This study explores the relationship between tourism, the nutrition transition, and prenatal dietary practices in the Monteverde Zone, Costa Rica. This rural tourism community, located in the central highlands of Costa Rica, has seen rapid growth and development since the tourism boom in the early 1990s, leading to changes in the local food system and increased food insecurity. This investigation added to this work by identifying the ways that prenatal dietary practices have shifted over time in the context of increased tourism and the concomitant nutrition transition, and by describing the relationship between food insecurity and nutritional status among pregnant women. In applying a critical biocultural approach, this study drew on both quantitative and qualitative methods. Pregnant women were recruited to participant in twenty-four hour diet recalls (n=21), the Household Food Insecurity and Access Scales (n=20), and semi-structured interviews (n=22). Women who had older children were also recruited for semi-structured interviews (n=20) to explore prenatal dietary practices and decision-making over time. Focus groups (N=2, n=15) and surveys with a free listing component (n=52) were administered to better understand the cultural construction of nutrition in this region, and how tourism and the nutrition transition have interacted with the local dietary norms. Overall this study found that there was a relationship between tourism, the nutrition transition, and diet, although findings suggest that pregnant women may be buffered from these effects by cultural factors. Food insecurity was present in the sample (n=7) and was associated with numerous variables, including saturated fat and zinc intake.

Pregnancy brings numerous physiological and psychosocial changes and conditions, which can include gestational diabetes mellitus (GDM), and mental health conditions, including anxiety, and mood disorders such as depression. Food insecurity, or not having access to a diet that meets needs and preferences, may make management of pregnancy complications more challenging. I examined whether or not food insecurity was associated with a greater prevalence of mental health conditions, or GDM during pregnancy. I used the biocultural and syndemics approaches to the investigate the relationships among these conditions and to understand their interactions with the larger environment. The main questions are: (1) Does pregnancy increase the risk of developing or worsening food insecurity? (2) Are there positive associations between food insecurity during pregnancy and GDM as well as mental health conditions? (3) How does food insecurity impact the management of above-mentioned issues? (4) What are the experiences of individuals who have had GDM during pregnancy? To answer these questions, I undertook a mixed methods approach that involved quantitative analysis of the Canadian Community Health Survey, as well as a survey administered to pregnant people in the city of Hamilton. I also quantitatively analyzed pre-existing focus group transcripts and conducted one-on-one interviews with pregnant and postpartum people in Hamilton. This study found that there is a syndemic interaction between food insecurity, GDM, and mental health conditions in Canada. Analysis of focus group and interview transcripts provided further insight into the complex environments that shape risk for developing one, or more of these conditions during pregnancy. These results indicate how the pregnancy experience is impacted by a multitude of factors, which can lead to increasing complication risk. / Thesis / Master of Arts (MA)

This doctoral dissertation examines the holistic health and wellbeing of a First Nation community to understand several factors relating to environmental racism and water contamination that support and hinder community health and wellbeing to inform future policy. This dissertation incorporates a mix of methodological approaches across three interrelated research studies to better understand the direct and indirect factors influencing water security and community health and wellbeing. Study 1 consists of a theoretical approach to co-creating knowledge between Indigenous collaborators and medical anthropologists. It highlights the importance of community-based participatory research in medical anthropology and frames the co-creation of a health survey through three phases as a boundary object that can create dialogical space for Indigenous and settler-scholar pedagogies and priorities. It demonstrates how CBPR and co-creation work allows for the reciprocal development of long-term partnerships that work in solidarity with the Two-Row Wampum (Kaswentha) treaty established by the Haudenosaunee Nation and European settler nations. Study 2 presents an analysis of household water access, quality, and use, specifically how E. coli and mercury contaminations of household tap water are related to reported household health conditions for a sample of 66 households (representing 226 individuals) living in Six Nations First Nation. Logistic regression models were built to identify possible associations with water use and treatment variables for mental health, eczema, and gastroenteritis, with a second model adding contaminants as predictor variables. In the second model, E. coli was found to be a significant predictor for the presence of mental health conditions within the household, and households primarily purchasing bulk bottled water were more likely to report mental health conditions. Those using bleach/chlorine to treat their tap water were more likely to report gastroenteritis. Reported tap water uses indicated that 57% of contaminated tap water was still being used for activities that may heighten exposure risks (such as washing produce). Investigating household tap water uses beyond drinking water demonstrates alternative pathways for contaminant exposures for Six Nations Peoples, who have deep cultural relationships with water. Study 3 contains a mixed methods approach to investigate the effects of water access, satisfaction, and experiences of water insecurity for the sample of 66 households in Six Nations of the Grand River First Nations, to inform culturally effective ways of assessing water insecurity for Indigenous Nations experiencing long term water shortages, contamination, and other water- related concerns. Water security was measured using the Household Water InSecurity Experiences (HWISE) scale and Likert-scale questions on water access at household, community, service, and environmental levels, and contextualized using interviews. Results demonstrate a high level of water insecurity in the sample of Six Nations households (57.5%, n=38); women were more dissatisfied with their drinking water (p=0.005), and younger participants were more likely to report contamination issues (p=0.02) and higher monthly water costs (p=0.03). Qualitative interviews informed these results, revealing that experiences of water insecurity and poor health were shaped by the degradation of traditional lands. This posed specific barriers for Six Nations women, who face physical and geographical barriers to household and community water access while caretaking for their communities and fulfilling their roles as water protectors. / Thesis / Doctor of Philosophy (PhD) / The goal of this doctoral dissertation was to explore the connections between water security and health with Six Nations of the Grand River First Nation, to explore the nuanced factors that inform perceptions of drinking water and better understand who in the community faces higher challenges and barriers throughout the water crisis. This project was co-created research using Indigenous Knowledge (IK) with medical anthropology approaches to understand water security, satisfaction, quality, and relationships as they relate to Haudenosaunee health. Water security was explored through tap and well water contamination tests, survey data, and interviews and focus groups. Water insecurity was reported for 57.5% of 66 households in this sample, with 21.2% having E. coli contamination in their tap water, 25.4% having mercury in their tap water exceeding provincial drinking water limits, and 77% of households relying primarily on bottled drinking water rather than their tap water. While water insecurity experiences were quite high in this study, Western metrics are not able to capture the crucial elements of Indigenous water relationships, such as community and cultural relationships with the land, environmental racism, and the consequences of environmental degradation, such as grief or poor mental health, relating to water and climate crisis. Water insecurity experiences are best understood as highly localized experiences that have mental health, physical health, and environmental consequences for Indigenous communities. To fully untangle the specific cultural, spiritual, racial, and colonial landscapes or structures that have shaped Six Nations experiences and perceptions of their local water, co-created and flexible place- based methodologies are needed.

