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:
- signs of imminent, near-term risk of intentional self-harm, and
- 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.
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.
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.
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.
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:
- Examining individual, social and structural factors that influence SUD among GLBY through photovoice methods.
- Identifying challenges experienced by GLBY in accessing SUD-related care by gathering experiences through an online survey.
- 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.
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:
- Helping to inform targeted treatment strategies by identifying patients at the greatest risk of developing EHMs associated with HCV.
- 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.
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.
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:
- Which patterns of substance use contribute to poor adherence.
- How we can best address the factors that negatively impact this population.
- 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.
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.
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:
- What causes adolescents to develop depression during the transition to high school?
- 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.
