Preserving and improving the health and well-being of older people is a significant public health issue of the 21st century. The increased attention to the promotion of health in old age has given rise to an extensive body of literature on the subject of “healthy aging” – a discourse dedicated to understanding the multidimensional factors associated with aging and health and the application of this knowledge. Adopting a place-based, qualitative approach, this dissertation addresses key gaps in the healthy aging literature. The public life of older people aging in place was examined to understand how neighbourhoods, as important physical and social places of aging, contribute to the well-being and healthy aging of older people. This dissertation employed a critical geographical gerontology research framework and a methodology called ‘friendly visiting’ which combines ethnography, narrative and case study research and utilizes participant observation, visual methods and interview techniques. The qualitative data were analyzed using grounded theory and an adapted coding strategy that integrated the textual, visual, and auditory data. The analysis process highlighted theoretically-informed themes that characterized participant’s perceptions and experiences of their neighbourhoods. Findings reveal neighbourhoods are important places of aging that impact the well-being of older people aging in place. This dissertation provides insight into the micro-territorial functioning of neighbourhoods for older people. Embedded within these environments are key sites for informal public life called third places (e.g., parks, streets and coffee shops). Third places are important material and social places for older populations. Preparing for, journeying to, and engaging in these public sites promotes healthy aging by providing opportunities for engagement in life and facilitating social networks. Results advance healthy aging and aging and place research, contribute to gerontological and geographical methodologies, and have implications for policy and practice in areas such as health promotion and age-friendly community initiatives.

A qualitative research study was conducted with people who had participated as healthy subjects in phase I drug trials at commercial research facilities, in order to develop a better understanding of their perspective regarding research participation. The participants were recruited using online advertisements posted on the University of Toronto student website (www.my.utoronto.ca) and NOW Magazine online. Thirty-one subjects were interviewed. The audiotaped interviews were transcribed and analyzed using grounded theory methods. A grounded theory was developed that describes the process of participation and the main factors affecting the experience of participation, from the perspective of healthy subjects. The theory, called Making Participation Work, explains how healthy subjects frame participation as an income earning opportunity, and how this framing shapes their behaviour with regard to participation. Participants expressed a range of attitudes about the experience of participation, from very positive to very negative. The main factor affecting the experience is the perceived net burden, which is in turn affected by the degree to which subjects find personal control over their participation. Net burden and finding personal control were both affected by the degree to which subjects felt valued by research staff, and by whether subjects had trust in the research enterprise. Although subjects framed participation as work, the relationship with the study doctors and nurses was viewed as clinical. Most subjects are generally trusting that participation in phase I drug trials is safe. These findings suggest that models of research participation assuming participation motivated by altruism or potential therapeutic benefit cannot accommodate the attitudes and behaviours of healthy subjects in phase I drug trials. New models must be developed which account for the framing of participation as work, while being sensitive to the trust that healthy subjects place in the research enterprise.

Background: Despite the growing evidence of the positive effects of fruit consumption on health, many individuals do not consume the recommended dietary guideline amounts. It has been suggested that socioeconomic status and income have an influence on food choices and consumption. The aim of this study is not only to examine whether payment structure has an association with food choices but also to assess fruit consumption independent of vegetables in the US. Methods: The 2011 Behavioral Risk Factor Surveillance System was utilized and the study design led to a sample size that was n= 19,122 respondents. Variables that were selected for associations with sufficient fruit consumption included demographic data, employment status, payment structure, education, and home ownership status. A p-value of <0.05 and 95% confidence intervals were used to determine statistical significance of the analyses performed. Results: Factors that were associated with greater odds of sufficient fruit consumption included being African-American, education- all levels of high school graduate and higher, all income categories above $15,000 annually, those employed, and those who rent a home (p-value<0.01). Multivariate logistic regression analysis indicated that respondents' education defined as having college education was associated with increased odds of sufficient fruit consumption (OR = 7.09: CI =1.86-27.09] (p-value<0.01). Conclusions: Assessing fruit consumption alone did not provide greater insight on sufficiency with the exception of race's (specifically African American) influence. Payment structure was found not associated with increased fruit consumption. Promotion of education on the relevance of fruit consumption to overall health is critical and necessary in the United States.

