Promoting Mental Health and Addressing Substance Use in Canadian Youth through Collaborative Research and Intervention

Mental health and substance use (MHSU) challenges are leading health issues facing youth globally. In Canada, 20% of the youth population experiences mental health disorders, and youth aged 15-24 have the highest rates of past year substance use and related harms. To address these concerns, MHSU researchers and advocates argue for a population health approach incorporating promotion, prevention, and treatment within a 'healthy public policy' framework. Yet while much research has focused on the prevention and treatment of youths' MHSU challenges, there has been limited focus on mental health promotion.

Further, while there is growing recognition of the importance of engaging youth in matters that affect their lives, there is a paucity of evidence-based guidance on how to do this effectively. This study contributes to addressing these substantial gaps by exploring how to meaningfully engage youth in the policymaking process to promote MHSU outcomes. Participatory approaches and mixed methods are being used to generate knowledge and inform a framework to guide youth-engaged research and action to better tackle the MHSU needs of Canadian youth.

Improving substance use care for gay, lesbian and bisexual youth in British Columbia

Gay, lesbian, and bisexual youth (GLBY) are at increased risk of experiencing substance use disorders (SUD) in comparison to their heterosexual counterparts. The aim of Dr. Ferlatte’s research is to identify the factors associated with SUD experienced by GLBY to inform interventions.

This will include:

  1. Examining individual, social and structural factors that influence SUD among GLBY through photovoice methods.
  2. Identifying challenges experienced by GLBY in accessing SUD-related care by gathering experiences through an online survey.
  3. Identifying how a coordinated set of interventions and policies could best be adapted to address SUD among GLBY through two world cafés, where GLBY and other stakeholders (e.g., intervention decision makers) will be invited to identify solutions to this issue.

The findings of this research will be shared through presentations, articles, and photovoice exhibitions to inform policy and programming decision-making that improves SUD care for GLBY.

Population-level impact of hepatitis C virus (HCV) direct-acting antiviral therapies on extrahepatic manifestations

Hepatitis C virus is an important public health concern in Canada; however, there is limited information concerning the impact of new direct-acting antiviral therapies on manifestations outside the liver (extrahepatic manifestations, or EHMs), including chronic diseases, cancers, and health-care resource utilization in Canada.

This knowledge is important, as new HCV treatments are generally restricted to those with advanced liver disease and there are no estimates of the reductions in EHMs that can be achieved with expansion of therapy.

Using data from an administrative-linked population-based cohort in BC, Dr. Rossi will assess the impact that HCV treatments have on EHMs and associated health-care utilization.

Results from this study could lead to improved clinical and population health practices in BC by:

  1. Helping to inform targeted treatment strategies by identifying patients at the greatest risk of developing EHMs associated with HCV.
  2. Identifying areas where additional allocation of resources will be necessary to manage chronic comorbidities associated with aging.

This study will also provide a better understanding of the challenges and limitations associated with using administrative data for population health research.

3, 2, 1… Might one dose of HPV vaccine be enough to prevent HPV-associated cancer?

Human papillomavirus (HPV) infection is a prerequisite for the development of cervical cancer. Screening for cervical cancer after HPV infection is possible by cervical smear testing, and since 2006 direct prevention of HPV infection has been available in the form of three different vaccines.

These vaccines need two or three doses, and protect against the most common types of cancer-causing HPV. Unfortunately, at this moment globally, women at the highest risk for cervical cancer are not reached by any of these prevention measures. Barriers to vaccine implementation and achieving higher uptake include high costs and lack of the infrastructure required for administering multiple vaccine doses.

Some studies have suggested sufficient and sustained protection against HPV infections occurs after just one dose of the vaccine. Evaluation of one dose of the HPV vaccine is complicated, since it is unknown how and at what level immune responses guarantee protection against infections.

With this study, Dr. Donken aims to measure the effectiveness of single dose vaccination in a real-world setting and to explore whether antibodies are boosted after exposure to HPV in vaccinated women, potentially reducing barriers to vaccine implementation and improving vaccine uptake among those at a high risk for cervical cancer.

Optimizing PrEP and TasP adherence among substance using gay, bisexual, and other men who have sex with men

While increased access to HIV treatment and other health services has contributed to significant declines in HIV among several key populations in British Columbia (BC), it is estimated that as many as 1 in 6 gay, bisexual, and other men who have sex with men (gbMSM) will be diagnosed with HIV in their lifetime.

To address this health equity concern, BC recently expanded access to a once-a-day pill, called pre-exposure prophylaxis (PrEP), that can prevent HIV acquisition. However, gbMSM who use drugs report reduced adherence to PrEP, as well as to other antiretroviral therapies (ART) that could prevent transmission—thus reducing the overall efficacy of these policy-driven interventions.

Recognizing the diverse experiences of substance-using gbMSM, Dr. Card, along with an interdisciplinary team at the Community Based Research Centre for Gay Men’s Health, will leverage data from the Sex Now Survey to improve our understanding of:

  1. Which patterns of substance use contribute to poor adherence.
  2. How we can best address the factors that negatively impact this population.
  3. What obstacles might limit successful intervention among this population (e.g., feasibility and acceptability).

