Health related quality of life following road trauma: An emergency department inception cohort study

Each year in Canada, road trauma causes over 2,000 deaths and 10,000 serious injuries. Disability after an injury is a major public health concern, but the long term health outcome after road trauma is poorly investigated and based mostly on older research that does not reflect modern vehicle safety features or modern medical treatment. In addition, there is almost no research that helps health care providers know which patients are most likely to have a bad outcome following a crash, making it difficult to provide them with the care they require. For policy makers, it is important to know the health care costs and lost productivity that results from road trauma, but this information has not been studied. My study will provide this missing information.

My team will interview patients who visit an emergency department after a traffic crash, including pedestrians, cyclists, and motorists. We will ask about their general health before the crash, the injuries they had from the crash, and other details of the crash. Repeat interviews at 2, 4, 6, and 12 months will ask about problems they had since the crash, including pain, ability to go about their usual activities, and return to work. We will also ask about the medical care they required after the crash.

This study will help doctors and nurses know how quickly people recover from their injuries after a crash and which patients are likely to have long term health problems. It will also describe the medical treatment that these patients require and how much work they miss. This information will give a better estimate of the true cost of road trauma, and may help policy makers decide how much funding to devote to crash prevention programs or to treatment programs for crash victims.

Identifying prodromal signs of multiple sclerosis: a multi-centre approach

Multiple sclerosis (MS) is a neurodegenerative disease for which there is no known cure. It is among the most common causes of neurological disability in young adults in the Western world and affects approximately 2.3 million people worldwide, including an estimated 75,000 Canadians. The symptoms of MS and related morbidity have a major impact on quality of life: weakness, fatigue, disability and depression can all influence social, family and work life.

Some intriguing preliminary findings from one study based in Manitoba indicated that people with MS had more medical consultations than people without MS, even throughout the five-year period prior to MS onset. This implies that the disease already starts to develop long before the currently recognized clinical onset of MS. However, these findings have yet to be replicated and it remains unknown as to what the reason(s) were behind the measurable increases in medical consultations.

The aim of this project is to search for early signs and symptoms that could facilitate more timely recognition of MS and to narrow down the relevant time window when searching for factors triggering MS.

I will examine databases of medical records from people with MS in British Columbia, Saskatchewan, Manitoba and Nova Scotia. I will explore their physician and hospital visits before MS onset and before MS diagnosis, and I will compare this data to medical information from the general population. I will also examine the reason(s) for the physician and hospital visits.

I hypothesize that among people who go on to develop MS, I will identify specific associated “disorders” that drive the elevated health service utilization before MS onset.

I will help the research team share the findings directly with BC provincial decision makers via one-on-one meetings and presentations. Connections with patient advocate groups will enable me to also raise awareness of the results among people with MS.

Ultimately, the results of this study could contribute towards an earlier recognition of MS.

Understanding health equity and resource development (UnHEARD): New tools for assessing the health equity implications of unconventional natural gas development on rural and remote communities in northern British Columbia

Resource extraction and development activities are the primary drivers of social and economic development for communities across northern Canada, and therefore are significant determinants of community well-being. However, there is growing global recognition that the benefits of resource development are not distributed evenly across the supply chain, and that new tools are required to understand how anthropogenic changes in the natural environment affect population health.

This study uses the case of unconventional natural gas development in northern BC’s rural and remote communities to enhance the scientific understanding between resource development pathways and human health. BC is currently preparing for the rapid development of its natural gas reserves in conjunction with other diverse forms of land use and development (e.g. forestry, mining, industrial agriculture, etc.). However, the health impacts of rapid industrial growth are not well understood, and differences will be abound between gas extracting regions in the northeast of the province, gas transportation corridors through the northern interior, and gas exporting communities on the northwest coast.

In seeking to contextualize health impacts associated with resource development across the supply chain, this research will work to develop a new health equity impact assessment tool that is rooted in international best practices to explicate the intersections between ecosystems, the boom and bust cycle of resource-dependent towns and regions, and the resulting impacts on human health which are often overlooked in existing provincial environmental assessment and cumulative effects assessment protocols. Indeed, an explicit focus on health equity is a purposeful way to understand how health impacts are distributed across time and geographic space related to rapid resource development, thereby giving voice to health issues that often go UnHEARD during project permitting and planning. This work will involve the integration of a variety of data types to track changes in the distribution of health outcomes over time, and enable the identification of programs and protocols capable of mitigating associated health risks. Accordingly, this research will inform provincial regulatory processes through an expanded understanding of environmental disturbance as a context for health promotion, while assisting regional stakeholders in minimizing harmful impacts of industrial activities on community and worker health.

The Effect of Psychosocial Stressors on Health Behaviours and Indicators of Cardiometabolic Risk in the Transition to Young Adulthood

Adolescence and young adulthood are critical periods for health promotion and disease prevention. Cardiometabolic risk (CMR) refers to a set of indicators that increase an individual’s risk for diabetes, heart disease or stroke. These indicators start to show predictive variability in adolescence and identification and implementation of early strategies for risk management can have significant long-term health benefits. Much of what we know about CMR comes from studies of adults; therefore, research focusing on earlier age groups is needed.

