Patricia Spittal

Professor

Relevant Degree Programs

 

Graduate Student Supervision

Doctoral Student Supervision (Jan 2008 - May 2019)
The intersection of conflict, substance use, trauma, and HIV : exploring their complex interplay among conflict affected populations in a rapidly changing northern Uganda (2018)

Background: Epidemiologists have long noted a paucity of research addressing the role of substance use in conflict and post-conflict settings especially as it interacts with mental health and HIV vulnerability in affected populations. Such is the case in northern Uganda where after two decades of conflict the region is rapidly changing, and where community leaders are expressing concerns as to perceived rapid increases in substance use and its impact on the population and growing HIV epidemic.Methods: This multidisciplinary research explored the intersection of mental health, substance use, and HIV in the context of conflict. This project was conducted in partnership with the “Cango Lyec Project” a five-year cohort project exploring HIV risk among Acholi people aged 14-49 in the Gulu, Nwoya, and Amuru districts of northern Uganda. The quantitative analyses began with a confirmatory factor analysis of the structure and underlying validity of the AUDIT alcohol scale. Next, multivariable regressions explored factors associated with hazardous drinking in the population. Qualitative analyses used an interpretive and interpretive description (ID) thematic approach to analyze 30 in-depth interviews and explored within the context of the quantitative analyses.Results: Quantitative findings indicated strong validity for the AUDIT scale. Overall, rates of drinking were much lower than the rest of Uganda, and women were significantly less likely than men to consume alcohol or have hazardous use behaviors. After adjustment neither post traumatic stress disorder (PTSD), depression, nor HIV were significantly associated with problematic drinking though there were significant associations with many sexual behaviors, and abduction was protective against problematic drinking among men. Qualitative findings highlighted participants’ views that substance use remained a large and growing problem in the region that was closely tied to HIV. Use was highly stigmatized especially as it pertained to perceptions that it constituted a rejection of Acholi traditions.Conclusion: This research highlights the need to integrate rigorous and population-level epidemiological evidence within community perspectives and understandings of risk. While at times the results appeared to contrast, underlying both were clear areas for intervention that acknowledge the profound trauma inflicted by the conflict and areas to support community- driven change.

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The Cedar Project : understanding the sexual vulnerabilities of Indigenous young people who use drugs in British Columbia, Canada (2017)

Background: For Indigenous communities in Canada, the legacies of colonization have severely compromised sexual wellbeing. Indigenous leaders are growing increasingly concerned for the sexual health of their young people, particularly those who use drugs to cope with adversity. However, there is a critical gap in evidence pertaining to the complex and multifaceted relationships between intergenerational trauma, self-medication, and sexual wellbeing.Methods: Data was gathered from the Cedar Project: an ongoing prospective cohort study of Indigenous young people who use drugs and live in British Columbia. A multidisciplinary approach was used to investigate historical and lifetime factors that impact sexual health. Epidemiological analyses were used to determine the prevalence and correlates of Herpes Simplex Virus-2 (HSV-2) and syphilis positivity among 250 participants. An interpretive thematic approach was used to qualitatively analyze in-depth interviews with 28 participants.Results: The seroprevalence of HSV-2 among women and men was 79% and 36%, respectively. For women, HSV-2 positivity was associated with being taken away from biological parents, involvement in survival sex work, and injecting drugs. For men, having ever been in prison was significantly associated with HSV-2 positivity. Young men who stated that culture played an important role during their developmental years were less likely to test positive for HSV-2. A history of syphilis infection was observed among 21 participants, 95% of which occurred among women living in Vancouver. Results from the qualitative study highlighted how sexual health continues to be negatively impacted by intergenerational trauma stemming from the residential school and child welfare systems. Participants’ narratives demonstrated the protective effect of family and cultural connectedness on sexual wellbeing. Participants offered detailed recommendations on how to improve sexual health outcomes through culturally-safe and trauma-informed sexual health resources that are integrated with mental health and drug recovery programs aimed at supporting struggling families.Conclusion: To support the sexual wellbeing of Indigenous young people who use drugs, the underlying causes of ongoing trauma and social marginalization must be urgently addressed. These findings call for the backing of Indigenous-led healing strategies that focus on young people’s inherent strengths, and use Indigenous wellness frameworks to promote collective healing.

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Sociocultural determinants of HIV vulnerabilities among ethnic and religious minority men who have sex with men in North China (2016)