Working with community members and front-line service providers, Dr. Card will also participate in community consultations to develop an empirically-valid and community-based intervention that will improve adherence among gbMSM who use drugs.

Studying the role of modifiable risk factors: Nutrition and body weight for the prevention of cancer

Nearly half of Canadians will be diagnosed with cancer during their life. Healthy eating, a healthy body weight, and regular physical activity can prevent one-third of cancers. Yet, many Canadians do not engage in these lifestyle behaviours. New approaches to improve diet-cancer research are needed to move the field forward and reduce the burden of cancer on Canadians.

Dr. Murphy's research focuses on modifiable risk factors for cancer; nutrition and body weight. The goal is to provide new insight on how and why these factors contribute to cancer development using data from large populations of Canadians and innovative approaches such as lifestyle biomarkers that may explain why factors lead to cancer development.

Advances in cancer prevention are needed to promote the health of people in BC and nationwide. This research will provide new insight into modifiable factors for cancer that may help encourage lifestyle changes and development of new strategies to prevent cancer.

Predicting depressive symptoms during the transition to high school

The transition to high school is a challenging developmental period, during which prevalence rates of depression more than double. In fact, by the end of the first year of high school, 11.5% of adolescents will have experienced a depressive episode in the last year, and many more adolescents will have experienced elevated depressive symptoms that interfere with school performance, social friendships, or physical health. Despite the importance of this transition, little is known about predictors of depression during it, and most students report feeling insufficiently supported to cope with it. Thus, the proposed research will work towards answering two questions critical to Canadian youth:

  1. What causes adolescents to develop depression during the transition to high school?
  2. What can we do to help students better cope with this transition and to mitigate risk for depression during it?

Findings will be critical to improving students' emotional health during the high-school transition. Knowledge translation activities will inform future research, practice, and policy.

A program of research on criminalization of sexuality, HIV and incarceration among marginalized women

Marginalized women (trans inclusive) living with and affected by HIV are disproportionately criminalized. This research will establish an empirical evidence base that documents the lived-experiences of criminalization and incarceration among sex workers and women living with HIV. The ultimate goal is to inform evidence-based law reform and interventions to redress over criminalization and negative effects of incarceration.

The objectives of this research program are to:

  1. Document how evolving laws and policy frameworks governing sexuality (criminalization of sex work; criminalization of HIV non-disclosure) impact HIV care trajectories, sexual health and social inequities among sex workers and women living with HIV.
  2. Describe and monitor the impacts of incarceration on HIV care trajectories and social outcomes among women living with HIV.
  3. Identify and pilot novel structural and community-based interventions to mitigate the impact of incarceration on HIV care trajectories and social outcomes among women living with HIV.
  4. Develop a research and training platform for innovative community-based participatory research approaches to inform program and policy interventions.

A causal inference framework for analyzing large administrative healthcare databases with a focus on multiple sclerosis

Provincial health authorities routinely collect patient information on a massive scale, but health researchers face the challenge of exploring cause-and-effect relationships using these non-randomized population-based data sources. Machine learning methods are increasingly used to analyze these large datasets, although they do not inherently take causal structures (i.e., how the variables affect each other) into consideration and may lead to less-than-optimal or even erroneous conclusions.

Health researchers urgently need new big-data analytic methods that are geared towards extracting causal explanations rather than merely increasing prediction accuracy. This project will develop innovative biostatistical methodologies that will better equip health researchers to infer causation from big-data sources.

As a motivating problem, with a bias reduction goal in mind, Dr. Karim will investigate potential benefits of disease-modifying drugs in multiple sclerosis patients 50 years of age or older. Ultimately, this methodological development will enable health researchers to convert information into actionable knowledge for other common, chronic conditions, leading to cost-effective medical decision making and improving the health of Canadians. 

Mental health trajectories of immigrant and refugee children: An ecological population-based approach

Canada's immigrant and refugee population is growing rapidly, representing over 20% of the population. Despite the significance for Canadian society, little is known about mental health and risk factors among immigrant and refugee children and youth. Such knowledge is, however, critical to understand how we can support them in adapting to Canada, and enhance their well-being. This project aims to create actionable evidence that health professionals, educators, and decision-makers can use to implement initiatives that can support the mental health of immigrant and refugee children and youth.

This research will:

  1. Use statistical analyses of multiple databases, linked at a population-level across 10 school districts of BC, to examine how child, family, school, and community factors relate to immigrant and refugee children's mental health outcomes, and how these children and youth are using health services in BC.
  2. Ask immigrant and refugee youth about their perspectives on factors related to their mental health and access/barriers to mental health services, via interview focus groups in school and mental health clinic settings.

This is the first study in BC to combine province-wide data with children's own perspectives to identify which factors may need to be addressed and what future prevention and intervention efforts are needed to support long-term health outcomes for immigrant/refugee children and youth in Canada.