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 diseases (STDs) and unplanned pregnancies. However, there are significant variations in the incidence of teen pregnancy and STDs among rural and remote BC communities. Terrace, for example, has relatively high rates, while 100 Mile House has lower rates than the provincial norm. Dr. Jean Shoveller is studying the factors that contribute to this variation in sexual health outcomes among youth. In addition to personal behaviours among teens, she is investigating how other factors – such as relationships with family and peers, community social norms and the influence of institutions including education, health and religion – may contribute to decisions they make around their sexual health. Through her five-year study of three rural/remote BC communities, Dr. Shoveller hopes to provide significant insight into how communities can help prevent adverse sexual health outcomes among their youth.
Research Pillar: Population Health
Community partnership research in population health promotion: The development of tools and measures for planning and evaluation
Strong evidence suggests that the health system is not the primary factor determining the health of Canadians. Non-medical factors – such as income, social support, education, employment, housing, health practices, child development, gender and culture – are crucial determinants of health and quality of life. Regional health authorities across BC are increasingly taking a population health approach, which addresses these non-medical factors, in community-based initiatives. However, these efforts are often complex and involve diverse participants from within and outside the health system, making it difficult to evaluate their effectiveness. Dr. James Frankish is studying how health authorities are addressing non-medical determinants of health. He is developing and testing tools to provide evidence-based evaluation of community-level effects resulting from population health initiatives. A particular focus is inclusion of vulnerable populations in these initiatives and related policy and practice implications. Dr. Frankish is also the leader of the MSFHR/CIHR program for Transdisciplinary Training in Community Partnership Research: Bridging Research to Practice, which is co-funded by the Michael Smith Foundation for Health Research and the Canadian Institutes of Health Research.
Literacy and health research
Low levels of literacy have been associated with poor health, poor understanding of treatment, greater use of health services, low adherence to treatment regimens, and poverty and unemployment. Considering that more than 40 per cent of Canadians fell into the two lowest categories of literacy in the 1994 International Literacy Survey, this is cause for concern. Recruited to BC from the University of Toronto, Dr. Irving Rootman is developing and implementing a research program on literacy and health in British Columbia. While the Canadian public health community has developed initiatives aimed at improving understanding of health information, there has been little research to measure the outcomes of these efforts. Dr. Rootman’s studies will assess the effectiveness of various approaches to improving health literacy in Canada and BC. His program will also provide training opportunities for graduate students, establish links between researchers across the country, and develop collaboration between researchers, health providers, policy makers and community members concerned about literacy and health.
Culture, self-concept, and the presentation of distress: Implication for depression
A wide range of behaviours and physical symptoms can accompany depression. Cultural background may also influence how a person expresses depression symptoms. In China, where a low depression rate has long been reported, depressed patients are thought to be more likely to describe physical symptoms while de-emphasizing psychological problems; the reverse is true with non-Chinese in Canada. This raises the possibility that clinicians have misdiagnosed depressed Chinese patients. Andrew Ryder is investigating this possibility, focusing on the differences in the presentation of symptoms, as well as exploring larger theories about how self-concept and culture may affect the way patients experience and express depression. He hopes the research will increase the likelihood that Chinese-Canadian patients with depression receive appropriate diagnosis and care.
Health status and health care utilization among mid-life Chinese, South Asian, and British Canadians in the lower mainland: An examination of socio-economic, immigration, and cultural dimensions
Dr. Karen Kobayashi has long been interested in how ethnicity affects aging and health. In her current research, Karen is comparing the health of Chinese and South Asian adults—the fastest growing ethnic groups in the Lower Mainland—with Canadians of British origin. She is examining differences in health status and use of health services among middle age Canadians to determine the factors that may promote or impede healthy aging. The research involves interviewing participants to determine how differences in such variables as education, income, time since immigration, English language ability, religious affiliation, and adherence to traditional values affect their health status and the way they use health services. She anticipates the research will reveal differences between and within cultural groups. For example, the way foreign-born and Canadian-born adults access health services may vary within each population group. The way new immigrants use health services may also vary from people who have lived in Canada for 10 years or more. This information could be used to predict health care needs among the groups and improve access to health services for these populations as they age.
