2011 YIHR Graduate Student Symposium
The York Institute for Health Research (YIHR) held its annual Graduate Student Symposium on Wednesday April 27th 2011. Graduate students from all disciplines who are engaged in health-related research presenting their work and/or attended the symposium.
This symposium offers graduate students an open interdisciplinary forum to present their research to like-minded peers from a diverse range of disciplines. Presenters may also have their papers published by the YIHR in the symposium proceedings.
Check YIHR Symposium Publication
Jen Rinaldi, Critical Disability Studies, York University
In this paper, I will examine the implications to grounding women’s legal reproductive rights in autonomy. Since the landmark case R. v. Morgentaler (1988), women’s entitlement to reproductive freedom has been constitutionally protected by the Charter’s s. 7 right to security of the person. I will make a case for how Morgentaler and subsequent Canadian legal decisions regarding abortion have issued rulings which are devoid of important discussions around social equity. Analyzing Morgentaler, Gavigan (1992) holds that reproductive equality – not autonomy – was the rally cry among feminist activists, while Rodgers (2006) argues that Morgentaler and later cases have missed a crucial detail: women’s inequality has throughout history been rooted in who controls their reproductive abilities. Despite the decriminalization and constitutional protection of abortion, access to abortion services in Canada continues to be limited: services vary from province to province; clinics as an alternative to hospitals are infrequent, even non-existent in PEI and New Brunswick; wait lists run long even in Ontario, British Columbia, and Quebec; threats of, and attempts at, violence are directed at abortion providers; and racial and disability-based discrimination (among other varieties) occur within hospitals and clinics against those seeking treatment. I will argue that Canadian jurisprudence ought to recognize that reproductive control is often a s. 15 equality matter, not simply a s. 7 concern, for such an acknowledgement would lead to drastically different health care services.
Inbal Marcovitch, York University
Co- Authors: Abi Sriharan, Peter A. Silverman Centre for International Health- Mount Sinai Hospital; Yehudah Roth, Tel-Aviv University Sackler School of Medicine and The Edith Wolfson Medical Center, Holon, Israel; Department of Public Health Sciences, University of Toronto, Canada
Introduction: The detection of severe genetic disease leads to difficult ethical questions of optional treatments, especially for non-fatal diseases. This study examines the application of genetic screening to hereditary hearing loss amongst Muslim and Jewish orthodox populations in Israel. By comparing the rehabilitation services available to each community, while understanding religious contexts, the research provides policy guidance and an insight to the ethical dilemmas. This research may interest a wide variety of stakeholders including families experiencing hereditary hearing loss, medical professionals and public health, education and social support policy makers.
Methods: A qualitative key informant interview was conducted to explore participants’ perceptions and attitudes about genetic counseling and hearing loss. Semi constructed interviews were conducted and the themes were analyzed using a systematic approach.
Results: Genetic counseling cannot provide a comprehensive solution to hearing loss. Prior to the provision of these services, free choice should be ensured for communities and families through programs specializing in education, rehabilitation, and empowerment. In the context of the Middle East, inter-community dialogue groups can promote knowledge sharing to develop better ways to support families and individuals experiencing hereditary hearing loss.
Discussion: Exploring the ethical questions raised by these issues in the light of prevailing norms provides a better understanding of future utilization of genetic screening services. Additionally, understanding the effect of these norms provides a starting point for a dialogue between policy makers, communities, religious leaders, educators, public health and medical practitioners through the implementation of ‘health as a bridge to peace’ framework.
