Papers by Chris Richardson
Information concerning patients' preferences for the treatment of osteoarthritis (OA) is limited.... more Information concerning patients' preferences for the treatment of osteoarthritis (OA) is limited. We examined patients' attitudes toward the acceptability of gastrointestinal, cardiac, and cerebrovascular events in order to obtain pain relief from OA. Methods. Patients responded to a set of threshold technique tasks. Each task described 2 treatment options, their levels of pain relief, and the risks of side effects. The risk for the side effect under investigation was then systematically increased to reveal the maximal acceptable risk increment associated with the pain reduction. Results. Of 196 patients, 22.3% and 14.7% were unwilling to accept any additional risk of stomach bleed or heart attack/stroke for 2-point and 5-point pain reductions, respectively. Patients were willing to accept significantly more risk for a 5-point pain reduction than for a 2-point pain reduction in stomach bleed and heart attack/stroke scenarios. Patients also accepted significantly greater additional risks of stomach bleed compared to heart attack/stroke for 2-point and 5-point pain reductions. Conclusion. Most patients with OA are willing to accept some additional risk of stomach bleed and heart attack/stroke to gain pain relief. Patients are willing to accept greater additional risk of stomach bleed than heart attack/stroke. However, there exists considerable variation in risk-taking attitudes across patients. We recommend that clinicians examine the risk attitude and treatment preferences of each patient on an individual basis when deciding on a treatment regimen.
Canadian Journal of Public Health, 2021
Objective Little is known about the association between mental health and diminished food worry d... more Objective Little is known about the association between mental health and diminished food worry during the COVID-19 pandemic. This paper examines worry about having enough food to meet household needs and its association with mental health during the early months of the pandemic in Canada. Methods Data are drawn from the first round of a multi-round mental health monitoring survey. Online surveys were administered between May 14 and 29, 2020, to a nationally representative sample of Canadian adults (n = 3000). Logistic regression models were used to examine associations between food worry and mental health indicators (anxious/worried, depressed, worse mental health compared with pre-pandemic, and suicidal thoughts/feelings), after adjusting for socio-demographic characteristics and pre-existing mental health conditions. Fully adjusted models explored the impact of controlling for financial worry due to the pandemic in the previous 2 weeks. Results Overall, 17.3% of the sample reported food worry due to the pandemic in the previous 2 weeks, with the highest prevalence found among those with a reported disability (29.3%), Indigenous identity (27.1%), or pre-existing mental health condition (25.3%). Compared with participants who did not report food worry, those who did had higher odds of reporting feeling anxious/worried (OR=1.36, 95% CI: 1.08-1.71) and suicidal thoughts/feelings (OR=1.87, 95% CI: 1.24-2.80) when controlling for socio-demographics, pre-existing mental health conditions, and financial worry. Conclusion This paper provides insights about the associations between food worry and mental health in Canada during the COVID-19 pandemic and indicates the need for improved policies and social supports to mitigate food worry and associated mental health outcomes.
Canadian Journal of Public Health, 2013
To investigate differences in the relationship between self-esteem and the initiation of substanc... more To investigate differences in the relationship between self-esteem and the initiation of substance use (tobacco, alcohol and marijuana) among male and female secondary school students in British Columbia. The data were collected in the 2010 fall and 2011 spring cycles of the British Columbia Adolescent Substance Use Survey (BASUS). The sample consisted of 1,267 adolescents (57% female) in Grades 8 and 9. Multivariate logistic regression models were used to examine the extent to which self-esteem and gender, and their interaction, influenced the odds of having initiated substance use at baseline and at follow-up 6 months later. For each one-point increase on the Rosenberg Self-Esteem Scale, there was a reduction in the odds of initiating substance use by up to 9% for tobacco, 3% for alcohol, and 7% for marijuana. The relationships between self-esteem and the initiation of tobacco and alcohol use varied by gender, with boys having slightly less robust associations at the baseline assessment. The results suggest that self-esteem is protective against the initiation of tobacco, alcohol, and marijuana use. Researchers are advised to consider the interactive effects of gender in future longitudinal research examining the relationship between self-esteem and the initiation of substance use, including implications related to the development of substance use prevention programs.
