Health Sciences - Theses, Dissertations, and other Required Graduate Degree Essays

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An exploratory study on how structural racism influences chronic disease and health and wellness of First Nations in Canada

Author: 
File(s): 
Date created: 
2022-03-10
Supervisor(s): 
Jeff Reading
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) Ph.D.
Abstract: 

Background: Indigenous peoples in Canada experience disproportionately higher rates of chronic disease than their non-Indigenous counterparts. Previous research has identified structural racism as a powerful determinant of health and well-being. Mounting evidence demonstrates First Nations are disproportionately overrepresented, compared to other Canadians, in several domains that have been used to measure structural racism in other countries. Despite growing concern of the impact of structural racism on health, there remains little empirical evidence on the impact structural racism has on chronic disease health outcomes of First Nations. Purpose: The purpose of this study is to examine the complex and intersecting ways in which structural racism can influence chronic disease health outcomes and overall health and wellness of First Nations in Canada. Methods: In-depth semi-structured interviews were conducted with twenty-five participants including subject matter experts in health, justice, education, child welfare, politics, and researchers in racism scholarship and First Nations who have lived experience with a chronic condition(s). Thematic analysis was used to analyze data collected. Results: The findings highlight the ways in which structural racism is pervasive across all domains within Canadian society. Six themes emerged on how structural racism influences chronic disease and the health of First Nations: (1) multiple and intersecting pathways; (2) systems of failure, harm, and indifference; (3) impacts access to healthcare; (4) colonial policies of structural deprivation; (5) increases risk factors for chronic disease and poor health; and (6) structural burden leading to individual level outcomes. To address structural racism, five themes emerged: (1) accountability and consequences; (2) Indigenous authority and representation; (3) anti-racism praxis; (4) education and training; and (5) legislative and policy reform. Approaches to measure progress towards addressing structural racism and types of measures were identified. Potential indicators that could be used to measure experiences of structural racism affecting First Nations are presented. Conclusions: Structural racism creates an ecosystem that negatively impacts chronic disease and health of First Nations. This study identifies Indigenous-specific approaches to addressing and measuring structural racism in Canada. Future research into the development of evidence-based interventions and testing the reliability and validity of structural racism indicators is required.

Document type: 
Thesis

Addiction/substance use, stigma, treatment and recovery: Impacts, access and barriers for families in British Columbia

Author: 
File(s): 
Date created: 
2022-04-08
Supervisor(s): 
Maya Gislason
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.
Abstract: 

This thesis explores experiences of addiction/substance-use, stigma, and addictionstreatment/recovery of families across social locations in British Columbia (BC); illuminating how their experiences reflect Bruce K. Alexander’s theory of addiction. Our current addiction-related systemic responses problematically reflect settler-colonial, patriarchal, neoliberal, free-market capitalist, and globalized systems ideologies and values. Indeed, public/private tiered service delivery in BC provides access to treatment according to social locations instead of need. This method of service delivery entrenches stereotypical notions of the ‘addict’ by shielding those with the privilege of privacy, but ultimately fails many families seeking treatment for addiction in different ways according to social locations. Especially worrisome are systemic barriers for families that perpetuate conditions for both relapse and intergenerational trauma to occur. The aims of this qualitative study are to contribute to a growing body of work that argues for the dismantling of oppressive and exclusionary systems of treatment and argues for the advancement of socially-just and family-accessible responses to addiction in BC.

Document type: 
Thesis

The association among maternal early life stress, prenatal stress, and offspring epistress scores

Author: 
File(s): 
Date created: 
2021-10-21
Supervisor(s): 
Nadine Provençal
Frank Lee
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.
Abstract: 

Maternal stress (early life stress (ELS) and prenatal stress (PNS)) influence offspring development via the biological embedding of stress. Maternal physiological stress system activation can be inherited by offspring in utero. However, the associations among maternal stress and offspring epigenetic profiles are unclear. This project aims to determine if PNS mediates the association between maternal ELS and offspring DNA methylation (EpiStress scores). A secondary analysis of data from expectant and new mothers (n=129) and their offspring was conducted. Age at sample collection and cell type proportions were highly correlated with offspring EpiStress scores leading to a stratified mediation analysis. Results indicate PNS was not a mediating factor between maternal ELS and offspring EpiStress scores. Maternal ELS negatively predicted newborn- and not infant EpiStress scores. This suggests that the biological embedding of stress from a mother to her newborn is specific to maternal ELS, not prenatal stress.

