Elizabeth Saewyc

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.

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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.

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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.

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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.

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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.

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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.

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