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My sincere and heartfelt gratitude and appreciation to a wonderful supervisor for providing me with the guidance and counsel I need to succeed in the PhD program. She has been a great mentor in mapping my PhD journey, advising on a research topic, connecting me with the resources I need, being available and responding to my emails and questions. My supervisor is a doyen in my area of research interest and her wealth of experience has been the main driver of my program.
Graduate Student Supervision
Doctoral Student Supervision
Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.
Many transgender (trans) youth require hormone therapy to bring their bodies into alignment with their gender; however, these youth frequently experience barriers to needed health care. Health care providers supporting trans youth encounter challenges of their own, including unresolved ethical dilemmas, a lack of consensus surrounding clinical practices, and a limited body of empirical research. Increased understanding of youth and parent experiences with decision-making around hormone therapy initiation could serve to inform clinical practices, but this topic remains unexamined in the literature. Existing research on trans youth experiences with hormone therapy generally includes youth who are enrolled in gender clinics, without attention to those actively experiencing barriers to care. Therefore, the aim of this study was to explore how trans youth with a broad range of health care experiences, parents of trans youth, and health care providers made decisions around hormone therapy initiation. This constructivist grounded theory study was conducted in British Columbia, Canada. Trans youth (aged 14-18), parents of trans youth, and health care providers offering hormone therapy readiness assessment/care planning services participated in semi-structured interviews. Youth and parents responded to questions and created lifeline drawings detailing their experiences both making and enacting decisions related to hormone therapy initiation. Health care provider interviews focused on ethical dilemmas and decision-making. Three-phase temporal models of decision-making processes were generated based on youth and parent interviews, highlighting common experiences before, during, and after engagement with health care providers. Decision-making processes varied; some decisions were made independently and some were shared. Five conditions necessary for engagement in shared decision-making within youth gender health care emerged, focused on strong relationships, strong communication, role agreement, decision agreement, and time. The Belief-Dilemma-Action Model was developed to illustrate three key constructs relevant to health care provider ethical decision-making processes. Beliefs, dilemmas, and actions were found to interact with one another, influencing the construction and resolution of ethical dilemmas in practice. Key dilemmas identified centered around family conflict, potential harm (e.g., regret), youth capacity to consent to care, and resource scarcity. Recommendations are given for clinical practice, ethical decision-making approaches, health care provider education, and future research.
Street-involved youth face difficulties due to their precarious living situation. Substance use is higher among these youth compared to the general youth population. This study examines the relationship between street-involved youth and school connection on their problem substance use. Problem substance use was defined as using marijuana 20 or more times a month, binge drinking alcohol three or more times a month, and facing consequences from severe substance use.The study design was a two-step sequential mixed-methods approach, beginning with a quantitative analysis using probability profiling via logistic regression with 762 street-involved youth ages 12 to 18 who responded to the province wide 2006 British Columbia Street-Involved Youth Survey in Canada. The second step used qualitative interviews to collect qualitative data with street-involved youth enrolled in school the previous year and identified using substances. Themes were identified from their experiences with substance use while in school. The probability profiling analyses uncovered school connectedness influenced problem substance use differently for young women and men. The presence of school connectedness decreased the probability of Problem Alcohol Use from 32% to 17% for young men and provided a 25% overall reduction in probability among known risk factors. The probability of Problem Marijuana Use decreased from 33% to 18% for young women as school connectedness increased; school connectedness reduced risk factors by 18%. Consequences from Substance Use was marginally protected against for young women, but school attendance protected against consequences for young men by 12%, in the presence of known risk factors. The second step examined qualitative data collected from interviews with four young women and seven young men who were street-involved in Vancouver, Canada at the time of the study. The age for youth participation was 16 to 24; they must been in school for a month over the past year and used substances while attending school. The recruited youth were between ages 16 and 21. They said having one caring adult in school, participating in extracurricular activities, and attending schools with zero tolerance policies toward substance use were ineffective in reducing substance use or creating stronger connections to school.