Document type: 
Thesis

Using latent profile analysis to examine associations between gestational chemical mixtures and child neurodevelopment

Author: 
File(s): 
Date created: 
2021-08-03
Supervisor(s): 
Lawrence McCandless
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.
Abstract: 

In this study, we introduced Latent Profile Analysis (LPA) as a novel technique for studying gestational chemical mixtures. Using data from the Maternal-Infant Research on Environmental Chemicals Study, a longitudinal birth cohort study of pregnant Canadian women and their children, we examined the relationship between 30 gestational biomarkers and Verbal IQ, Performance IQ, and Full-Scale IQ. We generated five latent profiles: A Reference profile, a High Level profile, a Low Level profile, a High Organophosphate Pesticides profile, and a Smoking Chemicals profile. Multiple regression analysis showed strong negative associations between the Smoking Chemicals profile and IQ scores. We also found positive associations between the Low Level profile and IQ, and a negative association between the High Level profile and Verbal IQ. However, all 95% confidence intervals spanned the null. After conducting sensitivity analysis comparing LPA with k-means clustering, we concluded that LPA is a promising alternative to other clustering methods.

Document type: 
Thesis

Causal mediation analysis with a partially missing mediator: exploring the effect of portable air purifier use during pregnancy on infant birth weight

Author: 
File(s): 
Date created: 
2021-08-26
Supervisor(s): 
Lawrence McCandless
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.
Abstract: 

Mediation analysis examines the exposure-outcome association that acts through an intermediate variable. However, mediation analysis becomes challenging when data have missing values. Although methods exist to deal with missing data and mediation analysis independently, few studies have examined how to combine the approaches, specifically, how to pool the mediation analysis results across a series of imputed datasets and compute confidence intervals for target parameters. We propose a new technique that combines multiple imputation with maximum likelihood estimation. Using computer simulations, we compare the performance of our proposed approach with a traditional bootstrap approach. Our method performs well and is more computationally efficient than other resampling methods. We apply the new method to randomized trial data on the role of cadmium exposure in mediating the effects of an environmental health intervention on birth weight.

Document type: 
Thesis

Immigration, sex/gender, and patterns of access to primary care in Canada

File(s): 
Date created: 
2021-04-19
Supervisor(s): 
Ruth Lavergne
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.
Abstract: 

Background: Primary care provides entry to the Canadian health care system, subsequent coordination, and integration of all levels of care. People who have immigrated to Canada may experience difficulties accessing primary care, but gaps in conceptualization and operationalization of “access” has resulted in conflicting results and uncertain policy implications. How the interaction of immigration and sex/gender impacts patterns of access to primary care has also been understudied. Objectives: The study examines how patterns of access to primary care differ between immigration groups and how sex/gender and immigration interact to shape patterns of access. Methods: I used 2015-2018 Canadian Community Health Survey Data to describe patterns of access to primary care among adult residents of Canada (age 18+), categorizing variables related to primary care access by stages of the Levesque framework including perception and desire for care, healthcare seeking, reaching and utilization. I compared patterns of access between recent immigrants (people in Canada for less than 10 years, including both temporary migrants and permanent immigrants), long-term immigrants (in Canada 10+ years), and non-immigrants (people who were born in Canada). I used logistic regression models to calculate adjusted and unadjusted odds estimates for each variable related to primary care, and to explore interaction effects of sex/gender and immigration. Results: Patterns of access among recent immigrants significantly differed from long-term and non-immigrants with respect to perception and desire for care, seeking and utilization. Similar patterns were observed between long-term and non-immigrants except at the utilization stage. Interaction effects of gender and immigration were more pronounced in earlier stages of health care seeking but not reaching nor utilization. Conclusion: The Lévesque framework of health services use was important in highlighting differences among immigration groups along the whole process of obtaining care. Interventions focused on improving approachability and acceptability of services and addressing gendered barriers, especially among recent male immigrants, are important to improve access to primary care.

Document type: 
Thesis

Priority setting for the overdose crisis: Challenges and opportunities for peer engagement in British Columbia

Author: 
File(s): 
Date created: 
2020-08-25
Supervisor(s): 
Kanna Hayashi
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Project) M.P.H.
Abstract: 

In recent years, decision-makers in BC have engaged people who use(d) drugs (PWUD) and the general public for their input on strategic directions regarding the overdose crisis. Given the oft-politicized nature of substance use, it is important for the response to centre around people with lived experience and to be grounded by the best available evidence. By engaging PWUD or “peers” as essential partners, the resulting policies and services may better reflect the community’s needs. Meaningful engagement can be challenging due to stigma and a multitude of systemic barriers. Special considerations must be taken to ensure participatory processes are inclusive and ethical. BC’s worsening overdose crisis demands that we reevaluate our drug policies and spending priorities across health and other social sectors. PWUD have identified several key priority areas, including expansion of harm reduction, controlled pharmaceutical prescribing, and drug decriminalization, some of which have ignited considerable debate among stakeholders.

