Research Pillar: Population Health

Development and assessment of strategies to promote social integration into new communities

Social connections and social support networks are essential for physical and mental health. In fact, recent research suggests that how long people live is better predicted by the quality of their social relationships and how well they are integrated in their community, than it is by how much they smoke and drink, or whether they are obese. Loneliness, on the other hand, is linked to negative health outcomes including depression, poor sleep quality, more hospital and doctor visits, and compromised immune system functioning.

This research will focus on the processes involved in successful social interactions with strangers, friendship formation, and social integration. It will focus on questions including: Why do some people have a harder time making friends than others? How do people develop a sense of belonging when they move to a new community? How do the size of someone's social networks, and the availability of social support, influence specific health outcomes like immune function and cardiovascular disease risk? Given that Canadian culture is characterized by high rates of immigration and residential mobility, developing effective evidence-based strategies for combating loneliness and social isolation can have direct benefits for individuals and communities alike.

Knowledge translation activities for this research will include active engagement with broad audiences of university administrators and advisors, student mental health groups, and community members. Dr. Chen will produce reports for groups directly involved in promoting community social integration efforts, whilst serving as a scientific/faculty advisor for initiatives to disseminate research findings directly to the public. She will use research findings to develop specific interventions to facilitate friendship formation and social integration, targeted to individuals who are experiencing social disruptions or difficulty transitioning into new environments. Enhanced knowledge about these topics is expected to contribute to the public good and welfare of British Columbians.

Towards a provincial policy framework for substance use services in BC

Opioid use disorder is one of the most challenging forms of addiction facing the health care system in BC and is a major driver of the recent surge in illicit drug overdose deaths in the province. In the context of the current public health emergency, Provincial Health Services Authority agencies the BC Centre for Disease Control (BCCDC) and BC Mental Health & Substance Use Services (BCMHSUS) have identified an urgent need for a policy framework articulating the full range of therapeutic options for the optimal treatment and harm reduction measures those with opioid use disorder.

Drawing on his expertise on substance use, first responder support and policy development, Adam Vaughan will work with experts and researchers at BCCDC and BCMHSUS, senior decision makers in the BC Ministry of Health and regional health authorities, and various addiction-related departments at UBC and SFU to develop a provincial policy framework that outlines a proposed continuum of care for those who require harm reduction, overdose prevention and opioid treatment services.

Vaughan's work on an opioid use disorder continuum of care will also contribute to the current development of an overarching provincial substance use policy framework and ultimately help advance BC drug policy. 

Integrating equity and cultural safety lenses to promote Indigenous health in BC’s southern interior

Interior Health (IH) serves more than 215,000 km² of BC’s southern interior. This part of BC falls within the traditional, unceded territories of the Secwepemc, Ktunaxa, Syilx, Nlaka’pamux, Ulkatcho, Tsilhqot’in and St’at’imc peoples. Within these territories are people, both on and off reserve, who live in small urban, rural or remote communities. The First Nations, Metis, and Inuit populations served by IH are disproportionately affected by health inequities. 

IH’s Aboriginal Health team is currently exploring ways in which health equity and cultural safety can be more systematically integrated into IH’s operational processes, program planning, and policy arenas. Dr. Shahram will focus on creating a policy proposal for broad integration of health equity impact assessments into the cultural fabric of IH — making culturally safe, equity-centred thinking the norm for leadership and practice. 

Dr. Shahram will bring her health research expertise and engaged scholarship methodologies (e.g. action research, integrated knowledge translation), and work with IH leadership to create a strategic plan for capacity building and policy change that will enable the advancement of a system-wide policy agenda aimed at integrating cultural safety and health equity assessment into IH policy and operations.

Dr. Shahram received a 2016 Research Trainee Award to examine how health equity strategies in the BC public health system could benefit from Indigenous knowledge and worldviews. This award will placed on hold during her health policy fellowship assignment.

Health related quality of life following road trauma: An emergency department inception cohort study

Each year in Canada, road trauma causes over 2,000 deaths and 10,000 serious injuries. Disability after an injury is a major public health concern, but the long term health outcome after road trauma is poorly investigated and based mostly on older research that does not reflect modern vehicle safety features or modern medical treatment. In addition, there is almost no research that helps health care providers know which patients are most likely to have a bad outcome following a crash, making it difficult to provide them with the care they require. For policy makers, it is important to know the health care costs and lost productivity that results from road trauma, but this information has not been studied. My study will provide this missing information.

My team will interview patients who visit an emergency department after a traffic crash, including pedestrians, cyclists, and motorists. We will ask about their general health before the crash, the injuries they had from the crash, and other details of the crash. Repeat interviews at 2, 4, 6, and 12 months will ask about problems they had since the crash, including pain, ability to go about their usual activities, and return to work. We will also ask about the medical care they required after the crash.

This study will help doctors and nurses know how quickly people recover from their injuries after a crash and which patients are likely to have long term health problems. It will also describe the medical treatment that these patients require and how much work they miss. This information will give a better estimate of the true cost of road trauma, and may help policy makers decide how much funding to devote to crash prevention programs or to treatment programs for crash victims.