BACKGROUND: In China, 29% of new HIV cases are among men who have sex with men (MSM). Sociocultural factors may be influencing the HIV vulnerabilities of certain ethnic and religious minority MSM, but little such research exists in China. This dissertation seeks to understand how ethnicity and religion are shaping HIV vulnerabilities and testing among MSM in China.METHODS: Data were collected in three phases in Beijing and Tianjin, China from January 2013 – April 2014. Participants were self-identified MSM over 18 years old. In phase one, in-depth qualitative interviews were conducted with MSM of various ethnic and religious affiliations (n=41). Interview transcripts were analysed using an interpretive thematic approach. In phase two, findings from phase one informed the design of a structured questionnaire, which was pilot tested in two feedback sessions (n=8). In phase three, the structured questionnaire was used in a clinic-based cross-sectional survey (n=400). Statistical tests were conducted to assess if HIV infection, vulnerability, and testing were correlated with: ethnic and religious affiliation, acculturation, religiosity, and ethnic and religious discrimination. Inter-ethnic and inter-religious sexual partnerships were also assessed. Homonegativity was also assessed as a possible mediating variable between: (a) ethnicity and religion and (b) HIV-related outcomes. RESULTS: Ethnic and religious affiliations profoundly influenced individuals’ social reference groups. Religious social norms, codes of sexual morality, and beliefs in supernatural interventions appear to be inhibiting same-sex sexual behaviours among religious MSM, especially Muslims. Buddhists and ethnic minorities of South China had higher odds of various HIV vulnerabilities. Religiosity appears to have both positive and deleterious influences on HIV vulnerability. Sexual minority religious organisations can provide unique social support. Buddhists, Muslims, and ethnic Hui were more likely to report sex with their own religious and ethnic peers. Homonegativity did not account for any associations between ethnicity and religion and HIV-related outcomes.CONCLUSION: This dissertation is the first study to explicitly explore the intersectionality of ethnicity, religion, sexuality, and HIV vulnerability in China. Findings highlight the ethnic and religious diversity among MSM in China and its salience for HIV prevention. Public health models of conceptualizing ethnocultural difference in China should be re-examined.

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The Cedar Project : understanding the association between childhood maltreatment and psychological distress, resilience, and HIV and HCV vulnerability among young Indigenous people who use drugs in three Canadian cities (2015)

Background: Indigenous leaders are deeply concerned about the adverse impacts of intergenerational and lifetime trauma on their young people, particularly those who use drugs and are vulnerable to HIV and HCV infection. However, few researchers have investigated the complex intersections of trauma, mental health, resilience, and HIV and HCV vulnerability among young Indigenous men and women in Canada. Methods: This multidisciplinary research was based on information gathered by the Cedar Project, a cohort of young Indigenous people (aged 14-30) who use drugs in Vancouver, Prince George, and Chase, British Columbia. The qualitative analyses used an interpretive thematic approach to analyze in-depth interviews. The quantitative analyses first evaluated the construct validity of psychometric questionnaires that measured childhood maltreatment, psychological distress, and resilience. Next, those questionnaires were integrated with longitudinal Cedar Project data to assess associations between childhood maltreatment with HIV and HCV vulnerability, psychological distress, and resilience. Results: The qualitative research highlighted participants’ ongoing struggles with unaddressed childhood maltreatment and the association between emotional pain and HIV and HCV vulnerability. However, participants were actively resisting the negative effects of trauma maintaining hope for a better life. In quantitative analyses, each of the psychometric questionnaires had acceptable fit for the data. In total, 91.7% of the participants had experienced at least one form of childhood abuse/neglect. Longitudinal vulnerabilities associated with specific types of childhood trauma and cumulative trauma experiences included significant drug and sex-related HIV and HCV risks, in addition to HCV infection. Childhood maltreatment, sex work involvement, sexual assault, heavy alcohol use, and injection drug use increased psychological distress, while living by traditional culture decreased psychological distress. Resilience was increased by having grown up in a traditional family environment, and by having access to and being able to speak traditional languages.Conclusion: This research supports the development of comprehensive, Indigenous-directed healing strategies for HIV/HCV prevention that are tailored for young Indigenous people who use drugs. These strategies must address concurrent trauma and mental health, support connections to Indigenous cultural identity, and facilitate understanding of the impacts of the residential school system and intergenerational trauma on family relationships.

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Lost in Transition: Determining HIV Prevalence and Relagated Vulnerabilities Among Young People Surviving Abduction and Displacement in Post-Conflict Northern Uganda (2012)

No abstract available.

Master's Student Supervision (2010 - 2018)
From prison to plate : how connections between men in federal custody and Indigenous families impacts food security, food sovereignty and wellbeing (2017)

For many Aboriginal communities in Canada, the legacies of historic and ongoing colonialism and the impacts of marginalization, dispossession and racism have produced barriers to meaningful and nutritious foods and foodways. This has resulted in high rates of diet-related diseases among Aboriginal populations. The same factors that impact Aboriginal food security also create barriers to employment and housing, and inequitable treatment within the criminal justice system. Founded in 2012, a prison garden based at a minimum security correctional institution in Mission, British Columbia (BC), attempts to address these correlates of crime and poor health by engaging men in federal custody in meaningful activity; specifically, the growing and subsequent donation of organic produce. The fruits and vegetables grown in the garden are donated to a variety of local organizations and Aboriginal communities, including the Tŝilhqot’in Nation of central interior BC. This ethnographic research, founded in critical social justice theories and the principles of food sovereignty, set out to understand the impacts of the garden on both the participating men and the recipient Tŝilhqot’in communities. Qualitative interviews were conducted with 10 participating men in custody, 10 Tŝilhqot’in recipients, and 5 program stakeholders. Iterative thematic analysis revealed multi-layered impacts for the participating men, starting with access to food and increasing over time to include gardening as a means to figuratively escape the correctional environment, to work productively, to give back, and as a means to begin imagining meaningful futures outside of prison. The distribution of vegetables within the Tŝilhqot’in highlighted a passive coalescence with histories of culinary imperialism, truncating impacts to two layers: access to food and connections with the men in prison. Drawing on the insights of both the men and Tŝilhqot’in community members and the theoretical principles of food sovereignty, decolonizing methodologies and food as social justice, potential ways to acknowledge the legacies of colonialism, increase connection between the prison and the communities, and increase impacts are discussed.

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