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

There is currently no international consensus around post-trial obligations toward research participants, community members, and host countries. This literature review and interview-based study investigate arguments and attitudes toward post-trial access. The literature review found that academic discussions focused on the rights of research participants, but offered few practical recommendations. Similarly, there are few regulations or legislation pertaining to post-trial access. Interviews with REB members indicated that respondents understood post-trial access to the intervention as being the role of the state, and many of the views on benefits were shaped by the fact that respondents were based in Canada. Since REB members are uniquely influential as gatekeepers of clinical trials and research, more information on their views and attitudes is particularly important. If regulatory changes are necessary, we need to understand the current arguments, legislation, and REB members’ attitudes towards post-trial access and participants, community members, and adolescents.

Public bike share (PBS) programs offer a flexible and convenient transport option that may also offer public health benefits from increased physical activity. Emerging evidence suggests several factors as important to bike share use, but little data exists from users where bicycle helmets are required. We completed two surveys, one a randomised telephone survey of Vancouver residents (n=901), and the other an observational survey of helmet use amongst cyclists in downtown Vancouver (n=4126). We also conducted a content analysis of print news articles to identify bike share topics and framing (n=62). We found that infrastructure and weather would be the most important considerations to bike share users. Overall, helmet use was high, but varied by personal and trip characteristics. The news media reported bike share topics in line with new policy developments, but framing depended on the media source. These findings suggest that efforts to increase system uptake should target the cycling infrastructure environment.

Mongolia’s rapid economic growth, propelled by rapid development of the extractives sector requires that the country be better prepared for potential negative impacts to the health of the people and the country. People are both excited for the remarkable development opportunities that mining promises and are concerned with the potential social, environmental and health risks it could bring. As a country highly dependent on the mining sector, Mongolia has realized that it needs to develop a strategy and institutional process to manage the public health impacts of mining activities. With the support of an SFU-based team of researchers and policy advocates, Mongolia is thus in the process of adopting Health Impact Assessments (HIA), a policy innovation tool that has potential to inform the decision making process through assessing underlying health problems and generating evidence-based recommendations. However, the values, principles, methods and deliverables of HIA are not easily understood in capacity-limited Low and Middle Income Country (LMIC) settings, including Mongolia, which makes full adoption and proper use of HIA a difficult process to achieve. The overall goal of the research was to evaluate the uptake and adoption rate of the HIA concepts, tools and methods in the emerging Mongolian mining sector. This evaluation process involved key informant interviews, observations, literature reviews and policy analysis as data collection methods. To understand the processes of HIA adoption, the theory of the Diffusion of Innovations (DOI) was used as an analytical lens. Analysis of HIA adoption processes suggested that DOI theory was a useful framework to understand and improve the rate of uptake of new public health policy innovations such as HIA in that it assists with understanding both the attributes of innovation and the communication actions that influence adoption. The existing literature on HIA lacks analysis of how it is adopted and implemented in diverse settings. This research thus contributes to the knowledge needed to inform discussion of how to improve the rate and success of HIA adoption. I conclude that the adoption of systematic methods to manage the public health impacts of mining in Mongolia, centered on the HIA, is generally off to a good start. However, there are many remaining challenges, including: a lack of government leadership, poor collaboration between relevant public and private institutions, low levels of capacity to conduct and evaluate HIAs, poor quality or non-existent baseline data. These challenges will need to be addressed in order to keep the momentum going. Following from the research, I offer the following recommendations: to develop HIA management system, to implement existing MoU between relevant ministries, to create HIA training center, and to enact an independent HIA law. In conclusion, the currently legislated system, which incorporates HIAs into a newly redesigned licensure system based on international standard environmental impact assessment methods, must be implemented. Ideally, the development of an independent HIA system will be required if Mongolia is to build and sustain an effective public health system in mining-affected regions.

Background: Vancouver, British Columbia has one of the highest HIV prevalence rates in Canada and a growing housing crisis. The limited data available on the impact of housing instability on the health of people living with HIV in this setting has been generated without meaningful involvement of the community. In order to fill this gap, we launched a community-based research project aimed at developing an understanding of the housing-health nexus that is grounded in the experiences of people living with HIV. Methods: Eight Community Researchers – people living with HIV who have experienced homelessness in Vancouver - were recruited and trained by the Project Coordinator to co-facilitate this community based participatory action research project. The Project Coordinator proposed the use of Photovoice to ensure the meaningful engagement of the Community Researchers. Photovoice is a research method that assists people, often marginalized by social-structural inequity, to reflect on their capacities and needs, engage with policymakers and encourage social change. Results: The Community Researchers generated over 300 photographs and engaged in facilitated discussion with the Project Coordinator to identify emergent themes. The Community Researchers described the detrimental impact of inadequate housing on their physical and mental health, and the resiliency promoted by healthy environments. The analysis culminated in the development of a multi-level ecological framework mapping the determinants and impacts of housing instability in this population, representing the first step towards building a comprehensive, community-informed definition of healthy housing as viewed through the eyes of people living with HIV. Interpretation: The findings underscore the need to expand the focus of housing strategies to incorporate the broader political, economic and social context, and to meaningfully engage affected populations in developing policy and programming targeting housing instability.