The progressive aging of the population corresponds with a movement in gerontology focusing on factors that promote the positive aspects of aging. The concept of healthy aging corresponds with the multifaceted nature of health but few researchers have examined this concept using a multidimensional approach. The creation of a biopsychosocial definition of healthy aging draws on previous literature to determine important components and potential predictors. The major domains of this definition include physical, cognitive, social, and psychological health. Using cross-sectional and longitudinal data from the Manitoba Study of Health and Aging (MSHA), the purpose was to develop a multidimensional construct of healthy aging based on the four components outlined above. The association between each of the components and the overall construct of healthy aging was examined. A significant interaction was found between physical and cognitive health, indicating that each dimension of health must be assessed in the context of the other. The definition was validated against mortality and institutionalization. Overall healthy aging was significantly associated with future mortality and institutionalization. In addition, healthy aging was compared with the construct of self-rated health to investigate if they are separate constructs. Results indicated that they were overlapping constructs but each variable also had an independent effect on future mortality and institutionalization. Significant demographic predictors of healthy aging at time 2 included younger age and higher education. A greater number of chronic conditions; the presence of vascular factors such as high blood pressure, stroke, heart problems, and chest pain; the presence of neurological factors such as memory problems and nerve trouble; and the presence of other conditions such as chronic pain, eye and ear trouble, and foot problems were also associated with not meeting criteria for healthy aging at time 2. Overall the findings from this study provide support for the importance of a multidimensional definition of healthy aging that is distinct from the construct of self-rated health. The findings underscore the need to assess individual characteristics, such as age, sex, and education, when attempting to predict future health outcomes. A greater understanding of the factors that are associated with healthy aging may encourage opportunities to promote healthy aging. This research may have important implications for researchers, clinicians, and policymakers as they focus on improving quality of life for our aging population.

Brownfields have an important impact on health. They can influence physical health by increasing risk for health hazards such as the potential for injury hazards, disease transmission, or exposure to chemicals. They can also influence social health determinants like neighborhood level social capital or behavioral risk factors. Reusing brownfields for community gardens reduces environmental hazards and associated health hazards. It further promotes public health, and sustainable quality environment. Community gardens increase nutrition access, especially for many in low income populations, and community aesthetic. They also strengthen social cohesion and create recreational or therapeutic opportunities for a community, becoming part of the urban green space network. Special care must be taken to protect public health when reusing a brownfield for a community garden, like sampling for chemicals, cleaning up soil, and using protective garden designs. The overall benefit to the community is worth the initial investment required.

The State Tobacco Activities Tracking and Evaluation (STATE) System is an interactive web-based application and data tool providing up-to-date state-level information related to tobacco use. Indicators in STATE present data related to current and former tobacco use, smoking cessation, funding, tobacco-related health costs, and tobacco control policies. The STATE System also serves as a primary data source for many objectives in Healthy People 2020’s Tobacco Use chapter. Currently, there is no common thread between access to information pertaining to Healthy People 2020 objectives and STATE System data. For this reason, a comprehensive evaluation was conducted of the STATE System’s individual reports and static web-content as it relates to Healthy People 2020 objectives. Implications for research and evaluation are intended to educate the Office on Smoking and Health’s staff & colleagues in the states, networks, and territories on identifiable, cross-promotional opportunities that highlight both state and national data.

Parents of children with disabilities need accurate information to help them provide tailored services and supports to their families. This is especially true for immigrant Latino families who tend to experience poor overall health and who tend to avoid formal services and supports. Based on input gathered from Latino parents of children with disabilities, a three module curriculum, 'Empowering Families,' was developed. Following a cultural appropriateness review of the curriculum and associated measurement instruments, revisions were made to the content and presentation procedure. This was followed by a field test of the curriculum with two groups of Latino parents/caregivers of children with developmental disabilities. Results from the training sessions with both groups indicate that the training resulted in moderate knowledge gains and that self-reported healthy lifestyle behaviors experienced minimal improvement. Overall health status was essentially unchanged. Participants rated the content very highly in terms of cultural appropriateness and usefulness.