Clinical care that meets young people’s needs can play a role in addressing serious inequities in terms of their sexual health. In considering the poor uptake of sexual health care and the potential disconnect between the care young people want and what they receive, this study makes a case for examining social context as a key influence in clinical encounters about sexual health. The goal of this study was to understand clinical encounters focused on promoting the sexual health of young people and the power dynamics embedded in social contexts that shape these encounters. Individual interviews and focus groups were conducted in Victoria, British Columbia, with 50 young people, aged 16 to 19, and with 22 clinicians who work with youth. The transcribed data were analyzed using critical techniques and intersectional analysis. Results indicated three dimensions of social context that shaped clinical encounters about sexual health, presenting obstacles to change: ideologies, structural barriers, and the influence of space and place. Three key discrepancies were also revealed between young people’s self-described needs and the clinical encounters they actually received. First, contrary to clinicians’ agendas focused on managing risk, young people favoured a more comprehensive approach that would accept their sexuality and indicate that positive sexuality mattered. Second, in contrast to the assumption that young people wanted clinicians as experts, young people described wanting acceptance but experiencing judgment. Third, instead of the gender-based approaches to managing sexual risks described by clinicians, young people described gender-specific strategies for managing the vulnerability of the clinical encounter. Young men often described resisting and avoiding care, or reducing exposure to vulnerability by “getting in and getting out” of the exam room. Young women sought personalized and warm relationships with clinicians. Young people’s perspectives highlighted their need to discuss sexuality with the understanding that acceptance and support are required in navigating both the dangers and pleasures of sexual activity. Sexual health care could be improved by promoting sex-positive approaches that take into account intersections of gender, sexuality, and space and place and by addressing the structural factors that limit clinical care.
Despite the large number of adolescents of East Asian origin in Canada, there is limited research on sexual health among this population. The primary objective of this study was to investigate factors associated with sexual initiation among East Asian adolescents in British Columbia. This dissertation consists of four studies, all of which used the British Columbia Adolescent Health Survey of 2008, including over 4,000 East Asian students in grades 7 through 12.The first study documented estimated prevalence of sexual health and risk behaviors. Nearly 10% of East Asian students had ever had sexual intercourse. Of those sexually active students, about 70% had engaged in risky sexual behaviors. Born in Canada and speaking English at home were associated with greater odds of being sexually active. The second study indicated that the Multigroup Ethnic Identity Meausre-Revised (MEIM-R) measured two highly correlated dimensions of ethnic identity (Exploration and Commitment). The MEIM-R was invariant across age groups and degree of exposure to Canadian or East Asian cultures. Using the MEIM-R, the third study examined the association between ethnic identity and sexual initiation. Students with stronger ethnic identity were less likely to have had sexual intercourse. Finally, the fourth study was conducted to identify risk and protective factors associated with sexual initiation, and to examine the likelihood of sexual initiation, given a specific set of risk and protective factors. School connectedness was a strong protective factor for boys; family connectedness, ethnic identity, and school connectedness were the top three protective factors for girls. The top three risk factors were lifetime alcohol use, sexual abuse histories, and emotional distress for boys; and lifetime alcohol use, sexual abuse histories, and looking older compared to peers of about the same age for girls. The presence of those protective factors substantially decreased the likelihood of sexual initiation for adolescents exposed to risk. For those with the three risk factors, the probability of sexual initiation was reduced by half with the addition of the top protective factor(s). The study findings suggest that a dual approach of reducing risk and fostering protection would promote sexual health among East Asian adolescents.
Master's Student Supervision
Theses completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest theses.
No abstract available.
Introduction: On any given night, thousands of Canadian youth face homelessness in either absolute (living on the street) or relative (couch surfing) terms. Youth experiencing homelessness report disproportionately high rates of illness and unique influences on their access to health care as compared to their stably housed peers. Method: I conducted a mixed methods study to examine influences on homeless youth access to health care. First, I interviewed eight homeless youth about their experiences accessing health care. Next, I conducted a focused analysis of the 2014 Homeless and Street-Involved Youth Survey which was conducted in 13 communities across British Columbia with 671 youth. Finally, I facilitated a solutions-focused dialogue with a panel of 4 health care and allied service providers who work with homeless youth. Data analysis was informed by procedures consistent with interpretive description as the methodological orientation. Results: I identified three themes from the interviews: youth experiencing homelessness feel powerless when interacting with health care providers; health care systems exist as ‘rule-based’ bureaucracies; and homeless youth are in ‘survival mode’ when it comes to their health. At the same time, findings from the focused survey analysis suggest that the effect of individual factors (e.g., age) on access to health care is confounded by more systemic factors, such as discrimination and access to stable shelter, which are themselves associated with foregone care. The expert panel supported these findings and further suggested that hurtful interactions may damage not only a youth’s relationship with the health care system but also their overall trust in others. The panel also suggested that before health care providers can ‘do health stuff’ with a youth they need to have had several opportunities to cross paths and connect in more informal ways first. Discussion and Implications: A multi-pronged intersectoral approach founded on communication, collaboration and coordination of care is needed to facilitate access to health care for homeless youth. Additionally, specialized training is needed for people who work with these youth. More work is also needed across health care and social service sectors to empower youth in relation to their health and seeking health care.