The first objective of the proposed research is to describe the frequencies of select, non-invasive CMR indicators, including body mass index (BMI), systolic and diastolic blood pressure (BP), and waist circumference in young adulthood (ages 22-29). Research in psychoneuroimmunology documents the deleterious effects of stress on physical health; however, less attention has been given to adolescents and young adults.

The second objective is to examine how psychosocial stressors that become salient in adolescence (e.g. internalizing symptoms and interpersonal stress) predict CMR.

The third objective is to examine how these stressors compromise the enactment of key health behaviours (e.g. physical activity, eating habits, sleep duration) leading to increased CMR.

The project will use six waves of the Victoria Healthy Youth Survey (V-HYS), a 10-year longitudinal study that surveyed youth (N = 662) biannually from 2003 (T1; ages 12-18) to 2014 (T6; ages 22-29). In-person measurements of CMR (BMI, systolic and diastolic BP, waist circumference) were collected at T6. Measurements of internalizing symptoms, interpersonal stress (e.g. peer victimization), and health behaviours were collected at each wave.

Findings will highlight the variability in CMR in young adulthood and increase knowledge on the effects of two salient stressors on CMR from adolescence to young adulthood, providing new information about targets for prevention and interventions. The results will also inform guidelines for early identification and preventative healthcare.

Knowledge translation efforts will include 1) peer-reviewed publications, conference presentations, media reports, and policy formats; 2) creating an infographic about CMR in young adulthood to release to the media; and 3) developing a training tool to educate healthcare professionals about the relations between stress and CMR in these young age groups.

‘APP’lying Supportive Movement: Trauma-Informed and Culturally Safe Physical Activity Programming for Young Pregnant and Parenting Women Marginalized by Poverty, Racism, and Trauma

Physical activity has been found to have numerous physical, emotional and psychological benefits, particularly for young pregnant/lone parenting women (YP/LP). Unfortunately, physical activity declines through adolescence, and women who are marginalized by poverty and racism have lower levels of leisure time. There is a lack of research on physical activity for YP/LP women who are marginalized by poverty, racism, and/or trauma, thus little is known about the barriers and facilitators for physical activity for this population. Physical activity is especially important for these women because they have a greater risk for obesity, anxiety, depression, low self-esteem, and PTSD.

My proposed mixed methods participatory research will focus on physical activity with YP/LP women who are marginalized by poverty, racism, and trauma – arguably some of the most marginalized women in Canada. My research has the following objectives:

  1. Assess current health and physical activity behaviours engaged in by YP/LP women.
  2. Understand the perceived barriers and benefits of physical activity for these women and establish strategies to support YP/LP in a culturally safe and trauma-informed manner.
  3. Assess if existing quality of life measures are relevant for this population and determine if there is a correlation between quality of live and physical activity levels for these women.
  4. Translate the knowledge gained to create a technologically-enabled approach to support/improve YP/LP well-being. 

This research will take place with partnering organizations on Vancouver's Downtown Eastside that serve pregnant and parenting women. I will work with participants to create and implement a technology-enabled health intervention that is culturally safe, age relevant, trauma-informed, and cost effective.

Understanding the evolution of expectant and new parents’ beliefs and behaviours about pediatric vaccination in British Columbia

Vaccines are the most effective way to prevent many communicable diseases, yet immunization rates in British Columbia are below the level required to mitigate outbreaks of infectious diseases. This can be partly explained by some parents’ doubts and concerns about pediatric vaccinations, termed “vaccine hesitancy”.

Numerous interventions have tried to address these concerns by focusing on communication between physicians and parents when their child is already several months old. Yet there is evidence that some parents make decisions about their child's vaccinations even before the first mention of vaccines in doctors’ offices or public health clinics; this makes the pre-natal period a potentially underutilized opportunity for initiating vaccination communication. Parents’ beliefs may also change over time in response to new information or conversations within their social networks.

As mothers are the primary decision-makers about vaccination, understanding maternal beliefs about pediatric vaccination is essential to ensure effective messaging and service delivery. It is also crucial to understand the beliefs and preferences of fathers and other co-parents, given the important role they play in shaping vaccination decisions.

Few studies to date explore how parents’ vaccination beliefs shift over time, particularly how parents’ beliefs before the baby is born continue to evolve during the first few months of their child’s life, and none to our knowledge in regions of BC where immunization rates are well below the Canadian average. Parental attitudes on southern Vancouver Island reflect specific local vaccination cultures and thus, may vary significantly from those on the mainland.

This longitudinal qualitative study explores decision-making processes about vaccinations among expectant and new parents in Victoria, BC by conducting four interviews with each mother, and two interviews with fathers or other co-parents, from the third trimester until just after the child’s first birthday. Analysis will focus on identifying points of leverage that may inform future interventions, providing data on the optimal time and method to engage parents.

