Addressing food insecurity and the double burden of malnutrition in a changing climate

Malnutrition is a serious public health concern in Inuit and northern regions of Canada, driven by a complex array of social and ecological determinants, including poverty, food insecurity, and climate change. In northern communities, country foods (wild foods harvested from the lands and waters) often comprise an integral component of food systems and contribute to food security, nutrition, and social and cultural integrity. Yet, many country foods are also high in environmental contaminants (e.g., mercury and persistent organic pollutants), which have negative implications for health. Meanwhile, due to transportation challenges, available retail foods in northern and Inuit communities tend to be pre-packaged, processed, and expensive.

In this research program, I will use existing health survey data to evaluate dietary patterns in Nunavik (northern Quebec) and associated nutritional benefits and health risks. Through interviews and community workshops, I will also identify political, social, geographical, and environmental factors that impact food access, affordability, and desirability. Findings will be shared with decision-makers to generate evidence for sustainable and healthy food systems in northern regions across Canada.

Childhood obesity management using innovative digital technology

Childhood obesity is a major public health challenge in Canada. Without intervention, overweight children will likely continue to be overweight during adolescence and adulthood. Family-based lifestyle programs delivered at local communities can be effective. However, many families cannot attend these in-person programs due to travel distances and program availabilities. The current situation has turned increasingly dire in the COVID-19 landscape, where face-to-face, group, and facility-based interventions are no longer viable. With continued improvements in the sophistication and access to digital communication technology (e.g. Internet, wearables, smartphones), delivering tailored lifestyle programs using these tools may be well-suited to meet these challenges.

The goal of this project is to evaluate the long-term efficacy and the cost of delivering a stand-alone web-based and a blended in-person and web-based program in improving health-related outcomes in children who are overweight or obese in British Columbia (B.C), Canada. This project can be incredibly impactful for B.C. residents as this web-based program can improve the access, reach and personalization of family-based childhood obesity management programs.

Systems transformation for health equity: The PHAIRNESS Research Program

There are growing differences in health among population groups due to unfair social conditions that disadvantage some people more than others in British Columbia and beyond. Health systems play a role in holding this problem in place by presenting unnecessary barriers to accessing quality healthcare. Health systems also have a key role in closing these gaps by taking action to change the underlying conditions that shape health and wellbeing. The Population Health Approaches to Implementing Research (k)Nowledge for Equitable Systems & Strategies (PHAIRNESS) Research Program aims to make visible and intervene on systems-level problems in three connected systems: health systems, surveillance systems and research systems. By working closely with health systems, communities and people who are impacted by these issues, research findings will be relevant, useful, and ready to be rapidly applied to improve health systems and support the wellbeing of all people in British Columbia.

Advancing Health Equity Action

The trajectories of people's lives are often shaped by things that fall outside of their control, having more to do with unearned disadvantages than with their own behaviours or biology. Despite solid evidence and practical policy solutions, systematic differences in health and health outcomes persist both within and between countries. Evidence shows the distribution of power, resources, and wealth along social gradients are causes of these inequities. Many people working in health and health research, and particularly in public and global health, describe their work as reducing health inequities or advancing health equity; but research shows their efforts are often poorly aligned the evidence, focusing on symptoms and not causes. 

This program of knowledge translation science supports researchers, students, and professionals in different settings (e.g., rural communities, municipalities, health systems) to align their equity intentions with evidence about causes of health inequities. By supporting people to integrate evidence-informed strategies and principles, efforts to improve population health can move toward more productive health equity action that focuses on addressing the causes, rather than symptoms, of inequities.

A program of research on optimizing trauma-informed practice in sexual, reproductive and HIV-related health services among marginalized women

Marginalized cisgender (cis) and transgender (trans) women experience high levels of gender-based violence, defined as violence perpetrated against someone based on their gender, gender expression, gender identity or perceived gender, as well as multiple forms of stigma. With the overarching aim to optimize trauma- and violence-informed approaches to enhance access to sexual and reproductive care and HIV prevention and treatment, this research program aims to work closely with marginalized cis and trans women to:

AIM 1. Launch a program of research that will i) develop an evidence base to describe complex relationships between and mechanisms linking gender-based violence and multiple forms of stigma with sexual and reproductive health access, and access to HIV treatment and care; and ii) develop innovative metrics, methodologies and tools to advance an understanding of gender-based violence and stigma and trauma- and violence informed care and practice;

AIM 2. Create a research and training platform to develop and inform innovative community-based interventions tailored for and with marginalized women to inform program and policy interventions.

