FOCUS on Adolescents: A mixed-methods study to optimize COVID-19 recovery and renewal efforts among adolescents in Canada and France

This award is co-funded by Health Research BC, through CIHR’s Operating Grant: Understanding and mitigating the impacts of the COVID-19 pandemic on children, youth and families in Canada. 

 

The COVID-19 pandemic and its corresponding health, social, and economic implications present potential lasting consequences for inequalities and vulnerabilities to manifest across later phases of the life course — a trend that may have significant impacts for adolescents aged 15-19. For example, school closures and other public health measures (e.g. isolation) have had significant effects on adolescent health — an age group whose need for social engagement and connection are essential for development. However, little is known about how social, economic, and cultural changes related to COVID-19 will affect adolescents’ health and social well-being over time.

 

To fill this knowledge gap, Dr. Rod Knight (principal investigator, assistant professor, UBC Department of Medicine) and Dr. Marie Jauffret-Roustide (co-principal investigator, research scientist, INSERM, University of Paris) are launching an international research study to extend their CIHR-funded France-Canada Observatory on COVID-19, Youth Health, and Social-wellbeing (FOCUS) – a research program launched in June 2020 to evaluate the impact of COVID-19 on youth aged 19-29 living in Canada and France – to include adolescents aged 15-19.

 

The FOCUS on Adolescents project will work alongside a group of adolescents from Canada and France to adapt the FOCUS Study’s program of research to include adolescents in a series of annual interviews and bi-annual national online surveys. At the end of the study, a participatory summit will be held in each country with youth and key stakeholders working with adolescents (e.g. clinicians, community members, policy makers) to identify interventions that best address the social and health needs of adolescents.

 

This research project will provide policy makers and clinicians with high-quality, real-time evidence to inform COVID-19 public health responses to improve health outcomes and reduce health inequities among adolescents.


Progress Update – March 2023

 

Objectives reached so far

One of the first objectives of our research project was to prepare and obtain ethic approvals from all of our university partners in Canada and France to ensure that our proposed research activities with adolescents and young adults will be completed in accordance with Canadian and French institutional ethics requirements. This was a long process, as the procedures and components of each application varied according to each ethics committee. In February 2023, we successfully received ethic approvals to start our data collection activities in Canada and France. In the meantime, we have developed new research partnerships with community organizations that provide health and social services to adolescents and young adults in Canada and France. These partnerships represent key resources and supports to best adapt and design our research activities for adolescents. For example, we held a series of virtual and in-person meetings with community organizations to discuss the content of our online questionnaire and identify a set of strategies to promote the online survey to adolescents and young adults in Canada and France.

 

Impact so far

Using the data collected from the previous FOCUS online surveys conducted in 2020 and 2021 among young adults in Canada and France, we have published two research articles in peer-reviewed scientific journals that provide findings on the changes in alcohol use and the effects of financial support on the mental health among young adults who lost income during the pandemic. These research findings and other ongoing data analyses related to the FOCUS survey have been presented at international conferences and to our community partners as part of our knowledge mobilization activities. These activities allowed us to engage in constructive discussions with health providers and peer workers from community organizations about the influence of the determinants of health on youth health and social wellbeing. These discussions also helped us to best tailor our data collection and analysis plans of the forthcoming FOCUS 2023 survey, which will include adolescents. For example, specific data analyses have been planned to inform community organizations about the health needs and concerns of adolescents and young adults in the current post-pandemic context.

 

Potential influence

Throughout our research project, we will continue to engage with community organizations and FOCUS youth participants to collaborate on the preparation of scientific articles. In order to accelerate the availability of our research findings, we will also develop a set of scholarly and policy-oriented deliverables, including those designed for key decision-makers (e.g., government officials), as well as brief summaries of evidence, which we will promote through media engagement (e.g., media interviews, posts on social media platforms). For example, our research findings will be shared with our existing research networks, including collaborations with key governmental agencies and influential decision makers within Canada and France, in the aim of using new research to optimize the responses to social and health inequities experienced by adolescents and youth.