Evaluation of efficacy of borate-based fungistatic treatments on building materials and growth, pro-inflammatory and toxic products of secondary metabolism by selected micro-organisms
With the prevalence of “”leaky”” buildings in BC, there is increasing awareness of the potential health risks associated with damp building products fostering the growth of fungal organisms. These organisms grow from spores, which are naturally abundant in outdoor air. Although spores cannot grow on dry building materials, they can readily form colonies and grow on building materials that have sufficient moisture (e.g. resulting from water leaks, flooding or condensation). These fungi are thought to contribute to respiratory and inflammatory health problems in people. Dr. Karen Bartlett is studying the effects of a class of anti-fungal preservative containing borate. This preservative, used to inhibit fungal growth on wood products, is not yet approved for use in Canada. Dr. Bartlett is monitoring whether borate leaches out building materials when they are wet and becomes ineffective. She is also investigating whether the fungi produce any harmful byproducts in response to these preservatives that might create further health problems.
Investigating the link between symptom expression, medicalization and acculturation: The case of Portuguese immigrants
Dr. James has conducted groundbreaking research into the experiences of Portuguese immigrants with agonias, a commonly-expressed disorder that is literally translated as “the agonies.” While North American clinicians often diagnose agonias as anxiety and/or depression, and treat it with medication and psychotherapy, these approaches are often unsuccessful. Dr. James’ previous research indicates that the meaning, symptoms and treatment of agonias do not match the standard psychiatric disorders of anxiety or depression. Dr. James is investigating the differences in the way clinicians and members of Portuguese communities understand agonias; whether it is related to anxiety or depression; and whether assimilation into North American society changes community members’ understanding and experience of agonias. This research will further inform her work teaching therapists throughout Canada and the US how to conduct psychotherapy with ethnic minority patients.
Social Support Among Patients with Rheumatoid Arthritis: A Daily Progress Study
Because there is no cure for Rheumatoid Arthritis (RA), treatment focuses on alleviating pain symptoms and maintaining function. With that in mind, Susan Holtzman studied the links between pain levels, stress, ways of coping and social supports in patients with RA. The few existing studies in this area indicated that patients with strong social supports experience less pain and disability, but Susan wanted to examine this more closely. In her study she used daily monitoring techniques and collected detailed data from patients and their spouses. Susan used an advanced modelling technique to analyse the findings and concluded that social support decreased pain levels by encouraging and improving coping strategies. Findings from this study highlight the importance of social support. The research may ultimately lead to the development of psychologically-based treatment and individually-tailored pain management for patients with RA.
Investigations into Risk Factors and Determinants of HIV and Hepatitis C Incidence and Prevalence among High Risk Youth
Researchers have conducted extensive studies of injection drug use in Vancouver, but few have focused specifically on high-risk youth. Enter Cari Miller. Her Masters research — a sub-study of the Vancouver Injection Drug Users Study (VIDUS) — examined prevalence and incidence of HIV and hepatitis C among more than 200 injection drug users aged 13 to 24. Cari has first-hand experience to draw from. She put in 24-hour shifts as a part-time youth worker with the Vancouver Native Health Underage Safe House. Working with youth — most of whom were drug dependent, female and Aboriginal — has fuelled her passion for research and the urgency for new health policies to support them. Results from the research show high prevalence and exceedingly high incidence rates for HIV and hepatitis C among young injection drug users. Her findings indicate that those at highest risk are female and Aboriginal youth engaged in both drug and sexual related risk, and half of young injectors acquire hepatitis C infection during their first two years of injection drug use. Cari hopes that developing a better understanding of the risk behaviours among these young people will lead to more effective prevention and intervention programs. Ultimately, she would like to see more treatment opportunities for high-risk youth.
The Perception and Utilization of Herbals and Complementary and Alternative Medicine (CAMs) Among Older Adults with Arthritis
Research has shown that a growing number of older adults with chronic illness are turning to complementary and alternative medicine (CAM) to manage their pain and chronic illness. But little is known about why people choose these approaches, or how use of complementary and alternative medicine is associated with changes in health status over time. Kristine Votova will address these questions by using powerful and cutting edge statistical tools to analyze data from the Longitudinal Panel of the National Population Health Survey. Her research also involves recruiting older adults to participate in focus groups, aimed at illuminating the perceived effectiveness of CAMs. Votova anticipates that this research – combining quantitative and qualitative techniques – will contribute to a better understanding of the use of complementary and alternative medicine and herbals, particularly by older adults.