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Understanding the energy needs of ovarian cancer patients

Ovarian cancer is one of the most common cancers affecting women and one of the most fatal, with a five-year survival rate of just 45 per cent. It’s also associated with muscle loss, which worsens a patient’s prognosis.

“Cancer is a condition that makes us waste away. Even before the cancer is detected, it is causing muscle loss,” says Carla Prado, director of the University of Alberta’s Human Nutrition Research Unit (HNRU) which conducts clinical nutrition research using cutting-edge techniques. HNRU research has shown that anyone can have low muscle mass, but patients with cancer are particularly susceptible, especially those with ovarian cancer.

One contributing factor is the high risk of malnutrition for those with ovarian cancer, as well as the tendency of patients to either gain or lose weight during treatment. Malnutrition can affect how well a person’s cancer treatment works, their strength, how fast they recover, their quality of life and can reduce lifespan. It can also increase both the time spent in the hospital and the likelihood of getting an infection.

Although the research is ongoing, preliminary results show that one-third of the participants had low muscle quality and/or quantity, and one-third had very different calorie needs than what was predicted using standard techniques.

“Any time you have weight change, you can have unfavourable changes to body composition, especially the muscle and fat mass in the body,” says Ana Paula Pagano, a PhD candidate in the Faculty of Agricultural, Life & Environmental Sciences. She is examining the energy – or caloric – needs of women with ovarian cancer both during and after treatment.

Funded by a WCHRI Graduate Studentship, Pagano is studying patients recently diagnosed with ovarian cancer who are being treated at the Royal Alexandra Hospital and Cross Cancer Institute. During the study, participants visit the HRNU three times — shortly after the start of treatment, after treatment, and a few months following treatment — where they undergo body composition and energy metabolism testing. Pagano, who is supervised by Prado, will also use data from blood tests measuring inflammation, which is a sign of muscle loss.

Although the research is ongoing, preliminary results show that one-third of the participants had low muscle quality and/or quantity, and one-third had very different calorie needs than what was predicted using standard techniques. These findings suggest the need to provide early, targeted nutritional assessment and intervention for patients with ovarian cancer, in order to prevent muscle loss and improve outcomes after treatment, says Pagano.

Once the study concludes, Prado’s lab will use the findings to create targeted interventions and create a way to use muscle mass to make dietary and supplement recommendations.

“I love that Ana’s bringing the spotlight to the importance of nutrition research to women with cancer,” says Prado. On top of this, Pagano is helping the patients involved with the study by providing detailed information about their body composition and teaching about the role of nutrition and muscle mass in cancer survivorship.

Pagano, who was a dietician in Brazil before pursuing her PhD work, says the support from WCHRI has helped her earn other scholarships and awards, including the prestigious Izaak Walton Killam Memorial Scholarship. Her involvement with the institute has also connected her with a number of prominent clinician-scientists, including gynecologic oncologist Helen Steed, who has become a mentor.

“WCHRI has opened doors to amazing opportunities,” Pagano says. “The institute was the first to believe in my potential as a graduate student.”

Ana Paula Pagano is supervised by Carla Prado. Her Graduate Studentship was funded by the Alberta Women’s Health Foundation through the Women and Children’s Health Research Institute.

Long overdue: Developing a treatment to prevent preterm birth

Babies born too soon are vulnerable to a host of health problems, including asthma, vision problems, hearing loss or development delays. Some don’t survive past childhood.

With about 15 million preterm births yearly worldwide, the health consequences are well understood. But there’s very little known about why preterm births happen, who is at risk or what can be done about it.

“We still don’t know exactly how a process as common as birth starts, how it goes wrong,” says researcher Kelycia Leimert.

The senior scientist at the University of Alberta is working to change that.

The current approach to treating preterm birth is to slow contractions, which delays birth by a few days. “We describe it as trying to stop a train when it’s already full-speed ahead down the tracks,” says Leimert.

One of her projects is developing a treatment that will, in a manner of speaking, stop the train before it leaves the station. The second is a diagnostic test to predict when the engine is warming up.

“Otherwise, we’re blind on both sides,” Leimert says. “Even if we come up with the perfect treatment, it’s really hard to understand who to give it to because there aren’t clinical signs until a woman is contracting.”

There are signs — they’re just hard to see.

David Olson, Leimert’s former PhD supervisor and head of the Olson Lab, has spent decades researching factors that influence preterm birth and piecing together molecular changes in the body that precede contractions. A key indicator is inflammation, when cell-level changes from the uterus “signal to the rest of the body to get ready, a big event is coming,” Leimert says.