Due to the failure of current studies of ergonomics programs in transnational factories in Honduras to adequately address the issue of prevention, this study examines how the production process in Canadian-owned factories operating in Honduras mitigate against primary and secondary prevention measures. Using a feminist lens and drawing on grounded theory, this study is based on interviews with seven Honduran women workers suffering from work-related musculoskeletal disorders (WMSDs) and seven key informants knowledgeable about women’s health experiences in maquiladoras. The key themes discussed are: failure or inadequacy of primary prevention; production quotas as a physical and psychological workplace hazard; treatment from company management; injured workers remaining on the assembly line; and ways of facilitating immediate and systematic changes to reduce exposure to occupational hazards in the maquiladoras. The study found that ergonomic programs have failed to adequately address the risk factors and processes that lead to the development of WMSDs.

Activation of either the cannabinoid CB1 receptor CB1 or dopamine D2 receptor D2R inhibits cAMP production since both are Gαi/o linked G protein-coupled receptors. This study confirms the interaction of CB1 and D2R with co-immunoprecipitation experiments using HEK-293T cells co-expressing both receptors. Moreover, GST and His-tagged fusion proteins of CB1 and D2R were generated and used in affinity purification assays to show that the carboxyl terminus of the CB1 receptor interacts with the third intracellular loop of the D2 receptor to form the CB1-D2R complex. Additionally, the CB1-D2R complex is formed by a direct protein-protein interaction. Furthermore, the activation of either D2R or CB1 in HEK-293T cells co-expressing both receptors leads to inhibition of forskolin stimulated cAMP accumulation. However, co-activation of both receptors results in a loss of cAMP inhibition. This study characterizes the interaction between CB1 and D2R as well as demonstrates the functional outcomes of the receptor complex.

Previous studies have found a high prevalence of sexually transmitted infections and associated risk behaviours among homeless and marginally housed adults. Although individual-level characteristics and their association with risk behaviours have traditionally been a major focus of research, the importance of structural factors, such as housing, that impact these behaviours have received increasing attention. Supported housing interventions like Housing First (HF) have been argued to potentially contribute to reductions in sexual risk behaviours. Using an experimental design, the present study investigated the effect of HF on unprotected sex among homeless adults with mental illness with a treatment as usual (TAU) comparison group. Over the 24 months of follow-up, no association was found between HF and unprotected sex when compared to TAU. Several other variables were independently associated with unprotected sex. Results indicate that in conjunction with HF, additional interventions are needed to reduce unprotected sex among homeless individuals with mental illness.

Evidence suggests the burden of treatable mental disorders on the correctional population is substantial. However, it remains unclear whether a non-substance related mental disorder diagnosis (NSMD) is independently associated with different levels of recidivism risk. This study estimated NSMD diagnostic rates for the BC Provincial correctional population and examined the association between NSMD diagnoses and recidivism by conducting a time to event analysis. Overall, 47% of Provincial offenders received a NSMD diagnosis. The risk of recidivism was greater among those diagnosed with personality disorder and lower for those diagnosed with depressive disorder. Findings signify an essential component needed to improve offender health includes greater provision of correctional mental health services and research suggesting an indirect relationship exists between most mental disorder categories and recidivism is supported. Additionally, intervention strategies that target underlying mediating factors may be more effective at reducing recidivism than the exclusive treatment of psychiatric symptoms.

The negative health impacts of racism and race-based discrimination have been well established within the public health literature. Though public health acknowledges racism and education as determinants of health, the field has failed to adequately address the health-harming impacts of racism within the education system, and thus has underutilized anti-racism work as a preventative and health equity strategy. This project piloted a school-based audit tool to assess school policies and practices for supporting cultural diversity and addressing race-based discrimination in two Alberta junior high schools to explore how an audit could be useful in guiding the development of anti-racism education. The study found that the utilization of an audit tool can help to begin a process of formalized discussion and raising awareness about interpersonal and institutional racism within educational contexts; however, the tool needs to be paired with action-oriented steps to successfully address racism as a determinant of health and education.

Crack-cocaine use represents a major social and public health challenge in Brazil. Important sex and gender differences have been found among crack users in other countries, but little comparative data exists regarding male and female crack users in Brazil. This secondary, sex-and-gender-based analysis explores potential sex differences in key characteristics of a community-based sample of young crack users (n=159) in two Brazilian cities. Participants completed an anonymous questionnaire on social, health and behavioural characteristics, and serological testing for HIV and HCV. Data was analyzed using univariate and stepwise discriminant analyses. Discriminant modeling found that: (1) Paid work, HIV testing, sex work, and begging differentiated male and female crack users; (2) Female sex independently predicted HIV testing history; and (3) Alcohol use, poor self-rated mental health and an absence of paid work predicted unprotected sex among participants. These findings suggest the need for gender-specific prevention strategies targeting sex-related risk among young Brazilian crack users.