulations could increase that potential. She hopes the research will lead to a model that policy makers can use to quantify how sources of air pollution can affect the health of surrounding communities.
Facial indicators of heart rate reactivity in a stress induced state
Studies show that stress can increase the risk of heart disease and other conditions. Therefore, identifying people who are most likely to have strong reactions to stress is an important goal in the prevention of heart disease. David Nordstokke believes facial expressions may be key markers for identifying people at risk of stress-induced heart disease. He is studying the relationship between facial expressions and stress by giving participants a test of social anxiety. During the videotaped test, David compares changes in heart rate with specific facial movements to determine if there is a link. He hopes the research will reveal patterns of facial expression that provide information about heart rate reactivity. Ultimately, David aims to help health care practitioners in the early detection of individuals at risk of developing heart disease so they can intervene with stress management programs.
Finding the metaphorical road back to health: Understanding the illness experience and locating the means of recovery
MSFHR Distinguished Scholar Michael Chandler is researching individual and cultural factors that could help reduce the high rate of suicide among youth in certain First Nations communities. His research is directed at understanding the ways cultural differences help or hinder young people’s ability to insulate themselves from risks of self-injury and suicide. With Dr. Chandler as his supervisor, Jesse Phillips is building on the focus of this research by examining how Aboriginal and non-Aboriginal youth view the relationship between their health and well-being, and the health and well-being of their community and culture as a whole. Jesse is exploring the notion that Aboriginal youth understand their health and well-being in ways that are more rooted in community life and cultural tradition than is ordinarily the case for non-Aboriginal youth. Achieving a better appreciation of such cultural difference could work to ensure that the health concerns and ability of First Nations youth are more adequately met by means sensitive to their cultural diversity.
Coping in serodiscordant couples: the role of HIV-negative partners' coping strategies in health outcomes of their HIV-positive partners
Effective anti-retroviral drug regimes are helping people with HIV live healthy for longer periods of time. As a result, people with HIV are increasingly able to enter long-term relationships, a development which has implications for the course of their disease. For example, there is research indicating that people with HIV have a higher risk of their disease progressing when they perceive negative support from family or friends. Eli Puterman is examining coping methods in relationships involving an HIV-negative person with a HIV-positive partner. He is studying how these couples cope with both HIV disease and the interpersonal problems that emerge from the illness. Eli hopes to reveal insights about how the interaction of coping methods affects the mental and physical health of people with HIV. The research will help identify coping strategies that either buffer the effects of HIV disease or contribute to increased suffering. The study could also help improve mental health treatments for couples coping with chronic illnesses in general.