Tracking inflammation is the basis for their diagnostic test, which looks at white blood cells of a pregnant person to predict — with about 90 per cent accuracy — whether contractions will begin within the week.

Knowing when labour is imminent creates a window to give the treatment, an inhibitor of inflammation, to people who are at risk of preterm birth. Leimert’s research shows that this inhibitor stops contractions from commencing by suppressing the release of some inflammatory proteins.

Animal studies are showing the treatment effectively stops preterm birth without compromising maternal immunity or fetal organs. “Even though we’re delaying birth and prolonging pregnancy, it’s not really going to help outcomes unless we’re also protecting the fetus from those harmful inflammatory effects,” she says.

“People are starting to recognize that women’s health technology is an area that people are very willing to spend money on.”

“Otherwise, we’re blind on both sides,” Leimert says. “Even if we come up with the perfect treatment, it’s really hard to understand who to give it to because there aren’t clinical signs until a woman is contracting.”

Promising results on the bench mean the scientists have already donned their business hats to get it to the bedside. Leimert and Olson helped co-found a company called Livmor Biosciences to develop their diagnostics and therapeutics.

Next steps for the diagnostic are already underway by the National Research Council, which is working on a microfluidic chip to simplify the complex test into one that can be done with a blood pinprick.

Meanwhile, the long-term goal of the inhibitor is to get it to human clinical trials.

Leimert and the team have been meeting with venture capitalists, hoping to raise interest and money to continue development through the first phase of a clinical trial. They hope that a successful first round would interest a pharmaceutical company to come, she says.

But it’s not an easy sell, she says.

Pregnant people are rarely included in clinical trials because of the doubled patient risk. And stigma from the thalidomide tragedy of the 1960s all but ended the development of drugs for conditions related to pregnancy.

That’s one reason Leimert is grateful for the support from WCHRI. She received a grant in 2015 as a PhD student studying inflammatory pathways related to the birth process and another in 2021 as a postdoctoral fellow for her work on the inhibitor.

Kelycia Leimert was supported by the Stollery Children’s Hospital Foundation and the Alberta Women’s Health Foundation through the Women and Children’s Health Research Institute.

Survivors share their stories of forced or coerced contraception

“The doctor told me, ‘You’re getting your tubes tied’. Not asking me, he told me,” says Linda, not her real name, about the reproductive violence she experienced. “When I came out of the room after I signed the paper, I didn’t know what I was doing. I was young … there were môniyâwskwêwak, white women, sitting there. I asked them, ‘Did you get asked to get your tubes tied?’ ‘No.’ No? I always thought, why me?”

Linda is one of a large number of Indigenous women in Canada who cannot conceive because they were sterilized without their informed consent through the medical system.

Although no confirmed figures exist on how many women are being sterilized against their will, Indigenous experts estimate that at least 12,000 women have been affected in Canada since the 1970s.

To support survivors and facilitate their healing, University of Alberta public health professor Denise Spitzer leads a collective of Alberta researchers, community partners and international collaborators who are raising awareness about the issue of reproductive mistreatment of Indigenous, migrant, and rural poor women, not only in Alberta (and elsewhere in Canada), but in Peru and Indonesia.

Their project began in the fall of 2021 with a series of multilingual web discussions with survivors, researchers and advocates from Peru, Indonesia and Canada. In the spring and summer of 2022, in-person gatherings took place in each region, where victims came together for arts-based healing sessions called “Telling Our Stories”.

In Alberta, the sessions took place at Poundmaker’s Lodge, a residential healing centre in Edmonton, which is a critical partner in the project, says Spitzer. Survivors came together to work with an artist to create glass artwork, while Elders shared teachings and led a sweat lodge ceremony.

“It became this really beautiful intergenerational conversation,” says Spitzer, a migrant settler of Central European Jewish ancestry residing on stolen Indigenous lands. “There was a great deal of support amongst the participants.”

The project culminated in a summit at the U of A in August 2022. Thirty participants, including survivors from Alberta, Peru and Indonesia, shared their stories and their artwork, then created a quilt and collective sculpture that was, along with artwork, videos, and photographs produced through Telling Our Stories, exhibited at the Whiskeyjack Art House gallery in Edmonton.

“The main objective was to give these women the space to be heard and to be valued,” says Paulina Johnson, an assistant professor in the U of A’s sociology department and a member of the project collective.