Gillian Parekh, Critical Disability Studies, York University
Often deigned a timeless disease (McCuaig, 1999), tuberculosis continues to stave off eradication in Canada. Having reached epidemic proportions at the turn of the 20th century, civil society groups in concert with varied levels of government actively supported social initiatives to curb the spread of disease (Wherrett, 2977). This paper explores how Canadian social policy evolved and redefined the shifting conceptualizations of tuberculosis. Historical and present day social reform movements and government reactions to tuberculosis will be discussed. The development of pharmaceuticals, such as antibiotics and inoculation vaccines, dramatically changed global approaches to preventing and treating communicable diseases. However, reliance on pharmaceuticals has removed the focus on improving social conditions such as housing, wages, nutrition, and sanitation, which have all shown to exacerbate the transmission of tuberculosis (Starr, 1982). Prioritization of individual wellness over addressing social determinants has led to the relative disappearance of tuberculosis among privileged groups and a resurgence of the disease among those already experiencing economic and social marginalization (Grzybowski, 1999). Through the exploration of select social policy approaches, Canada’s historical management of tuberculosis will be contrasted by its current participation in the effort to eradicate tuberculosis worldwide.
Julie Yang, Health Policy and Equity, York University
Despite Canada being an economically developed country, many Canadians still face issues of food insecurity. To deal with this issue, the community food security movement developed as an alternative to large-scale politics and the anti-hunger movement. The community food security movement relies on alternative food institutions (AFI) such as community gardens, farmers’ markets, and community-supported agriculture (CSA) as its main conduit system. However, some AFIs perpetuate the neoliberal principles of individualism, self-improvement, localism, and entrepreneurialism. This is of particular concern as neoliberal ideologies are associated with income and health inequalities. By examining the places and spaces of the community food security movement, this paper will explore how AFIs perpetuate neoliberal ideologies and will critique the ability of AFIs to bring about community food security with the intention of building a stronger social movement.
Pariss Garramone, Faculty of Education, York University
According to Canada’s Public Health Agency, “by 2026 one Canadian in every five will have reached age 65” (Public Health, 2009). In this time of unprecedented growth of Canada’s aging population, my research focuses on the important link between the role of autobiography (Brophy, 2004; Chivers, 2003; Raoul et al., 2007), and visual representation (Cole & McIntyre, 2007; Roman, 2008) to our social understanding of the aging body as a health threat. By focusing on the social construction of aging, Basting (1998) suggests, “postmodern theory can offer a vision of social space in which no single image or experience of aging is deemed ‘natural,’ ‘normal,’ or most importantly, ‘pathological’” (p. 19). In order to bring into view how “the aging body is the materialization of the various discursive constructions of age” (Basting, 1998, p.19) this presentation will examine how visual texts interpret the materiality of intersecting discourses on aging. The current Art Gallery of Ontario exhibition, House on Fire, by Sarah Anne Johnson (2009) will be one of the autobiographical texts that my presentation will examine. This collection of images and sculptures document the witnessing of illness and the social construction of women’s mental health in Canada in the 1970’s. Through the deconstruction of the autobiographical exhibit, this presentation will complicate spectatorship as it troubles the desire to pathologize, and naturalize the aging body as we make meaning from these images.
Bonita Heath, York University
Objective: Because web-based campaigns are an important part of health promotion campaigns for youth, this research examines sexual health websites aimed at youth and explores the messages on HIV/AIDS for their relevance and accessibility for youth with disabilities.
Methods: Within a critical constructivist framework, we adapted a directed content analysis approach, which facilitates research that validates or extends a theoretical framework and allows for the development of an initial coding scheme. From our expertise in youth sexual health promotion, we identified three key messages of interest and indicators of accessibility and relevance.
Results: The messaging across all sites was highly consistent: they were sex-positive, gay-positive, and non-judgmental about youth sexual expression. All sites urged young people to get tested, most noting that testing is the only way to be certain about having a sexually transmitted infection. All sites in the sample advocated condom use explicitly and offered “how-to” information for condoms and other barrier methods. However, the pages on disability linked back to the prevention information aimed at the general youth population. As such, none of that the prevention information specifically considers mobility, verbal and cognitive abilities, and the heightened sexual vulnerability of youth with disabilities. Only one site depicted disability in graphics and none depicted disability and sexuality.
Conclusion: There is a clear need to develop safe sex information specifically for youth with disabilities that takes into account their physical and intellectual abilities and to better understand their sexual health promotion needs.