Stress resilience across the adult lifespan: Linking dynamic day-to-day protective factors to aging and health

Canada is experiencing an unprecedented demographic shift with the aging of the population. Older adults face major stressors and life transitions (e.g., retirement, bereavement, caregiving), in addition to accumulated biological wear-and-tear due to a lifetime of exposure to stress.

Yet, the impacts of stress vary between people and across situations. It is therefore important to identify protective factors that may promote more adaptive stress responses, particularly in midlife and late adulthood when risks increase for aging-related diseases.

The proposed program of research will focus on stress resilience factors in daily life (positive events and sleep) that may mitigate the impacts of stress on health and aging. Research studies will examine the stress-buffering effects of daily positive events and sleep, positive events as protective factors for aging and health disparities, and the development of a mobile intervention to cope with stress as it unfolds.

This research will contribute to a better understanding of stress resilience and health in the context of adult development and aging. Findings will inform strategies to reduce stress-related health conditions and to promote optimal aging among Canadians.

Mental health in later life: A stakeholder-informed approach to health and technology interventions for older adults

Feeling down or worried happens to everyone, but for some people these feelings are very strong, long-lasting, and can be damaging to them and their families. Mental illnesses, such as depression or anxiety, may include feelings of hopelessness, helplessness, guilt, or even suicide. Worldwide, mental illness affects one in five people aged 60+.

However, problems faced by older adults impacting their mental health are often overlooked, such as loneliness, loss of a spouse, or ill-health. We need to change the way we treat mental health, with services that consider older adults' specific needs and situations.

To this end, we will bring together an advisory board of older adults to help inform the project, providing insights into what contributes to their mental health and what sorts of technologies promote better mental health. Using these insights we will identify factors that contribute to older adults’ poor mental health. 

Additionally, we will work with older adults to test technology-driven interventions, for example mobile apps, that best suit the needs of older adults in improving their mental health.

Investigating women’s socio-structural risk environment of overdose

British Columbia, Canada, continues to grapple with an overdose epidemic. Substantial gaps remain in the implementation and scale up of overdose prevention strategies, including attention to gender equity. Little has been said regarding how marginalized women (trans inclusive) are impacted by the crisis, or how they might be differently navigating overdose risk environments or access to life-saving health services.

The ultimate goal is to generate new evidence to reduce overdose-related harms among women who use drugs and increase the responsiveness of existing and emerging overdose interventions to gender inequities. The objectives of this research program are to:

  1. Identify how women’s overdose risk is shaped by evolving individual, social, structural, and environmental factors;
  2. Investigate factors that create barriers to (or that facilitate) women’s engagement with existing, novel and emerging overdose prevention interventions; and
  3. Document perspectives, experiences, and impact of women who use drugs working in overdose-related interventions to inform how best to optimize their engagement in ongoing and future initiatives.

Leveraging technology to support older persons in rural and northern communities through the Centre for Technology Adoption for Aging in the North – CTAAN

Rural and northern areas in BC cover large areas and support more and more older adults. Older adults may face unique challenges due to the geography, population, and resource availability. These places commonly lag behind urban centers in accessibility to healthcare services, and face healthcare workforce shortages. Innovative solutions are urgently required to support older adults to age safely with quality healthcare services. Technology solutions to support older adults exist and continue to be developed. However, there is a gap between technology development and its implementation and sustained use, especially for older adults in rural and northern areas.

My research program builds upon existing partnerships to address this gap through the creation of the Centre for Technology Adoption for Aging in the North (CTAAN)-A collaborating center for innovations in technology development and implementation to support older adults in rural and northern communities.

Through a range of technology focussed projects, my role as the academic lead of CTAAN is to enhance uptake of technologies supporting adaptation, piloting, and implementation of existing technologies from Canada and beyond and to support older persons to age gracefully.

Characterizing the Psychological and Social Predictors of Increased Preventive Service Use

In the next 20 years, the percentage of adults aged ≥65 in Canada is projected to increase by nearly 60%, and among all Provinces British Columbia is aging the fastest. As our population ages, identifying factors that foster healthy aging is crucial for improving the health of older adults, and containing healthcare costs. One way to cultivate healthy aging is by increasing preventive service use (e.g., flu shots, screening for chronic conditions). Yet, <50% of  adults aged ≥65 are up-to-date with them.

Thus, a central challenge is to identify modifiable factors that increase their use. The objective of this proposal is to identify key psychosocial well-being factors that are associated with increased preventive service use and begin piloting interventions. Building on prior work, the central hypothesis is that several hypothesized psychosocial well-being factors are associated with increased use of preventive services.

Regarding outcomes, this research is expected to have knowledge translation value as study results will identify psychosocial factors that might emerge as novel targets for interventions aiming to increase preventive service use; further, we will pilot test scalable interventions that target identified factors.