The purpose of this study was to examine the ability of the Health Utility Index Mark III (HUI-Ma... more The purpose of this study was to examine the ability of the Health Utility Index Mark III (HUI-Mark III) to provide a summary measure of health status for the 1994 National Population Health Survey (NPHS). The sample consisted of 838 (402 male, 436 female) randomly selected residents of Prince George, British Columbia. An exploratory factor analysis was conducted using the measures of physical, psychological and social well-being included in the NPHS. The saved factor scores were then regressed on to the HUI-Mark III in an attempt to determine the proportion of variance in the HUI-Mark III accounted for by the factor scores. The results suggest the HUI-Mark III is unable to discriminate between the many different levels of positive health experienced by the vast majority of the general population and that the HUI-Mark III is more or less insensitive to variation in key indicators of mental well-being.
SSM - Population Health, 2017
Investigating the determinants of positive mental health, as opposed to focusing on mental illnes... more Investigating the determinants of positive mental health, as opposed to focusing on mental illness, is a new research direction with important implications for population health promotion. Past research suggests that mental health develops in early childhood and that social factors including highest household educational attainment may play an important role. The current study examined the association between household educational attainment and adolescent self-reported positive mental health in a nationally representative Canadian sample using data from the 2011-12 Canadian Community Health Survey. The sample included 10,091 adolescents aged 12 to19 living at home with at least one parent. Household educational attainment was obtained from a Statistics Canada derived variable documenting the highest level of education in the household. Adolescent positive mental health was assessed using the Mental Health Continuum scale. Multivariable logistic regression analyses showed that after adjusting for household income, single parent status, and household size, adolescents had lower odds of experiencing positive mental health in households in which attempted but not completed post-secondary was the highest education level compared to completed post-secondary education (OR = 0.64, 95% CI = 0.44, 0.95). This association was strongest in adolescents aged 12 to14 (OR = 0.43, 95% CI = 0.21, 0.84) and females (OR = 0.50, 95% CI = 0.29, 0.88). Contrary to expectations, we did not find an incremental increasing association between adolescent positive mental health and household educational attainment. Instead, results suggested that common underlying factors may have contributed both to uncompleted post-secondary education in the household and adolescents' diminished positive mental health.
Journal of Medical Internet Research, 2014
Evidence indicating an association between cigarette smoke exposure and an increase in breast can... more Evidence indicating an association between cigarette smoke exposure and an increase in breast cancer risk highlights the need for health messages that aim to prevent smoking initiation and reduce secondhand smoke (SHS) exposure among adolescent girls. This study aimed to evaluate the efficacy of targeted gender-sensitive, breast cancer-specific, Web-based messages about the increased risk of breast cancer associated with cigarette smoke exposure. Outcomes assessed 6 months postmessage delivery included nonsmoking adolescent girls' knowledge of the link between cigarette smoke exposure and breast cancer, perceptions of breast cancer risk associated with cigarette smoke, smoking behavior and intentions, and stage of change related to avoidance of secondhand smoke. A prospective randomized controlled trial was used to compare standard (control) messages with targeted gender- and Aboriginal status-sensitive, breast cancer-specific (intervention) messages. Messages were delivered online to 618 nonsmoking girls, aged 13 to 15 years, clustered in 74 Canadian secondary schools. Compared with the control group, girls in the intervention group were significantly more likely to report that breast cancer is an illness caused by cigarette smoke (adjusted relative risk [ARR] 1.33, 95% CI 1.05-1.68) and to agree that exposure to SHS increases their risk of breast cancer (ARR 1.10, 95% CI 1.02-1.20). No significant effects were observed for a change in smoking status, intention to try smoking, or stage of change related to avoidance of SHS. Compared with standard messages, targeted gender-sensitive, breast cancer-specific messages had a stronger influence on girls' knowledge and perceived risk of cigarette smoke exposure as a risk factor for breast cancer. Brief information-based interventions delivered over the Internet have the potential to provide effective health promotion that could be broadly disseminated and lead to long-term effects on…
BMC Public Health, 2014
Background: Although rates of tobacco use and exposure to secondhand smoke (SHS) are declining in... more Background: Although rates of tobacco use and exposure to secondhand smoke (SHS) are declining in Canada, SHS exposure among non-smoking adolescents remains high. This study aimed to describe frequency, locations, and avoidance behavior related to SHS exposure among adolescent girls in British Columbia, Canada. Methods: Data were analyzed from 841 adolescent girls aged 13 to 15 years old who completed an internet-delivered survey as part of a cohort study examining SHS exposure and substance use. Measures assessed demographics, smoking behavior and intentions, frequency and locations of SHS exposure, and avoidance behavior related to SHS. Results: Excluding their own smoking, 27% of girls reported exposure at least once a week and an additional 17% reported daily or almost daily exposure over the past month. Among girls who reported daily or almost daily exposure, the locations of most frequent levels of high exposure were in the home, at or near school, inside a vehicle, and outdoor public places. Avoidance behavior related to SHS exposure significantly differed by overall SHS exposure in the past month. Conclusions: Despite historically low smoking rates, many adolescent girls continue to report regular SHS exposure in multiple locations in British Columbia. Girls with the most frequent exposure were significantly less likely to report habitual avoidance behavior related to SHS compared to those less frequently exposed. This study elucidates settings of high SHS exposure among adolescent girls that could be targeted in future policy interventions. Additionally, future interventions could target adolescent girls who are frequently exposed to SHS and report infrequent avoidance behavior around their SHS exposure.