Tamara McKay Thalman, Clinical Psychology, York University
Effects of the Internalized Partner; a therapeutic technique extracted from the Systemic- Constructivist Couple Therapy protocol, on relationship factors were examined. Seventy-five undergraduate females in a committed relationship for at least six months were randomly assigned to either the Internalized Partner (IP), comparison (RT) or control group (C). IP and RT groups engaged in a different in-lab exercise 3 times over a one week period. A 2 (time: pre and post test) × 3 (condition: IP, RT, and C) split-plot ANOVA on interpersonal processing (IPP) revealed a significant interaction with a large effect size (η2 = .08). Bonferroni post hoc tests revealed that only the IP group showed a significant increase in IPP from pre-test to post-test. A split-plot ANOVA on depression revealed a significant main effect of time among all groups at post test with a large effect size (η2 = .12), however what is crucial is that the IP group at pre-test was the only group that met criteria for depression and at post-test no longer met this criteria. At post-test for the IP group both their immature and neurotic defense styles were significantly negatively correlated with their IPP scores, while for the RT group their neurotic defense style was significantly positively correlated with their relationship satisfaction scores. These results are important due to the prevalence of couple distress, the impact this has on the psychological and physical health of couples and their families, and growing evidence in support of the effectiveness of couple therapy to treat these issues. 1
1 Snyder, Castellani and Whisman, 2006.
Ashley Spigelman, York University
Background: Depression is considered one of the leading causes of disability worldwide. Many short–term psychotherapeutic treatments are effective, but have modest, short-lived effects, and can therefore be improved. One way of improving therapies is to learn more about how they work by identifying change processes that are linked to client improvement and identifying factors that contribute to them. The working alliance and client emotional processing are two change processes that predict outcome in experiential therapy for depression (Hovarth & Bedi, 2002; Pos et. al, 2009). Experiential theory assumes that therapist empathy during session one is a critical factor essential in both early alliance building and later facilitation of client emotional processing. If this assumption is valid, empathy should predict clients’ post session one alliance reports and emotional processing in the working phase of therapy. This was examined in the present study.
Method: Therapist empathy was rated using a new observer-rated empathy measure: The Measure of Expressed Empathy (MEE; Watson & Prosser, 2002) for 31 clients (N = 31) who received experiential therapy for depression. Ratings were compared to client’s post session one alliance reports on the Working Alliance Inventory (WAI; Horvath & Greenberg, 1986, 1989) and emotional processing scores as rated by the Experiencing Scale (EXP; Klein, Mathieu, Gendlin & Kiesler, 1969).
Results: MEE ratings positively predicted clients’ post session one alliance reports and working phase emotional processing scores.
Kimberley Cullen, Adult Clinical Psychology, York University
Regular use of vaginal dilators has been recommended as a prophylactic measure following treatment for gynecological cancer (e.g., surgery or radiation). Despite the proposed benefits of using the devices, including prevention of vaginal stenosis and preservation of sexual function, compliance is notoriously poor. While many women struggle to use vaginal dilators as recommended, some are able to use them more readily. The purpose of this study was to investigate women’s experiences with the vaginal dilator, and to understand the factors that influence women’s adoption of rehabilitative dilator use.
Ten women with a history of gynecological cancer and who were prescribed a vaginal dilator were interviewed and asked a series of open-ended questions designed to elicit information concerning their experiences with the dilator. Interviews were analyzed using the grounded theory method and examined for recurrent themes.
The analysis revealed that women who were prescribed vaginal dilators fell into one of three categories: 1) Compliers viewed the dilator as an extension of treatment, 2) Resisters felt that they didn’t need the dilator or were unable to use it, 3) Strugglers experienced the dilator as a reminder of cancer and treatment.
This study increases our understanding of women’s unique experiences with rehabilitative vaginal dilator use and suggests that the issues associated with non-compliance behaviour are not as clear-cut as one might assume. These findings could help health care providers to better address women’s difficulties and concerns associated with dilator use, and may ultimately lead to improved quality of life for women recovering from gynaecological cancers.
