Linking administrative and survey data to examine substance use related diagnoses, hospitalization and mortality among gay, bisexual and other men who have sex with men in Metro Vancouver

Every day, over 400 Canadians are hospitalized because of drug and alcohol-related causes. These admissions are widespread, costly and deadly. This issue is especially problematic in British Columbia (BC) where hospitalizations related to alcohol abuse are highest in the country. Population data consistently highlight that licit and illicit substance use is more common among gay, bisexual and other men who have sex with men (GBM) compared with heterosexual individuals. However, research assessing substance use related mental and behavioral disorders, hospitalizations and mortality is lacking for GBM due to the lack of identifiers for sexual orientation in administrative research. This study links administrative and survey data to examine substance use related outcomes from 2012 to 2020 and compare these rates between GBM and heterosexual males in BC. Further, we will use cohort survey data to examine behavioural and structural factors associated with substance use related disorders, hospitalizations and mortality among GBM in BC. Our results will inform recommendations to improve substance use healthcare for GBM and support reductions in hospitalization costs related to substance.

Evaluating the impact of pharmaceutical interventions to reduce overdose among people with criminal justice system involvement in British Columbia

People with criminal justice system involvement (i.e. who have been to prison for a criminal offence) are more likely to use drugs like heroin and methamphetamine compared to the general population. People who use drugs also are at higher risk of negative outcomes like overdose and more rapid or frequent return to prison. Efforts to address overdose, both in prisons and in the community, have been focused on providing treatment for people who use opioids (e.g. heroin, fentanyl). This alone may not be sufficient to reduce overdose risk, particularly among people who use other substances (e.g. cocaine, alcohol) in addition to opioids. In March 2020, in the context of COVID-19, the British Columbia (BC) Ministry of Health provided new Risk Mitigation Guidance (RMG) for doctors, permitting them to prescribe opioids, stimulants, benzodiazepines, and alcohol withdrawal management medications to people at risk of overdose. In this study, I will evaluate whether the RMG has reduced overdose and return to prison among people with criminal justice system involvement in BC. This study will highlight gaps in substance use services in BC, and will inform evidence-based services that can help to reduce overdose in prison and community.

Healing indicators: Developing community-based Indigenous health assessment

Healing Indicators is a project that aims to improve health policy and assessment processes by creating tools that centre communities and Indigenous knowledge. The work is in response to the need to better assess the health impacts of resource development in Indigenous communities. This project is in partnership with the British Columbia First Nations Health Authority and Simon Fraser University, and is deeply committed to engaging in Indigenous methodologies, land-based health and healing, and health justice. It features an approach that strives to decolonize public health: the research approach is integrated, connecting land-based perspectives on health and wellness, and cultural foundations into population health reporting.

The question this research asks, is “What principles and processes are needed to create and develop indicators relevant to First Nations in relation to resource development and related policy?” Research will help support Indigenous health assessments through the collaborative creation of land-based healing indicators, that prioritize Indigenous perspectives and needs through community-based research. A goal of this work is to undertake culturally safe research in an applied health sciences context.

Addressing emerging health system priorities in cervical cancer prevention: determining optimal strategies for human papillomavirus test-based primary screening

Cervical cancer remains a significant women’s health issue in Canada even after the introduction of cytology screens (i.e. Pap smears) in 1949, which resulted in a reduction of cases. It is frequently diagnosed in young women, who are embedded in careers, raising families, or still planning to conceive. Treatment can affect women’s ability to work, care for families and cause infertility, and survival rate is often low. It is thus vital to improve preventative screening programs using recent testing innovations. Testing for human papillomavirus (HPV) is more effective than cytology, but it is not yet used in BC. HPV FOr CerviCAL Cancer (FOCAL) was a trial investigating HPV testing. Participants were followed for ten years post-trial through linkage to the BC Cervix Screening Program to create the FOCAL-DECADE cohort. We will use data from this cohort to compare long-term rates of cervical precancer between those who received cytology or HPV testing, expecting significantly reduced rates in the HPV group. These results will inform decision-makers, like the provincial screening program, of best screening practices (e.g. screen interval), aiding transition to HPV-based testing programs, thus helping reduce cervical cancer across BC.

Immigrants, work and health: Evaluation of services to reduce inequities

Work is a marker of successful integration for immigrants to Canada. While we know much about the health outcomes and employment patterns of immigrants within the Canadian context, less is known about the impact of work on health, in particular on work disability experiences. Emerging evidence suggests that immigrants take longer to return to work following a work injury/illness compared to Canadian-born workers. Provision of employment-related and rehabilitation services are meant to provide access to safe work and minimize work disability but, this has not been examined in immigrant populations. Using a unique research opportunity that will merge immigration data with 1) workers’ compensation and medical services data; and 2) settlement service use for the working population of British Columbia, the purpose of this study is to examine the impact of rehabilitation and employment-related services on work and work disability experiences of immigrants compared to Canadian-born workers, along the continuum from injury to rehabilitation to return to work and income earning. Evidence of different experiences and effectiveness of services can inform best practices and reduce health inequities for all workers, including immigrants.