Language used in the media to depict sexually exploited youth reflects societal assumptions that manifest in the health and well-being of these young people. Using Critical discourse analysis (CDA), this study examined word choice usage in 144 Canadian newspaper articles, attending specifically to the ethnicity of the victims and the perpetrators of sexual exploitation. The purpose of the study was to examine how power placement and to gain insight into how society perceives those involved in the sexual exploitation of youth. This study utilized both quantitative and qualitative analysis strategies. The results of the CDA suggest that society identifies that the sexual exploitation of youth in Canada is a problem; however, for the most part, society is not intervening. The findings also illustrate that the ethnic identities of the victims of sexual exploitation are more frequently revealed than the perpetrators. The victims of abuse are often from minority ethnic backgrounds; however, youth from a number of countries have been exploited. The almost invisibility of the exploiters of abuse who represent positions of power and trust, and whose ethnic identities are Caucasian support the concept of white privilege being present in society’s view of the sexual exploitation of youth. The results of the CDA support the need for culturally safe and competent nursing interventions for both the victims and perpetrators of sexual exploitation.
Structural Steel is one of the most important building materials used worldwide; special Seismic Force Resisting Systems (SFRS) have been developed to use steel to resist seismic forces in earthquake prone regions. In Canada, several steel SFRS have been adopted in the code, these include Moment Resisting Frames, Concentrically and Eccentrically Braced Frames, Buckling Restrained Braced Frames and Steel Plate Shear Walls; conventional construction frames may also be designed which have no seismic detailing. The design of these systems is covered comprehensively in literature; however no guidance has been provided regarding the selection of the best system for a project. In this thesis, the relative merits of each of the prequalified systems have been studied. A five story office building located in Vancouver, British Columbia, was redesigned nine times implementing each of the clauses for seismic design in CSA S16-09. The relative performance of each are compared using the Performance Based Earthquake Engineering (PBEE) method. PBEE accounts for the uncertainties in the seismic hazard, structural response and structural damage and their effect on the building performance during an earthquake. The relative merits of these systems were evaluated in terms of material usage and financial loss of the structure after a seismic event. The conclusion is that although the Moment Resisting Frame carries the lowest repair costs, it uses 20% more steel than the Eccentrically Braced Frame. The optimum systems in terms of material usage and repair costs were the Steel Plate Shear Wall (type ductile) and the Eccentric Braced Frame. The worst performing were the buildings designed with low ductility; both the conventional construction and limited ductility Concentrically Braced Frame structures performed poorly. Analysis shows that under the conditions of this thesis, most of the repair costs are related to the acceleration sensitive nonstructural components. Systems designed with higher ductility experienced lower accelerations and therefore lower costs. The PBEE methodology is an effective approach for evaluating different structures and comparing how they perform dynamically in an earthquake. Using PBEE, this thesis shows the advantages of frames designed in Canada for high ductility in economic terms.
