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NEXUS Portal Vol. 3, No. 3 (Summer 2009) ~ Special issue on youth health Coen, Stephanie 2009-08-31

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NEXUS Portal Summer 2009 Special Issue on Youth Health  Volume 3, Issue 3  NEXUS Research Improves the Context for Youth Health topics including tobacco, alcohol, marijuana, other drugs, and their psychosocial development. “We are not only interested in those teens who start using substances as they progress through high school; rather, we are very keen to understand why and how teens are able to avoid substances despite the many influences around them,” explains Dr. Ratner. image: BASUS  nvestigating ways to improve the health of young people in BC is a top research priority for NEXUS. NEXUS researchers are currently undertaking projects focusing on the social contexts of youth substance use and of sexual health. By conceptualizing youth health behaviour and outcomes as situated within the multiple, overlapping social contexts that frame young people’s lives, NEXUS seeks to gather evidence to inform broader structural changes. The following NEXUS studies, in examining these interrelationships, look for solutions to change the landscape of opportunities and constraints that youth face.  Building A “BASUS” for Understanding BC Adolescent Substance Use BASUS (BC Adolescent Substance Use Survey) is the newest study at NEXUS to focus on youth. Co-led by NEXUS investigators Chris Richardson and Pam Ratner with NEXUS team member Joy Johnson, BASUS is a CIHR-funded multi-year study of teen substance use that follows 8thgraders through their time in high school. This longitudinal approach is advantageous because, according to Dr. Richardson, “By following the same group of teens, we will be able to study how psychosocial development and substance using behaviour change over time.” In addition to expanding understanding of why certain patterns of substance use emerge in some teens, the team plans to offer each school district a specific report on trends in Youth Health their area and help (continued)...........2 with the development of prevention and Trainee Spotlight....3 intervention strategies NEXUSnews..........4 specific to each district’s unique situations. Students are asked Camp fYrefly (continued)...........4 to complete an online survey twice a year for Events...................5 at least three years on  A unique feature of this study is the use of online technology. The survey is completely web-based and the pilot study, already in full-swing, has been a success to date. The BASUS website (www.basus.ca) provides information for potential participants, their parents, teachers, and administrators, as well as helpful links to resources such as the Kids Help Phone. The design of BASUS allows for investigation of the numerous pathways from experimentation to higher levels of use and dependence. “Substance use by adolescents is a result of a complex interplay among a wide variety of factors, like family and peer influences, personal beliefs and expectations, and psychological characteristics related to risk taking and depression,” says Ratner. BASUS not only takes into account this heterogeneity, but also acknowledges that these pathways are shaped by and nested within the various social contexts of young people’s lives. The survey gathers a range of contextual  information, including data on the health behaviour of parents or guardians and friends. Richardson points out that “because BASUS is a longitudinal survey with several thousand participants, we will be able to identify trends as they emerge within specific schools and school districts.” The main study launches in September 2009 when thousands of grade 8 students will complete the first cycle.  “TRACE”-ing for Clues about Teens and Marijuana Led by NEXUS codirector Joy Johnson with NEXUS team members Joan Bottorff, Jean Shoveller, and Rebecca Haines, the CIHR-funded TRACE (Teens Report on Adolescent Cannabis Experiences) project focuses on the culture and context of frequent marijuana use among teenagers. Drawing on naturalistic observation and interviews with teens, parents, teachers, and other adults in three communities in BC, this ethnographic study has elucidated how marijuana is used by teens for different reasons. “While some teens smoke marijuana to get high and party, others smoke to heighten their experiences in nature, and others smoke to relieve painful - See “Youth Health” on page 2 experiences or  photo: iStockphoto  I  Camp fYrefly-BC Takes Youth Health to New Heights! photo: R. Knight  in this issue  Starting at 5:30am on Thursday, July 2, Camp fYreflyBC participants prepared themselves Campers at Camp fYrefly-BC to head to Horseshoe Bay. Destination: Gambier Island! A 56-passenger bus left UBC on time and made a quick stop