 

Next steps

This spring, we will launch the FOCUS 2023 online survey among adolescents and young adults living in Canada and France. To promote this survey, we will use different recruitment strategies such as sending email invitation to participants of the previous FOCUS surveys, posting articles on our research partners’ websites and newsletters, and launching a social media advertising campaign to recruit new survey participants. Once the online survey is complete, we will analyze the survey data with statisticians and in

consultation with researchers who have expertise working on adolescents and youth studies. Our community partners will also be involved in this data analysis process through virtual and in-person meetings. We will continue to conduct knowledge mobilization activities by organizing two workshops (one in Canada and one in France) that will bring together FOCUS youth participants, researchers, and key stakeholders in the area of adolescent health (e.g., services providers, policy makers, and community members) to identify strategies to improve adolescent health in Canada and France. Our research team also just received one year of bridge funding from CIHR’s Project Grant Pandemic Preparedness and Health Emergencies Research Priority Announcement stream to extend this work.

 

Useful Links

Impact of social determinants of mental health on child and parent risk, resilience and support access in the COVID-19 era: A nested mixed-methods study of short and long-term outcomes

This award is co-funded by Health Research BC, through CIHR’s Operating Grant: Understanding and mitigating the impacts of the COVID-19 pandemic on children, youth and families in Canada. 

 

Project co-leads include Evelyn Stewart MD and Hasina Samji PhD, who brought together their extensive collaborative networks. Dr. Stewart is a UBC professor, child and adolescent psychiatrist and Director of Research for Child and Adolescent Psychiatry, BCCH. Dr. Samji is an epidemiologist, SFU assistant professor and senior scientist at BCCDC.

 

Between November 2020 and July 2021, the group collected baseline data for the Personal Impacts of COVID-19 Survey (PICS), a Canadian study identifying vulnerability factors to poor mental health related to preexisting medical and living conditions, sex/gender minorities and poverty. Based on our PICS baseline findings, which includes 3,351 Canadians, rates of several COVID-era mental illnesses were several-fold higher than expected; and one quarter of parents reported needing but not receiving mental health support.

 

Our mixed-methods study will build upon PICS findings by re-contacting participants to better understand their pandemic-era mental health service access, future preferences and the role of social risk and resilience factors. It will also identify those with persisting, resolving and newly emerging mental illness during the COVID-19 recovery phase. In this way, our study will provide a current, comprehensive perspective on families’ experience of the COVID-19 pandemic and how services providers, community organizations and policymakers can best serve child and parent populations at highest risk for ongoing mental health impacts.


Progress Update – May 2023

 

Most exciting outputs so far

Data collection and qualitative analysis have been completed with a total of 18 youths and 17 parents who provided one-hour interviews on their experiences during the pandemic. As a result, two manuscripts are currently being written to share the most salient results.

The first manuscript is a mixed-methods study of unmet youth mental health support needs during COVID-19. This study combined longitudinal survey data from the first iteration of the Personal Impacts of COVID-19 Study (PICS 1) with the qualitative interview (PICS 2).

The COVID-19 pandemic occurred during critical social, emotional, and developmental phases for children and youth, which has led to significant disruptions in all facets of youth’s lives. While research has sprung into action to quantify outcomes for youth and families during this time, there are many personal narratives and small stories that exist amongst the data.

With this in mind, the second manuscript will explore the impact that the pandemic has had on youth’s domains of life through individual perspectives.
 

Impact so far

As part of the COVID and Kids Project and in partnership between BC Children’s Hospital, SFU, UBC, and CHART (Capturing Health and Resilience Trajectories), a deliberative dialogue was hosted to provide key stakeholders an opportunity to connect and discuss priority recommendations for promoting mental health and well-being among youth during and after the COVID-19 pandemic.

PICS 2 outcomes, quotes, and recommendations from youth and their families were presented to help inform stakeholders on family priorities. A report is being compiled with the recommendations from this event, and will hopefully help to inform future efforts to improve mental health coming out of the pandemic.

We have also presented outcomes from this study at various leadership meetings at the BC Children’s and Women’s Hospital and at research rounds. Additionally, we have been able to provide families and youths an opportunity to share their experiences and feel heard.
 

Potential Influence

We hope that the results from this project will be helpful in informing new initiatives to fill the gaps in youth and family mental health supports. COVID has increased the mental health burden and strained already strained mental health services and we hope to help pinpoint particular areas that are most needed by families and the barriers that are in the way of access.

Gaining a better understanding of COVID-19’s impact may also be important for building resilience for future events like COVID-19. By collecting qualitative data through interviews, we hope this study can begin to bridge a gap between families and mental health professionals, stakeholders, and researchers. We also hope to improve our understanding of the long-term consequences of the pandemic on youths from their own perspectives on what mattered most to them.
 