The progressive aging of the population corresponds with a movement in gerontology focusing on factors that promote the positive aspects of aging. The concept of healthy aging corresponds with the multifaceted nature of health but few researchers have examined this concept using a multidimensional approach. The creation of a biopsychosocial definition of healthy aging draws on previous literature to determine important components and potential predictors. The major domains of this definition include physical, cognitive, social, and psychological health. Using cross-sectional and longitudinal data from the Manitoba Study of Health and Aging (MSHA), the purpose was to develop a multidimensional construct of healthy aging based on the four components outlined above. The association between each of the components and the overall construct of healthy aging was examined. A significant interaction was found between physical and cognitive health, indicating that each dimension of health must be assessed in the context of the other. The definition was validated against mortality and institutionalization. Overall healthy aging was significantly associated with future mortality and institutionalization. In addition, healthy aging was compared with the construct of self-rated health to investigate if they are separate constructs. Results indicated that they were overlapping constructs but each variable also had an independent effect on future mortality and institutionalization. Significant demographic predictors of healthy aging at time 2 included younger age and higher education. A greater number of chronic conditions; the presence of vascular factors such as high blood pressure, stroke, heart problems, and chest pain; the presence of neurological factors such as memory problems and nerve trouble; and the presence of other conditions such as chronic pain, eye and ear trouble, and foot problems were also associated with not meeting criteria for healthy aging at time 2. Overall the findings from this study provide support for the importance of a multidimensional definition of healthy aging that is distinct from the construct of self-rated health. The findings underscore the need to assess individual characteristics, such as age, sex, and education, when attempting to predict future health outcomes. A greater understanding of the factors that are associated with healthy aging may encourage opportunities to promote healthy aging. This research may have important implications for researchers, clinicians, and policymakers as they focus on improving quality of life for our aging population.

While it has been long known that the behaviour of others can influence individual behaviour, norms (the views and behaviours of others) are not generally reported as strong motivators of physical activity. Using the theory of normative social behaviour as a guiding framework, the purpose of this research was to examine if descriptive norms (the perceived prevalence of others behaviour) would be more important in predicting activity than previously suspected. A secondary purpose was to extend this examination to another health behaviour, healthy eating. Three independent studies were conducted. The first two studies examined what individuals thought motivated their physical activity (Study 1) and eating (Study 2) as well as the relationship between descriptive norms and participants own activity behaviour and healthy eating intentions. Results revealed that, despite being rated by participants as less motivating, descriptive norms were stronger predictors of activity behaviour and healthy eating intentions than other well-established non-normative reasons. It also was found that descriptive norm perceptions about a group proposed to be high in group identity (i.e., friends) was most related to physical activity behaviour and healthy eating intentions. To extend these results, a third study manipulated normative and non-normative messages to examine effects on physical activity. Participants were grouped into one of four conditions (descriptive norm, health, appearance, and control) and received motivation-based email messages specific to their condition encouraging them to be active. It was hypothesized that participants in the descriptive norm condition would experience the greatest increase in physical activity but results did not support this hypothesis, as participants across all conditions significantly increased total physical activity after receiving the messages. A secondary hypothesis examining the focal nature of the targeted behaviours was supported in that responses to normative messages were greatest with the most focal behaviour (using the stairs). Taken together, the results of the first two studies provide preliminary evidence to suggest that the relationships between both descriptive norms and physical activity and descriptive norms and healthy eating may be going undetected. In light of the results of the third study, however, future studies are needed.

Older adults represent a growing part of the population of the United States. Due to decreased physical activity, dietary changes, and alterations in metabolic rate this population is susceptible to an increased rate of diseases. The generation entering older adulthood is one which welcomed fast food and meal replacement foods allowing them to adapt to a more sedentary lifestyle and to need programs of preventative health. The Nutrition and Life Satisfaction Survey was used to investigate gardening as a preventative health intervention for older adults. This instrument was used to compare older (age 50+) gardeners and nongardeners on their perceptions of personal life satisfaction, nutrition, health, and gardening habits. The instrument was posted online at the Aggie Horticulture website in spring 2005. Respondents differentiated themselves as gardeners or nongardeners by responding positively or negatively to the question “Do you garden?” Then, they completed the questionnaire about their quality of life andhealth status and, for gardeners, their gardening habits. Results indicated that gardeners had more desirable responses: Overall quality of life scores were higher for gardeners compared to nongardeners, and four individual quality of life statements yielded more positive answers by gardeners. Additionally, gardeners reported a higher consumption of total fruits and vegetables, including herbs, and of vegetables only including herbs. Personal reports of physical activity and of perceived health were higher among gardeners. Females were more likely than males to garden and spend a higher percentage of their budget on fruits and vegetables. Higher consumption of fruits and vegetables and higher levels of physical activity result in healthier lifestyles and, in turn, can increase quality of life.