Non-suicidal self-injury (NSSI) is a dangerous and common behaviour, particularly among adolescents. Childhood trauma, insecure child-parent attachment, psychological distress, and impulsivity are some of the risk factors for NSSI that have been previously identified. However, the pathways from distal risk factors to NSSI and the ways in which these correlated risk factors interact with each other remains unclear. Identifying these pathways will provide valuable insight into the aetiology of NSSI and potentially highlight targets for treatment and intervention. In this dissertation I examine data from multiple large samples of young people, looking at multiple risk and protective factors together, and examining moderation and mediation pathways between risk factors. Using longitudinal data from 933 adolescents with no prior history of NSSI I demonstrated that the association between childhood family adversity before age 5 and new onset of NSSI between the ages of 14 and 17 was mediated by age 14 family functioning and possibly mental illness. Next, I validated a new measure of child perceptions of positive parenting, which I used to demonstrate the uni-directional prospective association between positive parenting and lower rates of NSSI amongst 1489 adolescents (ages 14-25). I then used this new measure of positive parenting to demonstrate that the prospective parenting-NSSI association was mediated by psychological distress. This is also one of the first prospective studies to show that impulsivity is independently predictive of NSSI. Using data I collected myself from a sample of 596 adolescents (ages 16-19) I validated a much needed measure of childhood trauma, with which I then demonstrated that the trauma-NSSI association was mediated by attachment and distress. Using data from this sample I was also able to reaffirm my previous findings that the attachment-NSSI association was mediated by psychological distress, and that impulsivity was uniquely associated with NSSI. Finally, using data from a sample of 559 Flemish 13 year-olds, I demonstrated that behavioural problems were more salient to NSSI than emotional problems among young adolescents, and that the attachment-NSSI association might be mediated by hyperactivity and conduct problems. Together, these findings reaffirm that childhood trauma, insecure child-parent attachment, psychological distress, and impulsivity are robust risk factors for NSSI and potential targets for treatment and intervention. Moreover, both distress and child-parent attachment may be viable targets for interventions aimed at attenuating the impact of early childhood trauma after it has occurred. Future research should use randomised controlled trails to test the efficacy of NSSI treatments aimed at these risk factors.

Vapour products (e-cigarettes) have rapidly grown in sales. While competing claims about the effects of vaping are fiercely debated within the public health community, no studies have examined the claims accepted in the regulatory arena. In the first article of this manuscript-based dissertation, my co-authors and I utilized narrative policy framework to identify the claims about vapour devices in legislation recommendation reports from Queensland Australia, Canada, and the European Union, and the United States. The vast majority of claims represented vapour devices as a threat, while the potential benefits were very rarely presented, resulting in bans and strict regulations. Evidence on two claims, youth vaping as a risk for nicotine dependence, and vapour products as a cessation aid, was evaluated with systematic reviews. For the youth claim, we retrieved population surveys on (1) the first product used, (2) non-nicotine vaping, (3) the prevalence of infrequent users among past-30-day users, and (4) cannabis vaping. Surveys indicated that a near majority of students who were past-30-day users vaped only once or twice a month, and an appreciable number, 25% and more, reported consuming non-nicotine liquids. Furthermore, 80% to 90% of ever-users tried cigarettes first. Far fewer youth are at a risk for nicotine addiction than indicated by any past-30-day use. On the other hand, vaping as a mode of administration of other drugs has received little attention, and presents an unknown risk to youth. We evaluated the claims about cessation with a review of systematic reviews (umbrella review). Three reviews, Hartmann-Boyce et al. (2016), Malas et al. (2016) and El-Dib et al. (2017) received the better quality ratings. They were unable to reach a definitive conclusion due to the limited number of randomized controlled trials and the low quality of most of the studies. We considered the reviewers’ tentative statements on their findings, the findings of the quality cohort studies, the potential underestimation of effectiveness in the studies, and the improved nicotine delivery of newer models. The weight of the evidence allowed us to state our optimism that vapour products have potential as a cessation aid. In the jurisdictions studied in this dissertation, vapour products have been claimed to be a threat by leading youth to smoking and impeding cessation. Does the evidence support the claims? The possible risk of youth becoming dependent on nicotine from vaping is substantially lower than indicated by the metric of any past-30-day use. There is reasonable evidence that vapour products may be an effective cessation aid. With a better understanding of these two claims, we in public health should revisit the regulations, policies, and interventions for vapour products so that they are in line with the evidence, not unsupported claims. / Graduate / 2019-04-02

Nurses who work with people who use drugs in the Downtown Eastside of Vancouver (DTES), British Columbia are on the forefront in advancing a harm reduction framework in very controversial, cutting-edge practice environments. The purpose of this study was to explore how these nurses, using the framework of harm reduction, make sense of their nursing practice. It is hoped that the results of this study may advance adopting a harm reduction framework in nursing practice, education and policy development and serve as the foundation for further nursing research. This study utilized a qualitative interpretive descriptive methodology to gather data from eight nurses who work with people who use drugs in harm reduction practice environments. The nurses were divided into two focus groups and data was collected through a semi-structured focus group interview. Following initial data analysis, each focus group was reconvened and a second semi-structured group interview was held to clarify and to further discuss the emerging themes. The data analysis proceeded simultaneously with the interviews utilizing a process of constant comparative analysis. I completed the thematic analysis as I moved between the transcripts and identified commonalties and variations within the emerging themes. Ultimately, I described one overarching theme, which encapsulated the range of experiences described by the nurses. The theme that I identified was: meeting people where they are at. The importance to the nurses of both the therapeutic nurse-client relationship and a commitment to praxis were apparent. In conclusion, the value the nurses placed on "meeting people where they are at" was integral in gaining an understanding of how they make sense of their nursing work. / Applied Science, Faculty of / Nursing, School of / Graduate