Identifying prodromal signs of multiple sclerosis: a multi-centre approach

Multiple sclerosis (MS) is a neurodegenerative disease for which there is no known cure. It is among the most common causes of neurological disability in young adults in the Western world and affects approximately 2.3 million people worldwide, including an estimated 75,000 Canadians. The symptoms of MS and related morbidity have a major impact on quality of life: weakness, fatigue, disability and depression can all influence social, family and work life.

Some intriguing preliminary findings from one study based in Manitoba indicated that people with MS had more medical consultations than people without MS, even throughout the five-year period prior to MS onset. This implies that the disease already starts to develop long before the currently recognized clinical onset of MS. However, these findings have yet to be replicated and it remains unknown as to what the reason(s) were behind the measurable increases in medical consultations.

The aim of this project is to search for early signs and symptoms that could facilitate more timely recognition of MS and to narrow down the relevant time window when searching for factors triggering MS.

I will examine databases of medical records from people with MS in British Columbia, Saskatchewan, Manitoba and Nova Scotia. I will explore their physician and hospital visits before MS onset and before MS diagnosis, and I will compare this data to medical information from the general population. I will also examine the reason(s) for the physician and hospital visits.

I hypothesize that among people who go on to develop MS, I will identify specific associated “disorders” that drive the elevated health service utilization before MS onset.

I will help the research team share the findings directly with BC provincial decision makers via one-on-one meetings and presentations. Connections with patient advocate groups will enable me to also raise awareness of the results among people with MS.

Ultimately, the results of this study could contribute towards an earlier recognition of MS.

Understanding health equity and resource development (UnHEARD): New tools for assessing the health equity implications of unconventional natural gas development on rural and remote communities in northern British Columbia

Resource extraction and development activities are the primary drivers of social and economic development for communities across northern Canada, and therefore are significant determinants of community well-being. However, there is growing global recognition that the benefits of resource development are not distributed evenly across the supply chain, and that new tools are required to understand how anthropogenic changes in the natural environment affect population health.

This study uses the case of unconventional natural gas development in northern BC’s rural and remote communities to enhance the scientific understanding between resource development pathways and human health. BC is currently preparing for the rapid development of its natural gas reserves in conjunction with other diverse forms of land use and development (e.g. forestry, mining, industrial agriculture, etc.). However, the health impacts of rapid industrial growth are not well understood, and differences will be abound between gas extracting regions in the northeast of the province, gas transportation corridors through the northern interior, and gas exporting communities on the northwest coast.

In seeking to contextualize health impacts associated with resource development across the supply chain, this research will work to develop a new health equity impact assessment tool that is rooted in international best practices to explicate the intersections between ecosystems, the boom and bust cycle of resource-dependent towns and regions, and the resulting impacts on human health which are often overlooked in existing provincial environmental assessment and cumulative effects assessment protocols. Indeed, an explicit focus on health equity is a purposeful way to understand how health impacts are distributed across time and geographic space related to rapid resource development, thereby giving voice to health issues that often go UnHEARD during project permitting and planning. This work will involve the integration of a variety of data types to track changes in the distribution of health outcomes over time, and enable the identification of programs and protocols capable of mitigating associated health risks. Accordingly, this research will inform provincial regulatory processes through an expanded understanding of environmental disturbance as a context for health promotion, while assisting regional stakeholders in minimizing harmful impacts of industrial activities on community and worker health.

The Effect of Psychosocial Stressors on Health Behaviours and Indicators of Cardiometabolic Risk in the Transition to Young Adulthood

Adolescence and young adulthood are critical periods for health promotion and disease prevention. Cardiometabolic risk (CMR) refers to a set of indicators that increase an individual’s risk for diabetes, heart disease or stroke. These indicators start to show predictive variability in adolescence and identification and implementation of early strategies for risk management can have significant long-term health benefits. Much of what we know about CMR comes from studies of adults; therefore, research focusing on earlier age groups is needed.

The first objective of the proposed research is to describe the frequencies of select, non-invasive CMR indicators, including body mass index (BMI), systolic and diastolic blood pressure (BP), and waist circumference in young adulthood (ages 22-29). Research in psychoneuroimmunology documents the deleterious effects of stress on physical health; however, less attention has been given to adolescents and young adults.

The second objective is to examine how psychosocial stressors that become salient in adolescence (e.g. internalizing symptoms and interpersonal stress) predict CMR.

The third objective is to examine how these stressors compromise the enactment of key health behaviours (e.g. physical activity, eating habits, sleep duration) leading to increased CMR.

The project will use six waves of the Victoria Healthy Youth Survey (V-HYS), a 10-year longitudinal study that surveyed youth (N = 662) biannually from 2003 (T1; ages 12-18) to 2014 (T6; ages 22-29). In-person measurements of CMR (BMI, systolic and diastolic BP, waist circumference) were collected at T6. Measurements of internalizing symptoms, interpersonal stress (e.g. peer victimization), and health behaviours were collected at each wave.