Next steps

We hope to produce additional publications to continue disseminating the parent and youth narratives we have collected. In tandem with the quantitative outcomes from PICS 1 survey data, we hope to be able to paint a more detailed picture of pandemic mental health outcomes. We also have plans to present our findings at several conferences. An additional population with increased risk during the pandemic was young adults, who we found to have the worst mental health outcomes from PICS 1 survey data. Once we have completed our reports on youth and families, we hope to conduct similar interviews with young adults to better understand why this population was disproportionately impacted.

Evaluating a virtual care platform (REACHOUT) that delivers peer-led mental health support to adults with type 1 diabetes in rural and remote communities in British Columbia

Mental health is often overlooked in diabetes care. In fact, BC’s provincial health plan does not cover psychological services for patients with chronic illness. Studies have found that, of psychological stressors, diabetes distress (DD) is the most closely associated with poor blood sugar control and worse health consequences. DD refers to the unique and often hidden emotional burdens, and relentless frustrations and worries that patients experience when trying to manage this condition. In 2027, almost 35,000 British Columbians diagnosed with type 1 diabetes (T1D) will report clinically significant levels of DD. Unfortunately, T1D adults living in rural and remote regions will have the least access to mental health services. I seek to address three major gaps in BC’s diabetes care: the availability, affordability, and accessibility of mental health support for T1D patients living in settings with limited resources. In collaboration with T1D patients, clinical psychologists, digital health specialists, and biomedical engineers, I will use digital health strategies to “drive” a peer-led mental health support intervention (REACHOUT) to adults with T1D living in geographically isolated communities.

Improving clinical practice guidelines for antenatal corticosteroids: Incorporating a decision support tool to impact clinical counselling

Antenatal corticosteroids are a medication given to women who are at risk of an early delivery to reduce the chance of breathing problems for their baby after birth. Current guidelines recommend giving antenatal corticosteroids to pregnant women who might have their baby before 34 weeks of pregnancy. This medication may also help those at risk of an early delivery at 34-36 weeks of pregnancy but the balance between the benefits and harms of this treatment is less clear at these ages. Guidelines for giving this medication at 34-36 weeks of pregnancy are also unclear, making it difficult for doctors and patients to decide whether to use it. We will find out if including a decision support tool in clinical guidelines will improve how doctors discuss antenatal corticosteroids with patients at 34-36 weeks of pregnancy. We will ask patients whether they had better discussions with their doctor about this treatment after their doctor had access to the decision support tool within the clinical guideline, and we will ask doctors how this decision support tool impacted their counselling. This project could improve communication between doctors and patients, especially when it is unclear whether a treatment’s benefits outweigh its harms.

Exploring the experiences of racialized learners to understand and dismantle racist structures in our healthcare system

Racism is experienced by learners, professionals, and patients in our healthcare system and contributes to well-documented health inequities. However, patient care and health outcomes are improved through a diverse physician workforce. Medical schools have attempted to support diversity through the admissions process, including increased racial diversity in their programs. Yet we know little about the experiences of racialized learners once admitted. This study will explore the impact of existing policies, processes and practices on learners’ sense of agency, attending to their perspectives on how their experiences of racism impact patient care.
This study focuses on racialized learners’ experiences in their clinical education over time through the use of diaries and interviews. Engaging with learners across four medical schools, we will attend to the impact of important differences in their identities such as race, gender, and sexual orientation.
Through this study, we will identify concrete ways in which our healthcare (and clinical education) systems perpetuate racism. From this, I will work with clinicians, educators and policy makers to enact systems changes that will ultimately reduce health inequities.

Economic evaluation of the use of expanded criteria donor kidneys pre-emptively to improve the critical organ shortage

Kidney transplantation can be life saving for people with end-stage kidney disease at a lower cost than the only other alternative which is dialysis treatments. Unfortunately, there are not enough kidneys available for transplant. This means that until we can improve the kidney supply, patients will continue to have to wait on a waiting list and may die in the process.

Kidneys from older donors have been successfully used for transplant, but at a higher risk. This higher risk discourages some patients and physicians from accepting these kidneys for transplant. This results in kidneys being discarded that could otherwise have saved lives.

