Ethics: In collaboration with the Joint Centre for Bioethics at the University of Toronto and the Institute for Social Research at York University, we are surveying the Canadian public regarding ethical issues in H1N1 policy as well as conducting qualitative research based on three Town Hall meetings, all related to bringing ethical issues to the public for consultation. The first survey findings will be published in BMC Public Health (in press) and reflect the pre-pandemic period while the current survey began during the acute period of stress related to H1N1 (November, 2009) and is currently in the field.
Policy: Use of Incentives in Health Care: financial incentives are powerful tools for change, yet there’s reluctance to use them for health-related change. One exception, in Ontario, is the use of financial incentives to support physicians in supplying data informing administrators about current system function (pay for reporting) and in adopting best practices (pay for performance). Fortunately, an ongoing experimental program guided by Cancer Care Ontario (CCO) incents surgical oncologists, radiation oncologists and medical oncologists for these purposes. We are tracing the incentive paths and the perceived degree to which physicians identify changes attributable to incentive influences. Our findings are intended to guide incentive use in the future.
Policy – How to Achieve Further Reductions in Tobacco Use: use reductions and the Masters Settlement Agreement (MSA) are considered major public health achievements. Less publicly known are the realities that tobacco companies (MSA signees) have countered advertising restrictions by increased marketing (mainly dispersing free cigarettes with increased nicotine content) and have achieved a current stabilization in tobacco consumption. Another important fact is the great majority of MSA funds (amounting to $ 205 billion dollars) are transferred to state budgets without use restrictions. They are largely used for budget deficits and politically expedient purposes. The current study (N. Wayne, Master’s Thesis) addresses, through financial modeling, factors that were influential in reducing past tobacco use (e.g. pack price, tobacco reduction campaigns) and through cost modeling, identifies factors that could again be addressed in reducing future tobacco use. (N. Wayne, Masters Thesis, 2009)
Population Health: Undeniably, health disparities exist between people of varying socio-economic strata (SES) and ethnic backgrounds. These factors converge in economically disadvantaged, marginalized, immigrant groups. Canada, as a nation, maintains population (i.e. zero population gain or loss), through immigration, ensuring significant proportions of future population will consist of immigrant groups. Accordingly, interventions are needed to ensure the health of the currently economically disadvantaged, particularly populations diagnosed with chronic illness (e.g. Type 2 Diabetes) or with elevated risks for preventable disease (e.g. prevention of diabetes, cardiovascular disease, cancer). Our lab is committed to multiple projects aimed at extending the ‘right to good health’ to all ethnic and modest SES populations, particularly those with higher disease prevalence and risk.
Walkability and Physical Activity in the Jane Finch Community of Toronto: physical exercise is central to public health efforts as evident in the excess weight and sedentariness epidemic confronting North America and developed nations. While economically affluent sectors can afford gyms and exercise classes, members of lower SES populations are unlikely to devote similar funds for these purposes. This creates challenges to create ‘free’ environments supportive of exercise, including the ‘built’ environment, and free access to other community-based exercise-support activities. Our past research shows built environment factors do have impact on self reported physical activity in the Jane-Finch community of Toronto, an identifiable neighbourhood of 53,000 that largely consists of newer immigrants (11% have immigrated within the last 9 years), visible minorities (75%) and people of modest SES backgrounds. However, it mostly affects individuals who do not have car access, particularly as they approach and extend beyond middle age. Survey results have indicated perceived walkability in neighbourhood environments is important and improvements in walkability would contribute to engaging the population in increasing healthy physical activity. (D. Perez, Masters Thesis, 2009)
Targeted Community Based Interventions: past survey results support the importance of key variables (exercise self efficacy, social support for exercise) related to personal engagement and support for health-behaviour change. Fortunately, with colleagues, we are experimenting in designing community-based, targeted exercise programs for: individuals at elevated risk for developing Type 2 diabetes; Tai Chi exercise for elderly in danger of injuries due to falls (M. Athaide, Master’s Thesis); and for individuals diagnosed with Type 2 diabetes. A community-based targeted intervention adds to, employs and organizes community resources to assist identified groups. The goal is to influence a community cohort in adopting regular health behaviours and to build sustainable community-based supports for long term adherence. For example, we have recently created a free exercise room at the Black Creek Community Health Centre – Satellite (Yorkgate Mall, Jane-Finch community) where community members can exercycle, mall-walk (assisted by heart rate monitors) and use elliptical machines, free of charge, with immediate advice about how to develop regular programs of exercise.