Document type: 
Graduating extended essay / Research project

Increased risk of severe infections and mortality in patients with newly diagnosed systemic lupus erythematosus: A population-based study

Author: 
File(s): 
Date created: 
2021-01-25
Supervisor(s): 
Hui Xie
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) M.Sc.
Abstract: 

Systemic lupus erythematosus (SLE) is a chronic disease with a broad spectrum of clinical manifestations and infections are a leading cause of morbidity and premature mortality in patients with SLE. Findings from previous studies may be limited because of small sample sizes and using prevalent cohorts. To evaluate the risk of severe infection and infection-related mortality among patients with newly diagnosed SLE. We conducted an age- and gender- matched cohort study of all patients with incident SLE using administrative health data from British Columbia, Canada. Primary outcome was the first severe infection after SLE onset. Secondary outcomes were total number of severe infections and infection-related mortality. Multivariable Cox proportional hazard and Poisson models were used to evaluate the association of SLE with the outcomes, adjusting for confounders. The findings suggest SLE is associated with increased risks of first severe infection, a greater total number of severe infections and infection-related mortality.

Document type: 
Thesis

Patterns of health service use among people experiencing homelessness and mental illness in British Columbia

Author: 
File(s): 
Date created: 
2021-04-16
Supervisor(s): 
Julian Somers
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) Ph.D.
Abstract: 

Background: The burden of illness faced by people experiencing both homelessness and mental illness is staggering. When the needs of this population go unmet, it is often the healthcare system that is criticized. The aim of this thesis was to examine patterns of medical service use among people experiencing homelessness and mental illness, and to identify factors associated with high-levels of use, health outcomes and opportunities for intervention. It was hypothesized that people with the highest objective needs would access more medical services and that those who access care in a timely and continuous fashion would have better outcomes, including lower risk of hospitalization. Methods: Data were drawn from both the baseline interviews of Vancouver At Home (VAH) study participants and the Inter-Ministry Research Initiative database. All analyses were retrospective using both self-report and administrative data to examine factors associated with low vs. high health service use, continuity of care following hospitalization, and timeliness of community-based medical service use following detention in provincial custody. Results: Among VAH participants, we found that those with lower assessed need were accessing more health services that those with higher needs (i.e., schizophrenia). When continuity of care was examined, we found that our sample was accessing community-based outpatient services in both a timely and ongoing manner, however, it was not conferring a protective benefit against rehospitalization. Finally, when studying the impact of timely community medical service use following release from provincial custody, we found that those who accessed services in both a timely and continuous manner were more likely to be hospitalized than those not using services in this manner. Discussion: These findings highlighted the overwhelming burden of illness among people experiencing homelessness and mental illness. Contrary to our hypotheses, those with the greatest needs were not accessing the most health services, and for those who did access services frequently, these contacts did not offer protection against further negative health outcomes including hospitalization. Collectively these findings suggest looking beyond the healthcare system and underscore the importance of structural and systemic failings within our social, justice and healthcare systems as perpetuating the morbidity within this population.

Document type: 
Thesis

Factors associated with housing stability and criminal convictions among people experiencing homelessness and serious mental illness: Results from a Housing First study

File(s): 
Date created: 
2021-05-25
Supervisor(s): 
Julian Somers
Department: 
Health Sciences: Faculty of Health Sciences
Thesis type: 
(Thesis) Ph.D.
Abstract: 

Background: Housing First (HF) facilitates immediate access to independent housing with community-based supports for people experiencing homelessness and serious mental illness (PEHSMI). Despite positive outcomes associated with HF, studies have infrequently investigated factors that are associated with adverse outcomes once in HF. This thesis investigates factors which hinder housing stability following randomization to HF and factors associated with criminal convictions prior to and following randomization to HF. Methods: Three investigations were conducted using data from the Vancouver At Home study, which contains two randomized controlled trials each involving randomization to HF vs. treatment as usual (TAU) among PEHSMI. Using self-reported data, the first investigation examined the effect of experiencing homelessness in childhood or youth on housing stability (≥90% of days stably housed) after receiving HF (TAU excluded). The second investigation retrospectively examined factors associated with criminal convictions during the five-year period preceding baseline. The third investigation examined factors associated with criminal convictions after receiving HF (TAU excluded). Provincial administrative data were combined with self-reported baseline data for the second and third investigations. Results: 1) Among participants randomized to HF (n=297), those who had experienced homelessness in childhood or youth had significantly lower odds of housing stability. 2) Prior to study baseline, seven variables were significantly associated with criminal convictions among participants (n=425), such as drug dependence, psychiatric hospitalization, and irregular frequency of social assistance payments (vs. regular). 3) Following receipt of HF (n=255), five variables were significantly associated with criminal convictions, including daily drug use, daily alcohol use, and having received addictions counselling among others. Conclusions: Results underscore social marginalization as contributing to poorer housing stability in HF and criminal convictions while in HF and prior to enrollment among PEHSMI. Further supports are needed to facilitate improvements for a greater proportion of HF clients. HF providers may be able to identify clients with additional support needs related to housing stability and criminal convictions by asking about the factors found to be significant in analyses.

Document type: 
Thesis