in downtown Vancouver to pick up the remaining campers, youth  leaders, and adult volunteers. Eighty Camp fYrefly-BC participants immediately bonded through teamwork and a common goal: load the chartered ferry with four days worth of supplies and campers’ belongings. A chain was formed and everyone worked together. The group sang, danced, and laughed. “Despite growing acceptance within Canadian society, sexual minority and gender variant youth who identify as lesbian, gay, bisexual, - See “Camp fYrefly ” on page 4 transgender,  U n i v e r s i t y o f B r i t i s h C o l u m b i a - 3 0 2 , 6 1 9 0 A g r o n o m y R o a d - V a n c o u v e r, B C V 6 T 1 Z 3  NEXUS Portal  Volume 3, Issue 3  Youth Health (continued from page 1) symptoms,” explains Johnson. Gender and place are key themes in these experiences. Although marijuana use is consistently more prevalent among boys than girl, findings from TRACE reveal that most teens could not articulate specific gender differences in marijuana practices. Rather, gendered aspects were embedded within many teens’ descriptions of using marijuana, pointing to deep-rooted gender structures shaping marijuana use. Regarding the role of place, in one community, teens carved out their own spaces to smoke in the school environment. Dynamics between teachers and students created certain unspoken, yet accepted, physical and social boundaries delineating marijuana use. “Perhaps what is most striking about our findings is that teens are not receiving the information about marijuana that they want”, Johnson points out. Many adults simply lacked information or the means to engage youth in these discussions. “The silence on the part of teachers and parents is highly problematic because in many ways it condones use,” Johnson notes.  “It is erroneous to assume that [teens’ smoking] behaviour can be understood outside of a social context”  These findings make clear that interventions require a focus not only on individuals but also on the contexts that support and enable marijuana use. “It is erroneous to assume that this behaviour can be understood outside of a social context”, asserts Johnson. “The meaning of marijuana use, the way it is smoked, where it is smoked, and with whom is influenced by social norms, expectations, relations, and structures.” The team has now completed TRACE reports for schools in three areas, and is using these reports as a mechanism to foster discussion within the school communities about enhancing the health of these youth.  Cultivating Collaborations to Improve Youth Sexual Health: The YSH Team The Youth Sexual Health (YSH) Team is a long-standing program of research headed by NEXUS lead investigator Jean Shoveller and funded through a CIHR Interdisciplinary Capacity Enhancement Team Grant. The team, including, NEXUS investigators Jane Buxton, Judith Soon, Joy Johnson, Aleck Ostry, and Mieke Koehoorn, examines how gender, culture, and place help to shape social relations and structural conditions that in turn affect youth sexual health.  social and structural factors affecting young people’s sexual health, like employment opportunities or poverty.” The team has several major initiatives in progress to improve youth sexual health and to address the various factors underlying the sexual health inequities faced by BC youth.  “...many young women and men may be facing barriers to accessing and using contraception effectively.”  The Youth’s Perspectives on Birth Control study is a two-phased project led by NEXUS lead investigator Judith Soon. “Experiences with contraception are critical to youth sexual health, especially in places where, as is evidenced by high teenage pregnancy rates, it appears that many young women and men may be facing barriers to accessing and using contraception effectively,” says Soon. This qualitative study seeks to examine how gender, place and culture concomitantly affect youth’s experiences with contraception through ethnographic fieldwork engaging both the perspectives of youth and of service providers working in the area of youth sexual health. Phase One (funded by the BC Medical Services Foundation), recently completed in Fort St. James, revealed that the process of accessing contraception presents unintentional barriers for youth. The team is now working with local service providers to develop communityspecific recommendations to improve local access to contraception and sexual health services. “The partnership we built with the community during the process of compiling these reports has by far been one of our most desirable outcomes,” notes Soon. The team is looking forward to officially launching a youth report in the fall in conjunction with a local youth sexual health fair. Data collection for Phase Two (funded by CIHR) is now underway in Fort St. John and Vanderhoof. Also on the YSH Team docket is the BC Youth Sexual Health Atlas, led by Soon and Shoveller. The atlas will provide socio-epidemiological profiles and maps of the sexual health outcomes of youth living in BC, including STIs, early-age childbearing, and use of contraceptives. An interactive website will make the atlas available as a tool to engage stakeholders about reducing social and structural inequities among youth.  