But in a broader sense, it was important to raise awareness about the lack of respect with which Indigenous women are treated in Canada’s health-care system, which is a symptom of the systemic racism that still exists in medical care and across Canadian society, says Johnson, a member of the Samson Cree Nation.

“It’s not just about the individual woman,” she says. “All of these things have implications for families and for Indigenous communities. These messages that Indigenous women need to curb their childbearing can be incredibly hurtful, not only to the women but to their communities. We have to acknowledge that the implications are immense.”

Delia, not her real name, along with several other participants referred to forced sterilization as “genocide” against Indigenous women in their roles as life-givers of their communities – a sentiment echoed by scholars and leaders.

Spitzer recounted the story of one of the Alberta survivors who attended the events in 2022. She is a woman in her early 30s, with three children, “an amazing mother, very proud of being an Indigenous woman, and looking forward to having a large family.” Her doctor told her she could have an operation on her fallopian tubes that would be completely reversible. Once she had gone through with the procedure, she found out the procedure had been irreversible and she has been unable to conceive again.

“She’s really had a hard time dealing with this, not having had the opportunity to make an informed choice,” says Spitzer.

Carla Jamison, a community engagement officer at Poundmaker’s Lodge and a member of Blueberry River First Nations, says as a result of “atrocities” like these, there is widespread mistrust of physicians and the health-care system among Indigenous women, who are the most marginalized people in Canada.

“This is a great project,” she says. “It creates a community of women who have gone through the same thing. It transcends culture, it transcends language. It’s women saying ‘Me too. This has happened to me’.”

Funding for the project winds up this year, with a final report to follow. Once the report is published, the researchers plan to meet with leaders in health-care and medical schools to help create guidelines on contraception and informed consent.

The group has created a number of videos, available on their YouTube channel, and they are working on an infographic on contraception options, to be shared with Indigenous and migrant communities. They also hope to create a permanent art exhibit in an Indigenous space, to display the art created by the survivors from Alberta, Indonesia and Peru.

“We felt like so much love and pain and energy went into creating this work, it needs to be in a place where people can see it, people can learn from it, and where other people may be able to share their stories,” says Spitzer.

Alberta’s Sexual Sterilization Act, enacted in 1928, allowed the forced sterilization of people deemed to be physically or mentally disabled. About one-quarter of those who were sterilized were Indigenous, even though Indigenous people represented just 2.5 per cent of Alberta’s population at the time.

The act was rescinded in 1972. But the Senate Committee on Human Rights has found that coerced contraception – ensuring that women are no longer able to reproduce by forcing them to undergo procedures without their informed consent – has continued in some parts of Canada. There are class action lawsuits underway in several provinces, including one filed in Saskatchewan in which 100 women say it happened to them.

In Peru, more than 200,000 women were forcibly sterilized in the 1990s under former president Alberto Fujimori. Most of them were Indigenous.

In Indonesia, many women were forcibly injected with a long-term contraceptive in the 1990s. Even today, recruitment agencies require Indonesian migrant workers to accept a long-term injectable contraceptive as a requirement for working overseas.

Denise Spitzer is supported by the Alberta Women’s Health Foundation through the Women and Children’s Health Research Institute.

Recruiting superhero cancer patients to defeat pain

If you ask a teenage cancer patient to keep track of their pain symptoms on a piece of paper or a traditional symptom score sheet, you’ll likely get a roll of the eyes, maybe a sigh, and little chance that it’ll actually happen the way it should.

But a project involving nine Canadian pediatric oncology centres, including Edmonton’s Stollery Children’s Hospital, is tackling the challenge of proper pain reporting by teenagers by offering them an alternative they’re already very familiar with – a smartphone app.

Pain Squad+ was developed at Toronto’s Hospital for Sick Children, which is the lead site for a multi-year randomized clinical trial to evaluate the impact of the app on young cancer patients’ quality of life and self-management of pain. The trial involves 12- to 18-year-olds and has so far enrolled more than 70 participants across Canada.

The Edmonton research team, which has been involved in the project since November 2019, is led by Sarah McKillop, an oncologist at the Stollery and the Cross Cancer Institute and an assistant professor at the University of Alberta. With support from the Stollery Children’s Hospital Foundation and the Kids with Cancer Society, the local study is being managed by WCHRI’s study coordination team.

“We recognize that all of our adolescent and child patients have pain at some point, probably more than we hear about,” says McKillop. “It’s difficult sometimes to get the actual reporting of what pain they’re having.”