Ce mémoire en recherche création est divisé en deux principales sections : un recueil de poésie et un essai. Le recueil, intitulé Le Cœur est une permanence, explore différentes interprétations du phénomène d’empathie dans la création littéraire. Afin que l’empathie devienne l’objet du discours, ce dernier est centré sur la relation à l’autre. L’empathie prend vie à travers deux entités, un « je » et un « tu ». Alors que le « je » entre en contact avec ses propres zones d’ombres, il s’ouvre tranquillement aux souffrances du « tu ». Au fil des poèmes, le « je » et le « tu » apaisent leur douleur en la partageant, faisant de l’empathie une voie d’accès à l’intimité. Ce déploiement de l’intime prend forme en trois temps : les sections replis de voix, point archimédien et ensembles vides. Le recueil accorde une importance particulière à la figure du corps comme véhicule de la souffrance. Il propose une réflexion sur l’amour, balançant entre naufrage et terre promise, et fait de l’enfance une pierre de touche pour interroger la douleur. La deuxième partie de ce mémoire est un essai intitulé Empathie et souffrance dans Tête première / Dos / Contre dos de Martine Audet. Divisé en trois chapitres, cet essai étudie l’empathie à l’œuvre dans le recueil de Audet, selon une approche bioculturelle. Il allie interprétation littéraire, sciences cognitives de deuxième génération et philosophie de l’esprit. Dans le premier chapitre, le concept de « simulation incarné », développé par Vittorio Gallese, permet d’interpréter la figure du corps et de suggérer qu’elle véhicule la douleur tout en étant la manifestation d’un effacement identitaire. Le deuxième chapitre se penche sur l’intersubjectivité en lien avec l’empathie. Il intègre certaines notions clés de la phénoménologie husserlienne afin d’analyser les manifestations du lien empathique unissant les deux présences parcourant le recueil de Audet. Le dernier chapitre explique comment les représentations de l’environnement dans lequel évoluent ces présences peuvent refléter leur souffrance. Pour ce faire, certains concepts liés à l’environnement, particulièrement importants pour l’écocritique actuelle, sont analysés dans Tête première / Dos / Contre dos, comme ceux de place et de nature. Ces derniers, étant construits par les perceptions propres à la cognition humaine, sont envisagés d’un point de vue bioculturel. En interprétant ces trois principaux aspects du texte (figure du corps, intersubjectivité et environnement), l’hypothèse selon laquelle la perception de la souffrance dans Tête première / Dos / Contre dos repose essentiellement sur l’empathie comme effet et objet du discours s’en voit validée. / This M.A. thesis, combining research and creative writing, is divided in two parts: a poetry collection and an essay. The first part, Le Cœur est une permanance, explores different interpretations of empathy phenomenon in creative writing. In order for empathy to become the subject of my poetry collection I focused it’s discourse on the possibilities of a relation to another self. This relation takes form through the two entities of “I” (je) and “you” (tu). While the "I" comes into contact with its own darkness, it opens to the sufferings of the "you". Throughout the poetry collection, the "I" and the "you" soothe their pain by sharing it, making empathy a pathway to intimacy. This use of intimacy takes shape in three stages: the sections: replis de voix, point archimédien and ensembles vides. The poetry collection also gives special importance to the conception and representation of the body as a vehicle of suffering. The compilation proposes an interpretation of love that balances between shipwreck and promised land and uses childhood as a touchstone for questioning pain. The second part of this M.A thesis is an essay entitled Empathie et souffrance dans Tête première / Dos / Contre dos de Martine Audet. The essay, divided into three chapters, examines empathy throughout Audet’s poetry collection, through a biocultural approach. It specifically combines literary interpretation with second-generation cognitive sciences and philosophy of mind. The first chapter analyzes literary representations of the body taking into account the concept of "embodied simulation", developed by Vittorio Gallese. It suggests that literary representations of the body convey pain while revealing identity issues. With this theoretical basis, the second chapter studies the relation between the “I’ and the “you”. It also examines Husserl's phenomenology point of view of intersubjectivity to suggest the presence of an empathic, albeit problematic, link between the two presences in Audet’s collection. The final chapter explains how the representations of the environment, in which the two presences progress, mirror their suffering. To do this, it takes interests in the presence of certain key concepts related to the environment in Tête première / Dos / Contre dos, such as place and nature. These concepts are particularly important for present ecocriticism. They can also be considered from a biocultural point of view in this essay, since being built by the perceptions belonging to human cognition. By interpreting three main aspects of Audet’s poetry collection (literary representations of the body, intersubjectivity and environment), the hypothesis that the perception of pain in Tête première / Dos / Contre dos is essentially based on empathy as an effect and object of discourse is being validated.