Honouring all our relations: Advancing health and wellness of uncounted Indigenous peoples in BC through addressing gaps in population health and wellness reporting

Reporting on population health is important to monitor trends, identify priorities, and track progress to address inequities. All Indigenous peoples have the right to be counted. Yet, over 88,000 Indigenous people in British Columbia (BC) who do not have ‘Status’ under the Indian Act or are not registered with Metis Nation BC are currently ‘uncounted’ in population health reporting.

Responsibility for reporting on health of BC residents lies with the Office of the Provincial Health Officer, including collaborative reporting on health of diverse Indigenous peoples in BC. Currently, there is no process to report on health of uncounted Indigenous peoples. Gaps include: lack of formal relationships with those representing uncounted Indigenous peoples; no way of identifying this population in BC health data; absence of research frameworks reflecting uncounted Indigenous peoples’ perspectives; and no implementation plan for province-wide surveillance involving uncounted Indigenous peoples.

This study aims to support health of uncounted Indigenous peoples in BC by addressing current gaps in population health reporting, through partnerships that uphold Indigenous self-determination, decision-making and perspectives of health and wellness.

Exploring mechanisms, pathways, and mitigation strategies to prevent loneliness, social isolation, and their deleterious health impacts

We experience hunger so we eat, thirst so we drink, tiredness so we sleep, and loneliness so we find social connection. Social needs are fundamental to humans and when we are lonely the body’s central stress response system is dysregulated. As a result, our capacity to manage stress, inflammation, and energy reserves is reduced. The end result: lonely people live shorter and sicker lives.

In the wake of COVID-19, which itself manifested in an era of already increasing social isolation, it has never been more important to study loneliness. Yet, while a robust literature base has examined loneliness in older adults, we still know very little about what we can do to respond to experiences of loneliness across the life-course. This is particularly true in marginalized populations, such as gay, bisexual, and other men who have sex with men (gbMSM), who are especially vulnerable to social exclusion and related stressors, but they also exhibit unique coping strategies that may buffer these effects.

My research will help us better understand the epidemiology of loneliness among gbMSM in order to prevent its deleterious effects on these individuals, their communities, and the broader population in the wake of COVID-19.

Responding to the truth and reconciliation calls to action in healthcare through the arts as a way of knowing, disrupting and healing

The 2015 Truth and Reconciliation Commission calls for Indigenous knowledge and practices to be included in healthcare. But as can be seen in recent, troubling news stories and reports, Indigenous peoples often face racism and barriers to care. People are becoming interested in using storytelling and the arts to listen to Indigenous peoples’ views so we can change healthcare to better meet their needs and priorities.

The purpose of these studies is to work together with Indigenous and non-Indigenous peoples to create more meaningful paths towards reconciliation and equitable healthcare through the arts. First, I, together with a team of Indigenous and non-Indigenous partners, will look at the research using storytelling in Indigenous health research. Then, I will lead three studies to investigate arts-based strategies to support healthcare students in responding to the Missing and Murdered Indigenous Women and Girls Report; explore First Nations peoples’ cancer experiences using digital storytelling; and develop arts-based programs to support Indigenous patients facing illness. The findings will help us to include Indigenous perspectives and practices in healthcare to move towards reconciliation and address differences in health.

The ADAPT Project: Adaptation, Development, and Positive Trajectories in the context of childhood adversity

Over half of Canadians have experienced at least one childhood adversity (CA), which is linked to an increased risk of poor health and wellbeing across the lifespan. Current approaches have focused on linking CA to poor outcomes, yet this approach overstates the impact of risk and devalues the importance of protective factors enabling individuals to withstand, adapt, and recover. The focus on outcomes may also fail to capture the trajectories of wellbeing and cyclical nature of resilience and vulnerability.

This program of research utilizes a mixed-methods approach to explore pathways to wellbeing in the context of CA, focusing on the timing and type of protective factors. To fully understand how socio-environmental and biological factors contribute to health and wellbeing inequity due to CA, we must examine the pathways to impairment and wellbeing using a developmentally informed framework. Changing the question from ‘how are youth at risk’ to ‘how do youth adapt,’ and shifting to a model where those with trauma histories are not defined by their risk. Findings will produce actionable evidence for practitioners and policymakers to develop early intervention and prevention programs fostering health equity for those with CA.

A program of social epidemiology and metabolic outcomes research (SEMOR) to support healthy aging

Obesity is one of many chronic conditions that are rising in Canada, with heart disease as the top killer for women. Social inequalities exist in these conditions, but few studies focus on the social causes of obesity in women versus men, or on how social causes reinforce each other.

My research program aims to fill these knowledge gaps so that interventions to prevent and manage chronic conditions can be better designed and more effective. One of my projects is focused on co-developing novel ways to promote heart health among Indigenous women because of the profound burden of CVD in one of Canada’s most marginalised group. A key program goal is to produce strong research evidence to inform public health strategies and interventions for preventive action on obesity, and to build capacity of the next generation of researchers and healthcare providers to further improve health and health equity in Canada, especially BC.