While cancer is more common in older people, each year in Alberta, about 237 young people are diagnosed with cancer.

Pain in cancer patients can be acute or chronic, or both. It can result from chemotherapy and other treatments, surgeries and tests. The current method of tracking pain and other symptoms involves asking patients to record how they feel on paper score sheets, which are reviewed by their medical team at regular appointments, which can be weeks apart. McKillop says this isn’t effective with teenagers, who either don’t want to bother with the task or they get their parents to do it, which can result in inaccurate reporting.

Pain can impact a teenage patient’s quality of life, making them reluctant to go to school or get out with their friends. It can also affect their rehab and can contribute to mental health problems, which are common in cancer patients. “Having pain itself and its impact on their lives can certainly make the symptoms of depression or anxiety around doing activities worse,” she says.

The Pain Squad+ app is set up like a video game, where users create superhero avatars who carry out missions to defeat Squidopus — by completing two daily pain reports and unlocking a range of pain advice to help them manage their symptoms. “They’ve tried to make it as teenager-appropriate as possible,” says McKillop. “Early on it was recognized that if you didn’t have engagement and if you didn’t make it fun and provide rewards, no one was going to continue to do this reporting.”

Data is still being collected in Edmonton and the other sites to determine the effectiveness of the app. Proper pain reporting is crucial to giving doctors a better understanding of their patients and how their treatment is affecting them.

But empowering young patients to take control of their pain management is also a key element of the project, says McKillop.

“Doctors getting this information is important, but even more important is helping to educate that young person about looking at their own pain story and recognizing when they need to ask for help. And it helps to validate some of the experiences they’re having.”

Study management support for this project is supported by the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

Ketone therapy may protect fetal growth in low-iron mothers

Iron deficiency is the most common nutritional disorder worldwide and, in many cases, iron supplements can easily treat and cure it. However, pregnant women, who are very susceptible to low iron, are harder to treat — and the stakes are higher.

“What we know is that children of mothers who were anemic during pregnancy are at a higher risk of developing cardiovascular and kidney diseases,” says Shubham Soni an MD/PhD student with the University of Alberta Department of Pediatrics.

Iron supplements are seldom enough to raise blood iron levels adequately and come with side effects and health risks for both mothers and fetuses. After mulling over topics for his PhD dissertation, Soni wondered if ketone therapy might serve as an additional treatment for iron deficiency in pregnancy.

Ketones are chemicals produced by the liver when the body lacks glucose and needs an alternate energy source — a process called ketosis. This is the goal of the ketogenic or ‘keto’ diet, which involves restricting carbohydrates (which produce glucose) for weight loss purposes. However, ketones can also be given as supplements to provide health benefits without the risks associated with the classic keto diets.

Soni explains that, unlike a drug treatment, ketone therapy uses molecules that already exist in the body. “Your body knows how to make ketones, use ketones, and get rid of ketones when it needs to,” he says.

Research shows that ketones can change the way organs, like the heart and kidneys, metabolize energy and improve organ function. Other research suggests ketones may protect against inflammation and oxidative stress, two harmful effects of iron deficiency that contribute to cardiovascular and kidney problems.

After securing a WCHRI Graduate Studentship, Soni set out to test his hypothesis that ketones protect the heart and kidneys of a developing fetus from the negative effects of iron deficiency. Using an animal model, the study appears to support his hypothesis and suggests the treatment would have few side effects.

Soni explains that, unlike a drug treatment, ketone therapy uses molecules that already exist in the body. “Your body knows how to make ketones, use ketones, and get rid of ketones when it needs to,” he says. That said, more research is needed to prove the safety and efficacy of ketone therapy in pregnant humans.

While most PhD students work on projects laid out by their supervisor’s research program, Soni conceptualized a potential application of ketone therapy in a tangential area to answer these questions.

WCHRI support provided essential funding for his dissertation research but also boosted his morale. “It gave me a lot of confidence that, as a graduate student, I can rationalize important new ideas and properly put a proposal together — that I understand what I’m doing and can convey that message,” Soni says. Additionally, he was able to leverage his WCHRI award to earn the prestigious Izaak Walton Killam Memorial Scholarship and Dorothy J. Killam Memorial Graduate Prize.

As his PhD work comes to an end, Soni will soon shift his focus to completing medical school and becoming a physician. Eventually, he plans to become a clinician-scientist, with a focus on translational therapies, which use existing scientific evidence to treat health problems.

“My interest is in what we can do right now. What potential options are out there that we can immediately use to treat patients?”