Knowledge translation is integrated into the study design through collaborations with Island Health. Findings from this study will be presented for discussion in workshops with key stakeholder groups, disseminated through publications and conference presentations, as well as via a short radio piece.


Transforming Urban Form for Mobility: Interventions to improve population health

Governments are making major investments in transit, cycling, and walking infrastructure to alleviate the pressures of traffic congestion and emissions. These changes may have lasting impacts on population health.

The aim of this five-year program is to generate new evidence on the impact of population health interventions on health and health equity along two lines: 

  1. "Population Health Intervention Research" will generate new knowledge on the impact of population-level interventions on mobility.
  2. "Methods and Tools for Intersectoral Action" will develop and apply novel methods and tools to study urban form, and to facilitate uptake by intersectoral stakeholders.

This work aims to generate new, locally-relevant evidence in order to understand how to enhance health and mobility in mid-size cities and suburbs. While these settings are very common in Canada, they are surprisingly absent from the literature.

The program will assess how changes to urban form, such as new cycling networks or education programs, influence how people choose to travel, and how safety-conscious and active they are. This will be studied in the population overall, and also specifically with groups facing greater mobility challenges (e.g. women, new immigrants, older adults). The work will focus on how an investment in a city-wide cycling network for people of all ages and abilities impacts uptake, safety and equity.

Habitual Physical Activity as Stress Resiliency in Populations Experiencing High Adversity

In light of extensive research linking stress and disease, and the high rates of reported stress in Canadians, there is a need to identify what people can do to protect their health from the ill effects of stress.

My work to date demonstrates that highly stressed and active individuals have significantly healthier biological and psychological stress responses than those who are highly stressed and inactive. This model suggests that physical activity could be helping to protect active individuals against the disease-promoting influences of stress.

This program seeks to clarify whether this is a cause-and-effect relationship. Is the better health of active individuals merely a result of traits that also cause them to remain active when under stress? Or can highly stressed, inactive people also gain these health advantages through interventions that increase their physical activity levels?

Goals of this program include:

  1. Discovering whether increasing habitual physical activity levels in highly stressed and inactive adults reduces the impact of stress on pathways to physical disease.
  2. Developing novel targets for evidence-based intervention programs tailored to individuals with high levels of life stress

Collaboration with researchers, stakeholders in high-risk populations, and policy makers will support the design of interventions that target biological and psychological stress-reactive pathways years before disease appears.

By focusing on health promotion in high-adversity communities, the ultimate goal is to improve quality of life and to reduce the economic burden on our health care system.

A comparative and cross-jurisdictional research program on work and health

This project seeks to improve our means of developing social, economic, and workplace policies that improve worker health and reduce worker health inequalities. It builds on existing stakeholder collaborations and is structured around a series of comparative and cross-jurisdictional studies on occupational health and safety and workers’ compensation.

The broad aim of this research program is to expand current comparative research in order to develop an enduring policy and practice network that creates research and data infrastructure and a knowledge exchange and mobilization node that will support improved practices.

This program builds and extends data and research partnerships among researchers, compensation boards, and insurers from Canadian provinces, Australian states and New Zealand.

It has five objectives:

  1. Build and expand the network of compensation boards, researchers and other stakeholders to create a forum and group that can identify, guide and inform the focus of the cross jurisdictional policy comparisons.
  2. Expand the current comparative cross-provincial dataset on workers’ compensation to include all Canadian compensation boards’ data and a broader set of comparable variables.
  3. Work with international partners to create a more limited set of comparable data that would permit comparisons between different countries.
  4. Conduct policy-relevant, hypothesis-driven research with the comparative data to examine differences in and the effectiveness of different approaches to improving work disability outcomes.
  5. Utilize the policy and researcher network to effectively translate the results into policy and practice.

The vision of this research program is to advance our understanding of work-related disability and facilitate the translation of results into policy and practice.

Exploring the mediating effect of parenting practices on the relationship between the neighbourhood environment and child physical activity

The neighbourhood environment has been found to affect the levels of physical activity among children. We are investigating the mediating effect of parenting practices on this relationship.

For example, some studies have found that children living in neighbourhoods that are more walkable or have more green space were more likely to be physically active. This may be related to parenting practices. For example, parents may restrict their children from playing outdoors if they feel that their neighbourhood is unsafe but may encourage outdoor play if they live near a park.

This study will address this gap by using survey data collected from two sample populations. First, data collected from a web-based survey of 500 parents across Canada and the USA will be used to describe the relationship between the neighbourhood environment (e.g. safety, crime, walkability) and physical activity parenting practices.

Second, one child from each of 88 living in Metro Vancouver will be provided with an accelerometer to record their physical activity patterns. Their parents will complete a questionnaire measuring their perception of the environment and the parenting practices they employ.

The goal of the project is to better understand how the environment can influence parenting practices, enabling recommendations on designing neighbourhoods to allow children to be more physically active.