Objectives: The objective of this study was to assess youths’ readiness to receive sexually transmitted infection (STI) sexual health promotion Short Message Services (SMS) (or text messages) from a public health nurse. Methods: An anonymous survey was given to youth aged 16 to 25 in a metropolitan Canadian city in 2 different areas: (1) youth attending two drop-in public health run sexual health youth clinics; and (2) youth at a campus of a large urban university. Results: One hundred and sixty six (n= 166) youth responded to the survey, of which 98% owned a mobile phone and 73% preferred sending and receiving SMS on their phones compared to other modes of communication. The youth in this study still expressed a desire for face-to-face interaction with a nurse for notifications of STI results (56%) or for asking sexual health questions (55%). There was preference for SMS from a nurse for reminders to wear condoms (31%) or reminders to call the nurse/clinic (40%). The youth overall agreed that SMS would provide a continued link between the nurse and themselves (60%) and the ability to use SMS would make it more likely for them to contact the nurse for a question or concern (78%). Conclusion: Youth are using SMS on their mobile phones at very high rates. There is general acceptance for SMS sent from a public health nurse in the form of reminders for condom use and for contacting a nurse/clinic, however the youth also indicated preference for face-to-face communication for more personal communications such as notification of STI results.
Purpose: There is a substantial gap in research that examines mental health in immigrant and visible minority groups. Even less research has considered the link between acculturation, mental health, and protective factors among these adolescents. This study investigated gender and acculturation-related differences in mental health and identified protective factors that buffer against emotional distress among Southeast Asian youth in British Columbia. Methods: A secondary analysis was conducted using data from the 2008 BC Adolescent Health Survey. Measures included mental health (recent stress, despair, self-harm, suicide, and self-esteem); acculturation (foreign-born status, length of time in Canada, and language spoken at home); and theorized protective factors (family connectedness, school connectedness, and ethnic identity connectedness). Gender differences in level of protective factors were examined using general linear modeling and age-adjusted multivariate models predicting extreme stress and extreme despair were conducted separately by gender and included acculturation measures as well as protective factors. Results: Southeast Asian girls reported significantly higher rates of mental health issues than boys including self-harm activity, suicidal intent, and attempted suicide. In addition, significantly greater numbers of Southeast Asian girls experienced extreme levels of stress and despair. In bivariate testing, acculturation was not significantly related to mental health. However, in the multivariate models, boys and girls who had lived in Canada for less than 5 years were more likely to report extreme levels of despair; girls in Canada for less than 10 years were also more likely to report extreme despair as well as extreme stress. Significant protective factors for boys and girls were family connectedness for both stress and despair as well as school connectedness but only among girls. Higher levels of ethnic identity connectedness were associated with lower odds of despair among boys but higher odds of stress among girls. Discussion and Implications: Immigrant teens may be at higher risk for emotional distress, yet gender differences still exist in the mental health of Southeast Asian youth. Future research must account for gender and acculturation-related differences in mental health and to assess for protective factors that may help mitigate the negative effects of stressors on adolescent mental health.
Street involved adolescents are 4 times more likely to become pregnant than at-home adolescents; they are less likely to seek out prenatal care due to a variety of reasons, resulting in a higher risk of pregnancy complications. Previous studies that examined the meanings, experiences and functions of pregnancy in the lives of street involved young women have been exploratory in nature, and focused on developing theory, not testing theory. This study was a secondary analysis was of the 2000 British Columbia Street Youth Survey from the McCreary Centre Society [N=238 girls ages 12-19 years, 36% ever pregnant], to test the functions of pregnancy in the lives of street-involved girls as first postulated by E. Saewyc in her 1999 study, and affirmed by others since. Age-adjusted regression analyses were performed to determine whether pregnancy experience was associated with participant responses to questions in the survey that could indicate reconnecting to family, maturing or settling down, stepping away from risk behaviours, opportunities for a new life, and access to health and social services; for significant relationships, further analyses were performed comparing the ever pregnant sample with the never pregnant sample to assess the prevalence of behaviours or mean ranks on attitudinal measures. Statistical analyses revealed few instances where the functions of pregnancy were supported within this Canadian sample; the only area was the ever-pregnant sample did show higher interest in receiving or having received drug/alcohol treatment. However, the inability of this study to support the original findings may be due to the limitations of performing a secondary analysis rather than the soundness of the theories themselves; post hoc power analyses indicated limited power for most specific analyses. Alternatively, perhaps pregnancy is a form of harm reduction,but once the child is born, the effects are gone. Further research to test the reasons for pregnancy among street-involved young women is needed. The six functions of pregnancy provide a testable theory for future research, but the study design may need to use the functions as the basis for developing more precise questions to collect data in a new sample.