Journal of Epidemiology & Community Health, 2005
To test the hypothesis that Antonovsky's concept of sense of coherence (SOC) moderates (that is, ... more To test the hypothesis that Antonovsky's concept of sense of coherence (SOC) moderates (that is, buffers) the health impacts of stressful life events in a population based sample. Design: Multiple linear and Poisson regression analyses of longitudinal data from a national survey of population health were used to examine the relations among SOC, the experience of recent stressful life events (for example, family breakdown, financial crisis, physical abuse), and two outcomes, self reported health status (SRH) and self reported number of physician visits during the previous year. Setting: General population of Canada. Participants: Nationally representative sample of household residents aged 30 years of age or greater surveyed in 1998 and 2000 (n = 6505). Main results: After controlling for age, sex, and previous health status, a significant moderating effect (t = 2.24, p = 0.025) in the expected direction was found on respondents' SRH. The mean difference in SRH between those who did and did not experience a recent stressful life event was 0.24 (95% CI: 0.16, 0.32) in people with a below average SOC and 0.04 (95% CI: 20.04, 0.11) in people with a higher than average SOC score. The postulated moderating effect of SOC was not significant (t = 1.1, p.0.05) in predicting the number of visits to a physician. Conclusions: SOC seems to buffer the impact of recent stressful life events on SRH.
Drug and Alcohol Dependence, 2013
Background-Needle and syringe programmes (NSPs) have been shown to reduce HIV risk among people w... more Background-Needle and syringe programmes (NSPs) have been shown to reduce HIV risk among people who inject drugs (IDU). However, concerns remain that NSPs delay injecting cessation. Methods-Individuals reporting injection drug use in the past six months in the greater Vancouver area were enrolled in the Vancouver Injection Drug Users Study (VIDUS). Annual estimates of the proportion of IDU reporting injecting cessation were generated. Generalized estimating equation (GEE) analysis was used to assess factors associated with injecting cessation during a period of NSP expansion. Results-Between May 1996 and December 2010, the number of NSP sites in Vancouver increased from 1 to 29 (P < 0.001). The estimated proportion of participants (n = 2,710) reporting cessation increased from 2.4% (95% Confidence Interval [CI]: 0.0%-7.0%) in 1996 to 47.9% (95% CI: 46.8%-48.9%) in 2010 (P < 0.001). In a multivariate GEE analysis, the authors observed an association between increasing calendar year and increased likelihood of injecting cessation (Adjusted Odds Ratio = 1.17, 95% CI: 1.15, 1.19, P < 0.001). Conclusion-The proportion of IDU reporting injecting cessation increased during a period of NSP expansion, implying that increased NSP availability did not delay injection cessation. These results should help inform community decisions on whether to implement NSPs.
Canadian Journal of Diabetes, 2013
Introduction: Obesity and dyslipidemia are strongly related to each other and to the early onset ... more Introduction: Obesity and dyslipidemia are strongly related to each other and to the early onset and severity of atherosclerosis in children and adolescents (C&A). The association between dyslipidemia and anthropometric indices and obesity-related comorbidity is not well characterized in C&A. Methods: This cross-sectional study included C&A with severe obesity (BMI> percentile 85) referred for pediatric weight management. A lipid score (0 to 8) was calculated based on triglycerides, total-, LDL-and HDLcholesterol (each receiving a score of 0¼acceptable 1¼borderline and 2¼abnormal) based on established cutoff points. Based on lipid scores, dyslipidemia was classified into low (0-2), moderate (3-5) or high (6-8) categories. Differences among these categories were examined using one-way ANOVA. Results: In total, 300 C&A were included (45% male; 12.2AE2.8 y). Lipid categories were distributed as follows: Low (n¼81; 27%), moderate (n¼166; 55%), and high (x¼56; 18%). Increasing waist/hip ratio was associated with higher lipid categories (low: 0.