Cancer Screening: a key large scale preventive intervention is cancer screening, particularly colorectal cancer screening due to its capacity for preventing colorectal cancer (through surgical removal of polpyps during colonoscopy) and reducing morbidity/mortality when malignancies are detected. We are fortunately funded through the Canadian Institute for Health Research (as part of the Emerging Team for Colorectal Cancer Screening) to be conducting Focus Group and Intervention studies aimed at increasing the uptake of colorectal cancer screening (in Calgary, Alberta and Saute Ste. Marie and Toronto, Ontario). We are also conducting interview studies aimed at better understanding screening policies in Alberta, Quebec and Ontario, and undertaking cost modeling aimed at detecting the proportion of population that must be screened to balance investments and savings through decreases in disease and required treatment.
Breast Cancer Screening: although breast screening is well established through the Ontario Breast Screening Program (OBSP), constant efforts must be expended to increase uptake of this life saving procedure. Our research is in collaboration with OBSP and Dr. A. Chiarelli of Cancer Care Ontario and focuses on how risk perceptions and experiences at OBSP centres affect subsequent screening uptake.
Clinical Intervention: Electronic health: e-health interventions can achieve significant gains in large numbers through novel communication linkages. With motivated populations, links are inexpensive and carry data that improve treatment and preventive practices, and help clinical populations undertake lifestyle change. In Africa and Ontario, we are using e-health interventions to advance treatment benefits through changes in behaviours critical to success. In Africa, we are investigators in the Weltel trial designed to assess the effectiveness of text messaging and cell phone use in helping HIV + Kenyans comply with antiretroviral treatment. In Ontario in partnership with Centre for Global E-health Innovation (University Health Network), Research in Motion, Rogers and Nex J Systems, Inc., we are intervening with Type 2 Diabetics using Blackberry Smartphones and health coaching to improve blood glucose control. The site of this Ontario project is Black Creek Community Health Centre (BCCHC) in the Jane Finch community of Toronto, with primary care providers playing key roles in developing a coaching approach that is cost effective and saving and easily supervised by treating physicians. (N. Wayne, PhD dissertation)
Cancer Treatment and Exercise Benefits: while there was once consensus that patients in cancer treatment solely benefited from rest and relaxation, evidence now points to the measurable benefits of physical exercise during chemotherapy, radiation therapy and hormonal treatments. Over 75 randomized exercise intervention trials have been conducted in cancer patient groups, with the great majority demonstrating benefits. Our research at the Princess Margaret Hospital and Toronto General Hospital (University Health Network) focuses on patients with prostate cancer being treated with Androgen Deprivation Therapy (ADT) which, though life prolonging, has unfortunate side effects that are reversed with rigorous exercise programming. Currently we are assessing differences between Aerobic Exercise and Resistance Exercise Training, while assessing changes in key hormones (leptin, adiponectin, IGF) that have been shown to shift with rigorous exercise and are associated with protective effects in terms of preventing cancer proliferation. (D. Santa Mina, PhD dissertation)
Individual Wellness: wellness is being redefined as we move from a consumption dominated society to generative, sustainable lifestyles. Gradually, as a society, we are confronting the global warming crisis by developing relationships with physical and mental worlds that incur minimally destructive footprints. These transitions are neither comfortable nor convenient as we are thoroughly inundated with norms favouring environmentally expensive consumptions as the key to enjoyment and gratification. Our economic system favours high consumption levels that supposedly support growth and prosperity. From another perspective, exchanges of money and consumptions are placed into perspective with humanistic needs to guarantee health for all and educational opportunities leading to merit-based compensations. Building a new society free of terrorism, violence, ecological destruction and de-humanizing work is the necessary foundation for a functional concept of wellness in the 21st century. Achieving this requires revisiting the fundamentals of neuroscience and neurophysiological assessment, which we are doing by probing the divergences and convergences between ancient meditation and prayer practices, and state-of-art cognitive-behaviour therapies. Relevant findings must be conveyed as the cornerstones of lifelong education. In our wellness research, the focus is on developing programs that improve individual and interpersonal health.