Finally, the YSH Team has worked to develop Camp fYrefly-BC, a leadership retreat for 60 sexual minority youth from BC and the Yukon that took place July 2-5, 2009. (To learn more about this educational, social, and personal learning retreat, please see “Camp fYrefly,” page 1).  The YSH Team is committed to action Word cloud © Youth Sexual Health Team, 2009. “To date, the majority of research has and engaging youth in the process. focused on the so-called ‘problems’ As Chabot notes, “We address youth sexual health inequities by focusing of young people’s sexual behaviour, such as pregnancy and sexually on how elements of gender, culture, and place both transform sexual health transmitted infections (STIs), thus favouring the development of individualoutcomes and can themselves be transformed to improve youth health and level responses, such as improving sex education,” explains research social wellbeing.” manager Cathy Chabot. “While this is important, we also need to consider NEXUS: Researching the social contexts of health behaviour  Page 2  NEXUS Portal  Volume 3, Issue 3  NEXUS Trainee Spotlight  NEXUS trainees share a bit about their academic lives and beyond.  Rebecca J. Haines Takes on Mass Media to Understand Youth Substance Use  How did you initially become interested in social contexts of health behaviour? For a sociologist, theorizing and studying social context is absolutely everything! I have a long-standing interest in the socially-situated nature of adolescents’ health practices and how local and globalized youth cultures shape young people’s engagement with popular cultures, their relationships, and their substance use.  “For a sociologist, theorizing and studying social context is absolutely everything!”  What inspired you to focus your research on youth substance use in particular? Specific to youth and tobacco, while I was a doctoral student I had the privilege of becoming involved with a cross-disciplinary team of social scientists interested in applying critical social theory to tobacco research, as an alternative to the individual-level or psychosocial approaches to addiction that are common in research on smoking and substance use. As a result, we published an article in the journal Tobacco Control that was a call for an emphasis on the social context of smoking in tobacco research. (See: Poland, B., Frohlich, K., Haines, R. J., Mykhalovskiy, E., Rock, M., & Sparks, R. (2006). The social context of smoking: The next frontier in tobacco control? Tobacco Control, 15(1), 59-63). For my postdoc I’ve had the opportunity to expand my focus to other substances, in particular adolescent marijuana use.  How does a gender lens help us to understand youth substance use? My work on youth substance use locates gender as socially produced practice, with attention to how gender is accomplished by adolescents vis-à-vis norms of femininity and masculinity. I am interested in understanding how youth respond to, reproduce – and sometimes challenge – dominant cultural scripts or discourses around gender, smoking, drinking, and illicit drugs. In my view, a critical approach to gender is vital to unpacking how youth position their substance use and also to understanding the types of prevention or health education messages that are likely to resonate with the social contexts of their lives and experience. Unfortunately, the bulk of prevention messaging directed towards youth in western contexts has relied on onedimensional gender stereotypes, perpetuating what I term “visual violence” through the use of images that implicitly link health with external appearance and with being physically attractive.  present my research. What are some of your recent professional accomplishments that you are most proud of? I recently published articles from my dissertation and postdoctoral work in the journals Sociology of Health and Illness, Social Science and Medicine, and Tobacco Control. I chose these journals as I feel that they are most important to my discipline and field. It took me some time, but I was excited to finally reach my goal of getting at least three first-author publications out during my postdoc. Hopefully there will be several more to come over the next year and a half. photo: iStockphoto  Rebecca J. Haines is a NEXUS postdoctoral fellow under the supervision of NEXUS lead investigators John Oliffe and Joy Johnson. She is a health sociologist, specializing in gender and the social context of tobacco and other substance use by adolescents. With funding from the SSHRC and PORT training programs, Rebecca’s current postdoctoral project explores representations of gender and visual or symbolic violence in substance use prevention campaigns targeting youth.  “A critical approach to gender is vital to unpacking how youth position their substance use.’  What roles does NEXUS play in your postdoc career? I am really enjoying being a NEXUS trainee and being a part of a like-minded community of researchers. NEXUS provides great opportunities to connect with other trainees and investigators. The Spring Institute is always stimulating and I like the fact that trainees of all levels are encouraged to present their research. NEXUS provides support for travel, hands-on workshops and seminars, and several opportunities for me to  What are some of your totally unprofessional accomplishments that you are most proud of? None at this time. Postdoc life seems to leave time for little else these days!  If you could pursue any research topic outside your field, what would it be? In my master’s research I focused on race and racism in youth and popular cultures. I hope to eventually integrate more of a focus on race in my current research on gender and adolescent health. What profession other than your own would you like to attempt? A pastry chef. I love to bake when I have the time. What human quality do you most admire? Patience. If you had a motto, what would it be? Always be kind, because everyone is battling something.  NEXUS: Researching the social contexts of health behaviour  Page 3  NEXUS Portal  Volume 3, Issue 3  NEXUSnews  NEXUS Investigators Receive Promotions Lead investigators Jean Shoveller and Aleck Ostry were both promoted to the rank of full professor in their respective departments, the UBC School of Population and Public Health and the University of Victoria Department of Geography. Co-investigator Sabrina Wong was promoted to associate professor in the UBC School of Nursing.  image: Wilfred Laurier Press  Trainees at NEXUS are a highly distinguished collective of 32 graduate students and postdoctoral fellows. In 2008-2009, trainees collectively garnered over 60 different grants and awards, from prestigious funding agencies such as CIHR, CTCRI, MSFHR, and MITACS. NEXUS trainees are also a prolific lot, producing nearly 60 peer-reviewed publications (published, in press, submitted, or under review) in at least 30 different journals, including high-ranking Social Science & Medicine, Sociology of Health & Illness, and Health & Place. Several recent highlights include: • doctoral trainee Martha Mackay won first prize in the first Annual Philosophy of Nursing Postgraduate Essay Prize for her paper ‘Why nursing has not embraced the clinical-scientist role’, which will be published in Nursing Philosophy • doctoral trainees Katie Baines, Jennifer Bell, and Cindy Masaro received CIHR Fredrick Banting and Charles Best Canada Graduate NEXUS trainee Martha Scholarships • NEXUS trainee affiliate Karen Mackay wrote a top-prize Rideout won a Student Excellence Award from winning paper appearing in the Shastri Indo-Canadian Institute for her Nursing Philosophy. work on food security in India.  New Book on Breastfeeding Launched NEXUS lead investigator Aleck Ostry and colleague Tasnim Nathoo take a critical look at the history of Canadian breastfeeding policy and practices in their new book published by Wilfred Laurier Press (July 2009). The one best way? Breastfeeding history, politics, and policy in Canada takes a historical approach to lay out the social, political, cultural, and economic context within which current breastfeeding debates are couched. NEXUS celebrates the release of this book with a concurrent launch at the NEXUS poster session on September 30, 2009.  NEXUS Welcomes 3 New Trainee Affiliates NEXUS is pleased to welcome three new trainee affiliates to the team. Sarah Munro is a PhD student in health sciences at SFU, nominated by NEXUS lead investigator Aleck Ostry. Sarah’s research investigates the social and health service conditions that may influence breastfeeding experiences and outcomes in rural BC. Amery Wu is a postdoctoral fellow with NEXUS co-investigator Sabrina Wong. Her research expands the development of and simultaneously validates a primary health care instrument across Chinese and South Asian immigrants and non-minority English-speaking whites. Judy Burgess, also a postdoctoral fellow with Sabrina Wong, is designing psychometric instrumentation to measure and evaluate collaborative health care team culture, incorporating a “knowledge to action” approach.  Camp fYrefly (continued from page 1) Two-Spirit, queer, or intersex (LGBTTQI) continue to suffer health and social inequities compared with their heterosexual peers,” reports Camp fYrefly-BC director Rod Knight. Sexual minority youth in BC receive little to no educational support related to their sexual and gender identities.  