Ahmed Abdelrazec, Mathematics and Statistics, York University
West Nile virus (WNv) was detected for the first time in North America in 1999, and then spread prolifically within birds, with over 300 species can contribute to the spreading of the virus. Among these many species of birds, Corvids and non-corvids family of birds have different responses to the virus. We proposed a model for the transmission dynamics of WNv in the mosquito-bird cycle and human, putting in to consideration the two kind birds of bird populations: corvids and non-corvids. The model is extended to assess the impact of some anti-WNv control measures. For this talk, I will introduce the model and some preliminary results on the optimal control.
Yurong Cao, Mathematics and Statistics, York University
The changing climate can significantly affect the mosquito abundance in a region and cause emerging or remerging of mosquito disease, like WNv (West Nile virus) .Using the surveillance data and weather data, in this study, we focus on the distribution properties of each individual trap, to estimate the association between mosquito abundance and climate factors. Different clustering methods were implemented to study the mosquito abundance of 31 traps in Peel Region from 2004 to 2008. By employing the AIC and BIC model selection criteria, an optimal clustering result was obtained. Then we used Gamma distribution to fit the data. The results of the goodness of fit test showed that taking the confidence level to be 95%, most of the P-values are highly above 0.05. This result could be further used to estimate the association between mosquito abundance and more of climate and environmental factors.
Chunhua Shan, Mathematics and Statistics, York University
The two islets in the Yangtze River has been keeping expanding since their first emerge in 1970s. And schistosomiasis came back and started to become endemic in East China area along the Yangtze river. In order to explore the impact of the growing islets on the transmission of the schistosomiasis in the area, we formulate and analyze system of ordinary differential equations model for the transmission of schistosomiasis on the two islets in the Yangtze River near Nanjing, P.R.China. The impact of the growing size of the islet is investigated by the bifurcation analysis. The cusp bifurcation is found using center manifold theorem and normal form theory. Numerical bifurcation analysis shows rich and complexity dynamics of the system. By our modeling analysis, we conclude that when the islet reaches a critical size, the transmission of the schistosomiasis among the mammalian Rattus norvegicus and the Oncomelania snails could be established, and the cycle of mammalian Rattus norvegicus and the Oncomelania snails on the islets serves as a possible source of schistosomiasis transmission in East China area along the Yangtze river.
Louisa Kratka, Environmental Studies, York University
This presentation featured a participatory research project involving visual artists who have experienced illness from occupational exposure to toxic chemicals in their arts practice. How have illness, chemical sensitivities or an increased awareness of toxic materials and their health impacts motivated them to change their arts practice? Framed by a social determinants of health model, the presentation will feature statements and questions posed by participants that explore the complex phenomenon of environmental health and the social, political, economic and cultural forces which drive and shape relationships to art and art production, to the environment and to our own bodies.
Ellen Sweeney, Environmental Studies, York University
One in nine women will develop breast cancer in their lifetime and an estimated 23,200 women in Canada will be diagnosed this year (BCSC, 2010). Breast cancer is caused by a combination of hormonal, genetic, lifestyle and environmental factors, however, the established risk factors such as a family history account for less than half of diagnosed cases (Gray, 2010). Advances in medical and environmental science have created an increased awareness of the relationship between toxic agents and human health, as well as discussions surrounding the nature of risk in relation to environmental health and contested illnesses. The risk society perspective views risk as the probability of physical harm as a result of technological processes, and identifies the production and management of risk as a social responsibility (Beck, 1992). It is argued that virtually all diseases that can be attributed to environmental causes are highly contested because of the scientific limitations related to the burden of proof and potential liability issues. Breast cancer’s status as a contemporary contested illness has arisen since WWII and is linked to the growing uncertainty about the specific causes of breast cancer. It is argued that the disease stems from the widespread production and use of synthetic chemicals, many of which are persistent in the environment, bioaccumulate in body fat and have not been tested for human health effects (Gray, 2010). While the mainstream breast cancer movement continues to focus primarily on diagnosis and treatment, the environmental breast cancer movement calls for increased attention to research on environmental causes and prevention.
