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:
- Identify how women’s overdose risk is shaped by evolving individual, social, structural, and environmental factors;
- Investigate factors that create barriers to (or that facilitate) women’s engagement with existing, novel and emerging overdose prevention interventions; and
- 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.
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.
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.
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.
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.
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.
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.
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
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.
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.