Shubham Soni is supervised by Jason Dyck. His Graduate Studentship was funded by the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

New device effective in measuring children’s heart rhythms

As a pediatric cardiologist at the Stollery Children’s Hospital, Carolina Escudero often sees patients complaining of heart palpitations.

“These symptoms can either be due to having an abnormal heart rhythm, but sometimes children with normal heart rhythms sense them abnormally,” she says.

The best way to determine what’s happening — and whether medical treatment is needed — is to record a patient’s heart rhythms at the time they feel symptoms. “That can be difficult, depending on how long or how often abnormal rhythms happen,” says Escudero, co-lead of the Stollery’s Inherited Arrhythmia Clinic and an associate professor of pediatric medicine at the University of Alberta.

Currently, patients are sent home with an event recorder that they must carry around and attach to their chests via electrodes when they feel symptoms. Data is then transmitted to their doctor via landline.

“We noticed that some families were having trouble with this,” she says. “One of the challenges is the need for a landline, as fewer families have one nowadays.” The devices are also prone to poor recording quality as a result of user error, and the high cost means the clinic only has enough to lend out for two to four weeks at a time.

In recent years, newer technologies have emerged that are cheaper, smaller, and transmit information through smartphones, not landlines. “But the problem with using newer technologies for children is that they’re developed for adults,” she explains.

With funding through WCHRI, Escudero and her team were able to test one of these newer devices. Nearly 100 young patients experiencing heart palpitations received either the standard event recorder or a newer device called the AliveCor Kardia. This much smaller monitor connects to a smartphone and is outfitted with two metal plates where patients place their fingers to measure heart activity.

Escudero expected the new device to generate more readings due to the ease of use and transmission, but the study data showed no difference in how well the devices captured patient episodes. However, the data showed that parents preferred the newer device, which will help her clinic better meet the needs of families.

“This provides us with another tool that we can offer to monitor and record their child’s heart rhythm,” she says. Escudero hopes that by growing the clinic’s ‘toolbox’ of recording devices, families can get answers sooner: “If a patient truly has an abnormal heart rhythm, they will need treatment with medications or procedures, but if they have a normal heart rhythm, we can reassure patients and their families.”

Carolina Escudero is supported by the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

Evaluating the effectiveness of delivering medications to the lungs of children

Asthma is the most common chronic disease in children, affecting nearly 850,000 Canadian children under the age of 14. At its worst, asthma can cause a child’s airways to narrow so much that they need emergency medical care to breathe, but even milder symptoms can cause children to lose school days, sleep poorly, and experience long-term lung damage.

To protect children from these complications, doctors must diagnose and treat asthma as soon as possible. One medical test doctors use is called a bronchoprovocation test.

“During the test, the child breathes in a mist or spray from a nebulizer that contains a small amount of an agent called methacholine in it and then doctors perform additional tests to see how the lungs react,” explains Andrew Martin, director of the University of Alberta’s Aerosol Research Laboratory of Alberta.

If the airways of the lungs are hyperresponsive, methacholine can make it harder to breathe, which can help doctors decide whether or not the child has asthma.

“This can make it hard for doctors to interpret test results across labs, but it also puts children at risk of adverse reactions – like fainting and chest pain – if they receive too much methacholine.”

The trouble is that different nebulizers vary in terms of how much medication they can transport to the lungs and different laboratories use different nebulizers,” says Martin. This can make it hard for doctors to interpret test results across labs, but it also puts children at risk of adverse reactions – like fainting and chest pain – if they receive too much methacholine.

“These aerosols are quite complex,” says Martin, a mechanical engineering professor who specializes in designing and testing aerosol-based medical devices, like nebulizers.

Like most medical devices, nebulizers are typically designed for adults, not children.

With funding from a WCHRI Innovation Grant, he and his team developed computer models that predict how much medication is deposited into the lungs when using specific nebulizers.

Martin’s graduate student Kineshta Pillay is focusing on inhaled drug delivery for children and is creating a computational model that incorporates physiological differences related to child development.

“Children aren’t miniature adults,” she says, noting that how well medications reach the lungs is impacted by a child’s age and development. For instance, children have a smaller and shorter airway and faster breathing rate than adults.

Now that the models have been developed and validated, Martin is exploring other nebulizer-related collaborations with clinical partners on campus, especially the University of Alberta Hospital’s Pulmonary Function Lab. The lab, which performs bronchoprovocation tests in children and adults, sparked this research study when they approached Martin for help evaluating a new nebulizer.

