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Psychosocial Epidemiology

Key to the development and successful implementation of many health interventions is the careful consideration of how social, psychological, and biological factors intersect to influence health and quality of life outcomes.

Program Head: Dr. Chris G. Richardson

CHÉOS clinicians and scientists have had considerable impact on the health and well-being of marginalized populations, particularly those in urban environments. Critical to the success of improving health outcomes for these populations is the careful consideration of the complex ways in which social factors interact with the psychological and biological determinants of health. This integrated approach enables our clinicians and scientists to focus their collective expertise on the development of interventions that can be adapted to accommodate the real-world complexity of many high-priority patient groups.

Populations of focus include youth and adults with mental health and substance use challenges, people of Indigenous heritage, homeless and precariously housed youth and adults, injection drug users, and other marginalized populations in Canada and abroad.

The following is a selection of our work in the aforementioned research areas:

Characterizing the Potential Transplant Tourist in Canada: A Survey on Transplant Tourism among Canadians with Kidney Disease

Despite the fact that travelling to another country to purchase an organ for transplantation is illegal, an increasing number of Canadians are using this method to secure kidney transplants. This practice, known as transplant tourism, is denounced by the WHO and has serious social and medical risks, including exploitation of the world’s poor and an increased chance of serious infections.

A team, including CHÉOS Scientists Drs. Jagbir Gill (PI), John Gill, Adeera Levin, Chris Richardson, and Patricia Spittal, is investigating the factors associated with the decision to consider engaging in transplant tourism, including how potential “tourists” understand the risks and benefits, and the perceived barriers to local donor transplantations. To gather this information, Dr. Gill and his team have surveyed over 500 British Columbians with kidney failure about their awareness, understanding, and intention to engage in transplant tourism as well as perceived barriers to accessing local donors. Little is known about this troubling practice and this research will help us understand both why it is becoming more popular and how we might improve access to local transplant donors.

The Cedar Project

The Cedar Project is a community-based research initiative that addresses hepatitis C and HIV vulnerabilities among young Aboriginal people who use illicit drugs in three cities in British Columbia. On a global scale, the historical trauma associated with the process of colonizing Indigenous people is commonly considered to be the explanation for the profound health disparities they experience all over the world. To our knowledge, The Cedar Project is the first Indigenous “at-risk” young people’s cohort in North America. Drs. Patricia Spittal and Martin Schechter are the co-principal investigators for this project.

Inner City Youth Program

The Inner City Youth Program treats homeless and vulnerably-housed youth and young adults aged 16 to 24 with undiagnosed or untreated mental illness and/or addiction. The Program aims to improve health outcomes for this vulnerable population by providing youth with access to health care, housing, education, employment counselling, vocational training, and support services. CHÉOS Scientist Dr. Steve Mathias and his team are an interdisciplinary group providing a comprehensive care experience. CHÉOS Scientist Dr. Chris Richardson is the program’s Research Lead.

Addictions and Concurrent Disorders Group

The Addictions and Concurrent Disorders Group at CHÉOS, led by Dr. Michael Krausz (pictured), the Providence Health Care/UBC B.C. Leadership Chair in Addiction Research, conducts research that investigates correlations between social determinants of health and childhood trauma, mental illness, and addiction. The catalytic relationship between early life trauma, substance use disorders, and other mental illnesses is explored through a number of research projects. Learn more at http://acdresearch.med.ubc.ca/.

Health and Housing in Transition Study (HHiT)

The Health and Housing in Transition Study (HHiT) is a longitudinal study assessing the health and housing status of homeless and vulnerably-housed single adults in Vancouver, Ottawa, and Toronto.

Dr. Anita Palepu, the lead investigator for the Vancouver site, and her fellow researchers, explored whether changes in housing status are associated with changes in mental and physical health, alcohol and drug use, social supports, and utilization of health care services.

Data collection was completed in February 2014 and the project has now transitioned to the analysis phase. Researchers hope to identify risk factors and community, interpersonal, and individual-level resources associated with the onset of homelessness among vulnerably-housed individuals, and the attainment of stable housing among homeless individuals. Additionally, they hope to determine the rate at which homeless individuals achieve residential stability and the rate at which vulnerably housed participants become homeless over a two-year follow-up.

At Home/Chez Soi

At Home/Chez Soi was a four-year, multi-city research project. It examined the effectiveness of a Housing First approach, combined with appropriate health care and supports, as a way to combat homelessness. The final report was released to the public in April 2014. Findings indicated that a Housing First strategy could effectively be implemented in various Canadian settings with a positive impact on those who are homeless and living with mental health issues. The research also demonstrated that Housing First is a cost-effective strategy, particularly for those who have frequent contact with health and social services.

CHÉOS Scientists Drs. Jim Frankish and Michael Krausz (along with Dr. Julian Somers) were co-principal investigators on the study, and CHÉOS Scientists Drs. Verena Strehlau and Anita Palepu were co-investigators. Each study site had a particular area of focus; the Vancouver site of At Home concentrated on people experiencing addiction and complex concurrent disorders.

Since 2013, Vancouver investigators have been conducting a naturalistic observational cohort study as a follow-up to At Home. They are monitoring participants’ mental and physical health, substance use patterns, and housing status as they transition from the study. They will also evaluate the current system’s capacity to support this population. Funding for this project comes from the Vancouver Coastal Health Research Institute and the Mental Health Commission of Canada.

B.C. Adolescent Substance Use Survey (BASUS)

The use of tobacco, alcohol, and marijuana by teenagers continues to pose a significant threat to the health and safety of many young Canadians. Recent national surveys indicate that 15 per cent of Canadian teens smoke tobacco; one-third of all teens have tried marijuana more than once, with about 8 per cent of teens reporting marijuana use of at least once a week. Just over 44 per cent of teens reported drinking 1 to 3 times per month, with an additional 17 per cent of teens aged 15 to 17 drinking 1 to 3 times a week or more.

Despite extensive prevention efforts, the use of these substances appears to be a normalized part of adolescence. The goal of the B.C. Adolescent Substance Use Survey (BASUS) was to investigate patterns in the progression of substance use, using an internet-based survey, in approximately 10,000 adolescents as they progress through the first 3 years of secondary school.

Researchers grouped adolescents into different trajectories of alcohol, tobacco, and marijuana use and then examined how the level and influence of known risk factors (e.g., sensation-seeking and peer substance use) change as adolescents enter and then progress through high school. The information gained from BASUS improved the researchers’ understanding of the determinants of individual differences in the development of alcohol, tobacco, and marijuana use. The findings were shared with health promotion experts and school district supervisors to inform local drug education and health promotion activities. Dr. Pamela Ratner and CHÉOS Scientist Dr. Chris Richardson were principal investigators.

You can read more about BASUS here.

Health research in the heart of Vancouver