Healthy Children, Healthy Communities: Co-Benefits of Children’s Action on Climate Change and Mental Health

Problem: British Columbia is being increasingly impacted by climate change and therefore the health and wellbeing of children in this region are at risk, and will be throughout their lives unless action is taken.

Overview: Conducted for, by and with children, this research will answer 2 questions: How is children’s health being impacted by climate change? Can taking action on climate change through community projects, strengthen and build resilience in children, even in the age of climate change? A central focus of this work will be on mental health and wellbeing.

Outcomes: After filling a significant scientific knowledge gap about the public health impacts of climate change on children in BC, evidence gathered will be used to help develop community projects that tackle a local impact of climate change.

Impacts: This research will identify why and how certain community projects on climate change protect, and even improve, the mental health and wellbeing of children and make recommendations for how other communities can use this information to build their own healthy children, healthy community projects. These successes will be shared with decision makers to support the choices they make around climate change and health.

Towards TB elimination in Canada: Optimizing tuberculosis screening and prevention

The World Health Organization (WHO) aims to eliminate TB by 2050, but Canada is not on target to meet that goal. To reach our national TB elimination targets, we must reduce TB rates by 10% per year but we are only reducing TB rates by 2% per year. My research program is aimed at developing evidence to improve TB screening, prevention and treatment policies in order to accelerate TB elimination in British Columbia (BC) and Canada.  

In my primary research project, my team is using provincial health databases to describe TB epidemiology in the foreign-born population of Canada. Our goal is to develop a TB risk score and to create evidence that informs cost-effective TB screening policy. My team is also using TB genome sequencing data to understand TB transmission networks and to find areas for public health intervention. Lastly, we are developing evidence to improve treatment outcomes for people affected by TB.   

Making Healthy Connections: A Critical Anti-Racist and Decolonizing Geography of Immigrant and Indigenous Relations in Northern British Columbia

While resources support immigrant well-being in urban settings in southern Canada, little research exists on recent immigrants in northern communities. Moreover, while new research is emerging about the health disparities of Indigenous communities in remote and rural settings, there is very little research that brings the question of immigrant and Indigenous relations together.

To address this gap, this research program will determine factors that influence and support the well-being of recent immigrants in northern BC communities. The project will document, analyze, and provide much needed information about the unique social determinants of health for recent immigrants outside of large urban centres in southern Canada. I will engage recent Filipino immigrants using qualitative research methods and will establish and mobilize a community of experts and highly-trained practitioners to help provide a more nuanced, textured and richer picture of the health needs of northern BC.

Importantly, the research program will not only bring new awareness about the factors influencing health and well-being of Filipino immigrants, it will also explore these factors in relationship to health disparities and innovations of Indigenous northern communities. In sum, this is a project that puts Filipino and Indigenous communities in dialogue to address health disparities.

 

Disease-modifying Drug Safety and Effectiveness in Multiple Sclerosis [DRUMS]

British Columbia (BC) and Canada have some of the world's highest rates of multiple sclerosis (MS). The goal of this research is to find out how safe and effective the drugs used to treat MS are when used in the everyday, real world in BC and Canada.

To achieve these study goals, I have two main study Themes. The first Theme focuses on how effective the MS drugs are. I will examine whether the MS drugs can extend life expectancy or prolong a person's ability to stay mobile and walk. I will also look at whether the MS drugs have a beneficial effect on reducing the number of times a person with MS is admitted to a hospital or visits a physician. The second Theme focuses on side effects, including whether the MS drugs are associated with harmful effects, such as cancer, stroke or depression. I will be able to compare the different MS drugs to each other. Also, I will see if men and women or people of different ages and with other illnesses (such as having both MS and diabetes) respond to the MS drugs differently.

My research findings will help people with MS and their physicians when trying to make decisions as to which MS drug might be best for them. Ultimately, this study will benefit the >90,000 people living with MS in Canada.

A Lifespan Approach Towards Understanding the Importance of Movement Skills for Health-Enhancing Physical Activity Participation

Participation in regular physical activity is associated with reduced risks of cardiovascular disease, overweight/obesity, type 2 diabetes mellitus, numerous cancers, mental and reproductive health problems, and osteoporosis. Yet, only 9% of Canadian children and adolescents and 20% of Canadian adults meet physical activity guidelines. An essential component of being active involves having the skills needed to successfully participate in an activity. Skill development across time should be viewed in the context of how it leads to skillful performance and in terms of how movement skills support and maintain a lifetime of physical activity.

However, skill development across time is not well understood in relation to

  • how competent adults within the general population are at various movement skills and
  • how the association between movement skills and activity changes across the lifespan. To address this shortcoming, cohorts of 25 males and 25 females in 10-year increment age brackets between 5 and 75 years will be recruited for participation in this study (N = 350). Measures of motor skill competence, physical activity and enjoyment will be assessed.

