Asthma is a chronic disease that affects approximately one in 20 Canadians. Research has shown an association between lower socioeconomic status and poorer outcomes for asthma patients, including more hospital admissions and emergency room visits and a greater likelihood of a fatal attack. Excessive use of short-acting bronchodilators, which help manage acute episodes of asthma, indicates inadequate asthma control and has been associated with poorer outcomes. Larry Lynd is investigating whether there is a relationship between lower socioeconomic status-measured by education, income, occupation and characteristics of residence-poor asthma control, and the overuse of bronchodilators. Confirming that relationship could determine whether inappropriate management of asthma is at least partially responsible for poorer outcomes. Larry hopes this research can lead to policies and strategies aimed at improving the management of asthmatics of lower socioeconomic status.
Research Pillar: Population Health
An evaluation of the full circle project: The effects of a theatre-based HIV prevention intervention on audience and actor/educator learning
What are the best ways to ensure young people listen to and act upon information about avoiding high risk sexual behaviours? This is the research focus for Josephine MacIntosh, who is delving into the individual, social and cultural factors that may perpetuate the epidemics of HIV and sexually transmitted diseases, especially among young women. Josephine is studying the effectiveness of using a theatre-based intervention program among youth aged 13 to 15. The theatre productions will consist of a series of original dramatic productions researched, scripted, produced and presented by youth volunteers. She hopes to develop an educational approach that can engage the audience and actors as they learn about issues such as abstinence, treatment of HIV and sexually transmitted disease, pregnancy prevention, decision-making, peer-pressure, negotiation for safer sex and alternative safer sexual behaviours.
Adverse drug effects among persons using antiretroviral therapy for HIV Disease and impact on treatment patterns
Antiretroviral drugs successfully suppress the HIV virus and reduce mortality, but many people living with HIV and AIDS cannot benefit fully from the medication due to adverse side effects. These side effects make it difficult for people to take the drugs consistently, or at all. Many side effects do not become apparent until after people have taken antiretroviral drugs for a prolonged period. Dr. Katherine Heath is establishing a monitoring system to track adverse reactions to antiretroviral drugs, identify and describe newly emerging side effects, and assess the impact of these side effects on antiretroviral use in BC. Dr. Heath-based at the BC Centre for Excellence in HIV/AIDS, which houses the only North-American population-based database of information on people using antiretroviral drugs-hopes her research will enable early detection of trends or new side effects, lead to early intervention and ultimately improve the health of people living with HIV and AIDS.
Pain in preterm infants
Dr. Ruth Grunau is a world expert on the measurement and long-term consequences of pain in newborns and premature infants in neonatal intensive care units. From the late 1980s, when she conducted landmark research on measures for assessing pain in infants, she has continuously added to the body of research concerning how early pain experiences in very low birthweight infants may affect their clinical and developmental outcomes. Dr. Grunau is conducting several studies on pain and stress in fragile premature infants whose medical care involves repeated exposure to invasive procedures. She is studying how to distinguish pain from stress in very premature infants, and how pain, sedation and analgesia may affect their neurobehavioural development. She is investigating the effects of repetitive pain on attention, behavioural organization and development in very premature infants and toddlers. Finally, she is studying whether positive maternal interaction may moderate the potentially negative effects of neonatal intensive care unit experiences. By learning the most effective ways to minimize any detrimental consequences caused by early repetitive pain and stress, Dr. Grunau’s goal is to help clinicians improve the short- and long-term outcomes of very premature infants.
Studying the health care workers: A program of research on the relationships between work and health
The face of health care and the working environment for health care workers in Canada is changing, bringing increasing job complexity, an aging work force, changes in the delivery of patient care, and concerns for employee recruitment and retention. These changes have been coupled with cost containment strategies – such as restructuring – that alter the resources that staff have available to do their work. Dr. Mieke Koehoorn’s research focuses on how the work environment affects the health and well-being of health care workers in BC. She is using the BC Linked Health Database in conjunction with hospital employee and survey data to create a comprehensive population-based, person-specific, longitudinal database of health care workers. The database, recording information such as health care utilization, workers’ compensation and long-term disability records, is unique in its depth and breadth. Dr. Koehoorn is using this information to describe the health and health care utilization of health care workers and investigate the workplace practices and conditions that predict health outcomes. By understanding the complex determinants of health for health care workers, Dr. Koehoorn hopes to help inform industry decision-makers to allocate resources and implement workplace policies and procedures that improve employee health and performance and reduce work-related disability.
The impact of changing work and community conditions on the health of workers and their children in BC resource dependent communities
Health research has established a strong link between socio-economic status and health outcomes. However, in BC’s resource-dependent communities, the income and social status situations for many workers vary throughout their working lives as a result of changing technologies and labour market conditions. Downsizing and restructuring in the labour market often results in greater frequency and duration of unemployment. Workers who retain their jobs often experience increased work stress in adapting to new on-the-job requirements, and entire resource-based communities are affected when industries downsize and restructure. Dr. Aleck Ostry is focusing on the health of workers in resource-based industries, and the health of their children. Dr. Ostry is studying the health outcomes of more than 28,000 sawmill workers between 1950 and 1998 in 14 BC sawmills, as well as approximately 23,000 of these workers’ children. He will explore to what extent labour market experiences at work and in the community affect the health outcomes of workers, and how these experiences also affect the health of their children. As changing market conditions in the global economy affect workforces throughout the world, this research is gaining national and international recognition.
Ecological approaches to understanding health behavior and outcomes among youth
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.
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.