Findings will highlight the variability in CMR in young adulthood and increase knowledge on the effects of two salient stressors on CMR from adolescence to young adulthood, providing new information about targets for prevention and interventions. The results will also inform guidelines for early identification and preventative healthcare.

Knowledge translation efforts will include 1) peer-reviewed publications, conference presentations, media reports, and policy formats; 2) creating an infographic about CMR in young adulthood to release to the media; and 3) developing a training tool to educate healthcare professionals about the relations between stress and CMR in these young age groups.

‘APP’lying Supportive Movement: Trauma-Informed and Culturally Safe Physical Activity Programming for Young Pregnant and Parenting Women Marginalized by Poverty, Racism, and Trauma

Physical activity has been found to have numerous physical, emotional and psychological benefits, particularly for young pregnant/lone parenting women (YP/LP). Unfortunately, physical activity declines through adolescence, and women who are marginalized by poverty and racism have lower levels of leisure time. There is a lack of research on physical activity for YP/LP women who are marginalized by poverty, racism, and/or trauma, thus little is known about the barriers and facilitators for physical activity for this population. Physical activity is especially important for these women because they have a greater risk for obesity, anxiety, depression, low self-esteem, and PTSD.

My proposed mixed methods participatory research will focus on physical activity with YP/LP women who are marginalized by poverty, racism, and trauma – arguably some of the most marginalized women in Canada. My research has the following objectives:

  1. Assess current health and physical activity behaviours engaged in by YP/LP women.
  2. Understand the perceived barriers and benefits of physical activity for these women and establish strategies to support YP/LP in a culturally safe and trauma-informed manner.
  3. Assess if existing quality of life measures are relevant for this population and determine if there is a correlation between quality of live and physical activity levels for these women.
  4. Translate the knowledge gained to create a technologically-enabled approach to support/improve YP/LP well-being. 

This research will take place with partnering organizations on Vancouver's Downtown Eastside that serve pregnant and parenting women. I will work with participants to create and implement a technology-enabled health intervention that is culturally safe, age relevant, trauma-informed, and cost effective.

Understanding the evolution of expectant and new parents’ beliefs and behaviours about pediatric vaccination in British Columbia

Vaccines are the most effective way to prevent many communicable diseases, yet immunization rates in British Columbia are below the level required to mitigate outbreaks of infectious diseases. This can be partly explained by some parents’ doubts and concerns about pediatric vaccinations, termed “vaccine hesitancy”.

Numerous interventions have tried to address these concerns by focusing on communication between physicians and parents when their child is already several months old. Yet there is evidence that some parents make decisions about their child's vaccinations even before the first mention of vaccines in doctors’ offices or public health clinics; this makes the pre-natal period a potentially underutilized opportunity for initiating vaccination communication. Parents’ beliefs may also change over time in response to new information or conversations within their social networks.

As mothers are the primary decision-makers about vaccination, understanding maternal beliefs about pediatric vaccination is essential to ensure effective messaging and service delivery. It is also crucial to understand the beliefs and preferences of fathers and other co-parents, given the important role they play in shaping vaccination decisions.

Few studies to date explore how parents’ vaccination beliefs shift over time, particularly how parents’ beliefs before the baby is born continue to evolve during the first few months of their child’s life, and none to our knowledge in regions of BC where immunization rates are well below the Canadian average. Parental attitudes on southern Vancouver Island reflect specific local vaccination cultures and thus, may vary significantly from those on the mainland.

This longitudinal qualitative study explores decision-making processes about vaccinations among expectant and new parents in Victoria, BC by conducting four interviews with each mother, and two interviews with fathers or other co-parents, from the third trimester until just after the child’s first birthday. Analysis will focus on identifying points of leverage that may inform future interventions, providing data on the optimal time and method to engage parents.

Knowledge translation is integrated into the study design through collaborations with Island Health. Findings from this study will be presented for discussion in workshops with key stakeholder groups, disseminated through publications and conference presentations, as well as via a short radio piece.

 

Transforming Urban Form for Mobility: Interventions to improve population health

Governments are making major investments in transit, cycling, and walking infrastructure to alleviate the pressures of traffic congestion and emissions. These changes may have lasting impacts on population health.

The aim of this five-year program is to generate new evidence on the impact of population health interventions on health and health equity along two lines:

  1. “Population Health Intervention Research” will generate new knowledge on the impact of population-level interventions on mobility.
  2. “Methods and Tools for Intersectoral Action” will develop and apply novel methods and tools to study urban form, and to facilitate uptake by intersectoral stakeholders.

This work aims to generate new, locally-relevant evidence in order to understand how to enhance health and mobility in mid-size cities and suburbs. While these settings are very common in Canada, they are surprisingly absent from the literature.

 

The program will assess how changes to urban form, such as new cycling networks or education programs, influence how people choose to travel, and how safety-conscious and active they are. This will be studied in the population overall, and also specifically with groups facing greater mobility challenges (e.g. women, new immigrants, older adults). The work will focus on how an investment in a city-wide cycling network for people of all ages and abilities impacts uptake, safety and equity.