Journal of medical Internet research, Jan 21, 2018
Treatment rates for social anxiety, a prevalent and potentially debilitating condition, remain am... more Treatment rates for social anxiety, a prevalent and potentially debilitating condition, remain among the lowest of all major mental disorders today. Although computer-delivered interventions are well poised to surmount key barriers to the treatment of social anxiety, most are only marginally effective when delivered as stand-alone treatments. A new, Web-based cognitive behavioral therapy (CBT) intervention called Overcome Social Anxiety was recently created to address the limitations of prior computer-delivered interventions. Users of Overcome Social Anxiety are self-directed through various CBT modules incorporating cognitive restructuring and behavioral experiments. The intervention is personalized to each user's symptoms, and automatic email reminders and time limits are used to encourage adherence. The purpose of this study was to conduct a randomized controlled trial to investigate the effectiveness of Overcome Social Anxiety in reducing social anxiety symptoms in a nonclin...
BMJ Paediatrics Open
BackgroundPaediatric mental health-related visits to the emergency department are rising. However... more BackgroundPaediatric mental health-related visits to the emergency department are rising. However, few tools exist to identify concerns early and connect youth with appropriate mental healthcare. Our objective was to develop a digital youth psychosocial assessment and management tool (MyHEARTSMAP) and evaluate its inter-rater reliability when self-administered by a community-based sample of youth and parents.MethodsWe conducted a multiphasic, multimethod study. In phase 1, focus group sessions were used to inform tool development, through an iterative modification process. In phase 2, a cross-sectional study was conducted in two rounds of evaluation, where participants used MyHEARTSMAP to assess 25 fictional cases.ResultsMyHEARTSMAP displays good face and content validity, as supported by feedback from phase 1 focus groups with youth and parents (n=38). Among phase 2 participants (n=30), the tool showed moderate to excellent agreement across all psychosocial sections (κ=0.76–0.98).C...
Journal of Adolescent Health
Canadian Journal of Nursing Research
The purpose of this study was to design an approach to supporting the development of gender-and A... more The purpose of this study was to design an approach to supporting the development of gender-and Aboriginal-specific messages regarding the link between tobacco exposure and breast cancer, drawing on youth perspectives. Focus groups were held with 18 girls (8 First Nations and Métis) and 25 boys (12 First Nations and Métis) to solicit advice in the design of messages. Transcribed data were analyzed for themes. Girls preferred messages that included the use of novel images, a personal story of breast cancer, and ways to avoid secondhand smoke. Boys endorsed messages that were "catchy" but not "cheesy" and had masculine themes. First Nations and Métis participants confirmed the use of Aboriginal symbols in messages as signalling their relevance to youth in their communities. The results can be used as a guide in developing tailored health promotion messages. Challenges in developing gender-appropriate messages for youth are described.
Harm reduction journal, Jun 7, 2017
Take home naloxone (THN) programs reduce mortality by training bystanders to respond to opioid ov... more Take home naloxone (THN) programs reduce mortality by training bystanders to respond to opioid overdoses. Clinical observation by the health care team at the Inner City Youth (ICY) program indicated that young adults appeared to enthusiastically participate in the THN program and developed improved relationships with staff after THN training. However, we found a dearth of literature exploring the experiences of young adults with THN programs. This study set out to address this gap and identify suggestions from the young adults for program improvement. The primary research question was "How do street-involved young people experience the THN Program in Vancouver, BC?" The study was undertaken at the ICY Program. Two peer researchers with lived experience of THN were recruited from ICY and were involved in all phases of the study. The peer researchers and a graduate student facilitated two focus groups and five individual interviews with ICY program participants using a semi-...