Alisa Das, Environmental Studies, York University
‘Recovery’ originated in the writing of American psychiatric ex-patient/consumer/survivors in the 1980s and has spread throughout the Western world. It emerged in Ontario in 2002 and is being incorporated into mental health service delivery (Mental Health “Recovery” Study Working Group, 2009). This presentation will explore the results from a qualitative research study that investigated the intersections of queer sexuality, madness and mental health system involvement, and religion/spirituality in the lives of women. Specifically, this grounded theory study analyzed 48 written narratives collected from a variety of published and online sources and 13 participant interviews to examine what queer/mad/religious women think about the mental health ‘recovery’ vision and the unique factors that apply to these women’s mental health.
Results indicate that some women have not yet heard about recovery while others embrace or reject it. Particularly important is how a couple of women critique recovery from their perspectives as queer/mad women and survivors of sexual violence. Themes that are involved in supporting queer/mad/religious women’s mental health include: religion as distress or solace, accepting identities, passing and disclosure, and finding community. These results highlight the importance of an intersectional analysis in understanding women’s health. They are relevant to students, researchers, and supporters.
Ciann Wilson, Environmental Studies, York University
Artist Biography: This photovoice project was completed by 15 young African, Caribbean and Black – Canadian women from the Jane and Finch community in expression of the barriers and facilitators to realizing their sexual health. These personal photo-narratives give a different perspective to our understanding of adolescent sexual health, STI and HIV vulnerability.
Context: With over 3000 Black (of African or Caribbean ancestry) residents, the low-income neighbourhood of Jane and Finch is considered one of Toronto’s key Black communities. Social inequality and poor policy decisions impose negative, oppressive conditions on the inhabitants of Jane and Finch, which inhibit the opportunities available to youth to achieve educational, social and economic success. This context of inequality manifests in poor sexual health outcomes in the young inhabitants of Jane and Finch. For instance, youth from Jane and Finch have some of the highest Sexually Transmitted Infection (STI) rates in the city of Toronto. The situation is worsened for female youth who are reported to develop low self esteem, have sex at earlier ages, and are left socially and economically dependent on their male partners. As a result of their dependency, young, racialized women in Jane and Finch are left unable to negotiate safe sex, which puts them at increased risk for unplanned pregnancies, STIs and HIV. Importantly, due to the social unacceptability within Black communities of engaging in discussion about sexual health and HIV, alternative strategies are needed to address sexual health promotion and HIV prevention with young ACB women.
The Approach: During a photovoice workshop held once a week for 9 consecutive weeks, 15 young ACB women ages 14 – 18 from the Jane and Finch community used photography and creative writing to describe their photos in expression of their opinions on the barriers and facilitators to making healthy sexual decisions. This photovoice project is a part of a community based research project done in partnership with Northwood Community Centre and Black Creek Community Health Centre.
The Exhibit: A group photovoice exhibit has been created from the photos and corresponding narratives. The photos and narratives depict the great degree of thought and agency these young women exhibit when making sexual decisions, as well as the barriers to making healthy decisions such as: parental control; the lack of intergenerational communication and support; and the fear of being labelled or gossiped about if accessing sexual health resources and information.
Farah Islam, Kinesiology and Health Science, York University
Objective: To determine the correlates of mental health in community-dwelling individuals aged 65+ living in an ethnically diverse, low SES urban area in Toronto, Canada.
Methods: A total of 63 participants (14 male; 49 female) were recruited. The mental health outcome measures used were the Medical Outcomes Study Short Form (36) Health Survey (SF-36) mental health component, Perceived Stress Scale (PSS), and Subjective Happiness Scale (SHS). Sociodemographic (age, sex, marital status, education, and income), behavior (overall physical activity and alcohol drinking), and health (SF-36 general health and SF-36 role of limitations due to physical health) variables acted as potential correlates.