“This area of research is important for the health of children with and without asthma,” says Eric Wong, a pulmonologist and medical director of the Pulmonary Function Lab. “At the moment, misdiagnoses could be occurring as a result of nebulizers administering either too much or too little methacholine.”

As a result, healthy kids could receive an incorrect diagnosis of asthma and medication treatments they don’t need. But it’s also possible for asthmatic kids to be deemed healthy when they desperately need treatment. Unfortunately, untreated asthma leads to chronic lung inflammation that may cause permanent narrowing of the airway.

“We want to make the diagnosis early and get children treatment to prevent long-term damage,” says Wong. He adds that since asthma causes breathing difficulties, undiagnosed children may struggle to participate in physical activity, which all kids need to be healthy: “This can have long-term consequences in terms of health, weight gain, and other issues. Making that asthma diagnosis early can avoid these problems and allow kids to participate in activities normally.”

Andrew Martin was supported by the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

Lifestyle choices in adolescence linked to poor mental health

Research by a team at the University of Alberta establishes a clear link between a wide range of lifestyle behaviour choices made by middle adolescents and their mental well-being.

The project was the first to look at 12 lifestyle behaviours in middle adolescence, comparing those results to the frequency of depression and anxiety symptoms reported by the same group of youth a year later. The behaviours included diet – including eating vegetables, fruits and grains – physical activity, screen time, sleep and the use of substances such as tobacco, alcohol, e-cigarettes and cannabis.

Of those surveyed in 2017-18, more than 70 per cent were classified as having very unfavourable or unfavourable lifestyles. A year later, those who had made unfavourable lifestyle choices reported higher rates of depression and anxiety, particularly among girls.

The study, published in 2023, was supervised by Paul Veugelers, a professor in the School of Public Health whose career has focused on children’s lifestyles and how it affects their health. His then-PhD student Julia Dabravolskaj led the analysis.

This study builds on earlier research by Veugelers’s team, which looked at early adolescent lifestyle behaviours and found the same link with behaviour choices and mental health outcomes.

Mental health problems are growing at an alarming rate in Canada, especially since the COVID-19 pandemic. More than one million, or one in four, young Canadians live with mental disorders, and three-quarters of all mental health issues emerge before age 25.

Understanding adolescent behaviours and their link to mental health is crucial, says Veugelers, because it provides evidence that could lead to earlier and more comprehensive intervention programs. “If you intervene in all lifestyle behaviours early on, kids are more likely to retain those healthy lifestyles throughout their lives.”

The research project used data from COMPASS (Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking and Sedentary behaviour), a longitudinal study that collects information annually based on extensive questionnaires filled in anonymously by grade 9-12 students in Alberta, Ontario, British Columbia and Quebec.

The U of A project was based on answers from 24,274 participants, with an average age of 14.5 to 15.5 over the two-year data collection period.

Dabravolskaj said the answers to the behaviour questions were discouraging. On average, participants met 5.6 of 12 recommendations, and almost none met all 12 recommendations. Only 3.9 per cent of participants met recommendations for eating vegetables and fruits, 4.5 per cent for grains and 4.9 per cent for screen time, including streaming TV shows and movies, playing games, surfing the internet, texting, messaging and emailing. “The screen time results weren’t surprising – it’s our new reality – but they were really sad,” she says.

In the past, most school-based intervention programs have focused on just one or two lifestyle behaviours, and as a result, are usually only effective short-term, says Dabravolskaj. She and Veugelers hope this study will provide evidence to encourage policy-makers and education experts to fund complex intervention programs targeting a wide range of adolescent behaviours.

One such initiative is APPLE Schools, a comprehensive school health program founded by Veugelers in 2007, which is now operating in 93 schools in western Canada. It works with the whole school community to improve eating habits, physical activity and mental well-being.

Mental health problems are growing at an alarming rate in Canada, especially since the COVID-19 pandemic. More than one million, or one in four, young Canadians live with mental disorders, and three-quarters of all mental health issues emerge before age 25.

“The approach is out there,” says Veugelers. “We just need the policy-makers to have the courage to step up.”

Veugelers is grateful to WCHRI for its support for his work. “Generally, the first focus is always on patients and sick kids, and I understand that. But it’s really important that an organization like WCHRI has a broad perspective and understands that there’s different ways of addressing health, not only in hospitals or waiting until kids are sick, but doing something on the prevention side.”

Paul Veugelers was supported by the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

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