However, these kidneys will have better outcomes if they are given to patients before they ever need to start dialysis, instead of our current practice which is to wait until someone is at the top of the waitlist after years of dialysis. This research project will use economic models to study how allocating kidneys from older donors to some patients before they ever need dialysis might impact the overall kidney supply and patient outcomes. This research will help inform future health care policy which may improve organ supply for patients waiting for a life-saving transplant.

The DISCO study: Rethinking STI prevention

Syphilis, chlamydia and gonorrhea are three of the most common sexually transmitted infections (STI). Over the last decade, these STIs have seen a resurgence in many parts of Canada, with most infections seen in major urban centres. These infections have primarily affected gay, bisexual, and other men who have sex with men (gbMSM). Recently, a small pilot study found that doxycycline — an inexpensive, well-tolerated antibiotic — given daily may prevent new STIs in gbMSM. Another study looked at the use of doxycycline given after a sexual encounter for prevention of STIs, and the results of this study showed protection against STIs as well. Based on these promising data, along with the concerning increases in STIs seen in Canada, the current study will examine the use of doxycycline as either a daily prevention therapy (preexposure prophylaxis, or PrEP) or an ‘after sex’ prevention tool (postexposure prophylaxis, or PEP) for STIs in gbMSM. While examining for efficacy as its primary goal, this study will also do an examination of some of the potential challenges and concerns associated with the use of a daily antibiotic: drug resistance, tolerability and side effects, and how acceptable this drug is for people to take regularly.

Perioperative stroke screening and outcomes in high-risk surgical patients

Up to two percent of patients will experience a stroke during or after surgery and these patients have a high chance of disability and death. Currently, we don’t understand clearly how to prevent, detect, and treat stroke after surgery. Although risk factors have been identified including older age and cardiac surgery, high risk surgical patients are not usually identified and strokes can be missed, leading to fewer treatment options and more complications. My previous pilot study showed that anesthesia and surgery can limit the accuracy of standard screening tools for stroke. We urgently needed a screening tool and protocol specifically for surgical patients. We also don’t understand well how patients recover after perioperative stroke, such as which patients survive, and whether they can stay in their homes. Building on our prior research, this multiphase study aims to: (1) Understanding which patients do poorly after perioperative stroke and whether those factors can be changed; (2) Compare mortality and other complications after stroke between those who had recent surgery and those who did not; and (3) Identify a useful perioperative stroke screening tool to quickly and accurately detect stroke after surgery.

Does timing matter? A trial of intermittent fasting in haematological malignancies

Does when we eat make a difference to our health? We know that food choices can impact cancer risk but what if the timing plays a role as well? Evidence shows that fasting may slow cancer growth through a process called autophagy. Through an interdisciplinary research team, I am currently running a small trial testing the effects of intermittent fasting (IF) in patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) at BCC-Victoria who not on anti-cancer treatment. Specifically, I am asking whether IF regimens, differing in fasting timing and duration, stimulates autophagy, improves quality of life, impacts gut microbiome, and/or results in clinical benefit (i.e. reduced lymphocyte count). I am also following participants’ safety, ability to follow the fast, and fasting preferences. While early results look promising, I propose growing this study into a larger trial with three phases to clarify the effects of IF on cancer and the microbiome. Understanding these effects may help discover simple diet recommendations for patients with cancer that cause a response in cancer cells or slow cancer progression, are safe and reduce treatment side effects when used alongside current, standard treatments.

Neuropsychological functioning in treatment resistant schizophrenia

Schizophrenia is a severe and disabling psychiatric illness involving primary symptoms of psychosis (hallucinations, delusions, disordered thinking and behavior). Unfortunately, as many as 30% of patients respond poorly to standard antipsychotic medications and are considered to have treatment resistant schizophrenia (TRS). Neuropsychological impairment is an important clinical feature of schizophrenia, as cognitive deficits predict poor treatment response, daily functioning, and disability. However, very little is known about cognitive functioning in the clinically complex subset of patients with TRS. The aims of this project are therefore to investigate the severity, pattern, and variation in cognitive functioning among individuals with TRS, and to determine whether cognitive difficulties predict treatment response and functioning. This will be achieved by analyzing clinical and neuropsychological data that has been collected on TRS patients who have been treated within the BC Psychosis Program since 2012. Findings using this unique dataset will have a direct impact on shaping assessment and treatment strategies, improving prognosis and ability to predict functioning, and improving clinical decision-making and planning.