Key outcomes will include:

  • movement skill development trajectories across the lifespan
  • determination of the strength of association between movement skills and health-enhancing physical activity across the lifespan and
  • determination of the mediating effect of enjoyment on physical activity participation

Investigating the impact of evolving cannabis access and use on high-risk drug use behaviours and addiction treatment

Cannabis remains the most widely produced, trafficked and consumed illicit drug worldwide, and at this time Canada and many other countries are implementing alternative regulatory approaches to cannabis. While research on cannabis has traditionally focused on the harms of cannabis use, an emerging body of evidence suggests that cannabis use can also alter high-risk drug practices, such as reducing cocaine use, opioid use and associated overdose. Much of this work suggests that cannabis is often used as a substitute for harder drugs of abuse which may have important implications for health policy responses to the current opioid epidemic in British Columbia.

However, this evidence has been primarily cross-sectional and ecological in nature, and lacking are rigorous longitudinal studies unpacking the precise impacts of cannabis use and evolving cannabis policy on the development of high-risk drug use behaviours. Further, the impacts of cannabis use on HIV and addiction treatment outcomes remains unclear. In light of the recent legalization of non-medical cannabis, identifying the impacts of cannabis on high-risk substance use and drug treatment outcomes will be important for informing clinical and public health practice, as well as policy.

Prevalence, patterns, and harms associated with the co-injection of illicit opioids and crystal methamphetamine

Crystal methamphetamine use is associated with a wide array of physical and social harms. In spite of this, its prevalence is rising in many parts of North America. Several small studies have suggested increasing rates of co-injection of methamphetamine and opioids, though no research has focused on the specific harms associated with this trend. In Vancouver, preliminary reports have noted a similar pattern, in a context where fentanyl has become the most widely used form of illicit opioid.

In this study we propose to use a prospective cohort of people who inject drugs to ask how trends in the co-injection of methamphetamine and opioids are changing over time, and to explore the health consequences associated with this pattern of substance use as it relates to overdose risk and response to treatment.

Answering these questions will provide insight into important changes in the evolving epidemiology of substance use, and will provide information on potential implications. An appreciation of these changing patterns is not only crucial in developing evidence-based harm reduction and treatment strategies, but also in understanding how to devote treatment resources appropriately in the fight to reduce opioid-related deaths.

Developing long-, short-, and near-term dynamic models of risk and resilience for intentional self-harm in BC youth

My research aims to answer two questions: when and under what circumstances do some young people intentionally physically harm themselves, and how can we improve our clinical tools to reduce these behaviours? Intentional self-harm is alarmingly prevalent in young British Columbians: around 5-7% of BC youth have attempted to end their own lives, 10-15% have experienced serious suicidal thoughts, and 15-18% have engaged in non-suicidal self-injury. These behaviours can have devastating impacts on youth, their families, and their communities. Providing care for suicidal youth is among the most stressful tasks that mental health professionals face, due in part to the difficulty of accurately predicting risk.

To address this important health problem, we need to improve knowledge of:

  1. signs of imminent, near-term risk of intentional self-harm, and
  2. dynamic processes of accumulating risk or resilience in vulnerable youth. My research uses linked provincial health records, prospective cohort studies, and smartphone and wearable technologies to study how risk and resilience for intentional self-harm evolve over hours, days, weeks, months, and years. The research will be used to create and improve decision-making and self-monitoring tools that youth, caregivers, and clinicians can use to reduce and prevent self-harm.

Adapting BC’s healthcare system for equitable and tailored service provision to sexual and gender minorities

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people face judgment and discrimination on the basis of their sexualities and genders. This leads many LGBTQ people to avoid seeking treatment from the healthcare system, to hide aspects of their sexuality/gender when seeking care, or to selectively visit LGBTQ-affirming providers.

The goal of this research program is to develop a comprehensive understanding of healthcare access patterns among LGBTQ people in BC.

Objectives:

  • To describe points of healthcare access for LGBTQ people ('where')
  • To explore LGBTQ people's reasons for avoidance, concealment, and provider selection when seeking healthcare ('why')
  • To characterize the ways in which service providers in BC ensure that their services are LGBTQ-affirming ('how')

Administrative health data, surveys, and interviews with providers and LGBTQ people will produce a detailed description of where, why, and how LGBTQ individuals navigate healthcare.

Collaborators include public health clinics, community organizations, and general practitioners. This research will provide recommendations to adapt BC's healthcare system so that LGBTQ people receive the services they need, when they need them.

Advancing nutritional hematology to reduce the burden of anemia and inform nutrition policy

Anemia is a condition in which there is a decrease or destruction of red blood cells causing inadequate transport of oxygen throughout the body. It is a major public health problem affecting ~25% of the global population, or ~9 million Canadians of all ages.

In infants and children, anemia can impair brain development and decrease learning ability. In adults, it can cause fatigue, lower work capacity and increase the risk of adverse pregnancy outcomes (e.g. low birthweight). Causes of anemia can include micronutrient deficiencies (e.g. iron or folic acid), infection and disease, and genetic hemoglobin disorders (e.g. thalassemia). Understanding the causes of anemia is critical to inform appropriate strategies to prevent and treat anemia, and to reduce the risk and burden of disease.

Dr. Karakochuk's research program will seek to improve diagnostic methods and investigate novel biomarkers for anemia and iron deficiency, and assess the risk-benefit of iron and folic acid supplementation programs designed to treat anemia and other chronic diseases. The ultimate goals are to reduce the burden of anemia and to inform safe and effective nutrition policy, programs and interventions for individuals and populations in Canada and globally.