Despite thirty published evaluation reports citing the effectiveness of Vancouver’s safe injection site (Small 2008), the Canadian federal government refuses to endorse safe injection sites as a health service option available to injection drug users (IDUs). Insite’ s evaluation results are undergoing debate, because two communicative spheres of knowledge, each with a unique authoritative language, are conflicting as each is attempting to gain moral authority over the right to recontextualize drug users. Drawing on a literature review of two harm reduction programs in Vancouver, Insite and Sheway, and expert interviews with evaluators, I show that what constitutes “evidence” is in fact subjective, determined by spheres of communicability that are built upon social, professional and political contexts. To confront the problematic nature of this issue, I suggest that evaluators and overseers need to treat program evaluation as a process of negotiation, best approached in a fluid manner. By obscuring multiple user experiences in the evaluation of harm reduction programs, evaluators and overseers risk imposing their communicative ideologies on what it means to be a drug user. / Arts, Faculty of / Anthropology, Department of / Graduate

The climate change mitigation targets to maintain a relatively stable climate may not be met. Even if targets are met, substantial climate change could occur. In a changing climate, how can social science facilitate composed decision making? One way is through studying emotional reactions to a changing climate. Therefore, this thesis examined how engagement with climate catastrophe scenarios influenced various emotions. Relative to other conditions, “negative” emotions (e.g., fear) were predicted to increase in scenarios related to climate change, and “positive” emotions (e.g., serenity) were predicted to decrease in the same scenarios. Participants engaged with one of five conditions, four of which reflected environmental effects (e.g., local harmful effect from climate change). Before and after condition engagement, participants took a questionnaire of specific emotions. Conditions that described environmental harm were associated with large decreases in “positive” emotions (e.g., serenity) compared to other primes. However, they were not consistently associated with “negative” emotions (e.g., fear). Conversely, qualitative responses frequently mentioned increases in feelings of “fear” or “sadness”; however, decreases in emotions like “calmness” were rarely mentioned. Error played some role in emotional measurement. Nonetheless, psychological research about climate change may include a blind spot: focusing on emotions that are provoked by climate change while ignoring emotions that are depleted by it. A decrease in a “positive” emotion (e.g., calmness) may be conceptually distinct from an increase in an assumed “negative” counterpart (e.g., fear). What are the implications of this distinction? Does avoidance of climate change stem from fear of the subject, or more from its perception as a “buzzkill”? Overall, research of emotional reactions to climate change could facilitate engagement, mitigative behavior, contingency planning, and a more composed transition in a changing climate. / Graduate

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In this paper I propose a new type of therapy for dementia patients called AIIT. AIIT concerns using artificially intelligent programs to mimic the likeness of a dementia patients' spouse or relative in hopes of providing them comfort and an alternative solution to them constantly reliving grief or being lied to in unsatisfactory ways. I establish the moral permissibility of AIIT through the moral parity claim, which is a conditional claim stating that if current dementia care practices are permissible, then AIIT ought to be as well. This means that AIIT is no more morally problematic than current dementia care practices. To make this claim I evaluate and compare AIIT to current practices from three different perspectives/potential harms. I first find AIIT to be less harmful to dementia patients than current practices since AIIT better preserves dementia patients' beliefs, emotions, and desires. I then conclude that AIIT does not pose a unique harm to the impersonated person, since 1) Many theories of wellbeing do not support the possibility of the deceased being harmed and 2) People with dementia are not commonly creating new impressions, and therefore harms committed to the impersonated person are extremely unlikely. Finally, I claim that AIIT would not cause additional harms to society given that current practices already harm relatives in a similar manner, also have the potential to pose problems if used outside of dementia care, and don't differ from AIIT in respect to affecting trust in the medical system. Having established moral parity, I conclude with a push for a stronger claim, the superior option claim, which states that AIIT is morally permissible by arguing for the antecedent of the moral parity claim. I argue for this by denying that we have an obligation to not deceive dementia patients since they have special conditions that do not allow them to apprehend the world accurately. / Master of Arts / AI is becoming increasingly popular, especially within the healthcare industry. I explore the intersection of AI and dementia care. Dementia is a debilitating illness that affects millions of people worldwide. In this paper, I propose a new therapy for dementia patients called AIIT. AIIT involves using artificially intelligent programs to simulate the likeness of a dementia patient's spouse or relative, with the goal of providing comfort and an alternative solution to their grief. I argue that AIIT is morally permissible on the grounds that it is not any worse than current practices in dementia care. At the end of the paper, I also argue that AIIT may have significant benefits and so we should employ AIIT when it is applicable.

This paper attempts to offer a group-based approach to reparations for slavery. I argue that by appealing to a group-based approach to reparations, one can avoid some of the significant problems associated with attempting to justify reparations on an individual level. I argue that, properly formulated, a group-based approach can avoid problems of identification, the non-identity problem, as well as misgivings about appealing to the notion that groups can have a moral standing that is not merely the aggregation of the moral standing of the individual group members. In order to show that a group-based approach is a viable solution to these issues, I appeal to Larry May’s account of groups.

No description available.

The study explored maternal and paternal attachment, taking a multidimensional approach, in relation to adolescent self-harm. Based on adolescents’ perception of their mothers and fathers availability, anger, and empathy, we examined what contribution of attachment was most predictive of self-harm separately and simultaneously. The sample included 564 Canadian high school students in grade 8 to 12. The quantitative survey was conducted on computers, and was from a three year longitudinal study, using the second and third annual assessments. Cross-sectionally, the results suggested low parental availability, anger toward mothers, and low empathy toward fathers to be related to self-harm. Longitudinal analysis did not support the hypotheses. In sum, attachment to mothers and fathers both contributed to the understanding of adolescent self-harm.