programming consisted of workshops on gender identity, sexual health, and leadership skills. There were opportunities to engage in discussions about the social, health, education, and legal issues faced as sexual minority or gender variant youth in BC.  “It’s a rare thing to have eighty people from many In response to these disparities, the Youth different backgrounds supporting and encouraging Sexual Health Team, led by NEXUS lead one another,” reflects Camp fYrefly-BC project investigator Jean Shoveller, collaborated assistant and youth leader Taylor Basso. with the creators of Camp fYrefly (founded at the University of Alberta), BC-based Ultimately, through their participation in Camp community stakeholders, and the Camp fYrefly, sexual minority youth gained awareness fYrefly-BC Youth Advisory Committee, to of strategies, supports in their own communities, Camp fYrefly participants engage in discussion. create the first-ever leadership retreat in and youth networks, giving them access to sexual BC for sexual minority and gender variant youth. NEXUS co-directors minority-specific health, educational, and social services that may Joy Johnson and Pam Ratner are members of the Camp fYrefly-BC otherwise have been out of reach. Steering Committee. On the last day, campers had a dance party on the ferry ride home. Camp fYrefly-BC was designed to empower 60 sexual minority youth Everyone was safely dropped off at their respective locations. Within ages 14 to 24 years and improve their health and social wellbeing hours, Facebook was lighting up with campers’ pictures and thoughts of through positive peer socialization and educational activities. Camp the Camp fYrefly-BC experience! photo: R. Knight  photo: M. Mackay  NEXUS Trainees ‘Got’ Talent!  NEXUS: Researching the social contexts of health behaviour  Page 4  NEXUS Portal  Volume 3, Issue 3  Upcoming Events NEXUS Poster Session September 30, 2009 - 3:30-5:30pm NEXUS, #203 (2nd floor boardroom) - 6190 Agronomy Road Vancouver, BC  NEXUS Seminar Series 2009-10 Seminars are presented at the UBC Vancouver and Okanagan campuses and are broadcast online via WebEx.  October 28, 2009 | Contexts shaping women’s decision making about hereditary breast and ovarian cancer risk-reducing strategies |Fuchsia Howard, NEXUS trainee November 25, 2009 |Commuting for palliative cancer care: Experiences of rural patients and family caregivers Carole Robinson, NEXUS co-investigator January 27, 2010 | Youth and contraception: To use or not to use in Fort St. James, BC |Judith Soon, NEXUS lead investigator March 31, 2010 |Punjabi Sikh patients’ cardiac rehabilitation experiences following myocardial infarction |Paul Galdas, NEXUS co-investigator  NEXUS Training Workshop Series 2009-2010 October 20, 2009 | Putting together a CV | Pam Ratner, NEXUS co-director November 20, 2009 | Links between ontology, epistemology and methodology | Papia Raj, NEXUS postdoctoral trainee & Aditya Raj, postdoctoral fellow, Faculty of Education January 20, 2010 | Preparing a career award application | Jean Shoveller, NEXUS lead investigator March 26, 2010| How to write a manuscript review | Lynda Balneaves, NEXUS lead investigator May 13, 2010 | Responding to reviewer feedback | John Oliffe, NEXUS lead investigator For more information on NEXUS events please visit www.nexus.ubc.ca/opportunities/learning/learning.htm NEXUS Lead Investigators  NEXUS Co-Investigators  Dr. Lynda Balneaves Dr. Joan Bottorff Dr. Jane Buxton Dr. Lorraine Greaves Dr. Joy Johnson Dr. John Oliffe  Dr. Annette Browne Dr. Joyce Davison Dr. Renée-Louise Franche Dr. Paul Galdas Dr. Carolyn Gotay Ms. Sukhdev Grewal Dr. Su-Er Guo  Dr. Aleck Ostry Dr. Ric M. Procyshyn Dr. Pamela Ratner Dr. Jean Shoveller Dr. Judith Soon  Dr. T. Gregory Hislop Dr. Mieke Koehoorn Ms. Martha Mackay Ms. Mary McCullum Dr. Erin Michalak Dr. John Ogrodniczuk Dr. Birgit Reime  NEXUS is a community of academic and clinical researchers and graduate students pursuing health behaviour research from a variety of perspectives including nursing, public health, epidemiology, sociology, pharmaceutical sciences, psychology, and geography. Its mission is to develop knowledge, interventions, and policy recommendations based on a critical analysis of the social contexts that 1) create barriers to health, 2) affect health seeking, and 3) influence system responses. NEXUS is building expanded research programs related to these three themes in health behaviour using the analytical lenses of gender, diversity, and place. NEXUS: Researching the social contexts of health behaviour  Dr. Chris Richardson Dr. Carole A. Robinson Dr. Rick Sawatzky Ms. Tracy Truant Dr. Helen Ward Dr. Sabrina Wong Dr. Mary Lynn Young NEXUS is funded by  Page 5  


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