BMJ open, Jan 26, 2017
Early identification of distinct patterns of child social-emotional strengths and vulnerabilities... more Early identification of distinct patterns of child social-emotional strengths and vulnerabilities has the potential to improve our understanding of child mental health and well-being; however, few studies have explored natural groupings of indicators of child vulnerability and strengths at a population level. The purpose of this study was to examine heterogeneity in the patterns of young children's social and emotional health and investigate the extent to which sociodemographic characteristics were associated. Cross-sectional study based on a population-level cohort. All kindergarten children attending public schools between 2004 and 2007 in British Columbia (BC), Canada. 35 818 kindergarten children (age of 5 years) with available linked data from the Early Development Instrument (EDI), BC Ministry of Health and BC Ministry of Education. We used latent profile analysis (LPA) to identify distinct profiles of social-emotional health according to children's mean scores across ...
Substance use & misuse, Jan 4, 2016
Higher rate of Delay Discounting (DD) is associated with increased risk for the initiation and de... more Higher rate of Delay Discounting (DD) is associated with increased risk for the initiation and development of substance use disorders in adolescents. This study aimed to provide a preliminary assessment of the validity of a brief self-report measure of DD by examining discounting rates across 3 periods of increasing delay and subsequently examining the extent to which overall DD scores are associated with having initiated tobacco, alcohol and cannabis use. Data were collected in the 2012 fall cycle of the British Columbia Adolescent Substance Use Survey. The sample consisted of 1,143 adolescents (61% female) in grades 10 and 11. A brief self-report measure of DD was developed to assess the tendency of adolescents to discount a delayed monetary reward of $100 over a period of 1-year, 1-month, and 1-week. The area under the curve was calculated for each participant's DD responses and coded into quartiles. The amount of discounting increased as reward delay increased from 1-week to...
BMC public health, Jan 29, 2015
Indigenous scholars have long argued that it is critical for researchers to identify factors rela... more Indigenous scholars have long argued that it is critical for researchers to identify factors related to cultural connectedness that may protect against HIV and hepatitis C infection and buffer the effects of historical and lifetime trauma among young Indigenous peoples. To our knowledge, no previous epidemiological studies have explored the effect of historical and lifetime traumas, cultural connectedness, and risk factors on resilience among young, urban Indigenous people who use drugs. This study explored risk and protective factors associated with resilience among participants of the Cedar Project, a cohort study involving young Indigenous peoples who use illicit drugs in three cities in British Columbia, Canada. We utilized the Connor-Davidson Resilience Scale to measure resilience, the Childhood Trauma Questionnaire to measure childhood maltreatment, and the Symptom-Checklist 90-Revised to measure psychological distress among study participants. Multivariate linear mixed effect...
Addictive behaviors, 2014
Adolescence is a developmental period during which young teenagers are particularly susceptible t... more Adolescence is a developmental period during which young teenagers are particularly susceptible to shifting from well-defined behavioral intentions to abstain from substance use to intentions that include experimentation with substance use and in many cases engagement substance use. Coping mechanisms are often an important determinant of adolescent well-being, and the style of coping adopted by the individual can influence positive or negative health behavior. The goal of this study was to examine how the levels of positive coping style (i.e., engagement) and negative coping style (i.e., disengagement) associated with increased risk for tobacco and marijuana use, and intentions to use among those who have never tried. Higher levels of engagement coping were associated with lower odds of tobacco and marijuana use (AOR=0.96 (95% CI: 0.94-0.98), p<0.001 and AOR=0.95 (95% CI: 0.93-0.97) p<0.001, respectively). Higher levels of disengagement coping were associated with greater odds...
Canadian journal of public health = Revue canadienne de santé publique
The objective was to compare women's personal estimates of their risk with objective breast c... more The objective was to compare women's personal estimates of their risk with objective breast cancer risk estimates and to describe the risk factors for breast cancer identified by women. Telephone survey of a random sample of 761 rural and urban women with no history of breast cancer. Survey instrument included measures of perceptions of lifetime risk for breast cancer for themselves and for the average woman, perceptions of risk factors that influenced their risk and the average woman's risk for breast cancer. Objective estimates of breast cancer risk were calculated using the Gail et al. algorithm. Descriptive statistics and multiple linear regression were used to analyze the data. Women's estimates of their own lifetime risk for breast cancer were significantly higher than their Gail model risk estimates (mean difference = 19%, p < 0.001). The women's personal breast cancer risk estimates were lower than estimates of risk for a hypothetical average woman (mean d...
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Papers by Chris Richardson