Mentoring Disadvantaged Youth: The nation was shocked in May, 2007, when 15 year old Jordan Manners was shot and killed at the C.W. Jeffreys Institute in the Jane-Finch community of Toronto. National newspapers ran articles verifying handguns could be purchased in the Jane-Finch community for $300. The Toronto Mayor and the Premier of Ontario called for better gun control, reminiscent of statements after the tragic shooting death of 15 year old, Jane Creba, on Boxing Day, 2004, in downtown Toronto. On the day of Jordan’s fatality, we were completing the plan of a pilot project aimed at preventing tragic violence by direct intervention with young males (10 times as likely to commit homicide as females) in the Jane-Finch community where high school dropout rates are 40 % or 17 % above the mean for Toronto. These percentages are notable as academic failure is a key sign that socio-economically disadvantaged youth are becoming alienated from merit-based systems. In our mentoring program, we are assessing whether the attitudes and behaviours that cause academic failure can be changed to support academic success. We propose the emotional conflicts that escalate to tragic violence can be transformed into positive pro-social processes. The study, funded by the Canadian Institute for Health Research under the Boys and Mens Health Competition and Toronto Youth Challenge Fund has confirmed these beliefs. We are now transitioning into developing a course for volunteer mentors, intending to integrate mentoring into the central core curriculum of York University and similar institutions throughout Canada and North America. (M. Pirbaglou, Honours Thesis)
Web-Based Interventions with Maladaptive Perfectionists: Perfectionism is characterized by beliefs that anything less than perfect is unacceptable. It is marked by excessively high performance standards and overly critical self-evaluation. Perfectionism has been broadly conceptualized as adaptive and maladaptive perfectionism. Multidimensional theories (Hewitt and Flett, Frost et al.) are now widely employed in studies aimed at better understandings of perfectionism in post-secondary students, given the apparently high prevalence of perfectionistic tendencies in academic environments. Currently, we are assessing internet-based interventions (a manual is downloaded as a PDF) in assisting undergraduates who self identify as having ‘problematic perfectionism’. Following up previous studies that demonstrated effectiveness in terms of pre-post psychometric testing, we are additionally assessing subjects with a neurophysiological (EEG) lab-based protocol that evaluates attentional processing during working memory tasks and relative states of neuro-inhibition. This project is undertaken in close collaboration with members of the laboratory of Dr. J. Daskalakis at the Centre for Addiction and Mental Health. (N. Radhu, Masters Thesis)
Comparing Maladaptive and Adaptive Perfectionists Using Neurophysiological Assessment: When interventions are effective in reducing problematic perfectionism, it is likely that the shifts assist them in becoming ‘adaptive perfectionists’. Accordingly, it will be helpful to better understand the differences between these populations from neurophysiological as well as psychometric perspectives. In this study (again in collaboration Dr. Daskalakis’ lab), we are using protocols that evaluate attentional processing during working memory tasks and assess relative states of neuro-inhibition. (M. Yee, Honours Thesis)
Evaluating the Neural Mechanisms of Attention through EEG: Changes Associated with Attentional Practice – Meditation methods, like mindfulness-based stress reduction, are demonstrating distinct benefits with a wide variety of distressed populations. Meanwhile, advanced neurophysiological research with high-intensity, long term meditators (e.g. Buddhist monks) are yielding neuro-imaging findings that ascertain which neural pathways are involved in meditation-based phenomena. Our research is aimed at secular meditators who have amassed a total number of lifetime meditation hours that could be integrated by the typical individual pursuing a somewhat typical North American lifestyle (2000 to 5000 lifetime hours) and novel meditators who undertake a typical 8 week meditation course, comprising about 60 hours of meditation. Our neurophysiological protocol (again in collaboration Dr. Daskalakis’ lab) involves working memory tasks and the assessment of relative states of neuro-inhibition and EEG monitoring of Gamma–wave power during 1 hour of meditation. (C. Guglietti, Ph.D. dissertation)