Results: At the bivariate level, older age significantly predicted poorer mental health. Being male, having poorer general health, and experiencing more limitations due to physical health were significantly correlated with higher perceived stress. Being in poorer general health and experiencing more limitations due to physical health was significantly correlated with lower levels of happiness. According to the step-wise multivariate linear regression analysis, older elderly individuals experienced significantly poorer levels of mental health. Elderly individuals in poorer general health perceived significantly more stress in their lives. Lastly, being in poorer general health and being married were significantly associated with lower levels of happiness.
Conclusions: General health is a robust predictor of mental health. Older seniors, as well as those in poorer general health, could potentially be targeted for mental health outreach. Future studies could look into the effect of marital status on mental health in low-income elderly populations.
Vivian Stamatopoulos, Sociology, York University
Mental health is associated with more lost work days than any other chronic condition, costing the Canadian economy over $51 billion annually (Dewa et al 2010). The issue with this recent finding is the unclear temporal direction of association which lingers; does poor mental health affect labour trends, such as lost work days, or does labour itself engender mental health disorders? Since work roles significantly impact our personal identities and since women are dominating precarious employment contracts, it would also be expected that this would interact negatively with historical gender-related labour force inequality to co-facilitate a gendered rise in mental health disorders. Despite this, most research over the past few decades has looked at gender neutral associations between various psychosocial work environment traits and physical health outcomes, often within particular industries (call centre and nursing as examples). Even fewer have empirically assessed how facets of employment precarity in the Canadian labour force reflect the feminization of employment norms and fewer still have measured this gendered facet through mental health outcomes. Therefore, this research proposes ten working hypotheses which will be analyzed using multivariate regression analyses vis-à-vis Statistics Canada’s 2007-2008 Canadian Community Health Survey data (CCHS). On the whole, this analysis will clearly demonstrate an important correlation between the General Mental Health response variable and precarious labour indicators that are exacerbated by ones gender and visible minority status.
Dean Hodge,York University
In the context of a large economic recession, we chose to study its effects on the psychological health of students. In general, people are increasingly worried about personal finances and future economic prospects. Students may be particularly vulnerable, as student debt and an uncertain job market are likely to increase their anxiety, and affect mental health. To deal with such anxiety, people employ a variety of coping methods, some of which were assessed in this study.
Participants responded online to questions about their psychological health using the General Health Questionnaire (GHQ), how much economic hardship they perceived they were facing (the Economic Hardship Questionnaire), as well as measures assessing the extent to which they used proactive coping (PCI) and reframing strategies.
Results of regression analyses suggest that greater use of positive and proactive coping strategies relate to better psychological health. Additionally, those failing to use proactive coping techniques may instead be more likely to reframe events positively, in order to mitigate the deleterious effects of economic hardship on psychological health. For those perceiving more hardship, greater use of proactive coping techniques, in combination with greater psychological reframing, may work to reduce deleterious effects on psychological health.
The theoretical and practical implications of these findings will be discussed in a broader coping framework, highlighting the utility of multiple and varied coping methods in dealing with stressors.
Navindra Baldeo, Geography, York University
I plan to present two areas of my Master’s thesis including a discussion of my literature review on immigration and health, and preliminary findings from my project involving access to health care services amongst older aged immigrants with diabetes who are living in the outer suburbs of York Region.
My literature review discusses a changing health geography that has increasingly adopted more social constructivist paradigms and qualitative methodologies. A growing immigration and health focus is also apparent here in Canada as immigrants now make up roughly 20% of the country. Access to health care services is an especially important issue as numerous studies have discussed barriers s to preventing and managing chronic conditions. Various cultural, social and environmental factors that influence health will be explored.
I will ground my discussion by also presenting initial findings of my fieldwork from 20 in-depth interviews of older aged Indian immigrants who discussed health care access and management of their diabetes, and who are living in Markham, Richmond Hill and Vaughan. Several themes have emerged including changing sites of care where participants are using the home and religious spaces to gain health information and be referred to health providers. As well, while all participants interviewed lived in York Region, Toronto is being used for many health care services. Participants discussed the outer suburbs as isolating, and lacking neighbourhood and community services that would help with diabetes management. Other geographic factors such as distance and the built landscape, and lifestyle factors such as diet and physical activity will also be discussed.